NUR 114
FINAL EXAM 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Final Exam content from
the Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 4 Study Guide
1. Exemplar: Kidney Stones
Urolithiasis: presence of calculi (stones) in the urinary tract. Stones often do not cause symptoms until
they pass into the lower urinary tract, where they can cause excruciating pain. Stones are particles in the
urine that occur in amounts too high to stay dissolved (become supersaturated) in urine. As a result of
supersaturation, the particles precipitate and collect to form calculi. Most common condition associated
with stone formation is dehydration.
Nephrolithiasis: formation of stones in the kidney
Ureterolithiasis: formation of stones in the ureter
Everyone excretes crystals in the urine at some time, but fewer than 10% of adults form stones. Formation
of stones involves two conditions; 1. supersaturation of the urine with the particular element (calcium or
uric acid) that first becomes crystallized and later becomes the stone, and 2. Formation of a nidus (deposit
of crystals that can be the point of infection) along the lining of the kidney and urinary tract. Most stones
will contain:
Struvite (15%)
Uric acid (8%)
Cystine (3%)
Some patients might also have a decreased amount of inhibitor substances in the urine that would
otherwise prevent supersaturation and crystal aggregation. Low urine volume, high urine acidity (uric
acid or cystine stones), or alkalinity (calcium phosphate or struvite stones), drugs (topiramate,
corticosteroids, indinavir, acetazolamide) can all contribute to stone formation.
Hydroureter: when there is an enlargement of the ureter (can occur when the ureter is occluded)
Hematuria: bloody urine and may result from damage to the urothelial lining
Hydronephrosis: enlargement of the kidney caused by blockage of urine lower in the tract and filling of
the kidney with urine – permanent kidney damage can occur
Etiology and Risk Factors:
Dehydration
Metabolic problems that lead to stone formation:
o Hypercalcemia: calcium stones
Calcium Oxalate: forms in acidic urine due to increased amounts of calcium and
oxalate in the urine
Calcium phosphate: forms in alkaline urine, indicating a renal tubules issue
Primary:
Absorptive: increased intestinal calcium absorption.
Renal: decreased kidney tubular excretion of calcium
Secondary:
Resorptive: hyperparathyroidism, Vitamin D intoxication, kidney tubular
acidosis, prolonged immobilization
Risk factors:
Excess oxalate in diet
Intestinal Ca absorption
Hyperparathyroidism
Prolonged immobility, bone disease
Vitamin D intoxication
, Multiple Myeloma, Renal tubular acidosis, prolonged steroid use,
alkaline urine, dehydration, IBD
Management:
Diet for calcium oxalate: avoid oxalate sources such as spinach, black
tea, and rhubarb. Decrease Na intake
Diet for calcium phosphate: limit intake of foods in high in animal
protein 5-7 servings per week and never more than 2 per day. Some
patients may benefit from a reduced calcium intake (milk, other dairy
products). Decrease sodium intake.
o Hyperuricemia: uric stones
Primary: gout is an inherited disorder of purine metabolism (20% of patients
with gout have uric acid calculi)
Secondary: increased production or decreased clearance of purine from
myeloproliferative disorders, thiazide diuretics, carcinoma
Risk Factors:
Gout, purine intake, acidic urine
Management:
Potassium citrate, Allopurinol
Diet: Avoid foods high in purine such as organ meats, poultry, fish,
gravies, red wines, and sardines
Increase hydration
o Struvite: made of magnesium ammonia phosphate and carbonate apatite, formed by urea
splitting bacteria, most commonly Proteus mirabilis; needs an alkaline urine to form
Risk factors:
UTIs, especially proteus infections
Since women get UTI’s more commonly – struvite is more common in
women
Management:
Antibiotics for infections
Surgical removal of stone if needed
Diet: limit high-phosphate foods, such as dairy products, organ meats,
and whole grains
o Cystinuria: autosomal-recessive defect of amino acid metabolism that precipitates
insoluble cystine crystals in the urine. Rare
Risk factors:
genetic defect, acidic urine
Management:
Penicillamine, Sodium Bicarb
Diet: restrict sodium, limit animal protein intake
Increase hydration
Caucasian, obesity, diabetes, or gout
Recurrence of hyperparathyroidism, urinary tract obstruction, inflammatory bowel disease, and
history of GI problems
Remember that metabolic problems are non-modifiable risk factors
