Renal Calculi

foreign engineers in this video today we're going to be talking about renal calculi so if you do like this video please go ahead give it a thumbs up comment down below and don't forget to subscribe check out ninja.org that's where all of our notes and illustrations for these lectures are available for you guys so let's get started here with renal calculi also known as kidney stones so we're going to jump right into the pathophysiology as we move through our renal series here we've been talking about the kidney the ureter the bladder right and as we are talking about kidney stones today we're going to particularly talk about why do they form so with kidney stones the easiest way for you to think about it is that with urine right our body our kidneys are trying to filter make a filtrate that eventually becomes urine that we urinate out and it's trying to create that balance of filtering out the things that we don't need and keeping in what we do need Etc So within our urine there's a certain amount of concentration of these things now when we eat Foods when we sweat we work out when we take certain medications we have any type of comorbidities or imbalances within our body those balances of all those different electrolytes and nutrients and fluids are going to change and when they change they can also alter that concentration and when that concentration is too rich that's what we can have crystals form now those crystals could be many different things and we'll talk about them in a minute of some of the more predominant types of stones that we can eventually get but those crystals can then eventually accumulate together and form a stone so when we think about this we want to look at the problems that could be occurring if we were to develop a stone right and we have a stone up in here we have a stone here there can even be one prominent predominantly right here within the opening into the bladder and the stones for some people are looking in the kidney they can have no problems with them it's when the kidney starts to move so when the patient starts to experience the pain and the difficulty and then some further along the line problems so as this kidney stone starts to move think about it as like a really Jagged Stone right and it's trying to push through this tube and it's it's a tight fit right depending on the size of the stone if it's a really really tight fit it's going to start creating some tears or damage along and as it does that the patient starts to experience pain right he can also experience some bleeding then within our urine we can also have a problem where it physically gets stuck it's not advancing anymore it's not progressing down through into the bladder so we can urinate it out and then we're going to start to have that backflow that build up into the kidney and why does this occur what are some of the causes or risk factors that's going to have this patient have a problem where they want our developing kidney stones and then two potentially having an issue to pass that kidney stone we talked about concentration right so one of those things could just simply be dehydration we're not drinking enough fluid we're not drinking enough water okay and we're maybe dehydrated maybe we're sweating a lot maybe we're on a new type of diuretic and we're urinating a lot so because of that our concentration has changed there could be alterations within medications that we're taking because of those medications they are throwing off all of our levels there could be issues with absorption so a patient that has some type of irritable bowel disease like Crohn's ulcerative colitis they're having an issue with absorbing so that is going to lead to an increase in our concentration we can also think of them having just other chronic issues with their balances right they could have hyper calciumia they could have issues with their thyroid their hyperparathyroidism and all those could also cause issues with that concentration there's a couple others that we could talk about also where we have gout we have issues with neurogenic bladder or frequent UTIs that are also going to be causing a concentration with those and it could also be a risk factor that the stone is just too big or they've had once previously so it's hereditary within their uh their family genes and also males have a higher risk for stones so when we talk about all these different risk factors and these causes we're going to talk about quickly the types of stones so there's many different types of stones that the patients can have and for the NCLEX it's not necessarily important to know the different types of stones but I do want you to understand there's different ones because that could also indicate the different type of treatment or care that we give our patients so we're going to quickly run through the different types that we see up here there is calcium oxalate which is the most common what that is is there's basically an increase in calcium or oxalate within this patient especially in their urine that it's it's going to be a higher concentration and it can be due to a lot of different things hyperparathyroidism hypercalcemia hypercalcereemia dehydration or IBD like Crohn's and I want you to understand that this is the most common one so when we look at this there's different ways that we can possibly help this patient out changing the amount of calcium that they're in taking changing medications oxalate as well and it's just a very high predominance of these and then as we move through these Stones another one we have is uric acid uric acid increased in the urine it's increased in the bladder it's building up right it's going to create these crystals create these Stones those have to do with gout and again dehydration in here so those patients we could be treating their gout we help treat their gout they're going to have a better outcome of a decrease occurrence of this uric acid Stone then we also have a struvite stone this is more alkalinic in the environment it's related to bacteria so think of patients that have chronic UTIs neurogenic bladder where they're not able to empty their bladder as often they're going to have a buildup of this bacteria creating an environment