renal calculi ppt
TRANSCRIPT
HELLO
LEARNING OBJECTIVES
• review the anatomy and physiology of the renal system
• interpret the term renal calculi • describe the etiology of renal calculi• discuss the pathogenesis involved in the
disease process• list the types of renal calculi
LEARNING OBJECTIVES• examine the clinical manifestations closely• differentiate the various diagnostic
measures • explain the medical management• Identify the surgical management of renal
calculi• distinguish the nursing management for
renal calculi including the nursing diagnosis
THE RENAL SYSTEM
THE RENAL SYSTEM
DEFINITION
• Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine
•
ETIOLOGY
ETIOLOGYMETABOLIC
LIFESTYLE
GENETIC FACTORS
DRUGS
OTHERS
RISK FACTORS
HISTORY OF RENAL CALCULI
RISK FACTORS
HIGH MINERAL CONTENT IN DRINKING WATER
DIETARY INTAKE
UTI & H/O FEMALE GENITAL MUTILATION
PROLONGED INDWELLING CATHETERISATION
NEUROGENIC BLADDER
1PATHOPHYSIOLOGY
• Slow urine flow, resulting in supersaturation of the urine with the particular element that first become crystallized and later become stone
2PATHOPHYSIOLOGY
• Damage to the lining of the urinary tract
3PATHOPHYSIOLOGY
• Decreased inhibitor substances in the urine that would otherwise prevent supersaturation and crystalline aggregation
TYPES OF STONES• Calcium Phosphate• Calcium oxalate• Uric acid• Cystine• Struvite
CLINICAL MANIFESTSTIONS
• Severe abdominal or flank pain
• Frequency and dysuria
• Oliguria and anuria in obstruction
CLINICAL MANIFESTSTIONS
• Hematuria• Renal colic• Nausea• hydronephrosis
DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIESCY
STO
SCO
PY
DIAGNOSTIC STUDIESIV
P
DIAGNOSTIC STUDIES
USG
DIAGNOSTIC STUDIESRETROGRA
DE PYELOGRA
MCT SCAN
24 HOUR URINE
SPECIMENLAB
INVESTIGATIONS
MANAGEMENT?
MEDICAL• DRUG THERAPY
Opioid agents NSAIDS Spasmolytic agents
COMPLIMENTARY THERAPY•Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques•Positioning the client to comfortable position aids in pain reduction
OTHER TECHNIQUES• Avoiding over
hydration and under hydration
• Strain the urine• Send any strained
stone to laboratory to aid in preventive treatment in the future
SPECIFIC APPROACHESURINARY
STONECHARACTERISTICS
PREDISPOSING FACTORS
THERAPEUTIC MEASURES
Calcium oxalate35-40
Small often possible to get trapped in ureter ,more frequent in men
Idiopathic hypercalciuria hyperoxaluria ,Independent of urinary pH ,family history
Increase hydrationReduce dietary oxalateGive thiazide diuretics cellulose phosphate,(chelate calcium and prevent GI absorption), potassium citrate(alkaline urine),cholestyramine(bind oxalate),calcium lactate(precipitate oxalate in GI tract)Reduce daily sodium intake
SPECIFIC APPROACHESURINARY
STONECHARACTERISTICS
PREDISPOSING FACTORS
THERAPEUTIC MEASURES
Calcium phosphate8-10%
Mixed stones with struvite or oxalate stones
Alkaline urine, primary hyperthyroidism
Treat underlying cause and other stones
SPECIFIC APPROACHESURINARY
STONECHARACTERISTICS
PREDISPOSING FACTORS
THERAPEUTIC MEASURES
Struvite10-15 %
3 to 4 times common in women ≥ men,always in association with urinary tract infection
urinary tract infections
Antimicrobial agents acetohydroxamic acidSurgical interventions
Measures to acidify urine
SPECIFIC APPROACHESURINARY
STONECHARACTERISTICS
PREDISPOSING FACTORS
THERAPEUTIC MEASURES
Uric acid
5-8 %
Predominant in men high incidence in jewish men
Gout, acid urine ,inherited conditions
Reduce urinary concentration of uric acidAlkanize urine with potassium citrateAdminister allopurinolReduce dietary purines
