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o Make sure pt. knows that their urine may be pink tinged after any of these procedures, but that
should decrease over time
o Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL)- fragmenting stones, noninvasive
Percutaneous ultrasonic lithotripsy- neprhoscope inserted into kidney
Laser lithotripsy- sound/shock waves crush stone up
o Ureterolithotomy- incision in the affected ureter to remove a calculus
o Pyelolithotomy- incision into and removal of stone from the kidney pelvis
o Nephrolithotomy- a staghorn calculus that invades the calyces and renal parenchyma may require
this type of surgery
Nursing Process:
o Assessment
o Health history
o Pain assessment- check q15-30 mins
o Other symptoms
o Contributing factors
o Physical examination
General appearance
Tenderness
Characteristics of urine
Kidney assessment
o Nursing Diagnoses: Acute Pain, Impaired Urinary Elimination, Deficient Knowledge, Anxiety, Risk for
Imbalanced Nutrition, Risk for Infection
o Plan
o Client requests analgesics as needed
o Maintain urine output of 2500mL/24 hours
o Verbalize understanding of disease
o Demonstrate reduced anxiety
o Implementation: Acute Pain
o Assess pain using standard pain scale
o Encourage fluid intake and ambulation
o Use nonpharmacologic measures
Positioning
Moist heat
Relaxation techniques
Guided imagery and diversion
o If surgery performed: monitor I&Os, catheters, incision, wound drainage
o Implementation: Impaired Urinary Elimination
o Report symptoms of hydronephrosis
o Monitor amount, character of urine output
o Maintain patency of catheter systems
o Implementation: Deficient Knowledge
o Assess understanding
o Present material at appropriate level
o Teach about all diagnostic and treatment procedures
o Home management
o Prevention of further urolithiasis
o Relationship between urinary calculi and UTI
o Evaluation
o Client reports pain of 3 or less
o Able to perform ADLs
o Client remains infectionfree
o Client chooses appropriate diet
o Client demonstrates adequate fluid intake
Preparing Client for Discharge
o Fluid intake
o Medication management
o Calcium phosphates stones: Calcibind (cellulose sodium phosphate)
o Uric acid stones: Zyloprim (allopurinol)
o Diet recommendations
o Calcium phosphate stonesincrease acidity of urine
o Uric acid stoneslowering uric acid levels, limit sources of purine (sardines, liver, herring, and
sweetbreads.
o Oxalate stoneslimit spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran
o UTI
o Further diagnostic or treatment measures
Health Promotion
o Discuss importance of fluid intake
o Client with known gout
o Discuss risk of lithiasis with frequent UTIs
o Postoperative care if appropriate
Nursing Diagnoses & Interventions
Acute Pain
o Assess pain using a standard pain scale and its characteristics; admin analgesia as ordered and monitor
its effectiveness
o Unless contraindicated, encourage fluid intake and ambulation
o Use non-pharmacological interventions such as positioning, moist heat, relaxation techniques, guided
imagery, and diversion
o If sx is performed, monitor urinary output, catheters, incisions, and wound drainage
Impaired Urinary Elimination
o Monitor amount and character of urine output
o Maintain patency and integrity of all catheter systems, secure catheters well, label as indicated, and use
sterile technique for all ordered irrigations or other procedures
Readiness for Enhanced Knowledge
o Assess understanding and previous learning
o Present all material in a manner appropriate to knowledge base, developmental and educational level,
and current needs.
o Teach about all diagnostic and treatment procedures
o Teach measures to prevent further urolithiasis
o Teach ab the relationship between urinary calculi and UTIs emphasizing preventative measures and the
importance of prompt treatment