{
  "name": "Urolithiasis (Kidney Stones)",
  "slug": "kidney-stones",
  "url": "https://nursingplex.com/care-plans/kidney-stones",
  "category": "Urinary & Renal",
  "summary": "Stone passage care; aggressive pain relief, strain urine and hydration.",
  "nursing_diagnoses": [
    "Acute pain",
    "Impaired urinary elimination",
    "Nausea"
  ],
  "overview": [
    "Urolithiasis is the formation of stones in the urinary tract, most often calcium oxalate, followed by uric acid, struvite (infection-related) and cystine stones. Stones form when solute concentration exceeds solubility, which is why low urine volume is the single most important modifiable risk factor across every stone type. The classic presentation is renal colic: sudden, excruciating, wave-like flank pain radiating to the groin, testicle or labia, with a patient who cannot lie still — in contrast to peritonitis, where any movement is avoided.",
    "Most stones under 5 mm pass spontaneously with hydration, analgesia and medical expulsive therapy using an alpha blocker such as tamsulosin. Larger or obstructing stones need lithotripsy, ureteroscopy or percutaneous removal. Two nursing responsibilities are non-negotiable: strain every void to capture the stone for analysis, because the composition determines lifelong prevention, and recognize obstruction with infection — fever with colic — as a urologic emergency that can progress to sepsis within hours."
  ],
  "key_facts": [
    {
      "label": "Emergency combination",
      "text": "Fever plus obstructing stone equals infected obstructed system — a true emergency requiring urgent decompression."
    },
    {
      "label": "Strain all urine",
      "text": "Every void, every time; stone analysis determines the prevention plan for the rest of the patient's life."
    },
    {
      "label": "Fluid target",
      "text": "Enough to produce about 2–2.5 liters of urine daily — the one measure that helps every stone type."
    },
    {
      "label": "Calcium myth",
      "text": "Do not restrict dietary calcium for calcium stones; normal dietary calcium binds oxalate in the gut and reduces stone risk. Restrict oxalate and sodium instead."
    },
    {
      "label": "Uric acid stones",
      "text": "Alkalinize the urine and limit purines; struvite stones require eradicating the underlying infection."
    }
  ],
  "nursing_priorities": [
    "Relieve severe pain rapidly and effectively.",
    "Detect obstruction, infection and deteriorating renal function.",
    "Promote stone passage with hydration, ambulation and expulsive therapy.",
    "Strain all urine and secure the stone for analysis.",
    "Manage nausea and maintain hydration.",
    "Teach type-specific dietary and fluid prevention to reduce recurrence."
  ],
  "assessment": {
    "subjective": [
      "Sudden severe, colicky flank pain radiating to the groin, testicle or labia",
      "Restlessness and inability to find any comfortable position",
      "Nausea, vomiting and diaphoresis accompanying the pain",
      "Urinary urgency, frequency and dysuria as the stone nears the bladder",
      "Report of visible blood in the urine",
      "History of prior stones, family history, or low fluid intake and hot-climate work"
    ],
    "objective": [
      "Writhing, pacing, unable to lie still; pallor, diaphoresis, tachycardia and hypertension from pain",
      "Costovertebral angle tenderness on the affected side",
      "Gross or microscopic hematuria; crystals on urinalysis",
      "Fever, chills and leukocytosis indicating infection",
      "Decreased urine output or anuria suggesting bilateral or solitary-kidney obstruction",
      "Stone size, number and location on non-contrast CT or ultrasound; hydronephrosis",
      "Vomiting with dehydration; elevated BUN and creatinine",
      "Captured stone fragments in the strainer"
    ],
    "related_factors": [
      "Supersaturated urine from low fluid intake and concentrated urine",
      "Metabolic factors: hypercalciuria, hyperuricosuria, hyperoxaluria, low urinary citrate",
      "Chronic urinary infection with urea-splitting organisms forming struvite stones",
      "Immobility, hyperparathyroidism, gout, inflammatory bowel disease and bariatric surgery",
      "High sodium, high animal protein and high oxalate dietary patterns",
      "Ureteral spasm and distention proximal to the obstruction producing colic"
    ]
  },
  "goals": [
    "The client will report pain reduced to an acceptable level within 30–60 minutes of analgesia.",
    "The client will maintain urine output of at least 30 mL/hr with no signs of obstruction.",
    "The client will pass the stone or undergo successful removal, with the specimen captured for analysis.",
    "The client will remain free of infection, sepsis and renal impairment.",
    "The client will maintain hydration without vomiting.",
    "The client will describe a fluid and dietary plan specific to their stone type before discharge."
