Question

A client is being treated for nephrolithiasis. The nurse should monitor the client for the common complication of a. hydronephrosis b. gout c. immobility d. defective cystine metabolism

Short answer

The nurse should monitor the client with nephrolithiasis for the common complication of hydronephrosis.

Step-by-step solution

Understand Nephrolithiasis

Nephrolithiasis refers to the condition of having kidney stones. Understanding the pathophysiology of kidney stones is important to anticipate complications. Stones can block the urinary track and cause upstream dilatation.

Identify the Complication

Hydronephrosis is the swelling of a kidney due to a build-up of urine. It occurs when a kidney stone blocks the flow of urine out of the kidney, causing the urine to back up. This is a common complication of nephrolithiasis.

Eliminate Other Options

Gout is related to high levels of uric acid but is not a common direct complication of nephrolithiasis. Immobility isn't a typical complication of nephrolithiasis. Defective cystine metabolism is related to a specific type of kidney stone but is not a common complication of all kidney stones.

Key concepts

Hydronephrosis

Hydronephrosis is a concerning complication of nephrolithiasis, commonly known as the presence of kidney stones. When a stone obstructs the urinary tract, it can prevent urine from draining out of the kidney, leading to a backup of urine (urinary stasis), which causes the kidney to swell. The dilation of the renal pelvis and calyces is a direct consequence of such an obstruction. It's like a traffic jam in the urinary system; urine accumulates behind the blockage, stretching the kidney.

As a result of this increased pressure, kidney function can deteriorate over time. Symptoms might include pain, infection, or even kidney damage if left untreated. Monitoring for signs of hydronephrosis is essential in patients with kidney stones to prevent these serious outcomes. Additionally, prompt treatment, which may include the use of pain relievers, hydration therapy, or surgical interventions, can assist in restoring normal urine flow and preventing long-term kidney damage.

Kidney Stones Pathophysiology

Kidney stones, or renal calculi, form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. Dehydration is a common risk factor for kidney stone development. Various types of stones exist, including calcium oxalate, uric acid, struvite, and cystine stones, each with distinct causes and properties.

The pathophysiological process of stone formation involves supersaturation of these substances in the urine, which begin to crystallize and accumulate into stones. The stones can grow to a size that makes their passage through the urinary tract painful. In some cases, small stones can pass through the urine without much discomfort; however, larger stones can become lodged in the kidneys, ureters, or bladder, causing significant pain and leading to complications such as hydronephrosis or urinary tract infections.

Stone Movement and Symptoms

When a stone moves into the narrow areas of the urinary tract, it can cause acute, intermittent, and radiating pain, commonly known as renal colic. Hematuria, or blood in the urine, is another common symptom. Recognizing the early signs of stone movement can help to seek timely treatment and manage pain.

Urinary Tract Obstruction

Urinary tract obstruction is a partial or complete blockage that inhibits the flow of urine through its normal path from the kidneys to the urethra. Causes of obstruction can include kidney stones, tumors, enlarged prostate in males, or congenital abnormalities. An obstruction can lead to numerous complications, including infection, kidney damage, and in severe cases, kidney failure.

If the obstruction is acute, it can result in sudden and severe symptoms, like sharp pain, particularly if caused by a kidney stone (renal colic). Chronic obstruction might lead to less noticeable, but longer-term health issues, such as hydronephrosis, which can silently damage kidney function over time. Treatment of the underlying cause of the obstruction is crucial to prevent these complications and may involve medication to relax the urinary tract or surgery to remove or bypass the blockage.

Importance of Diagnosis and Management

Prompt diagnosis and management of any urinary tract obstruction is vital to maintain kidney health. Regular check-ups and imaging studies such as ultrasounds or CT scans may be recommended for individuals prone to obstruction to ensure that any blockages are identified and treated as swiftly as possible.