that's very alkalinity very basic and because of that these stones are more apparent to occur we also have the calcium phosphate different than our calcium oxalate these are an alkalinic urine as well you're going to see hyperparathyroidism and then tubular acidosis those are less common very more so on the rare side but the most rare is the Sistine Stone this is an increase in cysteine causing those crystals to form into stones and this is more on the hereditary scale but when we look at all these stones those biggest complications that we're looking to help with these patients are is there a is it progressing through the ureters down to the bladder so they can pass it and what are their symptoms that they're having so we can treat those symptoms because despite all different types of stones and there's even more that we can get categorize into there are symptoms and the clinical manifestations of the patients are relatively going to be the same or very similar so first there could be a patient that has these Stones it's not trying to advance anywhere through the kidney through the uterine to the bladder so they're not going to have any symptoms when that kidney does decide or when the stone does decide to start moving that's when we could have all of these symptoms so the biggest thing we're going to see here when we take the NCLEX and the biggest sign is going to be that flank pain particularly if the stone is dropping on the the right side they're going to have right-sided flank pain or versus the left if it's on the left side left side of flank pain so the biggest thing is going to be flank pain so you have to remember that when we're talking to patients they may not think it's their flank they may say you know for a day or so I've been having like this I don't know like discomfort and thought and I threw my back out a little bit but now it's not it's not getting any better it's getting worse it almost feels like I'm getting stabbed back there you know and then you're going to assess your patient and you could do a light tap on both sides and they're gonna really jolt because that's really painful and tender back there so flying pain is the biggest one it's severe it's stabbing they could also have abdominal distension or abdominal discomfort right as that pain maybe possibly radiates around to the front that'd be causing the pain for the patient they're going to have other signs that we're going to be thinking of okay is this patient having an issue with their kidney or a kidney stone they're going to have nausea they're going to have vomiting okay they're gonna maybe appear to be diaphoretic sweating possibly having a fever then because of this you want to think about that stone right it's it's trying to progress through if they start developing a fever and that stone is possibly lodged there could be an influx of some type of infection going on so with that fever we could be thinking okay there's backup into the kidney this patient could have things like elevated heart rate due to the pain or potentially an infection they could have an issue with their blood pressure either elevated because of the pain or if they're further along and possibly this is going to be going a little longer and they're starting to go on the side of septic their pressure could be starting to drop so you're going to start thinking about what their vital signs are looking like this patient could also have issues with urinating right this stone is partially obscuring or blocking obstructing that flow of urine so are they having possible difficulty going to the bathroom are they having a decrease of the amount so they're having urgency and frequency but they're having less output so all of those things we're going to think okay something's going on with the kidney and then the patient might also complain yeah my urine it looks like it looks a little bloody it looks like there's something in it I can't really tell but it looks like it's getting maybe a little darker a little red and that's where you're going to think is that blood in the urine because remember as that stone progresses it can scrape down the sides and then cause a little breakage of the vessels causing some blood to be apparent in the urine so when we look at this patient the biggest things we want to always remember especially when we're taking an exam is that we're going to have that flank pain is going to be a something we look for the hematuria is going to be something we look for and remember it's going to be very severe flank pain it's going to be a pain that's it's it's very apparent it's stabbing it's not giving up for this patient at all so we have a patient that comes in and looks like this we want to make sure that we are diagnosing them correctly so how do we do that when we want to diagnose this patient there's very little things that we're going to do in order to know that this patient has a kidney stone we can do a bunch of blood work that's going to be very nondescript for this patient but the things we can do is a urinary analysis and then get Imaging so with urinary analysis we want to start thinking about is there blood in the urine is there white blood cells in the urine then we're going to get an image why do we get an image a couple different reasons can we verify that there's a stone great we're going to find out where the stone is is it somewhere Lodge at the top of the urinal is it down at The Junction at the bottom is somewhere along the middle and then what is the size of this Stone so we can get a couple different Imaging we can get an x-ray which we can get a kidney ureter bladder which is called the KUB x-ray which is going to allow us to visualize again where the stone is we can also get a CAT scan that's going to help us notify where if there's a stone where is Stone and what is the size of it and the patient can also get an ultrasound and the reason it's really important for us to understand where it is and also the size of it particularly is because there is a certain threshold where patients typically pass stones and then there's a threshold where they're not going to pass the stone and where we have to do something more evasive to get the stone out so roughly around the four