A nurse is teaching a patient with Parkinson's disease about dietary practices.
What signs and symptoms are potential complications related to this disease? Select all that apply.

Choice A rationale

Palpating along the lumbar vertebral column primarily assesses for spinal tenderness or musculoskeletal issues, not specifically kidney inflammation. The kidneys are retroperitoneal organs, and direct palpation of the lumbar area might not elicit specific tenderness related to pyelonephritis, which involves renal parenchymal inflammation.

Choice B rationale

Striking a flat hand covering the costovertebral angle (CVA) elicits pain if the kidney capsule is inflamed, a classic sign of pyelonephritis. This maneuver, known as CVA tenderness, directly assesses for inflammation of the renal parenchyma or surrounding structures, which become sensitive to percussion with infection.

Choice C rationale

Pushing fingers upward into the two lowest intercostal spaces would primarily assess for liver or spleen enlargement, or tenderness related to the lower ribs, not directly for kidney tenderness. The kidneys are situated more posteriorly and superiorly, making this approach less effective for assessing pyelonephritis.

Choice D rationale

Percussing between the iliac crest and ribs at the midaxillary line targets the flank area but is not the most precise method for assessing kidney tenderness. While it's in the general vicinity, the CVA percussion directly overlies the kidney and is a more specific and sensitive maneuver for pyelonephritis.

Choice A rationale

The genitourinary tract itself can be the site of infection, but E. coli, a common cause of UTIs, primarily originates from the gastrointestinal tract. While the genitourinary system is affected, it's typically a result of ascending bacterial migration rather than the primary source of the E. coli.

Choice B rationale

Gram-negative bacilli, specifically Escherichia coli (E. coli), are normal inhabitants of the human gastrointestinal tract. Due to anatomical proximity, E. coli can easily migrate from the perianal region to the urethra and ascend into the bladder, causing urinary tract infections.

Choice C rationale

The integumentary tract, or skin, primarily hosts a different microbial flora, predominantly gram-positive bacteria like Staphylococcus and Streptococcus species. While skin can be a source of infection, it is not the typical reservoir for E. coli causing urinary tract infections.

Choice D rationale

The nasopharyngeal tract primarily harbors respiratory pathogens such as Streptococcus pneumoniae or Haemophilus influenzae. It is not the source of gram-negative bacilli like E. coli that commonly cause urinary tract infections. Transmission routes for these pathogens are distinct.