Kidney stones: pain, straining the urine, fluids and care after stone procedures
- Safe practice
With a kidney stone the nurse controls the pain, strains all urine to catch the stone, encourages fluids and watches for fever and blockage.
What it is
A kidney stone causes severe pain when it moves down the ureter and blocks the flow of urine: sudden pain in the flank or abdomen that may spread to the groin, often with nausea, vomiting and blood in the urine. Small stones usually pass on their own. Nursing care is pain assessment and the analgesia ordered, straining every void so the stone can be sent for analysis, fluids to keep a high urine flow unless restricted, and watching for fever, which with a blocked kidney is an emergency. After lithotripsy or other stone procedures the nurse watches the urine, the pain and the vital signs and teaches prevention.
What it requires
- Pain assessed with a scale and reassessed after each analgesic dose.
- A strainer for every void and a labelled container for any stone.
- Intake and output recorded.
- Prevention teaching according to the stone type, agreed with the provider.
How it is applied (and why)
- Assess pain with a scale: site, spread to the groin, timing — stone pain starts and stops suddenly and can be severe.
- Give the analgesia ordered and reassess — pain that cannot be controlled is a reason for a procedure.
- Strain all urine and keep any stone in a labelled container — analysing it guides prevention.
- Encourage fluids, mostly water, or give IV fluids as ordered — a high urine flow helps the stone pass.
- Record intake and output and the urine colour — little urine may mean blockage.
- Check temperature and vital signs — fever with blockage is an indication for urgent treatment.
- After lithotripsy, ureteroscopy or a percutaneous procedure, watch for bleeding, clots, pain and any tube or stent — they are the early complications.
- Teach the patient to keep straining at home if asked and to drink enough for pale urine — fragments may pass for weeks.
- Teach that diet changes depend on the stone type and that calcium should not be cut on their own — too little calcium may increase stones.
In nursing practice
- Call for severe flank or back pain that does not settle, fever and chills, or vomiting.
- Call for heavy bleeding or clots in the urine, lightheadedness or a fast heartbeat after a procedure.
- Call for very little urine, cloudy or bad-smelling urine, or burning on urination.
- Stones often come back; prevention matters as much as treating the episode.
Common mistakes
- Stopping straining because the pain has gone.
- Discarding the stone or fragments instead of sending them for analysis.
- Telling the patient to cut calcium from the diet without the provider's advice.
- Missing fever in a patient with a stone.
Test yourself
Think of the answer, then tap the question to see it.
Why does the nurse strain all of a patient's urine when a kidney stone is suspected?
To catch the stone for laboratory analysis, since its type guides prevention, and to confirm that it has passed.
Does the end of the pain prove that the stone has passed?
No; passage is confirmed by catching the stone in the strainer or by a follow-up image.
Why is fever in a patient with a kidney stone urgent?
Because a stone that blocks urine and causes infection can damage the kidney and needs urgent treatment.
What is expected in the urine after lithotripsy, and what is not?
A small amount of blood for days to weeks is expected; heavy bleeding, clots or very little urine need a call.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Kidney stones, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Kidney stones - self-care, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Kidney stones and lithotripsy - discharge, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.