Kidney disorders
A 35-year-old woman presents with sudden onset of flank pain. She is nauseated, cannot stand on her own, is diaphoretic, and had difficulty pointing out what is wrong with her. Flank pain is discomfort or distress in the part of the body below the rib and above the ileum as a result of the stimulation of the specialized nerve ending following the distention of the ureter or renal capsule (Aktürk, Güneş & Hekimoğlu, 2017). Ureteral stone is the most common cause of flank pain.
Assessment Questions
To better understand her problem the attending physician can the patient the following assessment questions.
When did the pain start?
What is the nature of the pain, does the pain radiate from one position to another?
Does the pain come in waves, is it intermittent?
On a scale of 1 to 10, how severe is your pain?
Any other symptoms besides the pain?
Pathophysiology
Pain as a result of kidney disorders usually develops in the flank. Severe kidney pain can result from a stone entering one of the ureters and is often accompanied by nausea and vomiting (Hanafusa et al.,2017). Kidney stone stones cause severe, cramping pain. A kidney stone in the ureter may block the flow of urine and a as a result the kidney may swell and the ureter spasm, which can be very painful. A stone moving from the renal collecting system can significantly affect the genitourinary system (Patti & Leslie, 2017).
Flank pain is often linked to less particular symptoms including nausea and vomiting, fever, and tachycardia (Aktürk, Güneş & Hekimoğlu, 2017). A stone that suddenly becomes lodged in one position on its way into the ureter causes extremely severe but intermittent pain. Each episode of pain corresponds to the stone being lodged in a new and more distal location in the ureter. A patient with acute distention of the ureter often has extremely severe pain and has mild dilation of the ureter but no irreversible renal damage (Aktürk, Güneş & Hekimoğlu, 2017). The degree of severity of pain is proportional to the acuteness rather than the degree of obstruction.
Structure of the renal/Urologic system affected
Kidney stones also called nephrolithiasis, renal calculi, or urolithiasis are hard deposits that form in the kidneys composed of minerals and salts (Alelign & Petros, 2018). Kidney stones affect parts of the renal system from the kidneys to the bladder. Minerals crystallize and stick together to form stones when urine is very concentrated.
Crystal formation in supersaturated urine marks the start of stone growth. The crystals then adhere to the urothelium creating the nidus for subsequent stone growth (Chalmers, 2019). However, researchers are yet to fully explain the biological process by which crystals anchor to the urothelium. The stone formation process is triggered by an imbalance in the proportion of inhibitors and promoters (Chalmers, 2019).
Patient Education
Pain is the most common symptom of a moving kidney stone. Usually, pain occurs with obstruction when a stone blocks urine flow from the kidney to the bladder. The pain occurs in waves and can move toward the groin (Chalmers, 2019). Another symptom that the patient should expect is blood in the urine. The urine might appear reddish or pinkish and in some cases, the blood may not be visible until looked under a microscope. Kidney stones are usually managed using pain medication and drinking lots of water to pass the stone. Surgery may be needed in cases where urinary infections set in or other complications arise (Alelign & Petros, 2018).