CARE SETTINGAcute episodes may require inpatient treatment on a medical or surgical unit.
Fluid and electrolyte imbalances
Metabolic acidosis (primary base bicarbonate deficiency)
Metabolic alkalosis (primary base bicarbonate excess)
Psychosocial aspects of care
Renal failure: acute
Patient Assessment Database
Dependent on size, location, and etiology of calculi.
ACTIVITY/RESTMay report: Sedentary occupation or occupation in which patient is exposed to high environmental temperatures
Activity restrictions/immobility due to a preexisting condition (e.g., debilitating disease,
spinal cord injury)
CIRCULATIONMay exhibit: Elevated BP/pulse (pain, anxiety, kidney failure)
Warm, flushed skin; pallor
ELIMINATIONMay report: History of recent/chronic UTI; previous obstruction (calculi)
Decreased urinary output, bladder fullness
Burning, urgency with urination
May exhibit: Oliguria, hematuria, pyuria
Alterations in voiding pattern
FOOD/FLUIDMay report: Nausea/vomiting, abdominal tenderness
Diet high in purines, calcium oxalate, and/or phosphates
Insufficient fluid intake; does not drink fluids well
May exhibit: Abdominal distension; decreased/absent bowel sounds
PAIN/DISCOMFORTMay report: Acute episode of excruciating, colicky pain with location depending on stone location, e.g., in the flank in the region of the costovertebral angle; may radiate to back,
abdomen, and down to the groin/genitalia. Constant dull pain suggests calculi
located in the renal pelvis or calyces.
Pain may be described as acute, severe, not relieved by positioning or any other measures
May exhibit: Guarding; distraction behaviors; self-focusing
Tenderness in renal areas on palpation
SAFETYMay report: Use of alcohol
TEACHING/LEARNINGMay report: Family history of calculi, kidney disease, hypertension, gout, chronic UTI
History of small-bowel disease, previous abdominal surgery, hyperparathyroidism
Use of antibiotics, antihypertensives, sodium bicarbonate, allopurinol, phosphates,
thiazides, excessive intake of calcium or vitamin D
DRG projected mean length of inpatient stay: 2.9 days
Refer to section at end of plan for postdischarge considerations.
Urinalysis: Color may be yellow, dark brown, bloody. Commonly shows RBCs, WBCs, crystals (cystine, uric acid, calcium oxalate), casts, minerals, bacteria, pus; pH may be less than 5 (promotes cystine and uric acid stones) or higher than 7.5 (promotes magnesium, struvite, phosphate, or calcium phosphate stones).
Urine (24-hr): Cr, uric acid, calcium, phosphorus, oxalate, or cystine may be elevated.
Urine culture: May reveal UTI (Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas).
Biochemical survey: Elevated levels of magnesium, calcium, uric acid, phosphates, protein, electrolytes.
Serum and urine BUN/Cr: Abnormal (high in serum/low in urine) secondary to high obstructive stone in kidney causing ischemia/necrosis.
Serum chloride and bicarbonate levels: Elevation of chloride and decreased levels of bicarbonate suggest developing renal tubular acidosis.
Hb/Hct: Abnormal if patient is severely dehydrated or polycythemia is present (encourages precipitation of solids), or patient is anemic (hemorrhage, kidney dysfunction/failure).
RBCs: Usually normal. WBCs: May be increased, indicating infection/septicemia.
Parathyroid hormone (PTH): May be increased if kidney failure present. (PTH stimulates reabsorption of calcium from bones, increasing circulating serum and urine calcium levels.)
KUB x-ray: Shows presence of calculi and/or anatomical changes in the area of the kidneys or along the course of the ureter.
IVP: Provides rapid confirmation of urolithiasis as a cause of abdominal or flank pain. Shows abnormalities in anatomical structures (distended ureter) and outline of calculi.
Cystoureteroscopy: Direct visualization of bladder and ureter may reveal stone and/or obstructive effects.
CT scan: Identifies/delineates calculi and other masses; kidney, ureteral, and bladder distension.
Ultrasound of kidney: To determine obstructive changes, location of stone; without the risk of failure induced by contrast medium.
1. Alleviate pain.
2. Maintain adequate renal functioning.
3. Prevent complications.
4. Provide information about disease process/prognosis and treatment needs.
1. Pain relieved/controlled.
2. Fluid/electrolyte balance maintained.
3. Complications prevented/minimized.
4. Disease process/prognosis and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.