NU576 IHUMAN Smith flank pain

NU576 IHUMAN Smith flank pain

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NU576 NP II – Primary Care of Women’s Health

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Flank Pain Assessment: Key Questions to Ask During Patient History Taking

Flank pain assessment requires a detailed patient history to identify possible causes such as kidney stones, urinary tract infections, kidney problems, musculoskeletal injuries, or gynecological conditions. A focused interview helps determine the location, severity, timing, associated symptoms, risk factors, and any warning signs that may require urgent evaluation.

Patient Information and Chief Concern

Begin the assessment by understanding the patient’s main concern and the reason for seeking medical care.

Ask:

• How can I help you today?

• What symptoms or problems are concerning you the most?

• When did your flank pain begin?

• Have you experienced flank pain before?

History of Present Illness (HPI) for Flank Pain

A complete history of present illness helps characterize the pain and identify possible causes.

Location and Characteristics of Pain

Ask the patient:

• Where exactly is your flank pain located?

• Can you point to the area where you feel the pain?

• What does the pain feel like (sharp, dull, aching, burning, cramping, or pressure-like)?

• How severe is the pain on a scale from 0 to 10?

• Has the location or intensity of the pain changed since it started?

Radiation and Triggers

Important questions include:

• Does the pain spread or radiate to another area?

• If it radiates, where does it travel?

• What was happening when the flank pain started?

• Does anything make the pain better or worse?

• Does the pain wake you up from sleep?

NU576 IHUMAN Smith flank pain

Previous Episodes and Treatments

Ask:

• Have you had similar flank pain episodes in the past?

• What treatments have you tried for this pain?

• Did any medications, home remedies, or other treatments provide relief?

Associated Symptoms Review

Flank pain may occur with other symptoms that provide important diagnostic clues.

Ask about:

• Fever or chills:

  • When did your fever begin?

  • How high has your temperature been?

• Urinary symptoms:

  • Is your urine pink, red, or bloody?

  • Have you noticed blood in your urine?

  • Are you having difficulty urinating?

  • Has there been a change in how often you urinate?

  • Have you had a urinary tract infection before?

• Gastrointestinal symptoms:

  • Are you experiencing nausea, vomiting, abdominal pain, or changes in bowel habits?

• Reproductive and gynecological symptoms:

  • Is your period late?

  • When did your last menstrual period begin?

  • Are your periods regular?

  • How long do your periods usually last?

  • Is there a possibility that you could be pregnant?

  • Do you have bleeding between menstrual cycles?

  • Do you experience bleeding before your period begins?

Past Medical History (PMH)

Review the patient’s previous health conditions and medical history.

Ask:

• Have you been diagnosed with any new medical conditions since your last visit?

• Do you have a history of kidney stones?

• Have you had kidney infections or urinary problems before?

• Have you had previous episodes of flank pain?

Medication and Allergy History

Review all medications and possible reactions.

Ask:

• Do you have any allergies?

• Are you currently taking prescription medications?

• Are you taking over-the-counter medications, vitamins, or herbal supplements?

Family History

Family history can help identify inherited risks, especially for kidney-related conditions.

Ask:

• Tell me about the health history of your grandparents, parents, and children.

• Does anyone in your family have kidney stones or kidney disease?

Social History and Lifestyle Factors

Lifestyle factors may contribute to symptoms or affect diagnosis.

Ask:

• Are you sexually active?

• Have you had unprotected sexual activity?

• Do you drink alcohol?

  • If yes, what type of alcohol do you drink and how many drinks do you have per day?

• Do you currently smoke or have you smoked in the past?

Sexual and Reproductive Health Assessment

A reproductive health history is important when evaluating flank pain, especially in patients who may be pregnant or have pelvic symptoms.

Ask:

• Are you currently sexually active?

• Have you had unprotected sex?

• Is pregnancy possible?

• When was your last menstrual period?

• Are your menstrual cycles regular?

• Do you have unusual vaginal bleeding or pelvic symptoms?

Review of Systems (ROS)

A complete review of systems helps identify additional symptoms that may not have been mentioned during the initial discussion.

Assess symptoms related to:

General

• Fever

• Chills

• Fatigue

• Unintentional weight changes

Skin, Hair, and Nails

• New skin changes

• Rashes

• Hair or nail changes

Breast

• Breast pain

• Breast changes or discharge

HEENT (Head, Eyes, Ears, Nose, and Throat)

• Headaches

• Vision changes

• Hearing problems

• Sinus or throat symptoms

Cardiovascular

• Chest pain

• Palpitations

• Swelling in the legs

Respiratory

• Shortness of breath

• Cough

• Breathing difficulties

Gastrointestinal

• Abdominal pain

• Nausea or vomiting

• Constipation or diarrhea

Genitourinary

• Blood in urine

• Painful urination

• Urinary frequency changes

• Difficulty urinating

• Menstrual concerns

Musculoskeletal

• Muscle pain

• Back pain

• Joint pain

• Injury-related symptoms

Hematologic

• Easy bruising

• Bleeding problems

• History of anemia

Endocrine

• Increased thirst

• Increased urination

• Heat or cold intolerance

Neurological

• Weakness

• Numbness

• Tingling

• Dizziness

Key Red Flags in Flank Pain Assessment

Certain symptoms may suggest a more serious condition and require further evaluation:

• Severe or worsening flank pain

• Fever with flank pain

• Blood in urine

• Difficulty urinating

• Possible pregnancy with abdominal or flank pain

• Recurrent kidney stone symptoms

• Signs of infection or systemic illness

References

American Academy of Family Physicians. (2015). Diagnosis and management of acute pyelonephritis in adults. American Family Physician. https://www.aafp.org/

European Association of Urology. (2024). EAU guidelines on urolithiasis. https://uroweb.org/guidelines/urolithiasis

National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Kidney stones. National Institutes of Health. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-stones

NU576 IHUMAN Smith flank pain

McCance, K. L., & Huether, S. E. (2023). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier. https://www.elsevier.com/

Bickley, L. S. (2021). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer. https://www.wolterskluwer.com/