Discharge And Home Healthcare Guidelines

Patient teaching is individualized, but for most patients it includes information about each of the following.

WOUND MANAGEMENT. This includes infection control, basic cleanliness, and wound management.

SCAR MANAGEMENT. Functional abilities, including using pressure garments, exercises, and activities of daily living, must be assessed and taught.

NUTRITION. Nutritional guidelines are provided that maintain continued healing and respond to the metabolic demands that frequently last for some time after initial injury.

FOLLOW-UP. If respiratory involvement exists, include specific teaching related to the amount of damage and ongoing therapy. Teach various techniques for dealing with the reaction of society, classmates, or those in the workplace. Explain where and how to obtain resources (financial and emotional) for assisting the family and patient during the recovery process.

Calculi, Renal

DRG Category: 323

Mean LOS: 2.9 days

Description: MEDICAL: Urinary Stones with CC

and/or ESW Lithotripsy

Renal calculi, or nephrolithiasis, are stones that form in the kidneys from the crystallization of minerals and other substances that normally dissolve in the urine. Renal calculi vary in size, with 90% of them smaller than 5 mm in diameter; some, however, grow large enough to prevent the natural passage of urine through the ureter. Calculi may be solitary or multiple. Approximately 80% of these stones are composed of calcium salts. Other types are the struvite stones (which contain magnesium, ammonium, and phosphate), uric acid stones, and cystine stones. If the calculi remain in the renal pelvis or enter the ureter, they can damage renal parenchyma (functional tissue). Larger calculi can cause pressure necrosis. In certain locations, calculi cause obstruction, lead to hydronephrosis, and tend to recur.

The precise cause of renal calculi is unknown, although they are associated with dehydration, urinary obstruction, calcium levels, and other factors. Patients who are dehydrated have decreased urine, with heavy concentrations of calculus-forming substances. Urinary obstruction leads to urinary stasis, a condition that contributes to calculus formation. Any condition that increases serum calcium levels and calcium excretion predisposes people to renal calculi. These conditions include an excessive intake of vitamin D or dietary calcium, hyperparathyroidism, heredity factors, and immobility. Metabolic conditions such as renal tubular acidosis, elevated serum uric acid levels, and urinary tract infections associated with alkaline urine have been linked with calculus formation. Cystine stones are associated with hereditary renal disease.

There are at least 10 different single gene conditions (e.g., primary hyperoxaluria type 1), resulting in familial nephrolithiasis, but these account for less than 2% of persons with renal calculi. Both genetic and environmental factors have been suggested to explain higher incidence of stone formation in certain geographical areas, including the southern United States.

Approximately 12% of the population develop a stone at some point in their lives. Calculi occur more often in men than in women, unless heredity is a factor, and occur most often between the ages of 30 to 50 years. The prevalence is higher in whites and people of Asian ancestry than in other populations. When women develop calculi, they are likely to be caused by infection. Children rarely develop calculi. Although the reasons are unknown, in the past 30 years, the prevalence of kidney stones has been increasing. Once a person gets more than one stone, others are likely to develop.

HISTORY. Symptoms of renal calculi usually appear when a stone dislodges and begins to travel down the urinary tract and enters the ureter. Establish a history of pain, and determine the intensity, duration, and location of the pain. The location of the pain varies according to the placement of the stone. The pain usually begins in the flank area but later may radiate into the lower abdomen and the groin. Ask if the pain had a sudden onset. Patients may relate a recent history of

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