1820: 42-year-old male endorsing right-sided flank pain, nausea, vomiting, dysuria, increased urinary frequency, and hematuria. The symptoms started twelve hours ago and have worsened. The client reports the pain as a '9' (0-no pain; 10-extreme pain). He states the pain is further exacerbated with urination, described as 'sharp and throbbing.' He says he recently ran out of prescribed medications because he lost his job. He has a medical history of major depressive disorder, gout, hypertension, and hyperlipidemia.

• Oral temperature 98° F (36.7° C)
• Heart rate 113/minute
• Respirations 22/minute
• Blood pressure 139/89 mm Hg
• Pulse oximetry 96% on room air

• Ketorolac 30 mg intramuscular (IM) x 1 dose now
• Computed tomography (CT) scan of the abdomen and pelvis without contrast
• Urine analysis
• One liter 0.9% saline bolus over one hour
• Ondansetron 4 mg Disintegrating Tablet x 1 dose now

2030: The client reports no pain, nausea, or vomiting. Stating, 'I feel so much better.' CT scan results showed a 2 mm stone in the right kidney. Dr. T. Smith gave a verbal order to discharge the client home and follow up with the primary healthcare provider (PHCP) within one week. Discharge teaching provided.