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Case Study: Acute Abdominal Pain
Patient Profile:
Mrs. Johnson is a 54-year-old female who presents to the emergency department with severe abdominal pain that started suddenly about an hour ago. She describes the pain as a sharp, stabbing sensation in the lower right quadrant of her abdomen that radiates to her back. She also reports nausea, vomiting, and an inability to pass gas or have a bowel movement for the past 24 hours. Mrs. Johnson has a history of hypertension, hyperlipidemia, and type 2 diabetes, which are well-controlled with medications. She denies any recent illnesses, surgeries, or injuries.
RELEVANT Data from Present Problem: Clinical Significance:
Severe abdominal pain in the lower right quadrant that radiates to the back – Indicates a potential acute abdominal condition, such as appendicitis, diverticulitis, or cholecystitis, that requires prompt medical attention.
Nausea and vomiting – Suggests possible gastrointestinal irritation or obstruction.
Inability to pass gas or have a bowel movement – Suggests possible intestinal obstruction or peritonitis.
RELEVANT Data from Social History: Clinical Significance:
History of hypertension, hyperlipidemia, and type 2 diabetes – Indicates possible risk factors for cardiovascular disease and complications related to these conditions.
RELEVANT Assessment Data: Clinical Significance:
Abdomen: Tender to palpation in the lower right quadrant with guarding and rebound tenderness. No distension or visible masses noted. Bowel sounds hypoactive. – Indicates possible acute abdominal condition, such as appendicitis, diverticulitis, or cholecystitis, that requires prompt medical attention. Tenderness and guarding suggest peritoneal irritation, while hypoactive bowel sounds suggest possible intestinal obstruction.
Vital signs: BP 160/90 mmHg, HR 110 bpm, RR 20/min, T 37.8°C, SpO2 98% on room air – Indicates tachycardia and hypertension, which may be due to pain, anxiety, or underlying medical conditions. Fever may suggest infection or inflammation.
Clinical Judgement:
Based on the assessment data, the patient is experiencing severe abdominal pain, nausea, vomiting, and inability to pass gas or have a bowel movement, which may indicate acute abdominal conditions such as appendicitis, diverticulitis, or cholecystitis. Immediate intervention is required to address the patient’s pain, evaluate her vital signs, and rule out potential complications such as peritonitis or sepsis.
The priority diagnostic/laboratory tests that the MRHP may order include:
Complete blood count (CBC) to evaluate for leukocytosis, which may indicate infection or inflammation.
Basic metabolic panel (BMP) to evaluate electrolyte and renal function, which may be affected by vomiting or dehydration.
Liver function tests (LFTs) to evaluate for possible cholecystitis or other liver conditions.
Urinalysis to evaluate for possible urinary tract infection or other kidney conditions.
Abdominal ultrasound or CT scan to evaluate the abdomen for signs of inflammation, infection, or obstruction.
The focus of the assessment is on the abdominal system, as the patient is presenting with severe abdominal pain and other symptoms that suggest possible acute abdominal conditions.
The MRHP may order an analgesic medication such as morphine or hydromorphone to manage the patient’s pain, but caution should be taken to avoid masking any potential diagnostic signs or worsening the patient’s condition.
Nursing interventions that should be provided first based on the initial assessment include:
Administering antiemetic medication to address the patient’s nausea and vomiting.
Starting an IV line and administering IV fluids to address any possible dehydration or electrolyte imbalances.
Providing oxygen therapy as needed to address any potential respiratory distress.
Assessing the patient’s vital signs frequently and monitoring for any changes or signs of worsening condition.
Assessing the patient’s pain level and response to analgesic medication.
Preparing the patient for potential diagnostic tests or procedures, such as an ultrasound or CT scan.
Based on the assessment data and initial interventions, the MRHP may diagnose the patient with acute appendicitis. The patient may undergo a laparoscopic appendectomy procedure to remove the inflamed appendix and prevent potential complications such as rupture or peritonitis.
Postoperatively, nursing interventions may include:
Monitoring the patient’s vital signs and assessing for any signs of bleeding or infection.
Administering pain medication as needed and monitoring for any adverse reactions.
Assessing the patient’s incision site for signs of healing or infection.
Encouraging the patient to ambulate and perform breathing exercises to prevent complications such as deep vein thrombosis or pneumonia.
Providing education to the patient and family on postoperative care, pain management, and signs and symptoms to report to healthcare providers.
Acute abdominal pain requires prompt medical attention and a thorough assessment to identify potential underlying conditions and prevent complications. The MRHP should prioritize interventions such as pain management, fluid and electrolyte balance, and diagnostic testing to determine the cause of the patient’s symptoms and provide appropriate treatment. Effective nursing care plays a crucial role in managing patients with acute abdominal pain and facilitating their recovery.
