UROLITHIASIS
A. DEFINITION
Urolithiasis is an emergency of a cumulation oksalat, calculi (kidney stones) in the ureter or the kidney area. Symptoms of excessive pain in the waist, Nausea, vomiting, fever, hematuria. More occurred in men dibanging women 3:1 in comparison with the age of 30-60 years. Urine color, such as snoring or red tea.
Vesikolithiasis (bladder stones) there is a stone in the bladder. Vesikolithiasis refers to the stone / kalkuli in vesika urinaria. Stone formed in the funnel urinal (vesika urinaria) when the thickness of the substance of urine, the calcium oksalat, calcium phosphate, acid strand of improvement. Stone urinal (urolithiasis) can arise at various levels of the system urination (kidney, ureter, bladder), but the most frequently found in the kidney (nephrollihiasis). Approximately one third of individuals who suffer at the channel will chew up the nomination dijangkiti the kidney.
B. Etiology
Theory of the formation of stones: 1). Theory core (nucleus): crystal and a foreign object is settling in urin crystals that have been experienced supersaturasi. 2) Theory matrik Matrik organic or derived from serum protein-protein provides the possibility urin crystal precipitation. 3) crystallization inhibitor Theory: Some substance in urin prevent the occurrence of crystallization, a concentration or occurrence of absennya allows crystallization. Almost half of the cases of stone in the urinal is idiopatik. Factors that influence the process of kalkuligenesis or the formation of stones in the vesika urinaria, among others: the flow of water ¬ Disorders urine / obstruksi static and Disturbances metabolism urin ¬ ¬ channel urine infection by microorganisms powerless to make urease (Proteus Mirabilis). Channel urine infection can cause kidney nekrosis network or other channels urine (vesika urinaria) and will be the core of the formation of stone lines urine. ¬ ¬ foreign Benda died Network (nekrosis papil) ¬ Sex Data indicate that the stone channel more urine found in the male. ¬ The descendants of a family member with a channel stone chew have more opportunity to have a stone channel urine from the other. ¬ have drinking water diuresis with how much water will reduce the possibility terbentuknya stone, while less water when the level of all substances in urin akan akan simplify and increase the formation of stones. According to the saturation water content, especially calcium mineralnya estimated influence terbentuknya ureter stones. ¬ Workers Employment-workers a lot of hard labor such as moving and farmers will reduce the likelihood of a stone channel urine when compared with many workers who are seated. ¬ Food Society consume a lot of animal protein morbiditas number decreased ureter stones, while the people with low socio-economic condition more often. Population vegetarian meals that are less white eggs often suffer stone urine channel (vesika urinaria dab uretra). ¬ Temperature is the bersuhu spent a lot of heat causing perspiration, will reduce the production of urin and easier formation of stone lines urine.
C. PATOFISIOLOGI
Stone in the urinal obstruksi lines derived from the urine, may occur only obstruksi partial or complete. Obstruksi can become a full hidronefrosis with the signs and symptoms. Patofisiologisnya process is mechanical. Urolithiasis is the crystallization of minerals from the surrounding matrix, such as pus, blood, a network that is not vital, tumor or blood vessel. Increasing the concentration of the solution due urin low fluid intake and also increase the organic materials due to static ISK or urin, mensajikan digs for the formation of stones. Add in the infection to increase basahan urin (Amonium by production), which result in presipitasi calcium phosphate and magnesium phosphate Amonium. Renalis calculus composition and the factors that are encouraging: No composition / type of stone supporting factors / causes of Calcium 1 (oksalat and phosphate) Hiperkalsemia Hiperkasiuri Impact of Vitamin D Hiperparatiroidisme Intoksikasi dislocated a severe disease Asidosis Tubulus Renalis Intake steroid purine Ph urin high Low urine volume and 2 acid urin (Gout) Diet and high purine ph urin low urin Volume 3 low xanthine Cystinuria and Cystine impact of genetic disruption of amino acid metabolism and mechanisms of formation of xanthineuria kidney stones or urine channel is not known exactly, but some the book is the stone could be caused by the following: a. There is presipitasi salt-soluble salt in the urine, when urine is saturated precipitation will occur. b. There is a core (nidus). For example there is infection then occurs tukak, which is the core tukak stone formation, as the place menempelnya particles on the stone's core. c. Changes in pH or any other colloid in urine will neutralize meyebabkan load and the occurrence of precipitation. Speed of growth depends on a stone to stone location, such as a stone jar on the faster growth of the disbanding of kidney stones. It also depends on the reaction of the urine, that is stone sour akan rapid growth in urin with a low pH. Urin composition will also facilitate the growth of stones, because there are substances-substances in urine that it can not be relatively late. Another thing that will accelerate the growth is due to a stone infection. Kidney stones in a certain amount to grow attached to the top of the papil and remain in kaliks, who came to pyelum which can then move to the distal area, remain or settle in a place where any time and developed into a large stone.
