You are a registered nurse in the emergency department. It is a hot summer day and S.R., a 25-year-old
woman, comes to the Ed with severe left flank and abdominal pain and nausea and vomiting.
S.R. looks
very tired, her skin is warm to the touch, and she is perspiring. She paces about the room doubled over
and is clutching her abdomen. S.R. tells you the pain started early this morning and has been pretty
steady for the past 6 hours. She gives a history of working outside as a landscaper and takes little time
for water breaks. Her past medical history includes three kidney stone attacks, all occurring during late
summer. Examination findings are that her abdomen is soft and without tenderness, but her left flank is
extremely tender to touch, palpation, and percussion. You place S.R. in one of the examination rooms and
take the following vital signs: 188/98, 90, 20, 99° F (37.2° C). A voided urinalysis shows RBCs of 50 to 100
on voided specimen and WBCs of zero.
What could be the cause of the blood in her urine? How could you rule out some of these
causes?
The presence of RBCs in the urine could indicate renal injury or infection, renal obstruction, or a
bladder infection. However, S.R. might be having her menses and just didn't tell anyone. Ask her
whether she is on her period. A straight catheterization can be performed to collect another urine
specimen to verify the results.
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A nurse at a long-term care facility has completed the admission assessment of a 79-year-old male resident
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