NURS 680B 23-year old female complains of severe left lower abdominal/pelvic pain

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 19-year old male.

A 23-year old female complains of severe left lower abdominal/pelvic pain for 6 hours. States her last menstrual period was “about 3 or 4 weeks ago”. She is sexually active and denies using any contraceptive method.

A 19-year old male complains of “burning sometimes, when I pee”. Is sexually active and denies using any contraceptive method.

A 32-year old male complains of severe pain to the left flank pain for approx. 2 hours. Was playing volleyball at the beach when it occurred. Admits to drinking 5-6 cans of beer throughout the day and denies other fluid intake.

For the case you have chosen, post to the discussion:

Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.

In SOAP format, list:

Pertinent positive and negative information

Differential and working diagnosis

Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

A 36-year-old woman presents to the emergency department with left-sided flank pain. The pain is severe, located just below her left ribs, and has been constant for the past 12 hours. It does not radiate or change with position. She also reports a fever to 101°F and general malaise.

What additional questions will further characterize her flank pain and help narrow the differential diagnosis?
What are the common diagnoses associated with flank pain?

Flank pain refers to pain occurring just below the 12th rib, encompassing the costovertebral angle and area lateral to that angle. Patients often describe flank pain as unilateral upper back pain. The initial differential diagnosis depends on the patient’s age, gender, and comorbid illnesses. However, nephrolithiasis, pyelonephritis, and musculoskeletal strain account for most cases.

A careful history often suggests one of these possibilities or raises suspicion for a less common cause. For example, a history of chronic atrial fibrillation increases the likelihood of a renal vascular embolus. Splenic infarct as a cause of left flank pain is unusual but should be considered in patients with suspected endocarditis. If “red flags” arise in the history, life-threatening diagnoses such as rupturing abdominal aortic aneurysm (AAA) or retroperitoneal hemorrhage must also be considered.