Formatted and cited in the current APA style
A 34-y.o. female presents with the complaint of a sudden excruciating pain in her back and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to 10, with 10 being the worst. She also complains of nausea with the pain. She states that she has never had anything like this before, and the pain is subsiding a little now.
What additional questions should you ask the patient and why?
What should be included in the physical examination at this visit?
What are the possible differential diagnoses at this time?
What tests should you order and why?
How should this patient be managed?
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Sample Solution
Patient Assessment and Management
Initial Assessment
History of Present Illness:
- Location and severity: The patient describes a sudden, excruciating pain in the right flank, rated as 10/10.
- Onset and duration: The pain began abruptly and is subsiding slightly.
- Character: The pain is described as sharp and intense.
- Associated symptoms: The patient reports nausea.
- Aggravating/relieving factors: The patient has not identified any specific triggers or factors that alleviate the pain.
- Past medical history: It is important to inquire about the patient's past medical history, including any history of kidney stones, urinary tract infections, or other urological conditions.
- Family history: A family history of kidney stones or other urological disorders may increase the risk.
- Medications: Ask about any current medications, as some may increase the risk of kidney stones.
- Allergies: Inquire about any allergies to medications or contrast agents.
Physical Examination
- Vital signs: Measure blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
- Abdominal examination: Palpate the abdomen for tenderness, guarding, or rebound tenderness. Assess for a palpable mass or distension.
- Costovertebral angle (CVA) tenderness: Percuss the CVA area to assess for kidney tenderness.
- Genitourinary examination: Examine the external genitalia for any abnormalities.
Full Answer Section
Differential Diagnoses
- Renal colic: This is the most likely diagnosis given the sudden onset of severe flank pain and associated nausea. It is often caused by a kidney stone obstructing the ureter.
- Pyelonephritis: This is an infection of the kidney, which can cause severe flank pain, fever, chills, and nausea.
- Ureteral stricture: A narrowing of the ureter can cause obstruction and lead to flank pain.
- Appendicitis: While less likely, appendicitis can present with flank pain, especially in women.
- Pancreatitis: Acute pancreatitis can cause severe abdominal pain, including in the flank area.
Diagnostic Tests
- Urinalysis: To evaluate for hematuria, proteinuria, and other abnormalities.
- Blood tests: To assess renal function (BUN, creatinine), electrolytes, and inflammatory markers (C-reactive protein).
- CT scan of the abdomen and pelvis: To visualize the kidneys, ureters, and bladder for stones or other abnormalities.
Management
- Pain management: Administer analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, to manage the pain.
- Hydration: Encourage the patient to drink plenty of fluids to help pass the stone.
- Antibiotics: If pyelonephritis is suspected, start appropriate antibiotic therapy.
- Observation: Monitor the patient's vital signs, pain levels, and urine output.
- Consult a urologist: If a kidney stone is confirmed, consult a urologist for further management, which may include lithotripsy (shock wave therapy) or endoscopic procedures to remove the stone.
References:
- National Kidney Foundation. (2023). Kidney Stones. https://www.kidney.org/kidney-health/kidney-stones
- American Family Physician. (2022). Acute Flank Pain: Diagnosis and Management. [invalid URL removed]