Which intervention do you plan to include with a patient who has renal calculi?
A. Maintain bed rest
B. Increase dietary purines
C. Restrict fluids
D. Strain all urine
Correct Answer: D. Strain all urine
All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.
Option A: Ambulation may help the movement of the stone down the urinary tract. Encourage the patient to walk if possible to facilitate spontaneous passage. Determine patient’s normal voiding pattern and note variations. Calculi may cause nerve excitability, which causes sensations of an urgent need to void. Usually, frequency and urgency increase as calculus nears ureterovesical junctions.
Option B: Offer fruit juices, particularly cranberry juice to help acidify urine. Irrigate with acid or alkaline solutions as indicated. Changing urine pH may help dissolve stones and prevent further stone formation.
Option C: Encourage fluid to help flush the stones out. Increased hydration flushes bacteria, blood, and debris and may facilitate stone passage. Investigate reports of bladder fullness; palpate for suprapubic distention. Note decreased urine output, presence of periorbital and dependent edema. Urinary retention may develop, causing tissue distension (bladder, kidney), and potentiates the risk of infection, renal failure.
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