D. PATHWAY
Decrease in fluid intake Static urin urine infection channel Renal / kidney concentration urin solvent crystallization of mineral matrix surrounding Obstruksi sal urine prsial / total kidney stone / urolithiasis Ureter / ureterolithiasis Vesikolithiasis auaretrolithiasis Changes elimination pattern BAK Operation open Resti infection Port entrée de micro Poor information Poor knowledge conditions does it feel comfortable Ggn: painful hipotalamus stimulate nociseptor
E. Complications
If the stone is left can be a breeding bacteria that can cause urine infection channel, pylonetritis, and ultimately, kidney damage, kidney failure and then emerged with all the consequences that are far more severe.
F. Clinical manifestations
a) In addition to the severe pain attacks that occur in a sudden take a moment and then suddenly disappear and then, reappear, along with rapid pulse, pallor, cold sweat and blood pressure down or called kolik, also accompanied by pain that blurred repeatedly in the kidney and the feeling of hot or burned at the waist that can take several days to several weeks. Hematuri can also occur when there is a wound in urine due to channel shifting stones.
b) When the going can be touched hydronefrosis kidney enlargement. Urin fever and a turbid akan also experienced kidney stone sufferer. Fever indicates infection broadcaster. If a stoppage comprehensive channel urine, body temperature can suddenly high repeatedly. c. Anuria akan stones occur when there is bilateral or if there is only one kidney patients.
G. FOCUS
1) Data subjective pain Pain (kolik renal) are the main symptoms of the acute episode of renal calculus. Location of pain depends on the location of the stone. When the trophies are in a new kidney, pain is the result of more hidronefrosis that it is dull and constant, especially arising in the costovertebral angle. When you walk along stone ureter pain increase and are becoming intermiten. Caused by pressure due spasme ureter stones. Pain along anterior path of the ureter down to the supra pubis and crawling to external genetalia. Often the quiet stone and do not cause symptoms for several years, and this indeed occurred in the kidney stone is very large. Stone which is very small and can be fine unwittingly passed by the person. Nausea and vomiting often accompany the kolik renal.
2) Objective data Urin monitored blood on there. Gross hematuria / fresh bleeding happens when the stones can be edge-tapering pinggirnya and can also occur mikrohematuri. If there is a stone is suspected, all urin be filtered to determine there is a stone that can be out of time berkemih. Pattern berkemih recorded, because berkemih but often a little bit once. Asiditas or kalkalisan urin checked with PH paper / litmus paper.
