Presence of large right renal calculus is confirmed

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Reference no: EM133921395

Case Study

Patient Profile:

E.G. is a 41-year-old male who presents to the emergency department complaining of severe right back pain that started a couple of hours ago, right after he finished his daily run. He has a history of gastroesophageal reflux disease, for which he takes famotidine (Pepcid) 20 mg PO once daily at bedtime.

Subjective Data:

Has been training for a marathon and has been running at least 10 miles a day, but today was so hot that he only made it 6 miles. Shortly after his run, the pain in his right back/side started.

States his pain is a level 9 on a 1-to-10 scale

States the pain is constant, nothing seems to make it better, and it does not get worse with movement

Denies any pain or numbness in his legs

While training, he has been supplementing his diet with protein shakes

Denies using performance-enhancing drugs

Objective Data:

Physical Examination

Temperature 99.6° F, pulse 78, respirations 16, blood pressure 122/80

No musculoskeletal pain or tenderness in spine

Right flank tenderness to fist percussion

Case Study Progress:

Based on the initial clinical manifestations and exam findings, the health care provider orders a urinalysis. At first, E.G. is unable to urinate, but after drinking several glasses of water, is able to obtain a clean-catch urine specimen.

Diagnostic Studies:

Urinalysis
Color: Dark, smoky color
Odor: Aromatic
Protein: None
Glucose: None
Ketones: None
Bilirubin: None
Specific gravity: 1.035
pH: 6.2
RBCs: 11/hpf
WBCs: 3/hpf
Casts: None

Discussion Questions:

1. Based on the data above, what do you suspect is occurring with E.G.? What assessment data led you to this conclusion?

2. What additional test(s) may be ordered to confirm this diagnosis?

3. E.G. has an ultrasound, and the presence of a large right renal calculus is confirmed. The health care provider orders E.G. IV Morphine sulfate for pain and recommends that he have a right extracorporeal shock-wave lithotripsy (ESWL). Explain this procedure.

4. What factors put E.G. at risk for developing a renal calculus?

5. What teaching should E.G. receive prior to his being discharged?

Reference no: EM133921395

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