Urolithiasis: Differential Diagnosis Essay

Assessment

Urolithiasis (ICD10-N20.1)

Stones (concrements) in kidneys can develop both with increased and normal content of calcium, oxalic acid (oxalate) compounds, cystine, and uric acid in the urine (Knoll, 2013). All these substances form crystals, which are fixed in kidney structures and gradually increase in size, forming stones. Flank pain radiating to the abdomen and groins, nausea, urinary frequency, and fever shown by the patient are common symptoms of the disorder. Other signs which may indicate urolithiasis include positive WBC, negative nitrates, and increased pH level (Knoll, 2013). Crystals of calcium and magnesium at urine pH 7.0 and above indicate phosphate urolithiasis and phosphaturia (Kirejczyk et al., 2014). As a rule, small concrements (5 mm or less), do not require specific treatment as they may come out of the organism naturally.

Additional Diagnostic Tests

Blood and urine tests should be carried out to find possible health problems that contribute to the development of urolithiasis (Knoll, 2013). The removed stones must be analyzed as well to determine their type. Based on the results of this study, some recommendations can be given, e.g., specific dietary interventions, etc. (Knoll, 2013).

Patient Education

In urolithiasis, dietary intervention is required because nutrition is one of the most important factors in the prevention and treatment of this disease. The diet should be exclusive of substances and products that contribute to the formation of the sediment (Monga, Penniston, & Goldfarb, 2015). Also, the patient needs to drink 2 liters or more per day (Monga et al., 2015). The constant lack of exposure to ultraviolet and vitamins in food can promote stone formation. Thus, a substantial change in lifestyle can be required. Moreover, if the patient will experience severe pain or nausea, he may take pain medication and, therefore, he must be instructed on potential negative effects of these drugs, i.e., addiction, lightheadedness, dizziness, and so on (Hollier, 2016).

Referrals

The patient should refer to the clinic in case the symptoms are aggravated.

Follow-Up Plan

Abundant drinking and change in dietary habits help to prevent further stone formation. The patient should control it in the following weeks. He should also report his observations of any unusual modifications in his condition to the practitioners during the intervention.

What Should the NP Do if the Patient Continues to Come back for Pain Medication?

According to medical requirements, the patient can take the pain medication only for a few days (Yong, Nguyen, Nelson, & Urman, 2017). If the pain does not disappear, it is not recommended to allow him to take painkillers further. The patient’s symptoms should be assessed again. In case Patrick’s condition does not improve, other treatment methods (e.g., lithotripsy ) should be prescribed for him.

What Are Possible Warning Signs of Prescription Drug Abuse?

1. Gradual growth in the medication dose and intake frequency indicates an increase in the threshold of the tolerance to anesthetic; it causes the body to require larger amounts of drugs.
2. An obsessive condition caused by an irresistible desire to get a prescription for the drug.
3. Continuation of the drug intake even when the health condition is improved, and the pain syndrome disappeared (Yong et al., 2017).

2016 CDC Recommendations That Would Help the Provider in Handling This Case

The practitioners should first evaluate the safety risks. Before starting the therapy for chronic pain, they “should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how therapy will be discontinued if benefits do not outweigh risks” (Dowell, Haegerich, & Chou, 2016, p. 48). The lower possible dosages and less harmful drugs should be prescribed: “when starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids” (Dowell et al., 2016, p. 48).

Practitioners should necessarily identify if the patient is predisposed to the development of addiction: “clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose” (Dowell et al., 2016, p. 48).

References

Dowell D., Haegerich, T. M., Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain. Web.

Hollier, A. (2016) Clinical guidelines in primary care. Scott, LA: Advanced Practice Education Associates.

Kirejczyk, J., Porowski, T., Filonowicz, R., Kazberuk, A., Stefanowicz, M., Wasilewska, A., & Debek, W. (2014). An association between kidney stone composition and urinary metabolic disturbances in children. Journal of Pediatric Urology, 10(1), 130-135. Web.

Knoll, T. (2013). Clinical management of urolithiasis. Berlin, Germany: Springer.

Monga, M., Penniston, K., & Goldfarb, D. (2015). Pocket guide to kidney stone prevention: Dietary and medical therapy. Cham, Switzerland: Springer.

Yong, R., Nguyen, M., Nelson, E., & Urman, R. (2017). Pain medicine: An essential review. Cham, Switzerland: Springer.