How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis?
A.
Percuss between the iliac crest and ribs at the midaxillary line.
B.
Push fingers upward into the two lowest intercostal spaces.
C.
Palpate along both sides of the lumbar vertebral column.
D.
Strike a flat hand covering the costovertebral angle (CVA).
The Correct Answer and Explanation is:
The correct answer is D. Strike a flat hand covering the costovertebral angle (CVA).
Flank tenderness is a key clinical sign of pyelonephritis, which is an infection of the kidneys. The costovertebral angle (CVA) is the anatomical region formed by the lower border of the 12th rib and the vertebral column on each side of the back. This is where the kidneys are located posteriorly, and assessing tenderness in this area can help determine if the kidneys are inflamed or infected.
Procedure to Assess for CVA Tenderness:
To check for CVA tenderness, the nurse will place one hand flat over the CVA and strike it with the fist of the other hand. This technique is called percussion. If the patient experiences sharp or significant pain upon percussion, it is indicative of possible kidney involvement, such as pyelonephritis or kidney stones.
Why This Method is Used:
Pyelonephritis usually presents with flank pain, fever, chills, and urinary symptoms such as dysuria or frequency. The kidneys, which are retroperitoneal organs, are situated at the CVA. Percussing this area triggers a pain response if the kidneys are inflamed, which is a common feature of pyelonephritis. This type of physical examination technique helps the nurse distinguish between musculoskeletal and visceral pain.
Incorrect Answers:
- A. Percussing between the iliac crest and ribs at the midaxillary line targets the lower thoracic area but not specifically the kidneys. This may assess for pleural or abdominal tenderness but not directly for renal tenderness.
- B. Pushing fingers upward into the two lowest intercostal spaces assesses diaphragmatic or respiratory issues rather than kidney problems.
- C. Palpating along both sides of the lumbar vertebral column assesses for spinal or musculoskeletal pain but does not specifically evaluate kidney inflammation.
Therefore, striking a flat hand over the CVA is the correct method for assessing kidney tenderness, particularly in suspected pyelonephritis.