Urinal Calculi & Kidney Stones Discussion
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 20 mg PO once daily at bedtime.
• 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
• 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.
• 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
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?6. What nutritional instructions should E.G. be given to prevent recurrence of urinary calculi?