Pathophysiological Development of Nephrolithiasis.

Pathophysiological Development of Nephrolithiasis.


Discussion 5 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.Pathophysiological Development of Nephrolithiasis.


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.Pathophysiological Development of Nephrolithiasis.

Nephrolithiasis, also known as kidney stones, is a disease that damages the urinary tract and causes blood in the urine. Kidney stones generally develop as a result of higher oxalate, calcium, and phosphorus levels that bunch up together leading to stones in the kidneys. Normally, persons with this condition are symptom-free until the stones enter the ureters or move around the kidney. Nephrolithiasis is then associated with symptoms, such as vomiting, nausea, hematuria, dysuria, and extreme lower and side back pain (Mayo Clinic, 2020). According to the scenario, Louis denies experiencing fever or dysuria but mentions nausea. He also mentions pain experience because he is “writhing on the gurney,” as he is not able to find a convenient spot. Additionally, the scenario reveals that microscopy shows 10-20 red blood cells and urinalysis examination indicates 1 + blood. Blood in the urinalysis examination suggests injury because of the movement of crystals, and crystals imply the likelihood of a stone.Pathophysiological Development of Nephrolithiasis.

Rationale for Further Evaluation

Renal surgery is only considered when nephrolithiasis is complicated by progressive renal insufficiency, infection, and urinary tract obstruction (Hammer & McPhee, 2019). While considering the pathophysiology related to the development of kidney stones and the situations that Louis Johnson is undergoing, it is absolutely essential that he goes through some tests to determine the advancement of the condition. However, the implementation of a renal surgery at this same time is not recommended, as advanced systems have not been conducted with surety.Pathophysiological Development of Nephrolithiasis.

Plan of Care

My care plan would involve justifying and clarifying the cause of pain and the significance of informing care providers of changes in pain incidence and characteristics. This would provide a chance for opportune administration of analgesia and signals healthcare providers on the likelihood of passing of stone and developing problems. Additionally, I would consider relaxation interventions (back rub, soothing setting) to encourage comfort, reduce pain, and improve coping (Bollner, 2017).Pathophysiological Development of Nephrolithiasis.