1. The client/caregiver can define urinary calculi.
   1. Calculi or a kidney stone is a solid mass consisting of a collection of tiny crystals.
   2. They can be in the kidney or ureter.
   3. Various types of stones include calcium oxide, magnesium-ammonium, uric acid, cystine, and mixed.
2. The client/caregiver can list factors that increase risk of urinary calculi.
   1. Familial tendency
   2. Dehydration
   3. Diet rich in calcium, oxalates, or uric acid
   4. Sedentary lifestyles or prolonged immobility
   5. Repeated urinary infections
   6. Osteoporosis
   7. Metabolic disorders (gout)
3. The client/caregiver can recognize signs and symptoms of urinary calculi.
   1. Fever and chills
   2. Nausea and vomiting
   3. Blood in the urine
   4. Flank pain or back pain
      • On one or both sides
      • Progressive
      • Severe
      • Spasm-like
      • May radiate or move to pelvic, groin, or genitals
   5. Restlessness
   6. Cloudy urine with sediment
   7. Decreased urine output
4. The client/caregiver can list measures to prevent or control urinary calculi.
   1. Nutritional recommendations are to restrict the following foods to small amounts if stones are composed of calcium oxalate.
      • Apples
      • Beer
      • Berries
      • Broccoli
      • Chocolate
      • Coffee
      • Collards
      • Grapes
      • Milk
      • Parsley
      • Pineapples
      • Spinach
      • Tea
      • Vitamin C
      • Asparagus
      • Beets
      • Black pepper
      • Cheese
      • Cocoa
      • Cola
      • Figs
      • Ice cream
      • Oranges
      • Peanut butter
      • Rhubarb
      • Swiss chard
      • Turnips
      • Yogurt
   2. If kidney stones are composed of uric acid, then a low-purine diet is recommended. The following list shows foods to use in small amounts.
      • Organ meats
      • Consommé
      • Lentils
      • Beans
      • Asparagus
      • Mushrooms
      • Butter
      • Yeast
      • Anchovies
      • Gravies
      • Whole-grain cereals
      • Peas
      • Cauliflower
      • Spinach
      • Cola
   3. Increase fluids (water is best) to at least 2.5 quarts per day.
   4. Increase activity to decrease urinary stasis:
      1. Use active or passive range of motion exercises.
      2. Change positions frequently.
   5. Strain all urine to secure a stone if it passes.
   6. Take pain medications as ordered.
   7. Take the full course of antibiotics.
   8. Consult physician before taking any over- the-counter medications.
   9. Avoid alcohol.
   10. Urine cultures should be taken periodi- cally as a follow-up to detect any recurrent infections.
   11. Report to physician signs of restlessness, flank pain, decreased urine output, and fever, or go to the emergency room if the pain is severe.
   12. Keep follow-up appointments with physician.
5. The client/caregiver is aware of possible complications.
   1. Urinary tract infection
   2. Urinary obstruction
   3. Renal failure
   4. Pyelonephritis
   5. Kidney damage and scarring

Resources

American Foundation for Urologic Disease
www.afud.org

National Kidney and Urologic Diseases Information
Clearinghouse
E-mail: nkudic@info.niddk.nih.gov

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B.
Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com