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.

Health Challenges-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 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
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

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?