Introduction
Kidney stones (also called renal calculi, nephrolithiasis, or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.
Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones. Kidney stones can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.
Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they’re recognized in a timely fashion. Depending on your situation, you may need nothing more than taking pain medication and drinking lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection, or cause complications — surgery may be needed.
This blog post discusses nursing care plans for kidney stones together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Symptoms of Kidney stones
A kidney stone usually will not cause symptoms until it moves around within your kidney or passes into your ureters — the tubes connecting the kidneys and the bladder. If it becomes lodged in the ureters, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. At that point, you may experience these signs and symptoms:
- Severe, sharp pain in the side and back, below the ribs
- Pain that radiates to the lower abdomen and groin
- Pain that comes in waves and fluctuates in intensity
- Pain or burning sensation while urinating
Other signs and symptoms may include:
Pink, red, or brown urine
Cloudy or foul-smelling urine
A persistent need to urinate, urinating more often than usual or urinating in small amounts
Nausea and vomiting
Fever and chills if an infection is present
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.
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Causes of Kidney stones
Kidney stones often have no definite, single cause, although several factors may increase your risk.
Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate, and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.
Types of kidney stones
Knowing the type of kidney stone you have helps determine its cause and may give clues on how to reduce your risk of getting more kidney stones. If possible, try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis.
Types of kidney stones include:
Calcium stones.
Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a substance made daily by your liver or absorbed from your diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
Dietary factors, high doses of vitamin D, intestinal bypass surgery, and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain medications used to treat migraines or seizures, such as topiramate (Topamax, Trokendi XR, Qudexy XR).
Struvite stones
Struvite stones form in response to a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones
Uric acid stones can form in people who lose too much fluid because of chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones
These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of specific amino acid.
Risk factors of kidney stones
Factors that increase your risk of developing kidney stones include:
Family or personal history. If someone in your family has had kidney stones, you’re more likely to develop stones, too. If you’ve already had one or more kidney stones, you’re at increased risk of developing another.
Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm, dry climates and those who sweat a lot may be at higher risk than others.
Certain diets. Eating a diet that’s high in protein, sodium (salt), and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
Obesity. High body mass index (BMI), large waist size, and weight gain have been linked to an increased risk of kidney stones.
Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease, or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the amounts of stone-forming substances in your urine.
Other medical conditions such as renal tubular acidosis, cystinuria, hyperparathyroidism, and repeated urinary tract infections also can increase your risk of kidney stones.
Certain supplements and medications, such as vitamin C, dietary supplements, laxatives (when used excessively), calcium-based antacids, and certain medications used to treat migraines or depression, can increase your risk of kidney stones.
Diagnosis of Kidney Stone
Blood tests: Doctors can diagnose if a patient has too much calcium or uric acid in the blood by doing a blood test. Blood tests can also tell the doctor a lot about how healthy the kidneys are.
Urine test: Shows if there are too many stone-forming minerals in your urine or not enough other compounds that stop stones from forming.
Imaging tests: Doctors use these to check for stones in the urinary tract. A patient might get an X-ray of the belly or a computerized tomography (CT) scan, which combines a series of X-rays to make a picture of the body. An X-ray can show larger stones, but the CT scan helps doctors find small ones.
Analysis of passed stones: The doctor will get a patient to pee through a strainer to catch any stones that might pass. They’ll send them to a lab to see what they’re made of. This can tell them what’s causing the stones and how to treat them.
Pregnant women should get an ultrasound rather than a CT scan in the first trimester when babies are most at risk of a radiation injury. A low-dose CT scan is less dangerous in the second and third trimesters.
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Nursing Care Plans for Kidney Stones Based on Diagnosis
Nursing Care Plan 1: Diagnosis – Acute Pain
It may be related to:
- Increased frequency/force of ureteral contractions
- Tissue trauma, edema formation; cellular ischemia
Possibly evidenced by:
- Reports of colicky pain
- Guarding/distraction behaviors, restlessness, moaning, self-focusing, a facial mask of pain, muscle tension
- Autonomic responses
Desired outcomes
Patient will:
- Report pain is relieved with spasms controlled.
- Appear relaxed able to sleep/rest appropriately.
Nursing Interventions
Pain Management
Independent
Document location, duration, intensity (0–10 scale), and radiation. Note nonverbal signs, e.g., elevated BP and pulse, restlessness, moaning, thrashing about.
Rationale: Helps evaluate the site of obstruction and progress of calculi movement. Flank pain suggests that stones are in the kidney area, upper ureter. Flank pain radiates to the back, abdomen, groin, genitalia because of the proximity of nerve plexus and blood vessels supplying other areas. Sudden, severe pain may precipitate apprehension, restlessness, severe anxiety.
Explain the cause of pain and the importance of notifying caregivers of changes in pain occurrence/characteristics.
