Wk 5 Nephrolithiasis

Question 1

These are a picture of…

Answer 1

Struvite (staghorn) kidney stones

Question 2

What might a patient have is their ureter is completely obstructed?

Answer 2

Nephrostomy tube

Question 3

How is a nephrostomy tube placed?

Answer 3

Surgically inserted into the renal pelvis via a small flank incision

Question 4

What is a nephrostomy tube attached to?

Answer 4

External bag for closed drainage

Question 5

What happens to the urine in a patient with a nephrostomy tube?

Answer 5

It goes directly into the bag, it bypasses the ureter, bladder, etc.

Question 6

A nephrostomy tube is considered a __ option

Answer 6

temporary

Question 7

If there is excessive pain or drainage around the exit site of a nephrostomy tube, what could that mean?

Answer 7

There could be a possible blockage

Question 8

How would you know if there was a blockage in a nephrostomy tube?

Answer 8

There may be excessive pain or drainage around the exit site

Question 9

What do you need to irrigate a nephrostomy tube?

Answer 9

A provider’s order

Question 10

What are 2 things to consider when irrigating a nephrostomy tube?

Answer 10

Strict aspetic technique

Gently instill no more than 5 ml of sterile NS

Question 11

Why is there only 5ml that can be irrigated into a nephrostomy tube?

Answer 11

Because you are irrigating into the renal pelvis which is a very small space

Question 12

What is the gold standard diagnostic exam to diagnose nephrolithiasis?

Answer 12

Non-contrast spiral CT (CT/KUB)

Question 13

What are 5 other diagnostic tests or procedures for nephrolithiasis?

Answer 13

Careful history and physical

Ultrasound

IVP

Urinalysis

Retrieval/analysis of stones

Question 14

What 3 things are you looking for on a UA for nephrolithiasis?

Answer 14

Hematuria

Crystalluria

pH

Question 15

What are 5 types of kidney stones?

Answer 15

Calcium oxalate

Calcium phosphate

Uric acid

Cystine

Struvite

Question 16

What is the most common type of kidney stone?

Answer 16

Calcium oxalate

Question 17

What is a struvite kidney stone made out of?

Answer 17

Magnesium ammonium phosphate

Question 18

A kidney stone is one of the strongest…

Answer 18

Pain sensations known to man

Question 19

Pain from a kidney stone can be so bad that it can cause…

Answer 19

hemodynamic compromise (vital signs)

Question 20

What may be a priority action/next best action in a patient with a kidney stone?

Answer 20

Treating their pain

Question 21

Would management of pain be a priority action in a patient who is post-op?

Answer 21

No, it will not KILL the patient

Question 22

What is kidney stone pain often called?

Answer 22

Renal colic

Question 23

What is renal colic treated with?

Answer 23

NSAIDs and opiods

Question 24

A patient with kidney stones may have what 2 GI symptoms?

Answer 24

Nausea

Vomiting

Question 25

When will the provider want the patient to pass the stone spontaneously?

Answer 25

If the stone is small, less than 4mm

Question 26

When will the provider want to remove the stone?

Answer 26

When it's larger than 4mm.

Question 27

What will the provider do to remove the stone?

Answer 27

Put a stent in the ureter to make it and the urethra large so the stone will pass Or surgically remove

Question 28

If a patient has frequent kidney stones you should teach them how to do what 2 things?

Answer 28

Keep adequate hydration How to strain urine

Question 29

What are examples of a low oxolate diet?

Answer 29

Dark roughage Spinch Cocoa Nuts

Question 30

Does a patient who frequently gets calcium oxalate kidney stones need to be on a low calcium diet?

Answer 30

Evidence says stones may not come from dietary calcium sources

Question 31

If a patient gets frequent kidney stones that are made up of uric acid, what type of diet should they be on?

Answer 31

Low purine

Question 32

What foods have purine in them? (3)

Answer 32

All alcohol Some fish, seafood, shellfish Some meats like bacon and turkey

Question 33

What is an endourologic procedure?

Answer 33

Minimally invasive techniques are used to inspect the urinary tract and perform surgery

Question 34

What is a lithotripsy?

Answer 34

A procedure that disintegrates (pulverizes) stones via shock waves

Question 35

A procedure that disintegrates (pulverizes) stones via shock waves is called a...

Answer 35

Lithotripsy

Question 36

What type of procedure is a lithotripsy?

Answer 36

Endourologic procedure

Question 37

What are 3 internal (direct) approaches to a lithotripsy?

Answer 37

Cystoscopic Percutaneous Laser

Question 38

What does percutaneous mean?

Answer 38

Of or through the skin

Question 39

What is an indirect (external) approach to a lithotripsy?

Answer 39

Stones may be broken down and washed out

Question 40

What is the major advantage to an external/indirect lithrotripsy?

Answer 40

Non-invasive

Question 41

What are 3 complications of an external (indirect) lithotripsy?

Answer 41

Hemorrhage Infection Retention of stone fragments

Question 42

Is hematuria expected after a lithotripsy?

Answer 42

Yes

Question 43

If a HCP places a stent to pass a kidney stone, when will it typically be removed?

Answer 43

1-2 weeks later

Question 44

What would not be an expected finding after a lithotripsy?

Answer 44

Decreased urine output, that would indicate an obstruction

Question 45

What is the goal for kidney stones for nurses?

Answer 45

Patient education - lower risk factors through lifestyle and dietary changes

Question 46

How much fluid intake should you encourage a patient to drink to prevent kidney stones (unless contraindicated)?

Answer 46

3 L per day

Question 47

Should you force fluids once a patient has a kidney stone?

Answer 47

No. Evidence does not support this.

Question 48

What are nursing implications for the patient who has kidney stones?

Answer 48

Reduce risk factors

Question 49

How does the nurse reduce risk factors for a patient who is hospitalized? (4)

Answer 49

Encourage ambulation Stand/sit up to void bladder on regular basis Turn q2 Adequate fluid intake

Question 50

Why should you filter urine?

Answer 50

To catcht the stone to analyze it

Question 51

What is the main reason a patient with kidney stones would be admitted?

Answer 51

Their pain is uncontrolled

Question 52

What is often ordered for a patient who is hospitalized with a kidney stone?

Answer 52

PCA pump