Greater than 1,000 mg/day of Ca, greater than 800 IU/day of Vitamin D, and high-dose ascorbic
acid (Vitamin C) have been implicated for stone formation
Family history
Men are at a higher risk
Prevention: high intake of fluids, fruits, and vegetables; low consumptions of protein; balanced intake of
fats and carbohydrates
, Stone Types Risk Factors Management
Hypercalcemia Excess oxalate in diet Diet: low-oxalate diet while maintaining
• Oxalate Intestinal Ca absorption adequate calcium intake, limit foods high in
• Phosphat Hyperparathyroidism sodium and protein, , increase foods that
e Prolonged immobility, bone disease acidify urine
Vit D intoxication pyridoxine (B-6),
Mult Myeloma, Renal tubular acidosis, Thiazide diuretics, phosphates
prolonged steroid use, alkaline urine, Increase hydration, exercise
dehydration, IBD
Hyperuricemia Gout, purine intake, acidic urine Potassium citrate, Allopurinol
Diet: Avoid foods high in purine
Increase hydration
Struvite UTIs, especially proteus infections Antx for infx
Surgery to remove stone
Cystine Genetic defect, acid urine Penicillamine, Sodium Bicarb
Diet: restrict sodium
Increase hydration
Assessment:
Ask patient about personal or family history of stones. If there is a history, ask about what
treatment methods were used, and what type of stone they had if a chemical analysis was
performed
Obtain dietary history, focusing on fluid intake patterns and supplemental vitamin and mineral
intake
Major symptom is severe pain, commonly referred to as renal colic. Pain is most intense when
the stone is moving, or the ureter is obstructed. Renal colic typically occurs suddenly and is often
unbearable.
Flank pain suggests that the stone is in the kidney or upper ureter
Nausea, vomiting, pallor, diaphoresis accompany pain
Staghorn calculus: large stationary stone in the kidney, that rarely causes pain because it is not
moving
Dysuria and frequency of urine occur when the stone reaches the bladder
Oliguria (scant amounts of urine) or anuria (absence of urine output) suggest an obstruction.
Obstruction is a medical emergency and must be treated immediately to preserve kidney function
Assess for bladder distention
FINAL EXAM 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Final Exam content from
the Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 4 Study Guide
1. Exemplar: Kidney Stones
Urolithiasis: presence of calculi (stones) in the urinary tract. Stones often do not cause symptoms until
they pass into the lower urinary tract, where they can cause excruciating pain. Stones are particles in the
urine that occur in amounts too high to stay dissolved (become supersaturated) in urine. As a result of
supersaturation, the particles precipitate and collect to form calculi. Most common condition associated
with stone formation is dehydration.
Nephrolithiasis: formation of stones in the kidney
Ureterolithiasis: formation of stones in the ureter
Everyone excretes crystals in the urine at some time, but fewer than 10% of adults form stones. Formation
of stones involves two conditions; 1. supersaturation of the urine with the particular element (calcium or
uric acid) that first becomes crystallized and later becomes the stone, and 2. Formation of a nidus (deposit
of crystals that can be the point of infection) along the lining of the kidney and urinary tract. Most stones
will contain:
Struvite (15%)
Uric acid (8%)
Cystine (3%)
Some patients might also have a decreased amount of inhibitor substances in the urine that would
otherwise prevent supersaturation and crystal aggregation. Low urine volume, high urine acidity (uric
acid or cystine stones), or alkalinity (calcium phosphate or struvite stones), drugs (topiramate,
corticosteroids, indinavir, acetazolamide) can all contribute to stone formation.
Hydroureter: when there is an enlargement of the ureter (can occur when the ureter is occluded)
Hematuria: bloody urine and may result from damage to the urothelial lining
Hydronephrosis: enlargement of the kidney caused by blockage of urine lower in the tract and filling of
the kidney with urine – permanent kidney damage can occur
Etiology and Risk Factors:
Dehydration
Metabolic problems that lead to stone formation:
o Hypercalcemia: calcium stones
Calcium Oxalate: forms in acidic urine due to increased amounts of calcium and
oxalate in the urine
Calcium phosphate: forms in alkaline urine, indicating a renal tubules issue
Primary:
Absorptive: increased intestinal calcium absorption.
