1.

Impaired Urinary Elimination (dysuria, urge, frequency, and or nocturia) related to a

kidney infection.
Nursing Interventions and Rationale:
- Measure and record the voiding of urine each time.
R /: To investigate the change of color, and to determine the input / output.
- Advise to urinate every 2-3 hours.
R /: To prevent the buildup of urine in the urinary vesicles.
- Palpation of the bladder every 4 hours.
R /: To determine the presence of bladder distension.
- Help clients use bedpans / urinals.
R /: To facilitate clients in urination.
- Help clients get a comfortable position to urinate.
R /: So that the client is not difficult to urinate.
- Encourage increased fluid intake.
R /: Increased hydration rinse bacteria.
- Observations of changes in mental status:, behavior or level of consciousness.
R /: Accumulated residual uremic and electrolyte imbalance can be toxic to the central
nervous system.
Collaboration:
- Perform laboratory tests; electrolytes, BUN, creatinine.
R /: Monitoring of renal dysfunction.
- Take action to maintain acidic urine.
R /: Acid urine hinder the growth of germs.
- Increase input berry juice and give medications to increase uric acid.
R /: Increased input juice can affect the treatment of urinary tract infections.
http://www.ncpnanda.top/2013/03/nursing-diagnosis-for-pyelonephritis.html

2. Acute pain related to ureteral colic, reports of colicky pain

Nursing Interventions and Rationale:
-

Determine and note location, duration, intensity (010 scale), and radiation.
Document nonverbal signs such as elevated BP and pulse, restlessness, moaning,
thrashing about.
R/: Aids to evaluate site of obstruction and progress of calculi movement. Flank pain
suggests that stones are in the kidney area, upper ureter. Flank pain radiates to back,
abdomen, groin, genitalia because of proximity of nerve plexus and blood vessels
supplying other areas. Sudden, severe pain may precipitate apprehension, restlessness,
severe anxiety.
Justify and clarify cause of pain and the need of notifying caregivers of changes in
pain occurrence and characteristics.
R/: Provides opportunity for timely administration of analgesia (helpful in enhancing
patients coping ability and may reduce anxiety) and alerts caregivers to possibility of
passing of stone and developing complications. Sudden cessation of pain usually
indicates stone passage.

Implement comfort measures (back rub, restful environment).

R/: Promotes relaxation, reduces muscle tension, and enhances coping.

Encourage use of focused breathing, guided imagery, diversional activities.

R/: Redirects attention and helps in muscle relaxation

Assist with frequent ambulation as indicated and increased fluid intake of at least 34
L a day within cardiac tolerance.
R/: Renal colic can be worse in the supine position. Vigorous hydration promotes
passing of stone, prevents urinary stasis, and aids in prevention of further stone
formation.

3. Deficient knowledge related to completion of drug therapy, optimal fluid intake, or

need to empty bladder every four hours to reduce bacterial count.
-

Recall and analyze disease process and future expectations.

R/: Provides knowledge base from which patient can make informed choices.

Emphasize importance of increased fluid intake of 34L a day or as much as 68 L a

day. Encourage patient to notice dry mouth and excessive diuresis and diaphoresis and
to increase fluid intake whether or not feeling thirsty.
R/: Flushes renal system, decreasing opportunity for urinary stasis and stone
formation. Increased fluid losses or dehydration require additional intake beyond
usual daily needs.

Review dietary regimen, as individually appropriate:

R/: Diet depends on the type of stone. Understanding reason for restrictions provides
opportunity for patient to make informed choices, increases cooperation with regimen,
and may prevent recurrence.

Low-purine diet
R/: Decreases oral intake of uric acid precursors

Low-calcium diet
R/: Reduces risk of calcium stone formation. Note: Research suggests that restricting
dietary calcium is not helpful in reducing calcium-stone formation, and researchers,
although not advocating high-calcium diets, are urging that calcium limitation be
reexamined.
http://nurseslabs.com/4-urolithiasis-nursing-care-plans/