Name of the clinical instructor:- Ankita Micheal
Name of the supervisor:- Ms Kavita Sharma
Topic:- Nebulization therapy
Venue:- Rohilkhand medical college and hospital Bareilly.
Time :- 10:00 am
Group :- GNM/Bsc/ANM students
Duration :- 20 minute
Language :- English and Hindi
Method of explanation:- Lecture Cum Discussion/Demonstration
A.V aids use:- Chalk Board
Previous knowledge of the group:- The group have some basic Knowledge.
Central objective:- Improved knowledge of the group
Specific objective:- At the end of the demonstration the students will be able to explain
To define Definition
To explain Purpose
To described Articles
To discuss Procedure
To define General instruction
S. Time Specific objective Teaching / A.V Evaluation
No Content Learning aids
activity
1 2 TO INTRODUCE Myself Deepika Sampson Clinical instructor Shri Rammurti Medical C
minutes SELF AND TOPIC L H
College and Hospital Bareilly. Today we will discuss about my topic E A
Renal Calculai. C L
T K
U
R B
2 2 TO DEFINE It is a condition in which stones are present in the urinary system. E O
minutes DEFINITION Stone or calculi or lithiasis represent the presence of stones in the A Students explain
C R Definition of
urinary system. U D Renal calculi.
M
3 2 minute TO EXPLAIN 1. Nephrolithiasis D
TYPES I Students explain
2. Uroliathiasis S its types.
NEPHROLITHIASIS :- Nephroliathiasis refers to the presence of stone C
U
in the kidney. S
S
I
UROLIATHIASIS :- Urolithiasis explain the presence of stone in any O
other part of urinary system. N
4 2 minute TO DISCRIBED Heridiatory Students
ETIOLOGY described
Food habits such as intake of food rich in oxalate ( spinach, etiology.
tomato, black tea, coco, cabbage) Calcium and uric acid
It can be also caused by some drugs. ( Long term treatment with
magnesium trisilicate)
5 3 minute TO ENLIST TYPE OF L
Calcium stones
STONES E F
Oxalate stones C L Students explain
T A types of stones..
Uric acid stones
U S
Phosphate stones R H
E
Cystine stones
C
Xanthine stone C A
U R
1. Oxalate – Though oxalate is the major component of 70%
M D
of all renal stones, yet hyperoxaluria as a cause of formation of such stone S
D
is relatively rare. Cabbage, rhubarb, spinach, tomatoes, black tea and cocoa
I
contain large amount of oxalate. Ingestion of excessive amounts of S
C
ascorbic acid and orange juice also increase urinary oxalate excretion.
U
2. Calcium - On regular diets normal urinary excretion of S
S
calcium ranges between 200 mg to 300 mg per day. The major calcium in
I
foods are in milk and cheese. Milk and dietary protein also cause increased O F
N L
absorption of calcium from the gut.
A
3. Uric acid - Many patients with gout form uric acid calculi S
H
particularly when under treatment. If the urine is made alkaline and dilute
while treating this disease chance of uric acid stone formation is less C
A
4. Cystine –
R
Cystinuria is an herditary disease which is more common in D
S
infants and children. Only a small percentage of patients with Cystinuria
form stones.
5. Drug induced stones –
In rare cases, the long term use of magnesium trisilicate in the
treatment of peptic ulcer has produced radio opaque silicon stones.
Xanthine stone :- stone from due to the accumulation of xanthin.
L
6 2 TO EXPLAIN PATHOPHYSIOLOGY E C
minutes PATHOPHYSIOLOGY C H Students define
Due to etiological factors T A pathophysiology.
U L
development of stone. R K
E
B
Obstruction with urinary stasis and urinary infection C O
U A
Species of staphylococci (these bacteria cause the urine to become M R
alkaline) D
D
Contribute to the formation of calcium ammonium phosphate stone) I
S
Infected stones when they are entrapped in the kidney C
U
S
Urinary diversion or retention of urine
S
I
Show sign and symptom
O
N F
7 2 TO DEFINE L Students
minutes CLINICAL A understand
Flank pain or abdominal pain (usually severe)
MANIFESTATION S clinical features.
Pain will be felt in the lateral flank H
hematuria
C
Nause, vomiting, chills A
R
Difficulty to pass the urine
D
Urinary infection, fever S
Urinary stasis (Retention of urine)
Change in urinary pH
Change in urinary concendency
F
L L
E A
8 3 SPECIAL INVESTIGATIONS C S Students explain
minutes TO ENLIST THE 1. Blood examination – T H diagnosis.
DIAGNOSIS Hardly reveals any specific abnormality, increased white blood cell U
associated with infection. Anemia may be found, blood urea, creatinine. R C
2. Urinalysis - E A
(i) Physical examination R
Show smoky urine due to slight haematuria or pale scent due to C D
presence of pus. U S
(ii) Chemical examination M
Show presence of protein due to haematuria and blood in the
urine. If pH of the urine is higher than 7.6, presence of urea-splitting D
organism is assured. I
(iii) Microscopic examination of urine S
Show R.B.C. pus cells and casts. Different crystals may be seen C
in the sediment to givea clue as to the type of stone present. Uric acid of U
glacial acetic acid, which lowers the urinary pH to about 4. S
(iv) Bacteriological examination of urine S
Highly important including culture and sensitivity tests. I
(v) Renal function tests O
Always be performed in calculus cases. The PSP may be N
normal even in presence of bilateral stag horn calculi.
