Assessment of the Patient with Acute Abdominal Pain

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.

INTRODUCTIONThis is a case study concerning a patient presenting with low abdominal pain, frequent micturation and dysuria. I will discuss the consultation and show how I used the problem solving consultation style detailed by Alison Crumbie. This involves listening to the patients' initial complaint and developing hypothetical diagnosis. Focused questioning and clinical examination and investigations will then be used to eliminate some of the initial hypotheses. The patients' perspective of their problem will be addressed and the synthesis of gathered information will enable the practitioner to arrive at a differential diagnosis and to agree on a treatment plan with the patient so that they can manage their problem.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

c) While palpating the liver ask the pt to take a deep breath. Sharp abdominal pain occurs in pt’s with cholecystitis. (in the RUQ)

Patients present with left lower quadrant pain, reiterating the tendency for diverticulitis to affect the sigmoid colon in western countries. The pain can be constant or intermittent, and lack of appetite, or nausea and vomiting can be present. Physical examination of the abdomen reveals localized tenderness but frank rebound or guarding should be negative. Bowel sounds are frequently distant or depressed, if bowel sounds are very active an obstruction may be present, in mild cases the bowel sounds may be normal. The WBC may be elevated and the patient may present with a fever. Occasionally a palpable mass may be felt and may be very painful. Eating exacerbated the pain of left-sided diverticulitis and pain can be lessened with the passage of feces or flatus. Patients may complain of a feeling of being bloated.

* Refer to primary care doctor to address ongoing pain in stomach client reported it uncontrolled for several month with over the counter medications and to rule out any other medical problems or symptoms.

This paper will examine the the nurses and pain assessment in the hospitalized patient. The paper will focus on pain and pain management and the need to assess pain. How much percentage of the population in the U.S. are experienced pain, and how much of the population abuse the pain medications. There are many barriers which hinder nurses from perform accurate pain assessment. These barriers are nurses experience, competence, perception and manipulation. Pain is subjective, but pain assessment tools and nurses’ perception may contraindicate with what the patients stated. Thus, the paper will try to find solution to accurate pain assessment during hospitalization, especially with abuse of opioid.

Sakeenah is 14 years old African american girl, she comes to the University of Michigan Pediatric Gastroenterology clinic on 5/22/2018 complaining of abdominal pain. She is accompanied mom and dad today and she provides the interval medical history, She states that the pain started month ago, epigastric, and occasionally radiate to right side, described as squeezing or burning pain. She states that the pain is on/off, in scale of 7-8/10, occur more in the morning. The pain lasts few hours several time a day. She feels that "food sits in my stomach and doesn't digest." Sakeenah states that pain is worse when she eating a grassy food, she stop eating it for a while and the pain seems

Patient might experience mild or sever pain, crampy, and aching that is similar to appendicitis. Passing of gas or stool elimination may reduce the adverse effect of pain. According to spivak & deSouza (2008), patient that are of high risk are those with the history of low-fiber diet, constipation, high intake of red meat, severe dehydration, and aging. The diagnostic tests are barium enema which determines number of diverticula, CBC indicates present of anemia, colonoscopy exposes present of diverticula, CT scan reveals changes in the colon wall, GI bleeding scan that identifies active bleeding, and CBC with differential reveals leukocytosis.

The patient states she feels as though her abdominal pain after full workup by the gastroenterologist, is likely related to muscular symptoms. She does state there are certain ways she can move, that she will get the pain.

Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be prompted by the MO. Although with more practice such incidence would be reduced.

It is always challenging to accurately diagnose abdominal pain in the primary care settings. An extensive knowledge of the anatomy and physiology could help narrow down possible causes of abdominal pain.

The American Pain Society (APS, 2008), defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (p.1). According to McCaffery (1968), “pain is whatever the experiencing person says it is, existing whenever he says is does”. Pain is a complex, multidimensional experience. It is present in all clinical settings and in many different patient groups. It is one of the main reasons why people seek medical attention. Many health professionals involved in pain control (Lewis, Heitkemper & Dirksen, 2004). In order to measure the level of knowledge of medical and nursing staff about pain management in critical care patients and the economic impact I make