Conditions › Renal & urinary
Kidney Stones Nursing Care Plan and Interventions
Kidney stone nursing care puts pain control first, then fluids and straining every void to catch the stone. A stone with a fever is an emergency (infected, blocked kidney), and prevention starts with drinking enough fluid.
Kidney stones nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Acute pain (renal colic) | Pain controlled. | |
| Impaired urinary elimination | Stone passes or is removed; urine flows. | |
| Risk for infection (blocked kidney) | Fever reported at once. | |
| Health maintenance: needs teaching | Drinks enough fluid and follows diet advice for the stone type. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Kidney stones: what they are
Minerals in urine (calcium, oxalate, uric acid) crystallize into a solid stone. It hurts when it moves into the ureter and blocks flow. 1,2,3
Most stones contain calcium, mainly calcium oxalate. A stone sitting in the kidney may cause no symptoms.
Who gets kidney stones
Low fluid intake, high salt or red meat intake, obesity, family history, prolonged immobility, and hyperparathyroidism (high calcium). 2,3
Concentrated urine is the common thread: less water, more minerals packed together.
Assessment: what you will see
Renal colic
Sudden, severe flank pain that comes in waves and can spread toward the groin, often with nausea and vomiting. 3
The client paces and can't lie still. Peritonitis makes clients lie very still.
Hematuria and the CT scan
Urinalysis usually shows blood, and urine may look pink, red or brown. A noncontrast CT finds the stone and shows any blockage. 3,4
A stone low in the ureter can cause urgency and frequency that mimic a UTI.
Priority: what the nurse does first
Red flag: stone plus fever
Fever or chills with a stone means infected urine trapped behind a blockage. Report now: the kidney must be drained, plus antibiotics. 3,5
Very little or no urine is also urgent. A blocked kidney can fail if not treated in time.
Nursing interventions and treatment
Pain control comes early
Opioids such as morphine, or ketorolac (an NSAID), which works fast without sedation. Add an antiemetic for vomiting. 3,6
Ketorolac is for short-term use only, up to 5 days. Reassess pain after every dose.
Fluids during an attack
Keep the client hydrated with normal amounts, by mouth or IV if vomiting. Forcing large volumes does not make a stone pass faster. 3,4
Vomiting and unable to keep fluids down? Expect IV fluids and an antiemetic.
Tamsulosin helps stones pass
An alpha blocker used off-label: it relaxes smooth muscle so small stones pass more easily. It can cause dizziness and low BP. 3,7,8
Teach the client to change position slowly to avoid dizziness when standing.
Procedures to remove stones
Shock wave lithotripsy breaks a stone into pieces that pass in urine. Ureteroscopy removes it; a stent may be left to help urine drain. 4
Pieces still get caught and sent to the lab to learn the stone type.
Evaluation: is care working?
Strain every void
Strain all urine to catch the stone. The lab finds out what it is made of, and that guides prevention. 4,3
Save any gravel or stone in a container and send it to the lab.
Client teaching
Prevention: fluids first
Drink enough, mainly water, to keep urine dilute: about 2 to 3 liters a day unless fluids are restricted. More in hot weather. 2,4
Citrus drinks like lemonade contain citrate, which helps stop crystals from becoming stones.
Calcium oxalate: keep the calcium
Don't cut dietary calcium: it binds oxalate in the gut. Limit salt, animal protein and high-oxalate foods (spinach, rhubarb, nuts). 4,3
Cutting out dairy is a common mistake. A low-calcium diet raises stone risk and weakens bone.
Uric acid stones
Limit animal protein such as red meat, organ meats and shellfish. Allopurinol lowers uric acid; potassium citrate makes urine less acidic. 4
Losing weight, if overweight, is especially important after uric acid stones.
Keep studying kidney stones in NurseLingo Pro
Everything for kidney stones in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free fluid and electrolyte practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for kidney stones?
Common nursing problems for kidney stones include acute pain (renal colic); impaired urinary elimination; risk for infection (blocked kidney); health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for kidney stones?
Fever or chills with a stone means infected urine trapped behind a blockage. Report now: the kidney must be drained, plus antibiotics.
How to help pass a kidney stone?
Pain control comes first, plus fluids and sometimes tamsulosin to relax the ureter. The nurse strains every void to catch the stone for analysis. A stone with fever or chills is an emergency because infected urine may be trapped behind the blockage.
More renal & urinary
Related cheat sheets
Sources
- OpenStax Fundamentals of Nursing, 26.3
- OpenStax Pharmacology for Nurses, 33.1
- merckmanuals.com
- niddk.nih.gov
- OpenStax Nutrition for Nurses, 16.2
- OpenStax Medical-Surgical Nursing, 7.3
- medlineplus.gov
- OpenStax Pharmacology for Nurses, 36.8
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.