[doctor] so anna good to see you today so reading here in your appointment notes you were you were diagnosed with kidney stones from your your pcp and you currently have one and so they they had you come in so can you tell me what happened how's all that going for you
[patient] sure i've been having some back pain on my right side it's been lasting for about a week now
[doctor] okay
[patient] and i also started to see some blood in my urine
[doctor] okay so on the right side so does that pain does it move anywhere or is it just kinda stay in that that one area
[patient] yeah it's moved down a little bit on to my right lower side a little bit
[doctor] side okay so how would you describe the pain is it constant or is does it come and go
[patient] it's pretty constant
[doctor] okay did you notice any pain when you're urinating i know i know you say you you saw you see blood but any pain with that
[patient] no no real pain when i'm when i'm peeing at all
[doctor] okay so have you taken anything i know have you tried like azo or any of that to
[patient] i took some ibuprofen that helped a little bit
[doctor] okay
[patient] but it still hurts even with ibuprofen
[doctor] alright have you noticed any nausea vomiting fever chills
[patient] i have n't thrown up but i felt a little bit nauseated
[doctor] little nauseated yeah that's we expected so have you do you have a family history of kidney stones i know some people when they have them like their parents have them stuff but
[patient] yeah my my dad had kidney stones i think he has passed a couple of them i'm not quite sure
[doctor] alright and have you had any in the past or is this your first one
[patient] this is my first time i've never had this before
[doctor] okay alright so we'll do we'll do an exam on you just to check you out so i guess you were in pain and stuff over the over the easter easter break there that
[patient] yeah yeah i had some pain over the weekend i saw my pediatrician this morning so they sent me over here they were concerned that i might have a kidney stone
[doctor] okay so i'm guessing you did n't get to go find the eggs on the easter egg hunt because of the you were in pain
[patient] not so much but i i got to participate a little bit i opened some eggs i just did n't go run around and find them
[doctor] okay well i i'm lucky enough my friends had an adult easter hag hunt for me and so i was able to find a couple eggs yesterday myself so i i'm glad you were able to get a few of them alright so let's do that that physical exam on you so your vitals look good you do n't have any fever your blood pressure heart rate is fine so when i press here on your belly does that hurt
[patient] a little bit yeah
[doctor] a little bit alright so on your exam of your abdomen there is mild pain and tenderness to palpation of the abdomen there's no rebound or guarding there is cva located near your flank tenderness on the right so that means that everything looks good but you do have what seems to be some inflammation of your kidney okay so we we were able to get a ct of your your side and it showed that you do have a stone measuring point five centimeters in size and it's located in the proximal right ureter and so that's that duck that passes from your kidney to your bladder alright i do n't see any evidence of hydronephrosis so that means that there's not obstructing ureter causing swelling in your kidney which is which is pretty good so let's talk a little bit about my assessment and plan so you do have that kidney stone on the right so what i'm recommending is i want you to push fluids just to help facilitate you passing that stone alright have you been taking in have you been drinking enough water do you think so far
[patient] probably not enough i drink some but
[doctor] okay yeah i i want you to to drink try drink as much as possible just to see if we can get you hydrated and pass the stone what i'm gon na do is i'm gon na prescribe you ibuprofen eight hundred milligrams you can take that as needed for pain i know you said you were in that much pain just in case it does start to move you're in pain i want you to take the ibuprofen i'm also gon na give you a strainer for you to strain your pee so we can see you wan na know when that that stone does pass gon na order a bmp and a urinalysis and a urine culture and based on what the urinalysis shows we can decide if i can decide if i need to put you on antibiotics if you do have an infection of some kind and i wan na see you back in about a week to two weeks and if you're still having symptoms we can discuss further treatment such as a lithotripsy and it's it's a mainly minimally invasive procedure where we use shock waves to try to break up that stone but otherwise do you have any other questions for me
[patient] no i do n't think so
[doctor] alright so we will see you back in a week or two and i'll have my nurse come in with that prescription and hopefully with all the treatment you'll be able to pass the stone okay alright

Medical orders:
description: see you back a week to two weeks
order_type: followup
reason: kidney stone on the right
description: ibuprofen eight hundred milligrams
order_type: medication
reason: pain
description: bmp
order_type: lab
reason: kidney stone on the right
description: urinalysis urine
order_type: lab
reason: kidney stone on the right
description: urine culture
order_type: lab
reason: kidney stone on the right