H. Nursing diagnosis AND INTERVENTIONS
1. Interference feeling comfortable: there is excessive pain in the waist area of the stone bd on a narrow area in the ureter or the kidney. Data support: ¬ ¬ weary of excessive weakness, nausea, vomiting, cold sweat ¬ nervous patients Destination: Pain can be sick / lost. Criteria: • Kolik reduced / lost • Patients do not complain illness • Patients can rest quietly. Action Plan ¬ Kaji intensity, location and area and the spreading of pain ¬ Observation of abdominal pain ¬ Explain to the patient the cause of pain patients Suggest ¬ ¬ Please drink a lot of positions and a comfortable environment ¬ Teach relaxation techniques, distortion and techniques to imagine a guide eliminate pain without drugs. ¬ cooperation with the health care team: • The provision of drugs The anti-drug addict • spasmotika
2. Perubaha pattern of elimination obstruksi bd (calculi) in the renal or the uretra. Supporting Data: • Urine out put <50 cc perjam • Regional perifer pale cold blood • <100/70 mmHg • Nadi> 120 x permenit respiratory •> 28 x permenit • Charging capillary> 3 seconds Objectives: Disturbances perfusi can be overcome Criteria: • 30-50 cc urine production perjam • • Perifer warm vital signs in the limit of normal • Charging capillary <3 seconds Action Plan - Observation vital signs - Observed urine production per hour - Observed changes in the level of awareness - Cooperation with the health care team: -- laboratory examination: kadae ureum / kreatinin, Hb, HCT Urine
3. Lack of knowledge about the condition of the disease less bd Data supporting information: Patients not claim to understand about the disease in patients less cooperative treatment program Purpose: Knowledge about the disease patients increased Criteria: • Patient understanding of disease processes • Discuss the process of the Action Plan of the disease: - Kaji level knowledge patients and families - an opportunity to patients / families to express perasaannya - Discuss the importance of infusion fluids - Suggest white patients to drink 6-8 liters of water per day for no contra indications - Limit physical activity weight - Discuss the importance of low-calcium diet - Cooperation with the health team : ¬ Diet low protein, low calcium and posfat ¬ chlorida of ammonium and mandelamine
4. Resti infections associated with microorganisms entrée de port through the operation wound. Goal: No infection occurred Criteria results: ¬ Improve healing time with the right, free from drainage purulen / eritema, and no fever ¬ says the cause of the risk factors ¬ Demonstrating techniques, changes in living patterns to reduce the risk intervention: - Record the characteristics of urine, and note whether the changes relate to the pain complaint pinggul. - Test urine with pH paper Nitrazin - Report a halt the flow of urin abruptly. - Observation and record wound drainage, signs inflamasi insisi, the systemic sepsis. - Replace the bandage according indication, when wearing. - Kaji area in the thigh skin fold, perineum - Awasi vital signs
Urolithiasis is an emergency of a cumulation oksalat, calculi (kidney stones) in the ureter or the kidney area. Symptoms of excessive pain in the waist, Nausea, vomiting, fever, hematuria. More occurred in men dibanging women 3:1 in comparison with the age of 30-60 years. Urine color, such as snoring or red tea.
Vesikolithiasis (bladder stones) there is a stone in the bladder. Vesikolithiasis refers to the stone / kalkuli in vesika urinaria. Stone formed in the funnel urinal (vesika urinaria) when the thickness of the substance of urine, the calcium oksalat, calcium phosphate, acid strand of improvement. Stone urinal (urolithiasis) can arise at various levels of the system urination (kidney, ureter, bladder), but the most frequently found in the kidney (nephrollihiasis). Approximately one third of individuals who suffer at the channel will chew up the nomination dijangkiti the kidney.
B. Etiology
Theory of the formation of stones: 1). Theory core (nucleus): crystal and a foreign object is settling in urin crystals that have been experienced supersaturasi. 2) Theory matrik Matrik organic or derived from serum protein-protein provides the possibility urin crystal precipitation. 3) crystallization inhibitor Theory: Some substance in urin prevent the occurrence of crystallization, a concentration or occurrence of absennya allows crystallization. Almost half of the cases of stone in the urinal is idiopatik. Factors that influence the process of kalkuligenesis or the formation of stones in the vesika urinaria, among others: the flow of water ¬ Disorders urine / obstruksi static and Disturbances metabolism urin ¬ ¬ channel urine infection by microorganisms powerless to make urease (Proteus Mirabilis). Channel urine infection can cause kidney nekrosis network or other channels urine (vesika urinaria) and will be the core of the formation of stone lines urine. ¬ ¬ foreign Benda died Network (nekrosis papil) ¬ Sex Data indicate that the stone channel more urine found in the male. ¬ The descendants of a family member with a channel stone chew have more opportunity to have a stone channel urine from the other. ¬ have drinking water diuresis with how much water will reduce the possibility terbentuknya stone, while less water when the level of all substances in urin akan akan simplify and increase the formation of stones. According to the saturation water content, especially calcium mineralnya estimated influence terbentuknya ureter stones. ¬ Workers Employment-workers a lot of hard labor such as moving and farmers will reduce the likelihood of a stone channel urine when compared with many workers who are seated. ¬ Food Society consume a lot of animal protein morbiditas number decreased ureter stones, while the people with low socio-economic condition more often. Population vegetarian meals that are less white eggs often suffer stone urine channel (vesika urinaria dab uretra). ¬ Temperature is the bersuhu spent a lot of heat causing perspiration, will reduce the production of urin and easier formation of stone lines urine.
