Pamantasan ng Lungsod ng Marikina

COLLEGE OF NURSING
Brazil St. Green heights Subd., Concepcion I Marikina City

In Partial Fulfillment in Related Learning Experience

1ST Semester

CASE STUDY OF
URETEROLITHIASIS

PRESENTED BY:
Dizon, Kathlynne Therese F.
Fernandez, Anri Joy Z.
Obispo, Julie Anne May G.
Pascual, Ralph Landon
BSN 401

CLINICAL INSTRUCTOR
Leopoldo Palisoc Jr. RN,MAN

TABLE OF CONTENTS
I. INTRODUCTION
II. OBJECTIVES WITH SPECIFIC OBJECTIVES
III. NURSING THEORY
a. Biographical Data, Patients Name (initial), Address, Date of Birth, Birth Place,
Occupation, Source of Health Assistance, Source of referral, Emergency contact
person and number.
b. Reason of Seeking Health care
c. History of Present Illness
d. Family Health History
e. Present illness
IV. IMMUNIZATION/EXPOSURE TO COMMUNICABLE DISEASE
V. HOME MEDICATION/ALTERNATIVE MEDICINE
VI. PSYCHOSOCIAL HISTORY
a. Alcohol use
b. Drug use
c. Caffeine use
VII. ANATOMY AND PHYSIOLOGY
VIII. PATHOPHYSIOLOGY
IX. PHYSICAL ASSESSMENT
X. GORDONS FUNCTIONAL PATTERN
XI. DIAGNOSIS/LABORATORY EXAMINATION
XII. DRUG STUDY
XIII.NURSING CARE PLAN
XVI. MEDICAL/ SURGICAL MANAGEMENT
XVII. DISCHARGE PLAN

INTRODUCTION

Ureterolithiasis is the formation of kidney stones, also known as renal calculi, in

the ureters, which are muscular tubes that move urine to the bladder from the kidneys.
When ureterolithiasis develops, the stones can block one or both of the ureters, causing
a painful condition known as arenal colic attack. The pain from such an attack usually
starts in the loin and travels through the urinary tract to the genitals as the stones are
passed from the body.

There are several possible reasons for the formation of the kidney stones that
cause ureterolithiasis, though it is not always possible for a doctor to find a cause. Diet
can play a role in the growth of stones, though it is not commonly believed to cause
their formation. A family or personal history with kidney stones, metabolic disorders, and
cystic kidney disease are all believed to play a role in the development of kidney stones.
A high percentage of patients who have the rare disease renal tubular acidosis also
tend to grow kidney stones. Calcium-based antacids and some kinds of diuretics can
also increase the chances of getting kidney stones.
The symptoms of ureterolithiasis tend to appear after the early stages of kidney
stone development. If symptoms of kidney stones present themselves, they will usually
appear when the stones move into the urinary tract. This condition happens later during
the progression of the stones through the body, when they move into one or both of the
ureters.
Stones in the ureter can cause extreme pain as the body attempts to push them
through the tubes and into the bladder. A patient may experience pain in the groin,
nausea, and vomiting. Urine can appear pink, due to the presence of blood. Patients
may also experience burning during urination and the urge to urinate more frequently. In
some cases, an infection may develop, causing chills and fever in addition to these
other symptoms.

Ureterolithiasis is usually treated by simply making the patient more comfortable

while the kidney stones finish their journey to the bladder. Heavy consumption of water
can help the kidney stones to move through the system. A doctor may also prescribe
medication for the management of pain. Often a doctor will request that a patient catch
and keep the kidney stones when they have passed. This is so the stones can be

analyzed in the hopes that the reason for their formation can be determined and
measures can be taken to prevent future kidney stone growth
Ureterolithiasis indicates stone in the kidney. The stone formed is called calculus. Stone or Calculi
may develop and cause obstruction at any point within the urinary tract, However, in the United States and
other industrialized country, Renal or kidney stone is most common.
Calculi are masses of cryastals composed of materials normally excreted in the urine. The majority (75%)
are composed of calcium, sturvite stone, ammonium phosphate, 20% are associated with chronic UTI.
The remainder of the stones are made up of uric acid.
Passage of a urinary stone is the single most common cause of acute ureteral obstruction and
affects as many as 12% of the population. The pain may be some of the most severe pain that humans
experience, and complications of stone disease may result in severe infection; renal failure; or,
in rare cases, death. Renal calculi occur in 5-12% of the American population, and they are bilateral in
10-15% of patients. The prevalence of urinary lithiasis is as high as 2-3% in the general population. A
slightly lower prevalence of urinary stones is found in less developed countries, possibly because of diets
lower in protein.
This case presentation pertains to a case of patient MB, a 36-year old female who was admitted
at St. Mattheus last August 16,2015. The patient was diagnosed with T/C Uretero Lithiasis.

1. (http://emedicine.medscape.com/article/381993-overview)
2. Medical and Surgical Nursing by Lemone and Burke

II. OBJECTIVES AND SPECIFIC OBJECTIVES

OBJECTIVES
At the end of the case study the student nurses will be able to learn more about
Ureterolithiasis, apply appropriate nursing interventions and skills to promote the
wellness and health of the patient. The researchers are expected to gain knowledge
through completing this case study and to share the experience and learning to those
directly and indirectly involve with the completion of this case.
The researchers maximized and applied all what the they have learned during the
process of completion of this case study to improve nursing care to meet Patient X
improvement of his general welfare or normal state of his body. The Ureterolithiasis is a
broad topic yet the researchers are expected to define the disease in order for the
readers and other researchers to further understand it. After this case study, the
researchers will be able to apply all information which has been stated in the data that
will be shown.

