Question

J.P. is a 50-year-old man who presents to the gastroenterologist with cramping and diarrhea. Subjective Data Pain level is a 6/10 location = right and left lower abdomen Works as a union construction worker, has missed 1 day of work States he has been going to the bathroom about 8 to 10 times a day for past 2 days Appetite is decreased PMH: Crohn’s disease, depression, anxiety Objective Data Vital signs: T 37 P 80 R 14 BP 120/68 Bowel sounds hyperactive in all four quadrants Medications: Infliximab (Remicade) infusions every 6 weeks, fluoxetine (Prozac) 25 mg per day Weight = 145, last visit weight = 152 Questions

1. What other assessments should be included for this patient?

2. What questions should the nurse ask with regard to the abdominal pain?

3. From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?

4. Develop a problems list from the subjective and objective findings.

5. What should be included in the plan of care?

6. What interventions should be included in the plan of care for this patient?

7. How to do you position and prepare for an abdominal assessment?

8. Inspection of the abdomen include:

9. Why is the abdomen auscultated after inspection?

10. How do you auscultate the abdomen? What are the characteristics of bowel sounds?

11. What sound heard predominately when percussing over the abdomen?

12. What organ can be palpated? 7. Palpation techniques include?

13. Explain visceral and somatic pain.

14. What is rebound tenderness?

15 How do you assess for costovertebral angle tenderness?

Answer 1

1. Other assessment:

a. Head to food assessment

b. Cardiac assessment

c. Abdominal assessment

d. Mini mental status examination

2. Question on abdominal pain:

a. Abdominal pain occur is it before eating or after eating

b. Do u have pain early in morning or late night.

3. Preferable cause of pain:

a. Pain assessment made with objective data, with chrons diseases.

4. List the problems:

a. Right and left lower abdominal pain

b. Anorexia

c. Hyperactive bowel movement

d. Diarrhea 8- 10 times a day

5. Plan of care:

a. Fluid volume deficit related to diarrhea

b. Altered nutritional status related to diarrhea, anorexia

C. Impaired skin integrity due to dehydration

6. Intervention:

1. Encourage to drink oral fluids

2. Intravenous fluids if necessary

3. Pain management

4. Proper skin care

5. Psychological support and counseling

7.Positions:

Supine positions is best for abdominal assessment.

8. Inspection of abdomen:

Color change, shape, discoloration, organomegaly, presence of any scar, vascular discoloration and bruits.

9. Abdomen auscultation after inspection:

Always inspection first, because auscultation with pressure may compress the mass.

10. Auscultation

a. Stethoscope placed over several area for at least five minutes with mild to moderate compression.

b. Gurgling, rumbling and glowing noises due to intestinal muscle contraction or peristaltic movement.

11. Sound

Tympanic or drum like sounds are heard over the abdomen over air filled cavities.

Dull sounds are heard observing ma's.

12. Organ palpated

On deep palpation - liver can be palpable.

Palpation technique- keep 4 finger pad together give 1cm depth on palpation.

13. Visceral pain: it occur duel activation of nociceptor of pelvic, thoracic and abdominal viscera.

Somatic pain: somatic pain is a pain araising from skin, muscles and tissues.

14. Rebounding tenderness:

Pain occur when we remove hand after application of pressure, patient does not have pain with pressure.

15.a.lay your non dominant hand flat over angel and make fist with your dominant hand and firmly thumb the fist with your dominant hand and firmly thumb the fist on the flat non dominant hand. Ask the patient if the felt tenderness or pain.