American Sentinel N522PE Module Four: Gastrointestinal, Breast and Axilla Assessment

When the patient arrives at the Emergency Department complaining of pain, the clinician’s most crucial thing is to determine by immediate assessment if this is a life-threatening condition or something that will resolve on its own. It has been reported that 40% to 45% of patients have pain that is not specific, although 15% to 30% often require surgery (Bickley & Szilagyi, 2017). If the patient presents with extreme pain lasting for no more than 6-24 hours, it usually means that the patient will most likely require surgery (Dain et al., 2016). Some of the most life-threatening conditions that require emergent care are perforated or ruptured appendix; ruptured abdominal aorta; small bowel obstruction; ectopic pregnancy; malrotation, and intussusception in an infant (Dains et al., 2016).

Several studies have evaluated patients’ most frequent diagnoses presenting with acute abdominal pain to the emergency room. The findings point to appendicitis as the top diagnosis in many articles. The observational retrospective study in India ER looked at the type of abdominal pain, onset, and primary diagnosis in a large sample. It showed that ureteric colic, urinary tract infection, pancreatitis, and appendicitis to be the most frequent diagnosis. The type of pain that was most frequently recorded was a dull pain. (Chanana et al., 2015).

The ER algorithm for non-traumatic abdominal pain management is geared towards nursing assessment and interventions in my institution. Upon patient arrival in the Emergency Department, the registered nurse will start with the assessment of chief complaint, signs/symptoms with a full description, onset, and duration. The history of allergies, current medication, and past medical history will be taken. History of a chief complaint will be assessed deeper, including pain location, severity and radiation; in female patients, GYN history will be obtained (i.e., LMP, gravida, possibility of pregnancy).

Focused assessment will be performed, including inspection for distention, scars, masses, auscultation for bowel sounds, palpation for tenderness, bruit, elicited pain response, and rigidity. The initial set of vital signs to be taken /assessed, including pain scale from 0-10. The patient to be kept NPO until MD indicates otherwise. At this point, Nursing to consider acute causes: abdominal aortic aneurysm, ectopic pregnancy, appendicitis, etc.

IV site (s) to be established and labs/urine obtained including CBCD, BMP, LFT’s and Lipase. Urine sample to be secured with UA and Urine HCG to rule out pregnancy prior to ordered radiologic tests. Other lab samples to be taken as ordered by MD, such as Coag Profile, Amylase, Lipase, Lactic acid, and stool culture and blood cultures. Medications to be administered as ordered by MD (such as analgesic, anti-emetic, IVF, p.o.gastrograph). At this point, the secondary assessment to be performed. Pain levels to be reassessed 30-60 minutes after pain medication was given. Vital signs, according to the acuity level outlined in ED vital signs policy to be reassessed. The patient to be prepared for all radiologic tests (x-ray, ultrasound, CT scan) by explaining the procedure, length of time to take/get results, and the purpose of each. Patient should be changed into gown with under garments removed. As ordered by MD, other interventions should be performed based on working diagnosis and diagnostic tests’ initial results. GI or surgery consult to be called timely.

References

Bickley, L. S., & Szilagyi, P. G. (2017). Bates guide to physical examination and history taking

(12th ed.). Wolters Kluwer.

Chanana, L., Jegaraj, M.A.K., Kalyaniwala, K., Yadav, B., & Abilash, K. (2015). Clinical profile

of non-traumatic acute abdominal pain presenting to an adult emergency department. Journal of Family Medicine and 

       Primary Care, 4(3), 422–425. doi: 10.4103/2249-4863.161344

Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). Advanced Health Assessment and Clinical

       Diagnosis in Primary Care (5th ed.). Elsevier.