Name
Purdue University Globle
NU576 NP II – Primary Care of Women’s Health
Prof. Name
Date
Flank pain assessment in the NU576 iHuman Smith case requires a systematic patient history to identify the likely cause, recognize urgent warning signs, and guide further evaluation. The most important approach is to assess the location, onset, severity, and radiation of pain while asking about urinary, gastrointestinal, reproductive, and constitutional symptoms. A focused medical, medication, family, and social history helps distinguish kidney stones and urinary tract infections from musculoskeletal, gastrointestinal, and gynecological conditions.
This nursing assessment guide explains the essential questions for evaluating flank pain and organizing a comprehensive history for the NU576 iHuman case.
Flank pain is discomfort located on either side of the body between the upper abdomen and the back, usually near the lower ribs. It may occur on the right or left side and can range from a mild ache to severe, debilitating pain. Symptoms may develop suddenly or gradually, depending on the underlying condition.
The kidneys are located in the flank region, making renal disorders an important consideration. However, pain in this area does not always originate from the urinary system. Muscles, nerves, gastrointestinal organs, and reproductive organs can also produce similar symptoms.
Common causes of flank pain include:
Kidney stones, also called nephrolithiasis.
Urinary tract infections (UTIs).
Acute pyelonephritis, or kidney infection.
Musculoskeletal strain or injury.
Other renal disorders.
Gynecological conditions.
Pregnancy-related complications.
Gastrointestinal disorders.
A complete history helps the healthcare provider narrow the differential diagnosis and determine whether the patient needs routine evaluation, urgent testing, or emergency care.
The assessment begins by establishing the patient’s main concern. Use open-ended questions to encourage the patient to describe their symptoms in their own words before moving to more specific questions.
Ask the patient:
How can I help you today?
What symptoms are bothering you the most?
When did your flank pain begin?
Have you experienced similar pain before?
Is there anything specific that concerns you about this pain?
The chief complaint establishes the reason for the visit and helps organize the rest of the history. Document the patient’s primary concern using their own words whenever possible.
The history of present illness is a central part of flank pain assessment. It describes how the symptoms started, how they have changed, and how they affect the patient. A structured pain assessment can be organized using the OPQRST framework, which covers onset, provocation or palliation, quality, region or radiation, severity, and timing.
Determine whether the pain began suddenly or gradually. The timing may help differentiate possible causes.
Questions to ask include:
When exactly did the pain start?
Did it begin suddenly or develop over time?
What were you doing when the pain began?
Has the pain been constant or does it come and go?
How long does each episode last?
Has the pain become more frequent or severe?
Sudden, severe pain may occur with renal colic from a kidney stone. Gradually worsening discomfort may have other causes, including infection or musculoskeletal conditions. Timing alone cannot establish a diagnosis.
Ask the patient to identify the exact location of the pain and describe how it feels.
Important questions include:
Where exactly is the pain located?
Is the pain on the right side, left side, or both sides?
Can you point to the area where it hurts?
Is the pain sharp, dull, aching, burning, cramping, or pressure-like?
Does the pain feel superficial or deep?
Has the location changed since the pain started?
The quality of pain provides useful diagnostic clues. Cramping or severe waves of pain may occur with kidney stones, while aching pain can be associated with several conditions, including musculoskeletal problems and kidney infections.
Determine whether the pain spreads to another part of the body and whether movement or other activities affect its intensity.
Ask:
Does the pain spread to your abdomen, groin, or back?
If it travels, where does it go?
Does movement make the pain worse?
Does coughing, bending, or twisting increase the pain?
Does urination affect the pain?
What makes the pain better or worse?
Does the pain wake you from sleep?
Pain that radiates toward the groin is a common feature of renal colic. Pain associated with movement or certain positions may suggest a musculoskeletal source, although these findings are not diagnostic on their own.
Assess the patient’s pain intensity using a numerical rating scale from 0 to 10, where 0 represents no pain and 10 represents the worst pain imaginable.
Ask:
What is your pain level right now, from 0 to 10?
What was the worst pain you experienced?
