Question

A 56-year-old male anatomy professor at a well-known university in North Hollywood was brought to the emergency room at the UCLA Ronald Reagan Medical Center. His chief complaint was right flank pain.

History of present Illness:

One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day.

One hour prior to admission, the patient developed severe right flank pain associated with nausea. His wife was brought him to the UCLA Ronald Reagan Medical Center. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1 to 10. On physical exam, patient had the following findings:

Vital Signs BP: 140/90

Heart rate: 110/minute

Respiration rate: 15/minute patient was afebrile

All exam findings for the head, neck, heart, lungs, and abdomen were normal.

On examination of the back, patient had tenderness on the right flank upon palpation.

On examination of the genitalia, there was no penile discharge.

Note of a 1 x 1 cm tophus on right big toe.

The following diagnostic exams were ordered:

CBC with WBC differential count

Urinalysis

Serum uric acid

KUB x-ray

MRI Scan abdominopelvic area

He was immediately injected by IV with a strong analgesic to relieve the pain.

Past Medical History:

Diagnosed with gout one year prior to admission

On medication with allopurinol

No heart and lung disease

No diabetes or hypertension

Click here to review the results of the diagnostic exam.

Questions and topics for discussion:

What would be the clinical diagnosis in this patient? Please explain in detail the pathogenesis of this disease.

What are the clinical manifestations: signs, symptoms of this particular disease?

Discuss and explain the results of the CBC, serum uric acid, and urinalysis.

What do you see in the plain KUB and the coronal MRI scan of the abdomen where the 2 upper arrows are located? Identify this particular lesion, where is it located, and the specific organs involved.

Review the patient’s medical history. With this in mind, what is the specific type of lesion that you should expect to see and why?

On the axial scan of the abdomen, what is the organ pointed to by the three arrows? Is there anything wrong with this organ? If you answered yes, please explain in detail. What is a possible complication in this patient and the possible effect on the function of this organ in the long term?

What are the possible treatment options both medical and surgical for this particular patient?

Describe in detail the possible nursing intervention, especially with regards to diet and fluid intake.

Answer 1

Renal calculi or renal stone is the clinical diagnosis where there is severe pain in the flank region

Due to the calculi or stone formation may be because of life style, medication , medical conditions ( gout where there is increased uric acid and it deposit in the kidney) ,it blocks the passage of urine smoothly through the urinary tract , resulting in severe pain

The main clinical manifestations are

• Severe flank pain
• Blood in urine
• Nausea

In Investigation it shows increased uric acid , blood and mineral deposits in urinalysis,KUB reveal the location of stone,CBC change occurs when there is infection

The possible complication is limited mobility, chronic pain, deformity, destroy joints , Harrison syndrome

The medical treatment are to clear stone with hydrotherapy,if stone are bigger then surgical intervention like lithotripsy to be done. Bringing uric acid to normal levels.

Surgical method of removing the toe if completion arise out of it.

The best nursing interventions is

• to increase the fluid intake which will aide in natural flush out of calculi
• restrictions of food high in uric acid has to be given
• Pain management to be done