The nurse is performing an admission assessment for a client with pyelonephritis who has urgency and burning while urinating. Which finding indicates an expected response when the nurse percusses the costovertebral angle?
A.
Audible thud without pain.
B.
Rigidity and firmness.
C.
Rebound tenderness.
D.
Sharp, severe pain.
The correct answer and Explanation is :
The correct answer is:
A. Audible thud without pain.
Explanation:
In the context of pyelonephritis, which is a kidney infection, assessing the costovertebral angle (CVA) is a critical part of the physical examination. The CVA is the area where the lower ribs meet the spine, and percussion here can provide valuable information about the health of the kidneys.
When performing CVA percussion, a normal finding would be an “audible thud without pain.” This means that the nurse taps the area with the fingers and hears a thud, but the client does not experience pain. This result is expected if the kidneys are healthy or if there is no severe inflammation or infection.
However, in the case of pyelonephritis, the expected response would be different. Pyelonephritis often causes inflammation of the kidneys, which can lead to pain in the CVA area when percussed. This pain is due to the infection and inflammation affecting the kidney tissues. The presence of pain upon CVA percussion is a common clinical finding in pyelonephritis and indicates the need for further diagnostic evaluation and treatment.
Here’s a brief look at why the other options are not suitable:
- B. Rigidity and firmness: This finding would suggest potential issues such as abdominal muscle guarding or peritoneal irritation, which are not typically associated with pyelonephritis.
- C. Rebound tenderness: This is more indicative of peritoneal irritation or acute abdominal conditions rather than a kidney infection.
- D. Sharp, severe pain: While sharp pain might occur in pyelonephritis, the question is about an expected finding when percussing the CVA. An audible thud without pain is a normal finding, while pain upon percussion would be indicative of the infection.
Thus, the appropriate expected response when percussing the CVA in a client with pyelonephritis would be an audible thud without pain in a normal scenario, though in a real-world case of pyelonephritis, you might more commonly encounter pain upon percussion.