to six depends on the patient depends on the size of the patient is where we can think about is the stone going to pass or not so the four to six millimeter depending on the facility you work at they may just say five is where if it's less than 4 or around the four Mark the patient may pass it if it's four or greater six or greater they may not pass it so depending on the stone size we can then talk about procedures quickly there's many different procedures but the NCLEX really hits on these two so we have the eswl which is our extra corporeal Shockwave lithotripsy the easiest way to remember this is the shock wave is usually a sound or a laser wave that just goes in and busts the stone up into little pieces so if you think about this we just took one big Stone we busted it into little Stones So the patient's going to have very similar recovery to somebody who we're just allowing the stone to pass but they're going to have the presence of a lot more littler stones and they may have a little more blood within the urine for that first 24 hours that's just because we went and busted it up so it's going to be a little more damage to the area you know just a little more trauma so it's not uncommon for patients to have a little bit of more bruising and a little bit of blood within the urine the more evasive if the stone is too big or something that we can't really bust up with the waves we're going to go percutaneous nephrophotomy meaning we're going to put a small incision we're going to go in and get grab out that stone okay and because of that this patient is going to potentially have a nephrotomy tube where they're going to have some drainage okay very common again for there to be a red urine blood looking like in that for the first 24 hours should be progressively getting clearer not darker so granted the patient doesn't go down this route it's a very small route for patients that have to get the nephrolithotomy our nursing interventions are mostly going to focus on the patients that we're going to be taking care of that are going to be passing their Stone without getting some type of procedure when we are hoping that our patient can pass this Stone on their own the biggest things we want to think about is it was dehydration right dehydration was one of the biggest things a high concentration of all these little crystals causing Stones so potentially uh alteration in that concentration or a patient being dehydrated so what do we want to do we want to give them fluids we want them to be able if they can drink fantastic take in some fluids or if not we can also give them some IV fluid so we want to increase fluids we're doing this because as we increase those fluids we're hopefully going to be able to perfuse those kidneys push that stone out as we're pushing that stone out it's really important for us to strain the urine okay a couple of reasons we want to strain the urine one so that we know when the Stone comes out we physically see the stone right Stone has come out there it is I see it okay two we can take that stone then and send it off to the lab to analyze it to figure out what stone it was okay was it one of these that we talked about earlier is it something different because that is going to indicate to us what our patients care should be further to prevent other Stones just like it so do we need to alter our diet do we need to change the medications so we're going to strain all urine and then hopefully send it to the lab so we want to promote our patient to be able to get rid of and pass this Stone one of the biggest ways we can do that is to encourage ambulate ambulation so we want our patients to be able to walk if they can to hopefully get that stone moving and we want to get these patients comfortable so within the NCLEX and within your patient-centered care you want to start thinking about their comfort one of their biggest complaints is pain so we want to make sure we're taking care of pain two ways that we do it is we can give an NSAID first particularly ketorolac or Toradol it's called it's an NSAID that we can get through the Iz helps decrease that inflammation helps the patient have a little more Comfort if they're having some trouble with NSAIDs they can't have an NSAID if it's not working for them we can move into the opiates and then we can give this patient morphine or some other medication depending on what the doctor orders once their pain is also under control we can also work into those other symptoms or issues that they're having if they're having some type of infection going on we can give them the correct antibiotics to treat the infection if they're having nausea and vomiting right maybe this is the first time they're getting opiates so they are experiencing nausea and vomiting we can give them an anti-medic we can give them ondosterone Zofran to help them and then we can also give an alpha blocker so alpha blockers such as tamilosin or Flomax are those medications that help create the diameter of our ureter to dilate creating a bigger passage for that stone to come through okay and then pass that stone and then once we have figured out got this patient comfortable we're able to pass the stone we're able to figure out what the stone was we can then alter our diet right so depending on the type of stone with this patient we may want to decrease proteins we may want to decrease purines we may want to increase something to decrease and all has to do with what kind of stone they have and what is going on with that patient so that is one that is not particularly the same for every single patient but the medications that we give increasing those fluids strain the urine and getting them to ambulate are the biggest nursing interventions we want along with you know documenting eyes and O's and making sure that their vitals are stable but these are the key components here for renal calculi or a kidney stone so I hope this video made sense I hope you learned something from it if you did hit that thumbs up comment down below and I'll see you next time [Music]

Channel: Ninja Nerd Nursing

Views: 12,574

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Id: bHA_u5k8cww

Length: 17min 55sec (1075 seconds)

Published: Wed Jun 21 2023