SPECIFIC OBJECTIVES

Define Ureterolithiasis; identify their signs, symptoms and clinical manifestations

Illustrate the pathophysiology of the patients condition and interrelate it with the
signs , symptoms and clinical manifestations elicited by the patient
Recommend appropriate Discharge Planning for the patient so that the patient
will develop knowledge and understanding of the home management and other
related treatments through health education
Analyze the signs and symptoms and clinical manifestations elicited by the
patient and other problems that the patient may develop so that the student
nurse may prioritize these problems to be able to render care in a systematic
and logical order
Apply appropriate nursing interventions and skills to aid the student nurses
produce a competent and reliable plan of care to help the patient promote health
and medical understanding of such condition
Develop Specific, Measureable, Attainable, Realistic and Time-bounded Nursing
Care Plan(s) in order to apply appropriate nursing interventions and skills to
promote patients health and understanding of condition

III.NURSING THEORY

Biographical Data

Patient X, A 30 years old woman lived at San Mateo Rizal. She was born on
November 8, at San Mateo Rizal. She is a Filipino citizen and a Roman Catholic.
She is married. She was admitted last August 16, 2015 in St. Mattheus Hospital at
10:55pm. The chief complaint was severe abdominal pain with principal diagnosis of
Ureterolithiasis.

Reason of Seeking Health care

CHIEF COMPLAINT: severe abdominal pain

History of illness:
No history of accidents or injuries
No history of known allergies to foods and medication
No history of previous confinement

Family Health History

(+) Diabetes Mellitus-father
(+) Hypertension-mother

Present Illness
Two days prior to admission the patient experienced epigastric pain located in
the upper right quadrant of the abdomen with a pain scale of 6/10, accompanied
with four episodes of vomiting of previously ingested food. She then went to the
hospital for consultation and was given antacid. Intermittent fever of 38.3 c.

IV.IMMUNIZATION/EXPOSURE TO COMMUNICABLE DISEASE

Complete immunization. Not exposed to any communicable diseases.

V. HOME MEDICATION/ALTERNATIVE MEDICINE

Have used OTC drugs before when the clients got sick like biogesic , amoxicillin,
and mefenamic acid to cure some illness.

VI.PSYCHOSOCIAL HISTORY
A. Alcohol use: Never
B. drug use: Never
C. Caffeine use: two caps in the morning and one cap in the afternoon.

ANATOMY AND PHYSIOLOGY

External Kidney Anatomy

Kidneys have a very distinct shape and color. They are bean-shaped and dark-red in
color. In fact, they look very similar to red kidney beans.

One side bulges outward (convex) and the other side is indented (concave).
The indented or concave section is known as the hilum. This is where the renal artery,
the renal vein and the ureter enter/ exit the kidney.
Each Kidney is enclosed in a semi-transparent membrane called the renal capsule. It is
the container or sac in which the other components of the internal anatomy of the
kidneys
are
stored.
The renal capsule is not only a storage container for internal components of the kidneys
but it also protects against infections and trauma.
Internal Kidney Anatomy

If a human kidney, is sliced vertically (from top to bottom), the intricate structure of the
internal anatomy is revealed. These internal components are responsible for performing
the many essential functions of the kidney.
Some of these components can be seen with the naked eye and are known as
the gross anatomy. Others are very tiny and can only be observed with a microscope.
These are referred to as the microscopic anatomy.

The internal structure of the kidney is divided into two main areas... a light outer area
called the renal cortex, and a darker inner area called the renal medulla. Within the
medulla there are eight (8) or more cone-shaped sections known as renal pyramids.
The renal papilla is located at the smaller end of the cone-shaped renal pyramids. The
areas between the pyramids are called renal columns.
Each renal papilla is attached to a cup, or a small tube, called the minor calyx (CAYlix), which collects urine for removal from the kidney, and eventually from the body. Two
or three of these minor calices (plural of minor calyx) merge into what is called a major
calyx.
The major calices then converge into a funnel-like cavity called the renal pelvis. The
renal pelvis, which is attached to the indented side of the kidney anatomy (hilum),
extends into the ureter. The ureter is a long narrow duct (tube) that conveys urine from
the kidneys to the urinary bladder.
Kidney Anatomy and Excretion

The most basic structures of kidney anatomy are called nephrons. Inside each kidney
there are about one million of these microscopic structures. They are responsible for
filtering the blood... removing waste products.

The renal artery delivers blood to the kidneys each day. Over 180 liters (50 gallons) of
blood pass through the kidneys every day. When this blood enters the kidneys it is
filtered and returned to the heart via the renal vein.
The kidneys are full of blood vessels. Blood vessels are integral to efficient kidney
function. Every function of the kidney involves blood. It, therefore, requires a lot of blood
vessels to facilitate these functions. Together, the two kidneys contain approximately
160 km of blood vessels.
The process of separating wastes from the body's fluids and eliminating them is known
as excretion. The body has four organ systems that are responsible for excretion:

The respiratory system - responsible for excretion of carbon dioxide and small
amounts of water and other gases;
The integumentary system - excretes water, lactic acid, inorganic salts and
urea in the sweat;
The digestive system - excretes water, salts, bile pigments, cholesterol, and
other metabolic wastes;
The urinary system.

The urinary system is one of the main organ systems responsible for excretion. It
excretes a broad variety of metabolic wastes, toxins, drugs, hormones, salts, hydrogen
irons and water. The kidneys are the main organs of the urinary system.