Pain Case Summary

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.

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

She is oriented x3, alert, cooperative. Good short-term, long-term, and intermediate memory. No aphasia. Normal fund of knowledge. Normal attention and concentration.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

Ht: 62”, Weight: 134 pounds, BMI: 24.5 Temp 98.4 BP 128/90 P 76 R18, even. The Oxygen saturation 98%.

The pt c/o abdomen8/10 pain x8 days. Pt was seen in the ER and in the clinic. However, current prescribed treatments are not relieving her pain. Pt states the her last BM was 2 days ago after taking Mag Citrate. Pt denies radiating pain. Due to increase pain level, per PA Alford the pt was instructed to go to the ER to be

Upon inspection the contour of the patients abdomen was rounded, symmetric, color appropriate to genetic background, striae present, 6 to 8 round bruises from subcutaneous injections. No apparent pulsations, masses, lesions, rashes, wounds, ascites, scars, or hernias present. Auscultated bowel sounds in all four quadrants; hyperactive sounds heard in lower right quadrant, hyperactive sounds heard in upper right quadrant, normoactive bowel sounds in upper left quadrant, and hyperactive bowel sounds heard in lower left quadrant. Auscultated the aorta, renal arteries, and iliac arteries for vascular sounds, no bruits heard. Lightly palpated the abdomen in all four quadrants, patient felt tenderness on bruised areas, no masses present, abdomen distended. Percussed the abdomen in all four quadrants noting the predominately tympanic in all four quadrants and minimum dullness. The patient’s last bowel movement was around 0830, loose, with no pain. The patient stated having three to five loose bowel movements daily and that, “several bowel movements a day was common for her.” The patient describe the characteristics of her bowel movement as “watery, stinky, and not a large amount”. No prescription medication related to the abdomen. However, patient takes over the counter medication for frequent bowel movements at home. No surgeries related to the abdomen. No laboratory data related to the

Vital signs: Blood Ppressure: 120/78 mmHg, Hheart Rrate: 92 beats/min, Rrespirations: rate 15 breaths/min, O2 Soxygen saturation: 97% on room air

According to Laurell, Hansson and Gunnarsson (2013), appendicitis is one the most common differential diagnoses among young males and accounts for a vast number of complaints of acute abdominal pain to the right iliac fossa with nausea and a loss of appetite. The inflamed appendix may develop secondary to blockage from either inflammation or stool and the diagnosis criteria consists of collecting assessment data like, an elevated white blood cell count, c-reactive protein and confirmation with either a computed tomography (CT) or ultrasound (Purysko, 2011). Acute appendicitis requires immediate treatment to avoid spread of infection and prevent the risk of the individual becoming septic. Other non-emergent causes of acute abdominal pain may include gastroenteritis and hernia. An acute cause of abdominal pain in the 50-year-old male would consist of biliary disease like acute cholecystitis (Sullivan, 2011). The individual would most commonly present with four clinical symptoms, a Murphy's sign (palpation with inhalation), acute pain in the right upper abdomen, leukocytosis, and possibly febrile (Schuld & Glanemann, 2015). This disease is an emergency requiring immediate surgical intervention known as a cholecystectomy and is often triggered by biliary obstruction of stones or bacterial infection resulting in possible

Client’s abdomen on inspection looks flat and symmetric, without bulging, or visible masses, or any asymmetric shapes. Umbilicus is in midline and inverted without any sign of discoloration, inflammation, or hernia. Further, skin is smooth with even homogenous color, and multiple pigmented circumscribed brown macular and popular nevi (smaller than 1 cm), there are no visible veins, and when skin gently pinched and released, it was immediately returning to original position. No any pulsation observed, like from aorta in the epigastric area, no respiratory movements of any waves or peristalsis are visible. Pubic hair was distributed evenly, in diamond shape. The client observed with benign facial expression and slow even respiration.

SC placed call to Pa on 2/3/2016 and completed M T/C. The Pa reported no change in health status, falls, ER visit or hospitalization. The did report that he’s entering into a pain management program due to his diagnoses: DJD, Herniated Disks in neck, Vertebrae Deterioration, Osteoarthritis, Rheumatoid Arthritis, Arthritis of the Spine & knee, Bulging Disc – lower back, Lumbar Degenerative Disc Disease, Carpal Tunnel, and Levoscoliosis, with symptom of shooting and stabbing pain at a rate of 9/10 w/o meds and 7/10 w/ meds, headaches, difficulty bending, limited ROM in legs and arms, unsteady gait, knees, Pa stated that his R leg is longer than L leg, and they are going make him a special shoe to make his legs equal so that he can walker better

Height: (without shoes) 5’ 10”. Weight: (dressed) 160lbs. BMI: 22.96. BP: 110/70 (right arm supine) HR: 70. RR 16. Temperature (oral) 98.6F.

This book was written by couple David P. Barash and Judith Eve Lipton. They are both a psychologist and psychiatrist respectively. Their book starts out with the topic of pain. How it causes suffering. Everyone feels pain, which leads to suffering. Suffering is deeper than pain to them (Barash 1). People don’t want to suffer. They want to minimize it, which leads to them passing their pain onto someone else. The couple then give three ways that people try to deal with their pain (besides doing nothing and suffering): the three r’s retaliation, revenge, and redirected aggression (all forms of payback) (Barash 2). These are all different ways to cope with pain. Then its pointed out that this is not just in humans, but in most animals too. Their next argument is how its evolved over time. They say that

Physical Assessment Findings: Abnormal physical findings include Heart: RRR with Grade II/VI systolic murmur heard best at the right sternal border; Rectum: Stool light brown, heme positive. Prostate enlarged, boggy and tender to