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Acute Pain - Nursing Diagnosis and Interventions for Urolithiasis

Kidney stones in the urinary tract (urinary calculus) is hard as a rock mass formed in the urinary tract and can cause pain, bleeding, infection or blockage of urine flow.

These stones can form in the kidneys (kidney stones) and in the bladder (bladder stones).
The process of stone formation is called urolithiasis (renal lithiasis, nephrolithiasis). The concentration of stone-forming substances high in blood and urine as well as eating habits or certain medications, can also stimulate the formation of stones. Anything that impedes the flow of urine and cause stasis (no movement) in the urine anywhere in the urinary tract, increasing the likelihood of stone formation.

Stone, especially small ones, may not cause symptoms. Stone in the bladder can cause pain in the lower abdomen. Stones that obstruct the ureter, renal pelvis and renal tubules can cause back pain or renal colic (severe colicky pain). Renal colic is characterized by severe pain intermittent, usually in the area between the ribs and hip bones, which spread to the abdomen,  pubic area and inner thighs. Other symptoms are nausea and vomiting, abdominal distention, fever, chills and blood in the urine. Patients may be frequent urination, especially when the stone passes through the ureter. Stones can cause urinary tract infections. If stones block the flow of urine, the bacteria will be trapped in the urine collected over the blockage, so that there was an infection. If the blockage lasts long, the water will flow back into the urinary tract in the kidney, leading to suppression of which would inflate the kidneys (hydronephrosis) and eventually kidney damage can occur.

Common symptoms of kidney stone disease are:
  • Urinate more often occurs
  • Pain at the waist
  • Sometimes accompanied by fever and seizures
  • Cloudy yellow urine
  • A history of kidney stones who previously suffered by one member of the family

Nursing Diagnosis for Urolithiasis : Acute Pain related to increase in the frequency of ureteral contractions, tissue trauma, edema and cellular ischemia.

Nursing Interventions:

1. Record the location, duration / intensity of pain (scale 1-10) and its spread. Pay attention to non-verbal signs such as: increase in BP and pulse rate, restlessness, grimacing, moaning, floundering.

2. Explain the causes of pain and the importance of reporting to the nursing staff of any changes that occur pain characteristics.

3. Perform actions that promote comfort (such as light massage / warm compress on the back, quiet environment)

4. Help the patient to deep breathing, guided imagery and therapeutic activity.

5. Help / encourage increased activity (ambulation active) as indicated with at least 3-4 liters of fluid intake per day within cardiac tolerance.

6. Note the increase / persistence of abdominal pain.

7. Collaboration of appropriate drug therapy program.

8. Maintain urinary catheter patency when needed.


Rational:

1. Help evaluate the progress of obstruction and stone movement. Pelvic pain often spreads to the back, groin, genitalia with respect to proximity plexus nerves and blood vessels that supply the other areas. Sudden pain and can lead to severe anxiety, fear / anxiety.

2. Reported early pain, analgesic provision provides an opportunity at the right time and help improve the client's coping ability in reducing anxiety.

3. Promote relaxation and reduce muscle tension.

4. Divert attention and help to relax the muscles.

5. Physical activity and adequate hydration increases the passage of the stone, prevent urinary stasis and prevent further stone formation.

6. Complete obstruction of the ureter may lead to perforation and ekstravasasiurine into perrenal area, this is an acute surgical emergency.

7. Prevent stasis / urinary retention, lowering the risk of increased pressure and kidney infections.

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