Has the pain prevented you from walking, sleeping, eating, or performing daily activities?
Is the pain improving, worsening, or staying the same?
Document both the patient’s reported pain score and its effect on daily function. Severe pain, particularly when associated with fever, vomiting, or difficulty urinating, requires prompt clinical evaluation.
A history of recurrent flank pain can help identify previous kidney stones, infections, or other chronic conditions.
Ask:
Have you experienced this type of pain before?
Have you ever been diagnosed with kidney stones?
Have you had a kidney infection or UTI in the past?
What treatment did you receive?
Did the treatment relieve your symptoms?
Have you taken any medication or home remedies for this episode?
Review previous imaging, laboratory findings, and treatment outcomes when available. This information can help determine whether the current symptoms resemble a previous condition.
Flank pain may occur with other symptoms that provide important diagnostic information. A focused review of systems should identify urinary, gastrointestinal, reproductive, and systemic complaints.
Ask about symptoms that may indicate infection or another systemic illness.
Have you had a fever?
Have you experienced chills or shaking?
Are you feeling unusually tired or weak?
Have you experienced night sweats?
Have you noticed unexplained weight loss?
Fever and chills accompanying flank pain raise concern for pyelonephritis or another infection. Fever with urinary obstruction may represent a serious emergency requiring prompt treatment.
Urinary symptoms are particularly important when evaluating possible kidney stones, UTIs, and kidney infections.
Ask the patient:
Have you noticed blood in your urine?
Is your urine pink, red, brown, or darker than usual?
Do you experience burning or pain when urinating?
Are you urinating more frequently than usual?
Do you feel an urgent need to urinate?
Are you passing less urine than usual?
Do you have difficulty starting or stopping urination?
Have you noticed cloudy or unusually strong-smelling urine?
Have you had UTIs in the past?
Hematuria may occur with kidney stones or other urinary tract conditions. Dysuria, urinary frequency, and urgency are common symptoms of UTIs. These findings should be interpreted alongside the physical examination and diagnostic testing.
Gastrointestinal disorders can sometimes cause abdominal or flank discomfort. Assess for symptoms that may point toward digestive involvement.
Questions include:
Have you experienced nausea or vomiting?
Do you have abdominal pain?
Have you experienced constipation or diarrhea?
Have your bowel habits changed recently?
Have you noticed abdominal bloating?
Does eating affect your pain?
Nausea and vomiting frequently accompany acute renal colic, but they may also occur with gastrointestinal conditions. The pattern of symptoms helps guide further assessment.
For patients who could become pregnant, reproductive history is an important component of flank or abdominal pain assessment. Ectopic pregnancy and other gynecological emergencies may present with abdominal, pelvic, or referred pain.
Ask:
When was your last menstrual period?
Are your menstrual cycles regular?
Is your period late?
Could you be pregnant?
Have you experienced unusual vaginal bleeding?
Do you have pelvic pain?
Have you noticed unusual vaginal discharge?
Are you experiencing pain during sexual intercourse?
A positive pregnancy possibility combined with abdominal or flank pain, especially with vaginal bleeding, dizziness, or fainting, requires urgent evaluation.
A comprehensive past medical history helps identify conditions that increase the likelihood of renal, urinary, or other causes of flank pain.
Ask the patient:
Have you been diagnosed with any medical conditions?
Do you have a history of kidney stones?
Have you experienced recurrent UTIs or kidney infections?
Have you ever been diagnosed with kidney disease?
Have you had previous episodes of flank pain?
Have you undergone kidney or urinary tract surgery?
Have you had a urinary catheter or other urinary procedure?
Do you have a history of hypertension, diabetes, or other chronic illness?
Previous renal disease, urinary obstruction, or recurrent stones can influence the differential diagnosis and the urgency of evaluation. Review relevant medical records when available.
Medication reconciliation is essential because some medications may contribute to kidney injury, affect urinary stone risk, or influence treatment decisions.
Ask:
Do you have any medication allergies?
Do you have food allergies?
What prescription medications do you take?
Do you use over-the-counter pain relievers?
Are you taking vitamins or herbal supplements?