C. PATOFISIOLOGI
Stone in the urinal obstruksi lines derived from the urine, may occur only obstruksi partial or complete. Obstruksi can become a full hidronefrosis with the signs and symptoms. Patofisiologisnya process is mechanical. Urolithiasis is the crystallization of minerals from the surrounding matrix, such as pus, blood, a network that is not vital, tumor or blood vessel. Increasing the concentration of the solution due urin low fluid intake and also increase the organic materials due to static ISK or urin, mensajikan digs for the formation of stones. Add in the infection to increase basahan urin (Amonium by production), which result in presipitasi calcium phosphate and magnesium phosphate Amonium. Renalis calculus composition and the factors that are encouraging: No composition / type of stone supporting factors / causes of Calcium 1 (oksalat and phosphate) Hiperkalsemia Hiperkasiuri Impact of Vitamin D Hiperparatiroidisme Intoksikasi dislocated a severe disease Asidosis Tubulus Renalis Intake steroid purine Ph urin high Low urine volume and 2 acid urin (Gout) Diet and high purine ph urin low urin Volume 3 low xanthine Cystinuria and Cystine impact of genetic disruption of amino acid metabolism and mechanisms of formation of xanthineuria kidney stones or urine channel is not known exactly, but some the book is the stone could be caused by the following: a. There is presipitasi salt-soluble salt in the urine, when urine is saturated precipitation will occur. b. There is a core (nidus). For example there is infection then occurs tukak, which is the core tukak stone formation, as the place menempelnya particles on the stone's core. c. Changes in pH or any other colloid in urine will neutralize meyebabkan load and the occurrence of precipitation. Speed of growth depends on a stone to stone location, such as a stone jar on the faster growth of the disbanding of kidney stones. It also depends on the reaction of the urine, that is stone sour akan rapid growth in urin with a low pH. Urin composition will also facilitate the growth of stones, because there are substances-substances in urine that it can not be relatively late. Another thing that will accelerate the growth is due to a stone infection. Kidney stones in a certain amount to grow attached to the top of the papil and remain in kaliks, who came to pyelum which can then move to the distal area, remain or settle in a place where any time and developed into a large stone.
D. PATHWAY
Decrease in fluid intake Static urin urine infection channel Renal / kidney concentration urin solvent crystallization of mineral matrix surrounding Obstruksi sal urine prsial / total kidney stone / urolithiasis Ureter / ureterolithiasis Vesikolithiasis auaretrolithiasis Changes elimination pattern BAK Operation open Resti infection Port entrée de micro Poor information Poor knowledge conditions does it feel comfortable Ggn: painful hipotalamus stimulate nociseptor
E. Complications
If the stone is left can be a breeding bacteria that can cause urine infection channel, pylonetritis, and ultimately, kidney damage, kidney failure and then emerged with all the consequences that are far more severe.
F. Clinical manifestations
a) In addition to the severe pain attacks that occur in a sudden take a moment and then suddenly disappear and then, reappear, along with rapid pulse, pallor, cold sweat and blood pressure down or called kolik, also accompanied by pain that blurred repeatedly in the kidney and the feeling of hot or burned at the waist that can take several days to several weeks. Hematuri can also occur when there is a wound in urine due to channel shifting stones.
b) When the going can be touched hydronefrosis kidney enlargement. Urin fever and a turbid akan also experienced kidney stone sufferer. Fever indicates infection broadcaster. If a stoppage comprehensive channel urine, body temperature can suddenly high repeatedly. c. Anuria akan stones occur when there is bilateral or if there is only one kidney patients.
G. FOCUS
1) Data subjective pain Pain (kolik renal) are the main symptoms of the acute episode of renal calculus. Location of pain depends on the location of the stone. When the trophies are in a new kidney, pain is the result of more hidronefrosis that it is dull and constant, especially arising in the costovertebral angle. When you walk along stone ureter pain increase and are becoming intermiten. Caused by pressure due spasme ureter stones. Pain along anterior path of the ureter down to the supra pubis and crawling to external genetalia. Often the quiet stone and do not cause symptoms for several years, and this indeed occurred in the kidney stone is very large. Stone which is very small and can be fine unwittingly passed by the person. Nausea and vomiting often accompany the kolik renal.
2) Objective data Urin monitored blood on there. Gross hematuria / fresh bleeding happens when the stones can be edge-tapering pinggirnya and can also occur mikrohematuri. If there is a stone is suspected, all urin be filtered to determine there is a stone that can be out of time berkemih. Pattern berkemih recorded, because berkemih but often a little bit once. Asiditas or kalkalisan urin checked with PH paper / litmus paper.
H. Nursing diagnosis AND INTERVENTIONS
1. Interference feeling comfortable: there is excessive pain in the waist area of the stone bd on a narrow area in the ureter or the kidney. Data support: ¬ ¬ weary of excessive weakness, nausea, vomiting, cold sweat ¬ nervous patients Destination: Pain can be sick / lost. Criteria: • Kolik reduced / lost • Patients do not complain illness • Patients can rest quietly. Action Plan ¬ Kaji intensity, location and area and the spreading of pain ¬ Observation of abdominal pain ¬ Explain to the patient the cause of pain patients Suggest ¬ ¬ Please drink a lot of positions and a comfortable environment ¬ Teach relaxation techniques, distortion and techniques to imagine a guide eliminate pain without drugs. ¬ cooperation with the health care team: • The provision of drugs The anti-drug addict • spasmotika
2. Perubaha pattern of elimination obstruksi bd (calculi) in the renal or the uretra. Supporting Data: • Urine out put <50 cc perjam • Regional perifer pale cold blood • <100/70 mmHg • Nadi> 120 x permenit respiratory •> 28 x permenit • Charging capillary> 3 seconds Objectives: Disturbances perfusi can be overcome Criteria: • 30-50 cc urine production perjam • • Perifer warm vital signs in the limit of normal • Charging capillary <3 seconds Action Plan - Observation vital signs - Observed urine production per hour - Observed changes in the level of awareness - Cooperation with the health care team: -- laboratory examination: kadae ureum / kreatinin, Hb, HCT Urine
3. Lack of knowledge about the condition of the disease less bd Data supporting information: Patients not claim to understand about the disease in patients less cooperative treatment program Purpose: Knowledge about the disease patients increased Criteria: • Patient understanding of disease processes • Discuss the process of the Action Plan of the disease: - Kaji level knowledge patients and families - an opportunity to patients / families to express perasaannya - Discuss the importance of infusion fluids - Suggest white patients to drink 6-8 liters of water per day for no contra indications - Limit physical activity weight - Discuss the importance of low-calcium diet - Cooperation with the health team : ¬ Diet low protein, low calcium and posfat ¬ chlorida of ammonium and mandelamine
4. Resti infections associated with microorganisms entrée de port through the operation wound. Goal: No infection occurred Criteria results: ¬ Improve healing time with the right, free from drainage purulen / eritema, and no fever ¬ says the cause of the risk factors ¬ Demonstrating techniques, changes in living patterns to reduce the risk intervention: - Record the characteristics of urine, and note whether the changes relate to the pain complaint pinggul. - Test urine with pH paper Nitrazin - Report a halt the flow of urin abruptly. - Observation and record wound drainage, signs inflamasi insisi, the systemic sepsis. - Replace the bandage according indication, when wearing. - Kaji area in the thigh skin fold, perineum - Awasi vital signs
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