Kidney Stones: NCLEX Priorities
Renal calculi: types, pain management, hydration, prevention by stone type.
Kidney stones cause severe colic. NCLEX tests pain management and prevention.
Recognition
Flank pain radiating to groin. Severe, colicky. Hematuria. N/V. Restless (vs peritonitis where patients hold still).
Workup
Non-contrast CT gold standard. UA shows blood. Strain urine for stones to analyze type.
Acute management
NSAIDs (ketorolac) first-line for pain. Opioids if NSAIDs contraindicated or inadequate. Hydration. Tamsulosin (alpha-blocker) to facilitate distal ureteral stone passage.
Stone types and prevention
Calcium oxalate (most common): hydration, low sodium, normal calcium intake, low oxalate. Calcium phosphate: alkaline urine, manage underlying cause. Uric acid: alkalinize urine, treat gout. Struvite: treat UTI (often from Proteus). Cystine: hydration, alkalinize.
Frequently asked
Stone too big to pass?
Lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy depending on size and location.
Coffee and stones?
Moderate coffee OK. Heavy intake associated with some stone types.
Quick check
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