Have you recently started or stopped any medication?
Have you taken antibiotics or pain medication for this episode?
Some medications can affect kidney function or contribute to stone formation in susceptible patients. Document the medication name, dose, frequency, and recent changes when possible.
Family history can reveal inherited conditions and predisposition to kidney stones or renal disease.
Ask:
Does anyone in your family have kidney stones?
Is there a family history of kidney disease?
Have close relatives experienced recurrent UTIs or urinary disorders?
Are you aware of any hereditary conditions affecting the kidneys?
A family history of kidney stones may increase the likelihood of recurrent stone disease. It is useful to document which relatives were affected and whether they experienced similar symptoms.
Lifestyle and environmental factors may influence urinary health, hydration, and the patient’s risk of certain conditions.
Ask:
How much water or other fluid do you drink each day?
Do you smoke or use tobacco products?
Do you consume alcohol?
What is your typical diet?
Have you recently experienced heavy physical activity?
Have you had a recent injury or strenuous exercise?
What is your occupation?
Have you been exposed to heat or conditions that cause excessive sweating?
Low fluid intake and dehydration can contribute to kidney stone risk. Recent heavy lifting or injury may suggest a musculoskeletal cause. Social history should be collected respectfully and connected to the patient’s symptoms.
Sexual history should be obtained when clinically relevant and with attention to privacy, consent, and respectful communication. This assessment may help identify pregnancy-related conditions, sexually transmitted infections, or pelvic disorders that can mimic urinary symptoms.
Ask:
Are you currently sexually active?
Is pregnancy possible?
Have you had unprotected sexual intercourse?
When was your last menstrual period?
Have you noticed unusual vaginal discharge or bleeding?
Are you experiencing pelvic discomfort?
Do you have any history of sexually transmitted infections?
Use a nonjudgmental approach and explain why the questions are relevant. A pregnancy test may be indicated based on reproductive potential and symptoms.
A review of systems identifies additional symptoms that may not have been mentioned during the initial interview. The assessment should remain focused on clinically relevant findings while screening for conditions outside the urinary system.
Assess for:
Fever and chills.
Fatigue or weakness.
Night sweats.
Unintentional weight loss.
Changes in appetite.
Ask about:
Skin rashes.
New skin lesions.
Changes in skin color.
Hair loss.
Nail changes.
These findings may provide clues to systemic or inflammatory conditions when clinically relevant.
Review:
Headaches.
Visual changes.
Hearing concerns.
Sinus symptoms.
Sore throat.
Include these symptoms when indicated by the patient’s history or broader review of systems.
Assess for:
Chest pain.
Palpitations.
Leg swelling.
Shortness of breath.
Persistent cough.
These symptoms may indicate a condition outside the urinary system and may require additional evaluation.
Ask about:
Abdominal pain.
Nausea and vomiting.
Constipation.
Diarrhea.
Changes in bowel habits.
Abdominal bloating.
Review:
Hematuria.
Dysuria.
Urinary frequency.
Urinary urgency.
Difficulty urinating.
Reduced urine output.
Menstrual abnormalities.
Pelvic pain.
Assess for:
Back pain.
Muscle pain.
Joint pain.
Recent injuries.
Pain associated with movement.
Heavy lifting or strenuous activity.
These findings can help identify a possible musculoskeletal source of flank discomfort.
Ask about:
Weakness.
Dizziness.
Numbness.
Tingling.
Increased thirst.
Increased urination.
Heat or cold intolerance.
These symptoms may indicate broader systemic conditions that should be considered during a complete patient assessment.
Certain symptoms require immediate or urgent medical evaluation because they may indicate infection, urinary obstruction, internal bleeding, or another serious condition.
Important red flags include:
Severe, sudden, or rapidly worsening flank pain.
Fever or chills accompanied by flank pain.
Flank pain with confusion, fainting, or signs of low blood pressure.
Inability to urinate or a marked reduction in urine output.
Visible blood in the urine, particularly with severe pain or other concerning symptoms.
Suspected pregnancy with abdominal or flank pain.
