1. General information
    1. Presence of stones anywhere in the urinary tract; frequent composition of stones: calcium, oxalate, and uric acid
    2. Most often occurs in men age 20-55; more common in the summer
    3. Predisposing factors
      1. Diet: large amounts of calcium, oxalate
      2. Increased uric acid levels
      3. Sedentary life-style, immobility
      4. Family history of gout or calculi; hyperparathyroidism
  2. Medical management
    1. Surgery
      1. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi.
      2. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus.
    2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization
    3. Pain management and diet modification
  3. Assessment findings
    1. Abdominal or flank pain; renal colic; hematuria
    2. Cool, moist skin
    3. Diagnostic tests
      1. KUB: pinpoints location, number, and size of stones
      2. IVP: identifies site of obstruction and presence of nonradiopaque stones
      3. Urinalysis: indicates presence of bacteria, increased protein, increased WBC and RBC
  4. Nursing interventions
    1. Strain all urine through gauze to detect stones and crush all clots.
    2. Force fluids (3000-4000 ml/day).
    3. Encourage ambulation to prevent stasis.
    4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area.
    5. Monitor I&O.
    6. Provide modified diet, depending upon stone consistency.
      1. Calcium stones: limit milk/dairy products; provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, whole grains); take vitamin C.
      2. Oxalate stones: avoid excess intake of foods/fluids high in oxalate (tea, chocolate, rhubarb, spinach); maintain alkaline-ash diet to alkalinize urine (milk; vegetables; fruits except prunes, cranberries, and plums).
      3. Uric acid stones: reduce foods high in purine (liver, brains, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine.
    7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production; push fluids when giving allopurinol.
    8. Provide client teaching and discharge planning concerning
      1. Prevention of urinary stasis by maintaining increased fluid intake especially in hot weather and during illness; mobility; voiding whenever the urge is felt and at least twice during the night
      2. Adherence to prescribed diet
      3. Need for routine urinalysis (at least every 3-4 months)
      4. Need to recognize and report signs/symptoms of recurrence (hematuria, flank pain).