Advanced Pathophysiology Essay.

Discussion Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. Advanced Pathophysiology Essay.

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He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief. In this discussion: Discuss with your colleagues the pathophysiological development of nephrolithiasis. Provide a rationale for whether this patient should be further evaluated for renal surgery at this time. Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge. Include citations from the text or the external literature in your discussions. Advanced Pathophysiology Essay.

Nephrolithiasis: Discussion

Nephrolithiasis, or kidney stones, contributes to the solubilization of different urine compounds’, contributing to salt precipitation or nucleation. The most known factors contributing to the development of all stone forms are declines in kidney stone blockers in the urinary, acidic urine pH, and supersaturated urine. As per Ganji-Arjenaki, Nasri, and Rafiejan-Kopaei (2017), three-quarters of stones comprise calcium. That may be induced by hypercalciuria, which is autoimmune. Uric acid in individuals with severe pyrimidine consumption or those who have osteoporosis could produce kidney stones. Advanced Pathophysiology Essay. Struvite stones could be generated in individuals with persistent Urinary tract infections with urease-producing species, whereas cystinuria may end up causing stones in individuals with faulty amino acid transportation (Hammer & McPhee, 2019). Individuals could pass such stones normally by passing through the urinary tract. The stone may trigger a blockage of urine flow whenever this occurs, which would result in hydronephrosis or infections (Ganji-Arjenaki et al., 2017). Ureteral obstruction, hematuria, and discomforts are all self-limiting, implying it goes away by itself. For tiny stones, analgesia, bed rest, and plenty of fluids are needed for passage. Even so, hypertension, renal damage, infection, and hydronephrosis can result from larger stones that cannot automatically pass through. Advanced Pathophysiology Essay.

Louise Johnson should further be evaluated for surgery. His heart rate is 160/80 mm Hg, considered very high for adults since the average resting heart rate varies between 60 and 100 beats per minute (Mirmozaffari, 2019). He winces on the hospital bed, struggling to find a suitable spot indicating that he is in much pain, and microscopy reveals 10–20 red blood cells per high-power field. However, before surgery is recommended, the stones must be measured. Patients may need surgical treatment for any stones measured greater than 0.5cm (Mirmozaffari, 2019). X-rays or ultrasound scans may reveal the scale or the volume of stones. Nevertheless, if the stones are tiny, Loiuse Johnson needs to try all of the care mentioned above. Advanced Pathophysiology Essay.

There are certain things Louise Johnson should do while in the hospital and after. The patient ought to drink a minimum of 2L of water each day. That enables any bits of stone which still exist to move through (Ahn et al., 2018). To make it much easier for the bits of stone to move, his medical practitioner can give him a prescription medication known as an alpha-blocker (Ahn et al., 2018). The patient should also consume citrate, magnesium, and fiber foods to minimize the probability of stone formation. He should take into account weight loss and adjusting his lifestyle if he is obese. Also, to keep stones from developing, Louise ought to consume a fiber-rich diet with minimal sodium. Advanced Pathophysiology Essay.

References

Ahn, J. S., Holt, S. K., May, P. C., & Harper, J. D. (2018). National imaging trends after ureteroscopic or shock wave lithotripsy for nephrolithiasis. The Journal of urology, 199(2), 500-507.

Ganji-Arjenaki, M., Nasri, H., &Rafieian-Kopaei, M. (2017). Nephrolithiasis as a common urinary system manifestation of inflammatory bowel diseases; a clinical review and meta-analysis. Journal of Nephropathology, 6(3), 264.

Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Mirmozaffari, M. (2019). Presenting a Medical Expert System for Diagnosis and Treatment of Nephrolithiasis. EJMED. May, 1, 1.

Advanced Pathophysiology Essay.