41-year-old Patrick Granite has been diagnosed with renal calculi. He presented with excruciating pain to the Emergency Department (ED) describing pain which “moves” radiating from his back to his groin; on presentation he was administered a strong analgesic (Morphine). Now on the ward, Patrick indicates his pain has increased again. The Registered Nurse administers prescribed PRN analgesic Oxycodone 5mg and 1g of Paracetamol. Patrick is confused about his condition and asks you what is causing this intense moving pain.

• Explain to Patrick what is occurring in his body to cause this pain. In your explanation, you need to outline the pathophysiology of this condition so that the marker will recognise your understanding, but also that the patient will understand.

ANSWER

Understanding Renal Calculi and its Excruciating Pain

Patrick Granite’s experience with renal calculi, also known as kidney stones, is characterized by intense and radiating pain that can be excruciating. To help Patrick understand the underlying cause of his pain, it’s important to explain the pathophysiology of renal calculi in a way that is both accurate and comprehensible.

Explanation to Patrick

“Hello Patrick, I understand you’re going through a difficult time with this intense pain. Let me explain what’s happening in your body that’s causing this discomfort. The pain you’re feeling is linked to something called renal calculi, or kidney stones. These are small, hard deposits that form in your kidneys, which are responsible for filtering waste and excess substances from your blood to create urine.”

“To help you understand, imagine your kidneys as filters that work to keep your blood clean. Sometimes, certain minerals and salts can accumulate in your kidneys and form solid crystals. Over time, these crystals can join together and create small, hard stones. Now, these stones can either stay in your kidneys or travel through your urinary tract, causing pain and discomfort.”

“When a stone moves from your kidney to your ureters, which are the tubes connecting your kidneys to your bladder, it can cause blockages or irritation. The pain you’re experiencing is a result of this movement. As the stone travels, it can cause spasms in the muscles of your ureters, which are trying to push the stone along. This leads to the radiating pain that you’re feeling, which can sometimes start in your back and move towards your groin area.”

“It’s important to note that the intensity of the pain can vary depending on the size and location of the stone. Larger stones might cause more severe pain, while smaller stones might cause milder discomfort. The pain can come and go as the stone moves, which is why you’re experiencing these episodes of increased pain.”

“In terms of treatment, we’re managing your pain with medications like Oxycodone and Paracetamol to help alleviate the discomfort. Additionally, we’ll work on identifying the size and location of the stone through tests, so we can determine the best approach to either let the stone pass naturally or consider other interventions if needed.”

“Remember, you’re not alone in this, and we’re here to support you every step of the way. If you have any questions or concerns, feel free to ask.”

By providing Patrick with a clear and simplified explanation of the pathophysiology of renal calculi, you’re ensuring that he comprehends the underlying cause of his pain while feeling supported and informed about his condition.