NURSING CARE OF

PATIENT WITH
UROLITHIASIS
BY EFRIS KARTIKA SARI

Introduction
Definition
Aetiology
Patophysiology
Classifications
Clinical Manifestations
Diagnostic Tests
Treatment
Nursing Care

Introduction
Between 1,200 and 1,400 per 100,000
will develop urinary stones each year
with a male/female ratio of 3:1.
Although most patients have only one
stone episode, 25% of patients
experience recurrent stone formation.
Urolithiasis therefore has a significant
impact on quality of life and
socioeconomic factors.

Definition
Urolithiasis refers to stones (calculi)
in the urinary tract.
Stones are formed in the urinary
tract when urinary concentrations of
substances such as calcium oxalate,
calcium phosphate, and uric acid
increase.

etiology
Certain factors favor the formation of
stones, including infection, urinary stasis,
and periods of immobility (slows renal
drainage and alters calcium metabolism).
Increased calcium concentrations in
blood and urine promote precipitation of
calcium and formation of stones (about
75% of all renal stones are calciumbased).

Causes of hypercalcemia (high serum calcium) and

hypercalciuria (high urine calcium) are:
Hyperparathyroidism
Renal tubular acidosis
Cancers
Granulomatous diseases (sarcoidosis, tuberculosis),
which may cause increased vitamin D production
by the granulomatous tissue
Excessive intake of vitamin D
Excessive intake of milk and alkali
Myeloproliferative diseases

Pathophysiology

Classifications
Stone size is usually given in one or
two dimensions, and stratified into
those measuring up to 5, 5-10, 1020, and > 20 mm in largest diameter.
Stones can be classified according to
anatomical position: upper, middle or
lower calyx; renal pelvis; upper,
middle or distal ureter; and urinary
bladder.

Stones classsified by x-ray

characteristics

Stones classified by
aetiology

Stone compositions

Knoll (2010)

Ratu, Badji, Hardjoeno (2006)

Clinical Manifestations

Signs and symptoms of stones in the urinary tract depend on

obstruction, infection, and edema.
Chills
Fever
Dysuria
Pain
Discomfort
Hematuria
Pyuria
Nausea
Vomiting appear
Renal colic.
Diarrhea
Abdominal discomfort

Diagnostic Tests

 The diagnosis is confirmed by x-ray

films of the kidneys, ureter, and
bladder (KUB) or by ultrasonography,
intravenous urography (IVU), or
retrograde pyelography, and noncontrast enhanced computed
tomography (NCCT).

Notes

Treatment
The basic goals of management :
To eradicate the stone
To determine the stone type
To prevent nephron destruction
To control infection
To relieve any obstruction that may be
present
To relieve the pain until its cause can be
eliminated.

Drugs
Fluid
Nutritional therapy
Ureteroscopy
Extracorporeal Shock Wave
Lithotripsy (ESWL),
Endourologic (percutaneous) stone
removal.

Indications for active removal of

ureteral stones:
Stones with low likelihood of
spontaneous passage
Persistent pain despite adequate
analgesic medication
Persistent obstruction
Renal insufficiency (renal failure,
bilateral obstruction, or single kidney)

Indications for active removal of kidney stones:

Stone growth
Stones in high-risk patients for stone formation
Obstruction caused by stones
Infection
Symptomatic stones (e.G., Pain or haematuria)
Stones > 15 mm
Stones < 15 mm if observation is not the option of choice
Patient preference
Comorbidity
Social situation of the patient (e.G., Profession or travelling)
Choice of treatment

Nursing Care
Nursing Diagnosis:
Acute pain related to inflammation,
obstruction, and abrasion of the urinary tract
Deficient knowledge regarding prevention of
recurrence of renal stones
Potential Complications:
Infection and sepsis (from UTI and
pyelonephritis)
Obstruction of the urinary tract by a stone or
edema with subsequent acute renal failure

 The major goals for the patient may

include relief of pain and discomfort,
prevention of recurrence of renal
stones, and absence of
complications.
Nursing interventions: relieving pain,
monitoring and managing potential
complications, teaching patients selfcare.

Expected patient outcomes may include:

Reports relief of pain
States increased knowledge of health-seeking behaviors to prevent recurrence
1. Consumes increased fluid intake
2. Participates in appropriate activity
3. Consumes diet prescribed to reduce dietary factors predisposing to stone
formation
4. Recognizes symptoms to be reported to health care provider (fever, chills,
flank pain, hematuria)
5. Monitors urinary pH as directed
6. Takes prescribed medication as directed to reduce stone formation
. Experiences no complications
1. Reports no signs or symptoms of sepsis or infection
2. Voids normal urine productions without evidence of bleeding
3. Experiences absence of dysuria, frequency, and hesitancy
4. Maintains normal body temperatur

References
Knoll, T. Epidemiology, pathogenesis, and pathophysiology of
urolithiasis. European Urology Supplements 2010; 9:802806.
Ratu, G., Badji, A., Hardjoeno. The analysis of urethral stone profile
at the clinical pathology laboratory. Indonesian Journal of Clinical
Pathology and Medical Laboratory 2006 July; 12 (3):114-117.
Smeltzer, S.C.O., Bare, B.G., Hinkle, J.L., Cheever, K.H. (2010).
Brunner&Suddarths Textbook of Medical-Surgical Nursing.
Philadelphia: Lippincott William&Wilkins.
Turk, C., Knoll, T., Petrik, K., Sarica, M., Seitz, C., Straub, M. (2012).
Guidelines on Urolithiasis. European Association of Urology.
Turk, C., Knoll, T., Petrik, K., Sarica, A., Skolarikos, M., Seitz, C.
(2013). Guidelines on Urolithiasis. European Association of
Urology.