Asymptomatic nephrolithiasis

Introduction
You are a New Graduate Registered Nurse working on the Urosurgical Unit in a large tertiary
hospital. You are asked to take over care of Julian Tran and are currently receiving handover at the
bedside.
Situation
Julian is a Ngunnawal man who is 67-years of age. Julian has been admitted via the Emergency
Department (ED) today, after experiencing an acute episode of left flank and groin pain, discomfort
with voiding, and episodes of nausea and vomiting.
On arrival to ED, Julian was diaphoretic, tachycardic (HR 129) and hypotensive (BP 86/45). On
assessment Julian’s skin appeared pale, and his lips were dry and cracked. The ED team
subsequently, administered a STAT 1L bag of Intravenous (IV) crystalloid, which has now completed.
Blood and urine specimens were sent to the laboratory for microbiology, culture, and sensitivity, and
the results are pending.
On arrival to the ward, Julian describes that he is still experiencing similar pain to before, although
less intense, with a pain score of 6/10. Julian also describes feeling thirsty.

Pathology: FBC and UEC. Results showed elevated white blood cells, with all other results within
normal ranges. The ward urine analysis showed pH 5.5, high specific gravity, blood moderate,
leukocytes ++, nitrites+, glucose nil, and protein +.

Background
Asymptomatic nephrolithiasis
Assessment (on arrival to the ward)
Airway
• Patent
Breathing
• Spontaneous effort

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