A nurse is caring for a client with acute pyelonephritis. Which area should the nurse percuss to assess for pain related to pyelonephritis?
A.
McBurney’s point on the abdomen
B.
Psoas sign at the knee
C.
Rovsing’s Sign on the abdomen
D.
costovertebral angle (CVA) on the back
The correct answer and Explanation is :
The correct answer is D. costovertebral angle (CVA) on the back.
Explanation:
Acute pyelonephritis is an infection of the kidney that typically presents with symptoms such as fever, flank pain, and urinary tract symptoms like dysuria or frequent urination. One key physical examination technique used to assess for pyelonephritis is percussion of the costovertebral angle (CVA), which is the angle formed by the spine and the lower rib cage on the back.
Percussion of the CVA:
To perform this assessment, the nurse places one hand over the CVA area (located on the back, just below the rib cage on either side of the spine) and taps the hand with the fist of the other hand. This maneuver is also known as Murphy’s punch sign. In cases of acute pyelonephritis, this percussion typically causes tenderness or pain due to the inflammation and infection in the kidney. Pain in this area is a classic indicator of kidney involvement and helps in distinguishing pyelonephritis from other types of abdominal or back pain.
Other Signs:
- A. McBurney’s point on the abdomen: This point is used to assess for appendicitis rather than pyelonephritis. McBurney’s point is located in the lower right abdomen and tenderness here is more indicative of appendiceal inflammation.
- B. Psoas sign at the knee: This sign is also used in the evaluation of appendicitis. It involves asking the patient to flex the right hip against resistance or extend the leg while lying on their side. Pain in this maneuver suggests irritation of the psoas muscle by an inflamed appendix, not pyelonephritis.
- C. Rovsing’s Sign on the abdomen: Rovsing’s sign is another test for appendicitis. It involves palpating the left lower abdomen and assessing if pain is felt in the right lower abdomen, indicating irritation of the appendix.
In summary, assessing the CVA by percussion is the most appropriate method for detecting tenderness associated with pyelonephritis, as it directly relates to the inflammation of the kidney.