SPECIFIC APPROACHESURINARY
STONECHARACTERISTICS PREDISPOSING
FACTORSTHERAPEUTIC MEASURES
Cystine
1-2 %
Genetic autosomal recessive defect,defective absorption of gi cystine from gi tract and kidney excess concentrations causing stone formation
Acid urine Increase hydrationGive α pencillamine and tiopronin to prevent cystine crystallizationPotassium citrate to alkaline urine
SURGICAL MANAGEMENT
SURGICAL MANAGEMENTESWL
RETROGRADE URETEROSCO
PY
ANTEGRADE
NEPHROURETEROLITHOTO
MY
STENTING
ALONEPERCUTANEOUS URETER
O LITHOTO
MY
NEPHROLITHOTO
MY
PRO
XIM
AL U
RETE
R
SURGICAL MANAGEMENT
RETROGRADE URETEROSCOPY ESWL
ANTEGRADE NEPHROSTOURETEROLITHOTOM
Y
OPEN URETERO-LITHOTOMY
MID
URE
TER
SURGICAL MANAGEMENT
ESWL/ureteroscopyAntegrade nephrostoureterolithotomyStenting alone
Open ureterolithotomyDIS
TAL
URE
TER
SURGICAL MANAGEMENT
LASER
PERCUTANEOUS
ESWL
LITH
OTRI
PSY
OPEN SURGICAL PROCEDURES
NEPHROLITHOTOMY
PYELOLITHOTOMY
URETHROLITHOTO
MYCYSTOTO
MY
NURSING MANAGEMENT
NURSING DIAGNOSIS
• Acute pain related to irritation and spasm from stone movement in the urinary tract as manifested by complaints of pain, facial grimacing, restlessness
• Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions
NURSING DIAGNOSIS
• Ineffective therapeutic regimen management related to lack of knowledge as manifested by repeated questions
NURSING DIAGNOSIS
• Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine
NURSING DIAGNOSIS
• Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow
NURSING DIAGNOSIS
PREVENTION
• Avoid protein intake; usually protein is restricted to 60g/day to decrease urinary excretion of calcium and uric acid.
• A sodium intake of 3 to 4 g/day is recommended. Table salt and high-sodium foods should be reduced, because sodium competes with calcium for reabsorption in the kidneys.
• Low-calcium diets are not generally recommended,except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones.
• Avoid intake of oxalate-containing foods (eg, spinach,strawberries, rhubarb, tea, peanuts, wheat bran).
PREVENTION
• During the day, drink fluids (ideally water) every1 to 2 hours.
• Drink two glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night.
PREVENTION
• Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration.
• Contact your primary health care provider at the first sign of a urinary tract infection
PREVENTION
JOURNAL PRESENTATIONS
CA B D E
QUESTIONS
???
?a)Cystic fibrosis b) sjogrens syndrome c) gout d) myasthenia gravis
Genetic factor involved in renal calculi formation:
?a) nephrolithiasisb) ureterolithiasisc ) cystolithiasisd ) cholelithiasis
Stone in the kidney is called as
?a)Allopurinol b)thiazide diureticc)pencillamine d)potassium citrate
Uric acid stones can be reduced or prevented by the use of:
?a)Morphine b) ketorolac c)propanthelene d)tramadol hydrochloride
Preferred opioid agent used in renal calculi pain management initially is:
REFERENCES
• Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008
• Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;2008.
REFERENCES
• Black M.J, Hawks H.K. Medical Surgical Nursing. 7th edn. Missouri: Saunders;2005
REFERENCES
• Taal M.W,Cherton G,Marsden P.A. Brenner and Rector`s: The Kidney. 9th edn.Philadelphia: Elsevier;2012
REFERENCES
•Walsh C.Urology. 10th edn. Philadelphia: Elsevier;2012
REFERENCES
• Nettina S M, Mills E.J.Lippincott Manual of Nursing Practice. 8th edn.Philadelphia :Lippincott Williams & Wilkins; 2006
REFERENCES