Left Flank and Abdominal Pain



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Scenario You are a registered nurse in the emergency department (ED). It is a hot summer day and S.R., a 25-year-old woman, comes to the ED with severe left flank and abdominal pain and nausea with vomiting. S.R. looks very tired, her skin is warm, and she is perspiring. She paces about the room doubled over and is clutching her abdomen. S.R. tells you the pain started early this morning and has been pretty steady for the past 6 hours. She gives a history of working outside as a landscaper and takes little time for water breaks. Her past medical history includes three kidney stone attacks, all occurring during late summer. Her abdomen is soft and without tenderness, but her left flank is extremely tender to touch. You place S.R. in one of the examination rooms and take the following vital signs: 188/98, 90, 20, 99° F (37.2° C). A voided urinalysis shows RBCs of 50 to 100 on voided specimen and WBCs of zero

CASE STUDY PROGRESS The noncontrast CT scan shows a left 2-mm ureteral vesicle junction stone

CASE STUDY PROGRESSS.R. was discharged with instructions to strain all urine and return if she experienced pain unrelieved by the pain medication or increased nausea and vomiting

CASE STUDY PROGRESSS.R. returns to the ED in 6 hours with pain unrelieved by the pain medication and increased blood in her urine. She is being held in the ED until she can be transported to surgery.

CASE STUDY PROGRESSA 2-mm calculus was removed by basket extraction. Pathologic examination reported the stone to be calcium oxalate.

CASE STUDY OUTCOMES.R. recovers from this most recent episode and continues to follow the protocol for fluid intake and dietary measures. One year later, she has yet to report a recurrence of stones