NR 570 Final Exam Study Guide
What is nephrolithiasis? - answer renal calculi (kidney stones)
How does Renal calculi form? - answer formed d/t elevated levels of minerals in the
body
What minerals in excess can cause renal calculi? - answer calcium oxalate (most
common),
phosphate
uric acid
struvite
cystine
Urolithiasis - answer stone in the bladder
Ureterolithiasis - answer condition of stones in the ureter
Risk Factor & complications of renal calculi - answer-Male, 20-50yo, previous stones,
obesity, HTN, diabetes, low fluid intake.
-complications of stones: obstructions, pyelonephritis (kidney infection), CKD
Classic Kidney stone presentation - answeracute onset of severe, colicky flank pain that
wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
history and physical for nephrolithiasis (kidney stones) - answerIrritative Bladder
symptoms -dysuria (painful or difficulty urinating), urgency, & frequency
Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
CVA tenderness tell your the stone is located where? - answercaused by passing of the
stone through the ureter with obstruction & spasm
Where is the stone located if the patient has pain in the groin region? - answerpain that
radiates downward into the groin indicates the stone has passed into the lower third of
the ureter
,Vague flank pain or acute colicky pain with increasing intensity means the stone is
located where? - answerstones in renal pelvis
Differential Diagnosis for abdominal pain and/or flank pain: - answerNephrolithiasis
(kidney stones)
Pyelonephritis (kidney infection)
Ectopic pregnancy
Ovarian or testicular torsion
Appendicitis
Bowel obstruction
Diverticulitis
Rupture of aortic aneurysm
Right lower abdominal tenderness with a +Blumberg sign. What should be suspected? -
answerBlumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis.
*Appendicitis
What labs do we run to diagnose a kidney stone? - answerUA dipstick, urine
microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
What radiology methods are preferred for outpatient treatment and why -
answerinexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
What stones can be seen on a KUB?
What stone can you not see on a KUB - answerCAN see: Calcium oxalate - most
common type of stone
CANNOT see: uric acid stones (radio translucent)
What is a Renal Ultrasound used for when testing for kidney stones? - answergood for
assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine that can be
caused by an obstruction). Bad for identifying a stone.
What is the GOLD STANDARD for diagnosing a kidney stone? - answerNon-contrast
CT scan.
Goal of renal calculi treatment - answerfocused on symptomatic relief
pain medications -NSAID or narcs
antiemetics -n/v
facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers
to help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH.
<5 mm renal calculi can - answerbe passed through the urine. may only require NSAIDs
for management.
, >5 mm renal calculi requires what? - answerurology consult.
this may cause an obstruction or kidney failure.
this type of stone may need surgical intervention to be removed.
when is a Urology Referral indicated? - answerstone > 5mm
recurrent stones
When is a hospital admission appropriates for a patient with nephrolithiasis? -
answerHospital admission is indicated when:
-Inability to control pain
-Impaired renal function with an obstructing stone
-Infection (pyelonephritis or sepsis)
-Intractable n/v
What does a 24 hour urine collection analyze? - answer-total volume
-urine pH
-calcium oxalate
-uric acid
-citrate
-sodium
-potassium
-creatinine
Factor Regarding hospital DC for nephrolithiasis - answer-Pain is reasonably controlled
-n/v controlled
Treatment depends on:
Stone type
Location of the stone
Extent of obstruction
Kidney function
Progress of stone passage.
When should a patient with a kidney stone seek emergency treatment - answerinability
to void
severe pain
fever
intractable nausea and vomiting
patient ed for nephrolithiasis regarding fluid intake? - answerincrease fluid intake to 2-3
L per day to help with the passage of the stone
Stone prevention is based on what? - answerstone analysis-urine straining
24-hour urine collection result
Stone Prevention information:
What is nephrolithiasis? - answer renal calculi (kidney stones)
How does Renal calculi form? - answer formed d/t elevated levels of minerals in the
body
What minerals in excess can cause renal calculi? - answer calcium oxalate (most
common),
phosphate
uric acid
struvite
cystine
Urolithiasis - answer stone in the bladder
Ureterolithiasis - answer condition of stones in the ureter
Risk Factor & complications of renal calculi - answer-Male, 20-50yo, previous stones,
obesity, HTN, diabetes, low fluid intake.
-complications of stones: obstructions, pyelonephritis (kidney infection), CKD
Classic Kidney stone presentation - answeracute onset of severe, colicky flank pain that
wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
history and physical for nephrolithiasis (kidney stones) - answerIrritative Bladder
symptoms -dysuria (painful or difficulty urinating), urgency, & frequency
Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
CVA tenderness tell your the stone is located where? - answercaused by passing of the
stone through the ureter with obstruction & spasm
Where is the stone located if the patient has pain in the groin region? - answerpain that
radiates downward into the groin indicates the stone has passed into the lower third of
the ureter
,Vague flank pain or acute colicky pain with increasing intensity means the stone is
located where? - answerstones in renal pelvis
Differential Diagnosis for abdominal pain and/or flank pain: - answerNephrolithiasis
(kidney stones)
Pyelonephritis (kidney infection)
Ectopic pregnancy
Ovarian or testicular torsion
Appendicitis
Bowel obstruction
Diverticulitis
Rupture of aortic aneurysm
Right lower abdominal tenderness with a +Blumberg sign. What should be suspected? -
answerBlumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis.
*Appendicitis
What labs do we run to diagnose a kidney stone? - answerUA dipstick, urine
microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
What radiology methods are preferred for outpatient treatment and why -
answerinexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
What stones can be seen on a KUB?
What stone can you not see on a KUB - answerCAN see: Calcium oxalate - most
common type of stone
CANNOT see: uric acid stones (radio translucent)
What is a Renal Ultrasound used for when testing for kidney stones? - answergood for
assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine that can be
caused by an obstruction). Bad for identifying a stone.
What is the GOLD STANDARD for diagnosing a kidney stone? - answerNon-contrast
CT scan.
Goal of renal calculi treatment - answerfocused on symptomatic relief
pain medications -NSAID or narcs
antiemetics -n/v
facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers
to help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH.
<5 mm renal calculi can - answerbe passed through the urine. may only require NSAIDs
for management.
, >5 mm renal calculi requires what? - answerurology consult.
this may cause an obstruction or kidney failure.
this type of stone may need surgical intervention to be removed.
when is a Urology Referral indicated? - answerstone > 5mm
recurrent stones
When is a hospital admission appropriates for a patient with nephrolithiasis? -
answerHospital admission is indicated when:
-Inability to control pain
-Impaired renal function with an obstructing stone
-Infection (pyelonephritis or sepsis)
-Intractable n/v
What does a 24 hour urine collection analyze? - answer-total volume
-urine pH
-calcium oxalate
-uric acid
-citrate
-sodium
-potassium
-creatinine
Factor Regarding hospital DC for nephrolithiasis - answer-Pain is reasonably controlled
-n/v controlled
Treatment depends on:
Stone type
Location of the stone
Extent of obstruction
Kidney function
Progress of stone passage.
When should a patient with a kidney stone seek emergency treatment - answerinability
to void
severe pain
fever
intractable nausea and vomiting
patient ed for nephrolithiasis regarding fluid intake? - answerincrease fluid intake to 2-3
L per day to help with the passage of the stone
Stone prevention is based on what? - answerstone analysis-urine straining
24-hour urine collection result
Stone Prevention information:
