FSU Right Flank and Back Pain Diagnosis and Treatment Discussion

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Please respond to discussion below:

What additional questions should you ask the patient and why?

The back pain of a patient might be caused by a variety of conditions, and it can have unknown causes on the right side. Examples of right flank and back pain include, but are not limited to, kidney stones, liver or gastrointestinal conditions, shingles, pinched nerves, and herniated discs. The nurse practitioner might inquire about the patient’s pain’s beginning when it started, and what she was doing. To determine the patient’s medical condition, the nurse practitioner should also inquire about the precise area of the back discomfort. The patient should be questioned about how long she has experienced her pain, how long it has lasted, what relieves it, and what causes it. How the pain feels in the flank can help figure out what is causing it. Some important features are whether the pain is felt only in one spot or spreads to other areas, whether it is sudden or long-lasting or comes and goes, how bad it is, and how long it lasts. Other signs like fever, feeling sick and throwing up, and irregular heartbeat can also help identify the problem.

What should be included in the physical examination at this visit?

Patients like the one in this case study would get a physical exam for non-specific back pain at this session, as well as neurological testing, psychiatric testing, and history taking that covers family and social history (Oliveira et al., 2018). The back and right flank should be visually assessed or evaluated as part of the physical examination. It is important to assess the lower extremities’ power, feeling, and reflexes.  Examine the back’s range of motion, spasming, and restrictions. Check for atrophy, tension, and soreness in the spinalis muscles, which are the paraspinal muscles.  The cervical spine’s extension, flexion, lateral flexion, and rotation should be evaluated (Will et al., 2018).

What are the possible differential diagnoses at this time?

A possible differential diagnosis could be Urinary tract infections (UTIs), which afflict women more than males and typically occur between the ages of 16 and 35, (Bono et al., 2022). Another possibility for a differential diagnosis is lumbar radiculopathy, which most frequently affects adults in their third to fifth decades of life.  Back pain in the lumbar-sacral region is one of the symptoms (Dydyk et al., 2023). Due to nausea and vomiting brought on by the intensity of the pain, nephrolithiasis may potentially be a differential diagnosis (Nojaba & Guzman, 2022).

What tests should you order and why?

A basic metabolic panel, which would test for evidence of abnormal kidney function, could be performed to screen for kidney stones, infection, injury, or illness in this patient. A complete blood count could be given to look for infections or tumors (Nojaba & Guzman, 2022). Kidney stones, as well as their size and shape, can be examined during a lower back CT scan or ultrasound. A lower abdomen cystoscopy can be used to examine for illness. Images of injuries or anomalies in your spine can be obtained via an MRI or XRAY (Nojaba & Guzman, 2022).

How should this patient be managed?

If the patient has an infection, it may be possible to treat or control it with antibiotics, depending on what is causing their back and flank pain. For pain, over-the-counter drugs like NSAIDs can be used. If all other therapeutic measures have been used and have failed the patient, surgery may be an alternative. Rest, relaxing, and staying hydrated could all be used as non-pharmaceutical treatments.