Rationale: Provides an opportunity for timely administration of analgesia (helpful in enhancing patient’s coping ability and may reduce anxiety) and alerts caregivers to the possibility of passing of stone/developing complications. Sudden cessation of pain usually indicates stone passage.
Provide comfort measures, e.g., back rub, restful environment.
Rationale: Promotes relaxation, reduces muscle tension, and enhances coping.
Assist with/encourage the use of focused breathing, guided imagery, diversional activities.
Rationale: Redirects attention and aids in muscle relaxation.
Encourage/assist with frequent ambulation as indicated and increased fluid intake of at least 3–4 L/day within cardiac tolerance.
Rationale: Renal colic can be worse in the supine position. Vigorous hydration promotes the passing of stone, prevents urinary stasis, and aids in the prevention of further stone formation.
Note reports of increased/persistent abdominal pain.
Rationale: Complete obstruction of the ureter can cause perforation and extravasation of urine into perirenal space. This represents an acute surgical emergency.
Administer medications as indicated: Narcotics, e.g., meperidine (Demerol), morphine;
Rationale: Usually given during acute episodes to decrease ureteral colic and promote muscle/mental relaxation.
Antispasmodics, e.g., flavoxate (Urispas) oxybutynin (Ditropan)
Rationale: Decreasing reflex spasms may decrease colic and pain.
Collaborative
Apply warm compresses to the back.
Rationale: Relieves muscle tension and may reduce reflex spasms.
Maintain patency of catheters when used.
Rationale: Prevents urinary stasis/retention reduces the risk of increased renal pressure and infection.
Nursing Care Plan 2: Diagnosis – Impaired Urinary Elimination
It may be related to:
- Stimulation of the bladder by calculi, renal or ureteral irritation
- Mechanical obstruction, inflammation
Possibly evidenced by:
- Urgency and frequency; oliguria (retention)
- Hematuria
Desired outcomes
Patient will:
- Urinary Elimination
- Void in normal amounts and usual pattern.
- Experience no signs of obstruction.
Nursing Interventions
Urinary Elimination Enhancement
Independent
Monitor input and output characteristics of urine.
Rationale: Provides information about kidney function and presence of complications, e.g., infection and bleeding. Bleeding may indicate increased obstruction or irritation of the ureter. Note: Hemorrhage due to ureteral ulceration is rare.
Determine the patient’s normal voiding pattern and note variations.
Rationale: Calculi may cause nerve excitability, which causes sensations of an urgent need to void. Usually, frequency and urgency increase as calculus nears the ureterovesical junction.
Encourage increased fluid intake.
Rationale: Increased hydration flushes bacteria, blood, and debris and may facilitate stone passage.
Strain all urine. Document any stones expelled and send them to a laboratory for analysis
Rationale: Retrieval of calculi allows identification of the type of stone and influences choice of therapy.
Investigate reports of bladder fullness; palpate for suprapubic distension. Note decreased urine output presence of periorbital/dependent edema.
Rationale: Urinary retention may develop, causing tissue distension (bladder/kidney) and potentiating infection renal failure risk.
Observe for changes in mental status, behavior, or level of consciousness.
Rationale: Accumulation of uremic wastes and electrolyte imbalances can be toxic to the CNS.
Collaborative
Monitor laboratory studies, e.g., electrolytes, BUN, Cr.
Rationale: Elevated BUN, Cr, and certain electrolytes indicate the presence/degree of kidney dysfunction.
Obtain urine for culture and sensitivities.
Rationale: Determines presence of UTI, which may be causing/complicating symptoms.
Administer medications as indicated, e.g.: Acetazolamide (Diamox), allopurinol (Zyloprim)
Rationale: Increases urine pH (alkalinity) to reduce the formation of acid stones. Antigout agents such as allopurinol (Zyloprim) also lower uric acid production and the potential of stone formation.
Hydrochlorothiazide (Esidrix, HydroDIURIL), chlorthalidone (Hygroton)
Rationale: May be used to prevent urinary stasis and decrease calcium stone formation if not caused by an underlying disease process such as primary hyperthyroidism or vitamin D abnormalities.
Ammonium chloride; potassium or sodium phosphate
Rationale: Reduces phosphate stone formation.
Antibiotics
Rationale: The presence of UTI/alkaline urine potentiates stone formation.
Sodium bicarbonate
Rationale: Replaces losses incurred during bicarbonate wasting and alkalinization of urine; may reduce/prevent the formation of some calculi.
Ascorbic acid.
Rationale: Acidifies urine to prevent recurrence of alkaline stone formation.
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Nursing Care Plan 3: Diagnoses – Fluid Volume and Risk for deficient
Risk factors may include:
- Nausea/vomiting (generalized abdominal and pelvic nerve irritation from renal or ureteral colic)
- Postobstructive diuresis
Desired outcomes
Patient will:
- Hydration
- Maintain adequate fluid balance as evidenced by vital signs and weight within the patient’s normal range, palpable peripheral pulses, moist mucous membranes, good skin turgor.
