Health challenges-case study patient profile e.g. is a 41-year-old

  

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

  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? Why would      this additional test(s) 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      renal calculi?