Renal: decreased kidney tubular excretion of calcium
Secondary:
Resorptive: hyperparathyroidism, Vitamin D intoxication, kidney tubular
acidosis, prolonged immobilization
Risk factors:
Excess oxalate in diet
Intestinal Ca absorption
Hyperparathyroidism
Prolonged immobility, bone disease
Vitamin D intoxication
, Multiple Myeloma, Renal tubular acidosis, prolonged steroid use,
alkaline urine, dehydration, IBD
Management:
Diet for calcium oxalate: avoid oxalate sources such as spinach, black
tea, and rhubarb. Decrease Na intake
Diet for calcium phosphate: limit intake of foods in high in animal
protein 5-7 servings per week and never more than 2 per day. Some
patients may benefit from a reduced calcium intake (milk, other dairy
products). Decrease sodium intake.
o Hyperuricemia: uric stones
Primary: gout is an inherited disorder of purine metabolism (20% of patients
with gout have uric acid calculi)
Secondary: increased production or decreased clearance of purine from
myeloproliferative disorders, thiazide diuretics, carcinoma
Risk Factors:
Gout, purine intake, acidic urine
Management:
Potassium citrate, Allopurinol
Diet: Avoid foods high in purine such as organ meats, poultry, fish,
gravies, red wines, and sardines
Increase hydration
o Struvite: made of magnesium ammonia phosphate and carbonate apatite, formed by urea
splitting bacteria, most commonly Proteus mirabilis; needs an alkaline urine to form
Risk factors:
UTIs, especially proteus infections
Since women get UTI’s more commonly – struvite is more common in
women
Management:
Antibiotics for infections
Surgical removal of stone if needed
Diet: limit high-phosphate foods, such as dairy products, organ meats,
and whole grains
o Cystinuria: autosomal-recessive defect of amino acid metabolism that precipitates
insoluble cystine crystals in the urine. Rare
Risk factors:
genetic defect, acidic urine
Management:
Penicillamine, Sodium Bicarb
Diet: restrict sodium, limit animal protein intake
Increase hydration
Caucasian, obesity, diabetes, or gout
Recurrence of hyperparathyroidism, urinary tract obstruction, inflammatory bowel disease, and
history of GI problems
Remember that metabolic problems are non-modifiable risk factors
Greater than 1,000 mg/day of Ca, greater than 800 IU/day of Vitamin D, and high-dose ascorbic
acid (Vitamin C) have been implicated for stone formation
Family history
Men are at a higher risk
Prevention: high intake of fluids, fruits, and vegetables; low consumptions of protein; balanced intake of
fats and carbohydrates
, Stone Types Risk Factors Management
Hypercalcemia Excess oxalate in diet Diet: low-oxalate diet while maintaining
• Oxalate Intestinal Ca absorption adequate calcium intake, limit foods high in
• Phosphat Hyperparathyroidism sodium and protein, , increase foods that
e Prolonged immobility, bone disease acidify urine
Vit D intoxication pyridoxine (B-6),
Mult Myeloma, Renal tubular acidosis, Thiazide diuretics, phosphates
prolonged steroid use, alkaline urine, Increase hydration, exercise
dehydration, IBD
Hyperuricemia Gout, purine intake, acidic urine Potassium citrate, Allopurinol
Diet: Avoid foods high in purine
Increase hydration
Struvite UTIs, especially proteus infections Antx for infx
Surgery to remove stone
Cystine Genetic defect, acid urine Penicillamine, Sodium Bicarb
Diet: restrict sodium
Increase hydration
Assessment:
Ask patient about personal or family history of stones. If there is a history, ask about what
treatment methods were used, and what type of stone they had if a chemical analysis was
performed
Obtain dietary history, focusing on fluid intake patterns and supplemental vitamin and mineral
intake
Major symptom is severe pain, commonly referred to as renal colic. Pain is most intense when
the stone is moving, or the ureter is obstructed. Renal colic typically occurs suddenly and is often
unbearable.
Flank pain suggests that the stone is in the kidney or upper ureter
Nausea, vomiting, pallor, diaphoresis accompany pain
Staghorn calculus: large stationary stone in the kidney, that rarely causes pain because it is not
moving
Dysuria and frequency of urine occur when the stone reaches the bladder
Oliguria (scant amounts of urine) or anuria (absence of urine output) suggest an obstruction.
Obstruction is a medical emergency and must be treated immediately to preserve kidney function
Assess for bladder distention