Nursing Interventions
Fluid/Electrolyte Management
Independent
Monitor input and output.
Rationale: Comparing actual and anticipated output may aid in evaluating the presence/degree of renal stasis/impairment. Note: Impaired kidney functioning and decreased urinary output can result in higher circulating volumes with signs/symptoms of HF.
Document incidence and note characteristics and frequency of vomiting and diarrhea and accompanying or precipitating events.
Rationale: Nausea/vomiting and diarrhea are commonly associated with renal colic because celiac ganglion serves both kidneys and stomach. Documentation may help rule out other abdominal occurrences as a cause for pain or pinpoint calculi.
Increase fluid intake to 3–4 L/day within cardiac tolerance.
Rationale: Maintains fluid balance for homeostasis and “washing” action that may flush the stone(s) out. Dehydration and electrolyte imbalance may occur secondary to excessive fluid loss (vomiting and diarrhea).
Monitor vital signs. Evaluate pulses, capillary refill, skin turgor, and mucous membranes.
Rationale: Indicators of hydration/circulating volume and need for intervention. Note: Decreased GFR stimulates the production of renin, which acts to raise BP in an effort to increase renal blood flow.
Weigh daily.
Rationale: Rapid weight gain may be related to water retention.
Collaborative
Monitor Hb/Hct, electrolytes.
Rationale: Assesses hydration and effectiveness of/need for interventions.
Administer IV fluids.
Rationale: Maintains circulating volume (if oral intake is insufficient), promoting renal function.
Provide appropriate diet, clear liquids, bland foods as tolerated.
Rationale: Easily digested foods decrease GI activity/irritation and help maintain fluid and nutritional balance.
Administer medications as indicated: antiemetics, e.g., prochlorperazine (Compazine).
Rationale: Reduces nausea/vomiting.
Nursing Care Plan 4: Diagnosis- Deficient Knowledge
It may be related to:
- Lack of exposure/recall; information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; request for information; statement of misconception
- Inaccurate follow-through of instructions, development of preventable complications
Desired outcomes
Patient will:
- Verbalize understanding of disease process and potential complications.
- Correlate symptoms with causative factors.
- Verbalize understanding of therapeutic needs.
- Initiate necessary lifestyle changes and participate in treatment regimen.
Nursing Interventions
Teaching: Disease Process
Independent
Review disease process and future expectations.
Rationale: Provides knowledge base from which patient can make informed choices.
Stress importance of increased fluid intake, e.g., 3–4L/day or as much as 6–8 L/day. Encourage the patient to notice dry mouth and excessive diuresis/diaphoresis and to increase fluid intake whether or not feeling thirsty.
Rationale: Flushes renal system, decreasing the opportunity for urinary stasis and stone formation. Increased fluid losses/dehydration require additional intake beyond usual daily needs.
Review dietary regimen, as individually appropriate:
Rationale: Diet depends on the type of stone. Understanding the reason for restrictions provides an opportunity for the patient to make informed choices, increases cooperation with regimen, and may prevent a recurrence.
Low-purine diet, e.g., limited lean meat, turkey, legumes, whole grains, alcohol
Rationale: Decreases oral intake of uric acid precursors.
Low-calcium diet, e.g., limited milk, cheese, green leafy vegetables, yogurt
Rationale: Reduces risk of calcium stone formation. Note: Research suggests that restricting dietary calcium is not helpful in reducing calcium-stone formation, and researchers, although not advocating high-calcium diets, are urging that calcium limitation be reexamined.
Low-oxalate diet, e.g., restrict chocolate, caffeine-containing beverages, beets, spinach.
Rationale: Reduces calcium oxalate stone formation.
Short regimen: low-calcium/phosphorus diet with aluminum carbonate gel 30–40 mL, 30 min pc/hs.
Rationale: Prevents phosphatic calculi by forming an insoluble precipitate in the GI tract, reducing the load to the kidney nephron. Also effective against other forms of calcium calculi. Note: May cause constipation.
Discuss medication regimen, avoidance of OTC drugs, and reading all product/food ingredient labels.
Rationale: Drugs will be given to acidify or alkalize urine, depending on the underlying cause of stone formation. Ingestion of products containing individually contraindicated ingredients (e.g., calcium, phosphorus) potentiates the recurrence of stones.
Encourage regular activity/exercise program.
Rationale: Inactivity contributes to the stone formation through calcium shifts and urinary stasis.
Active-listen concerns about therapeutic regimen/lifestyle changes.
Rationale: Helps patient work through feelings and gain a sense of control over what is happening.
Identify signs/symptoms requiring medical evaluation, e.g., recurrent pain, hematuria, oliguria.
Rationale: With an increased probability of recurrence of stones, prompt interventions may prevent serious complications.
Demonstrate proper care of incisions/catheters if present.
Rationale: Promotes competent self-care and independence.
References
- ncbi.gov
- sholar.google.com