3.Radiography F
A) STRAIGHT X-RAY - Before taking straight X-ray for KUB region L
(both kidneys, ureters and bladder), the bowels must be made empty by A
giving laxative. S
B) Excretory Urogram H
4 Ultrasonography –
Helpful to distinguish between opaque and non-opaque stones. It is C
also of value in locating the stones for treatment with extra corporeal shock A
wave therapy. R
5 Computed topography – D
Particularly helpful in the diagnosis of non-opaque stones. S
6 Renal Scan
7 Instrumental examination :- Cystoscopy
8 Examination of the stone
History collection and physical examination
L
Microscopic examination of the urine. E
Bacteriological examination of the urine. C
T C
RFT U H
KUB R A
E L
CT. Scane K
9 5 C
minutes Ultrasound U B
TO EXPLAIN
MANAGEMENT M O Students explain
MEDICAL MANAGEMENT A management of
Symptomatic management D R renal calculi.
I D
SURCICAL MANAGEMENT S
C
ESWL ( EXTRA CORPOREAL SHOCK WAVE U
S
LITHOTRIPSY) S C
In this technique the stone is removed with shock wave without I H
O A
the need for instrumental penetration of the body. The stone in the kidney N L
is fragmented by repeated shock waves which are focused towards the K
kidney stone. The fragments are made so small that they are automatically B
passed through the urine. In some instances a ureteroscope may be required O
A
for the passage of fragments. R
This method is gradually replacing operative methods of D
removal of renal calculi.
URITROSCOPY
NEPHROCTOMY
LITHOTRYPSY
LITHOTOMY / NEPHROLETHOTOMY
NURSING MANAGEMENT
L Students explain
E its prevention.
Prevention of Recurrent Stone Formation C
10 3 minute TO DEFINE 1. For pts with calcium oxalate stones T
PREVENTION a. Instruct on diet – avoid excess of calcium and phosphorus; maintain a U
R
low sodium diet (sodium restriction decreases amount of calcium absorbed
E
in intestine)
b. Teach purpose of drug therapy – thiazide diuretics to reduce urine C
calcium excretion, allopurinol therapy to reduce uric acid concentration. U
2. For pts with uric acid stones M
a. Teach methods to alkalinize urine to enhance urate solubility.
D
b. Instruct on testing urine pH.
I
c. Teach purpose of taking allopurinol – to lower uric acid concentration. S
d. Provide information about reduction of dietary purine intake (low C
protein – red meat, fish, fowl) U
3. For pts with infection (Struvite) stone S
a. Teach signs and symptoms of urinary infection; encourage him to report S
infection immediately; must be treated vigorously. I
O
b. Try to avoid prolonged periods of recumbency – slows renal drainage
N
and alters calcium metabolism.
c. Teach pt with drug therapy with D – Pencillamine (Depen) – to lower
cystine concentration, or dissolution by direct irrigation with thiol
derivatives.
d. Explain importance of maintaining drug therapy consistently.
4. For all pts with stone disease,
a. Explain need for consistently increased fluid intake (24 – hour urinary
output greater than 2l) – lowers the concentration of substances involved in
stone formation.
8 3 Students make
minutes TO LISTING THE nursing
NURSING DIAGNOSIS Acute pain related to inflammation, obstruction, and abrasions of diagnosis.
UT by migration of stones.
Impaired Urinary Elimination related to blockage of urine flow by
stones.
Risk for Infection related to obstruction of urine flow and
instrumentation during treatment.
Controlling Pain
1. Give opioid analgesic (usually IV or IM) until cause of pain can be
removed. L
E
a. Monitor pt closely for increasing pain; may indicate inadequate
C
analgesia. T
b. Very large doses of opioids are typically required to relieve pain, so U
monitor for respiratory depression and drop in blood pressure. R
2. Encourage pt to assume position that brings some relief. E
3. Reassess pain frequently.
4. Administer antiemetics (IM or rectal suppository) as indicated for C
U
nausea.
M
Maintaining Urine Flow
1. Administer fluids orally or IV (if vomiting) to reduce D
concentration of urinary crystalloids and ensure adequate urine I
output. S
2. Monitor total urine output and patterns of voiding. Report oliguria C
or anuria. U
S
3. Strain all urine through strainer or gauze to harvest the stone. Uric
S
acid stones may crumble. Crush clots, and inspect sides of urinal / I
bedpan for clinging stones / fragments. O
Patient Education and Health Maintenance N
Recovery from surgical Interventions for Stone Disease
1. Encourage fluids to accelerate passing of stone particles.
2. Teach about analgesics that still may be necessary for colicky
pain, which may accompany passage of stone debris.
3. Warn that some blood may appear in urine for several weeks.
9 5 TO SUMMARIZED Today we discuss about the topic renal calculi in this we cover some points
minutes THE TOPIC To define Definition
To explain types
To described etiology
To enlist types of stone
To discuss pathophysiology
To define sing and symptom
To list down diagnostic evaluation
To explain its management
To explain prevention
To explain Nursing diagnosis
BIBLIOGRAPHY
Annamma Jacob “ Clinical Nursing Procedures: The Art of Nursing Practice”; second
edition; 4838/24 Ansari Road, New Delhi; Page no- 249- 251.
