Primary Nursing Diagnosis

Altered urinary elimination related to the blockage of ureter with a calculus

OUTCOMES. Urinary elimination; Knowledge: Medication; Symptom severity; Treatment behavior: Illness or injury

INTERVENTIONS. Urinary elimination management; Medication prescribing; Fluid monitoring; Pain management; Infection control; Tube care: Urinary

U PLANNING AND IMPLEMENTATION Collaborative

In about 80% of cases, renal calculi of 5 mm or less are treated conservatively with vigorous hydration, which results in the stone passing spontaneously. Increased fluid intake is ordered orally or intravenously (IV) to flush the stone through the urinary tract. Unless contraindicated, maintain hydration at 200 mL per hour of IV or orally. Strain the patient's urine to detect stones that are passed so they can be analyzed.

For calculi that are larger than 5 mm or that cannot be passed with conservative treatment, surgical removal is performed. Percutaneous ultrasonic lithotripsy or extracorporeal shock wave lithotripsy (ESWL) uses sound waves to shatter calculi for later removal by suction or natural passage. Calculi in the ureter may be removed with catheters and a cystoscope (ureteroscopy), while a flank or lower abdominal surgical approach may be needed to remove calculi from the kidney calyx or renal pelvis.

Pharmacologic Highlights

General Comments: If nausea and vomiting are present, administer antiemetics as ordered. Diuretics may be ordered to prevent urinary stasis.

Medication or Drug Class

Dosage Description

Rationale

Analgesia: primary drugs that are used are morphine sulfate and ketorolac (Toradol)

Varies with drug Narcotics, nonsteroidal anti-inflammatory agents

To relax the ureter and facilitate passage of stone

Other: Antibiotics if infection is present

Independent

Initially, the most important nursing interventions concentrate on pain management. Teach relaxation techniques, diversional activities, and position changes. Help promote the passage of renal calculi. Encourage the patient to walk, if possible. Offer the patient fruit juices to help acidify the urine. Teach the patient the importance of proper diet to help avoid a recurrence of the renal calculi, with particular emphasis on adequate hydration and avoiding excessive salt and protein intake.

To reduce anxiety, give the patient and family all pertinent information concerning the treatment plan and any diagnostic tests. Preoperatively, explain the procedure and what to expect afterward. For patients who are undergoing a flank or abdominal incision, teach deep breathing and coughing exercises. Give postoperative care and monitor for signs of infection or pneumonia. Do not irrigate urinary drainage systems without consulting with the physician.

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