Health Challenges-Case Study
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
- 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
- Based on the data above, what do you suspect is occurring with E.G.? What assessment data led you to this conclusion?
- What additional test(s) may be ordered to confirm this diagnosis? Why would this additional test(s) confirm this diagnosis?
- 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.
- What factors put E.G. at risk for developing a renal calculus?
- What teaching should E.G. receive prior to his being discharged?
- What nutritional instructions should E.G. be given to prevent recurrence of renal calculi?