Pregnancy with vaginal bleeding, dizziness, or fainting.
Persistent vomiting or inability to maintain hydration.
Severe pain in a patient with a solitary kidney or known kidney disease.
A patient with flank pain and fever, particularly when urinary obstruction is suspected, may have an infected obstructed urinary system. This is a potentially life-threatening emergency and requires prompt medical attention.
Although history-taking is essential, it is only one part of the complete flank pain assessment. The healthcare provider should perform a focused physical examination and order diagnostic tests based on the patient’s presentation.
Relevant components may include:
Assessment of vital signs, including temperature, heart rate, blood pressure, and respiratory rate.
Inspection and palpation of the abdomen.
Assessment for costovertebral angle tenderness.
Evaluation of the back and flank muscles.
Assessment for abdominal guarding or rigidity.
Evaluation of hydration status.
Focused pelvic examination when indicated.
Costovertebral angle tenderness may occur with pyelonephritis but is not specific to one diagnosis. Findings must be interpreted alongside the patient’s history and other examination results.
Depending on the suspected cause, the clinician may order:
Urinalysis to evaluate blood, leukocytes, nitrites, and other findings.
Urine culture when urinary infection is suspected.
Pregnancy testing when pregnancy is possible.
Complete blood count when infection or systemic illness is suspected.
Serum creatinine and other renal function tests when kidney impairment is a concern.
Imaging, such as ultrasound or computed tomography, when indicated.
Diagnostic testing should be guided by clinical findings, pregnancy status, kidney function, and the suspected diagnosis.
A structured flank pain history helps nurses and healthcare providers identify potential causes, recognize urgent warning signs, and support appropriate clinical decision-making. The assessment should not focus exclusively on the kidneys because gastrointestinal, musculoskeletal, and gynecological conditions may produce similar symptoms.
For the NU576 iHuman Smith case, a thorough approach includes pain assessment, associated symptom review, past medical history, medication and allergy review, family history, social history, and reproductive health screening when appropriate. The information collected during the interview supports the differential diagnosis and helps determine the need for further examination, laboratory testing, imaging, or urgent referral.
The key nursing priority is to identify whether the patient’s flank pain is uncomplicated or associated with red flags such as fever, urinary obstruction, severe worsening pain, or possible pregnancy. Early recognition of these findings promotes timely treatment and improves patient safety.
The most important part is a detailed history of present illness. Ask about the onset, location, quality, severity, timing, radiation, and aggravating factors of the pain. Also assess urinary symptoms, fever, nausea, vomiting, and reproductive symptoms when appropriate.
Common causes include kidney stones, UTIs, pyelonephritis, musculoskeletal strain, renal disorders, gastrointestinal conditions, and gynecological disorders. The patient’s history and examination are needed to distinguish between them.
Urinary symptoms such as dysuria, hematuria, frequency, urgency, and reduced urine output may suggest a urinary tract condition. These findings help guide further evaluation for kidney stones, infection, or obstruction.
Severe or worsening pain, fever with flank pain, inability to urinate, confusion, fainting, signs of low blood pressure, and suspected pregnancy with abdominal or flank pain require urgent assessment. Fever with suspected urinary obstruction is particularly concerning.
Pregnancy-related conditions, including ectopic pregnancy, can present with abdominal or pelvic pain that may be mistaken for urinary or flank pain. Asking about the last menstrual period and the possibility of pregnancy helps identify patients who may need urgent evaluation.
American Academy of Family Physicians. (2015). Diagnosis and management of acute pyelonephritis in adults. American Family Physician, 92(10), 875–882. https://www.aafp.org/pubs/afp/issues/2015/1115/p875.html
Bickley, L. S. (2021). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer. https://www.wolterskluwer.com/
European Association of Urology. (2024). EAU guidelines on urolithiasis. https://uroweb.org/guidelines/urolithiasis
McCance, K. L., & Huether, S. E. (2023). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier. https://www.elsevier.com/
National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Kidney stones. National Institutes of Health. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones
National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Bladder infection (urinary tract infection—UTI) in adults. National Institutes of Health. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults
