(1) Medical history and physical examination: There are many typical renal colic and hematuria in the medical history, or stones have been discharged from the urethra. Physical examination found that there was percussion pain in the affected kidney area, which was more obvious when complicated with infection and hydronephrosis. Severe hydronephrosis can touch the swollen kidney, and sometimes rectal or vaginal finger examination can touch the stones at the end of ureter.
(2) Laboratory examination: red blood cells, white blood cells or crystals can be seen in urine routine, and the urine pH value of patients with oxalate and urate stones is often acidic; Phosphate stones are usually alkaline. When complicated with infection, there are many pus cells in urine, and urine bacterial culture is often positive, with a count of more than 65438+ 10,000/ml. When acute infection and severe infection are combined, the total number of white blood cells and neutrophils can be increased by routine blood examination. For patients with multiple and recurrent stones, the values of calcium, phosphorus and uric acid in blood and urine should be determined to further clarify the causes of stones.
(3) X-ray examination: X-ray examination is an important method to diagnose renal and ureteral stones, and more than 95% of urinary calculi can be developed on X-ray plain films. Combined with excretory or retrograde pyeloureterography, it is of great value to determine the location of stones, whether there is obstruction or not, whether the contralateral renal function is good, distinguish the shadow of urinary calcification, exclude other lesions of upper urinary tract, determine the treatment plan, and compare the location, size and number of stones after treatment. Low density or transparent stones, ureter and renal pelvis inflatable radiography, stones are more clear.
(4) Other examinations: B-ultrasound can find dense light spots or light masses at the stone site, and can detect the liquid level when hydronephrosis occurs. Isotopic renogram showed that the affected urinary tract was obstructed. Although CT scan can also diagnose urinary calculi, it is not as intuitive as X-ray film and urography film, and it is expensive, so it generally does not need routine examination.
Cause analysis and nursing care of 504 cases of urinary calculi
Urinary calculi include upper urinary calculi (kidney and ureter) and lower urinary calculi (bladder and urethra), which are formed by crystals and colloids contained in blood. Generally, blood clots, fibrin, cell fragments, casts, bacteria and other foreign bodies are the core, and crystals and colloids in urine are deposited around this core [1], gradually increasing to form stones. The crystal of stone is composed of calcium oxalate, calcium phosphate and calcium urate. The course of disease is long and the onset is urgent. Patients often go to the doctor with symptoms such as unilateral or bilateral colic, hematuria, nausea and vomiting. 504 cases of urinary calculi treated in our hospital from June 2002 to June 2005 were analyzed retrospectively. This paper analyzes the causes of this kind of disease, summarizes the nursing and preventive measures, and achieves good clinical results. The report is as follows.
Clinical data of 1
There are 504 patients in this group, including 278 males and 226 females. Age 15 ~ 79 years, with an average of 48 years. Among them, 15 ~ 17 years old in 5 cases, 18 ~ 50 years old in 385 cases and 0 ~ 79 years old 1 14 cases. There were 458 cases of upper urinary calculi and 46 cases of lower urinary calculi.
2 the cause of the disease
2. 1 is characterized by young adults, more men than women, and it is more common in summer and autumn; Animal protein and refined sugar in diet increased, while cellulose decreased; Some drugs, less exercise, heredity, metabolism, water shortage, urine concentration and other factors are easy to lead to the formation of stones.
2.2 urinary factor [2] (1) urinary excretion of calcium, oxalic acid and uric acid increased. (2) The pH value of urine changes, and uric acid stones and cystine stones are formed in acidic urine. Magnesium ammonium phosphate and calcium phosphate stones are formed in alkaline urine. (3) The decrease of urine volume and the increase of salt and organic matter concentration are the real risk factors for the formation and recurrence of stones [3]. (4) The content of substances inhibiting crystal formation in urine is reduced, such as citric acid, magnesium, acidic mucopolysaccharide and some trace elements. (5) See Table 1 for reasons such as habits and hobbies.
Table 1 analysis of the causes of urinary calculi (omitted)
2.3 Anatomical structural abnormalities, such as urinary tract obstruction, lead to the deposition of crystals or matrix in the site with poor drainage [2].
2.4 Urinary tract infection The urinary epithelium at the stone site is easy to cause bacterial growth. The mechanism of subclinical urinary tract infection caused by infectious stones may be related to the biofilm effect of bacteria that form stones and exist behind urinary tract.
3 nursing
3. 1 Basic nursing (1) Observe and ask the patient whether the nature, quantity and color of urine have changed; Timely check hematuria, low back pain, abdominal pain and other stone symptoms; Urine should be filtered, and attention should be paid to whether stones are discharged. (2) Pay attention to balance the intake and discharge of patients. When nausea and vomiting are serious, intravenous fluids should be given immediately to maintain electrolyte balance in the body; Give antibiotics in time according to the doctor's advice to control urinary tract infection. (3) Closely observe the changes of patients' vital signs. When the temperature rises above 37.5℃, report to the doctor in time and give physical cooling. (4) Correctly record the inflow and outflow to provide reliable basis for doctors to accurately judge the condition.
3.2 Pain Care (1) When colic suddenly occurs, ask the patient to stay in bed and take a deep breath to relax muscles to relieve the pain. (2) Give analgesic (static) drugs in time according to the doctor's advice: intramuscular injection of dolantin 50 ~ 100 mg, atropine 0.5 ~ 1.0 mg or diazepam 10mg has a satisfactory effect on calculous colic. Progesterone 20mg intramuscular injection 1 time for 3 days a day can also achieve the purpose of removing stones and relieving pain.
3.3 Psychological nursing and health education guidance
3.3. 1 When nursing patients with acute onset, they are nervous and fearful because of spasm, tossing and turning, fidgeting, groaning, pale face, sweating, and even collapse due to blood pressure drop, and are eager to relieve the pain in time. Nurses should, according to patients' psychological characteristics, warmly receive patients, be compassionate, use communication skills, give psychological counseling and comfort to patients kindly, patiently explain the causes of pain, the relationship between pain and stones, and the relevant knowledge of diseases, give psychological support and comfort, and help patients build confidence in overcoming diseases, get rid of tension and fear, and achieve the purpose of cooperating with treatment.
3.3.2 After the pain of stone prevention by drinking water is relieved, let patients drink plenty of water to play the role of diuresis and stone prevention. Drink 3 ~ 4L water every day, and drink it evenly all day [1]; Drinking water can dilute urine and reduce the chance of stone formation; Exercise after drinking water is also an effective way to prevent the formation of stones. For example, smooth stones with a diameter less than 0.6cm can be discharged from the body by jumping on the ground with the heel or going up and down the stairs; Chinese herbal medicine Lysimachia christinae is soaked in 50g of water every day, which is cheap and effective, and is not limited by conditions. Appropriate vitamin K drugs should be supplemented, and methods such as postural lithotomy should be adopted [5].
3.3.3 Develop good urination habits and take treatment or dredging measures for patients with urinary tract obstruction.
3.3.4 Reasonable diet plays a very important role in the formation and prevention of stones. Food can affect the composition and pH value of urine, and make stones form and grow. A reasonable diet is of great benefit to most patients in preventing the recurrence of stones. Avoid foods high in animal protein, fat and sugar, and eat more foods containing cellulose; Limit strong tea, tomatoes, spinach, tofu, asparagus and other foods rich in oxalic acid and foods high in calcium; Uric acid stones should not be ingested with high purine foods such as animal viscera [6].
3.3.5 Regular review will automatically discharge small stones before they have no symptoms to prevent complications such as colic.