E.G. is a 41-year-old male who presents

E.G. is a 41-year-old male who presents to the emergency department complaining of severe right back pain that started a couple of hours ago, right after he finished his daily run. He has a history of gastroesophageal reflux disease, for which he takes famotidine (Pepcid) 20 mg PO once daily at bedtime. Subjective Data: Has been training for a marathon and has been running at least 10 miles a day, but today was so hot that he only made it 6 miles. Shortly after his run, the pain in his right back/side started. States his pain is a level 9 on a 1-to-10 scale States the pain is constant, nothing seems to make it better, and it does not get worse with movement Denies any pain or numbness in his legs While training, he has been supplementing his diet with protein shakes Denies using performance-enhancing drugs Objective Data: Temperature 99.6° F, pulse 78, respirations 16, blood pressure 122/80 No musculoskeletal pain or tenderness in spine Right flank tenderness to fist percussion Based on the initial clinical manifestations and exam findings, the healthcare provider orders a urinalysis. At first, E.G. is unable to urinate, but after drinking several glasses of water, can obtain a clean-catch urine specimen. Urinalysis Color: Dark, smoky color Odor: Aromatic Protein: None Glucose: None Ketones: None Bilirubin: None Specific gravity: 1.035 pH: 6.2 RBCs: 11/hpf WBCs: 3/hpf Casts: None 1 Recognize/analyze cues What assessment data do you identify as significant? 2. Priority Hypothesis Based on the data above, what do you suspect is occurring with E.G.? 3. Take action What additional test(s) may be ordered to confirm this diagnosis? Explain your answer(s).

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