Differential Diagnosis Case Study
Primary diagnosis
The primary diagnosis for Patrick is unspecified (N20.9). This condition is confirmed by the imaging process which reveals the presence of a 5 mm calculus placed between the ureter and bladder. It is also evident that pain does not stop when Patrick involves position changes and Tums. Pain is reported to be 8/10 and comes in waves which are deceptive of stone passage within the ureter. The bowel sounds are indicated to be reduced, and the abdomen is tender coupled with a positive CVAT. Urinalysis detects white blood cells, and the presence of blood in Urine means abrasion during the passage of the stones (Tiselius & Chaussy, 2015).
Medication
- Ibuprofen, OTC 400 mg to be taken one tab after 6 hours to relieve pain. Ibuprofen alternated with Norco
- 15 tabs of Sig: 5/325 to be taken one tab after every 6 hours. Maximum of 6 tabs in a day (Goroll & Mulley 2014).
Additional Diagnostic Tests
A biochemistry analysis of urine (24-hour urine) should be done to test for levels of magnesium, uric acid creatinine, citrate and calcium (Prochaska, Taylor & Curhan, 2016).
Education
The treatment offered to Patrick aims at controlling pain and ending the formation of stones in the urinary system. The treatment is also designed to allow for passage of the stones detected during imaging. The Norco drugs are given to control the current pain within three days after which the Ibuprofen will be administered. Patrick is advised to alternate Norco with Ibuprofen in case the pain is not relieved (Goroll & Mulley 2014). It is important that the patient increases the daily intake of fluid to reach 3 liters. This will increase the amount of urine that is passed out to aid in removal of the stones within the urinary system. It is important to have the urine stained after 72 hours to test for the presence of stones after the reported symptoms disappear (Prochaska, Taylor & Curhan, 2016).
Referrals
If the condition is not successfully treated or gets worse, further medical interventions should be sought from a Urologist (Goroll & Mulley 2014).
Follow-up
The patient should return to the hospital after one week to review response to treatment achieved. Laboratory diagnosis will test for creatinine levels to aid to help describe the success of the treatment offered (Prochaska, Taylor & Curhan, 2016).
Answers to questions
- If Patrick comes back complaining of persistent pain, it is advisable to seek specialized medical services from a Urologist. It is here that a CT scan will be done to determine the type of stones correctly. This will help in the determination of alternative treatment options that will be offered. In case an alternative treatment option is given, the previous medication will be withdrawn.
- Abuse of prescription drugs can be easily detected by checking for symptoms such as lowered blood pressure, nausea, watery eyes, dry skin, poor coordination, and vomiting (Drug Rehab Org. 2017).
CDC Recommendations
- The right time to start use of opioids in managing chronic pain.
- Type of the opioid to be used.
- Assessment of the risk related to the opioids used (CDC, 2017).
References:
CDC. (2017). Guideline for Prescribing Opioids for Chronic Pain.. Centers for Disease
Control and Prevention. Retrieved 21 September 2017, from https://www.cdc.gov/media/dpk/prescription-drug-overdose/opioid-prescription-guidelines/dpk-opioid-prescription-guidelines.html
Drug Rehab Org. (2017). The 45 Warning Signs Of Prescription Drug Abuse.
DrugRehab.org. Retrieved 21 September 2017, from http://www.drugrehab.org/the-45-warning-signs-of-prescription-drug-abuse/
Goroll, A. H., & Mulley, A. G. (2014).Primary care medicine: Office evaluation and
management of the adult patient(7thed.).Retrieved fromhttp://online.vitalsource.com
ICD-10 Version (2017). Apps.who.int. Retrieved 21 September 2017, from
http://apps.who.int/classifications/icd10/browse/2015/en#/N20-N23
Prochaska, M. L., Taylor, E. N., & Curhan, G. C. (2016). Insights into nephrolothiasis from
the nurses health studies.American Journal Of Public Health, 106(9), (p. 1638). doi:10.2105/AJPH.2016.303319