  ],
  "interventions": [
    {
      "title": "1. Pain and nausea management",
      "points": [
        "Treat renal colic as a genuine emergency for pain control; give NSAIDs such as ketorolac, which reduce ureteral spasm and edema, plus opioids as ordered.",
        "Reassess pain within 30 minutes of every dose and advocate for escalation if it is not controlled.",
        "Allow the patient to move, walk or change position freely rather than enforcing bed rest, and apply heat to the flank.",
        "Give antiemetics for nausea and vomiting, which are part of the colic reflex rather than a separate illness.",
        "Maintain a calm environment and stay present; the pain is frightening and anxiety heightens it.",
        "Explain that pain often disappears abruptly when the stone passes into the bladder."
      ]
    },
    {
      "title": "2. Straining urine and stone recovery",
      "points": [
        "Strain every single void through the provided device and inspect for even sand-like grit.",
        "Place strainers in every bathroom the patient uses and post reminders; a passed unstrained stone is lost information.",
        "Send any recovered material to the laboratory for analysis and record the date and circumstances.",
        "Teach the patient to continue straining at home until told to stop, even after pain resolves.",
        "Do not discard urine until it has been strained and inspected."
      ]
    },
    {
      "title": "3. Promoting stone passage and monitoring for obstruction",
      "points": [
        "Encourage 2.5–3 liters of fluid daily, mostly water, unless contraindicated by cardiac or renal disease.",
        "Encourage ambulation, which aids stone movement, as soon as pain allows.",
        "Give alpha blockers such as tamsulosin as prescribed for distal ureteral stones and warn about orthostatic hypotension and dizziness.",
        "Measure intake and output strictly and report urine output below 30 mL/hr or a sudden decrease.",
        "Monitor BUN, creatinine and electrolytes for obstructive renal injury.",
        "Report fever, chills, worsening pain or hypotension immediately — infection behind an obstruction requires emergency decompression by stent or nephrostomy."
      ]
    },
    {
      "title": "4. Procedural care",
      "points": [
        "Prepare the patient for extracorporeal shock wave lithotripsy and explain that bruising, hematuria and passage of fragments for days afterward are expected.",
        "Provide post-ureteroscopy or post-stent care, warning that a stent commonly causes urgency, frequency, flank discomfort with voiding and hematuria until it is removed.",
        "After percutaneous nephrolithotomy, monitor the nephrostomy tube for patency, output volume and color, and never clamp or irrigate it without a specific order.",
        "Monitor for post-procedure bleeding, infection and inability to void.",
        "Increase fluids after any procedure to flush fragments and reinforce continued straining."
      ]
    },
    {
      "title": "5. Prevention based on stone type",
      "points": [
        "Set the universal goal first: enough fluid to produce 2–2.5 liters of pale urine daily, including a glass at night when urine is most concentrated.",
        "For calcium oxalate stones, maintain normal dietary calcium, restrict sodium and animal protein, and limit high-oxalate foods such as spinach, rhubarb, beets, nuts, chocolate and strong tea.",
        "For uric acid stones, limit purine-rich organ meats, sardines and shellfish, and give urinary alkalinizers such as potassium citrate as prescribed.",
        "For struvite stones, eradicate infection completely and arrange complete stone removal, since fragments harbor bacteria.",
        "For cystine stones, emphasize very high fluid intake, urinary alkalinization and specific prescribed therapy.",
        "Give thiazides, allopurinol or citrate as prescribed and explain the mechanism so adherence makes sense.",
        "Arrange metabolic evaluation and follow-up imaging for recurrent stone formers."
      ]
    }
  ],
  "patient_teaching": [
    "Strain every urination until told to stop, and save anything you find, even grit — the analysis decides your prevention plan.",
    "Drink enough water that your urine stays pale, about 2.5 to 3 liters a day, including some at night.",
    "Walking helps stones pass; keep moving as pain allows.",
    "Go to the emergency department for fever with chills, uncontrolled pain, vomiting you cannot stop, or no urine output.",
    "Do not cut out dietary calcium — cut back on salt, animal protein and high-oxalate foods instead.",
    "If you have a stent, expect urgency, some blood and discomfort with voiding until it is removed, and keep the removal appointment.",
    "Take preventive medication as prescribed; stones recur in about half of people within ten years without prevention."
  ]
}