NURS 6512 Week 6 : Abdominal Assessment
The diagnosis of gastroenteritis cannot be supported by current information. The advanced practice nurse needs additional subjective and objective information to complete a proper assessment. Also, diagnostic testing needs to be ordered to rule out any other possible diagnoses. NURS 6512 Week 6 : Abdominal Assessment
Additional Subjective Information Needed
The patient is very vague about his abdominal pain. In his description, he failed to mention the exact location of his abdominal pain. While rating his pain on a scale of 0 to 10, he failed to describe the pain he is feeling. Is the pain sharp, cramping, aching, shooting, stabbing or throbbing? What was the patient doing when the pain started? Are there any foods that aggravate the pain or cause it to flare up? How long does the pain last when it starts? Are there any alleviating factors such as belching or defecating? Does the patient have any problems urinating? Not only does the provider need more information from the patient about the chief complaint, he/she also needs the subjective review of systems (ROS) to complete a proper examination. The subjective ROS would be as follows:
Additional Objective Information Needed
In order to complete a thorough assessment regarding an abdominal complaint, the advanced practice nurse must examine a number of different systems in addition to what has already been assessed. The provider must examine the patient’s groin area to exclude an incarcerated hernia or testicular torsion (Dains, et al, 2016). The provider should also percuss for tenderness in the flanks. Flank pain can indicate a kidney stone. Genital and prostate examinations should be performed in men to rule out sexually transmitted infections (STIs) and prostatitis. The advanced practice nurse must also look for frank blood or fecal occult blood. The presence of blood can indicate an acute process or carcinoma. Because abdominal pain can be referred from other areas, the provider should also examine the lungs, heart, head and neck, and musculoskeletal system (Dains, et al, 2016). NURS 6512 Week 6 : Abdominal Assessment
Is the Current Diagnosis Acceptable?
The current diagnosis is unacceptable without further assessment and testing. While gastroenteritis can be diagnosed via subjective and objective assessment data only (Dains, Bauman, Scheibel, 2015), the advanced practice nurse must rule out any other possible diagnosis. Usually patients with gastroenteritis have a diffuse, cramps, abdominal pain accompanied by nausea, vomiting, diarrhea, and fever. The patient is afebrile with nausea and diarrhea, but has not informed the provider of any vomiting. According to Dains, et al, the patient with gastroenteritis will have hyperactive bowel sounds, which our patient does have. Gastroenteritis usually resolves without any treatment and requires no diagnostic testing.
Conditions That May Be Considered as a Differential Diagnosis
The patient could be experiencing a number of abdominal issues. The patient has complained of diffuse abdominal pain with nausea and has hyperactive bowel sounds. These vague symptoms can also point to ureterolithiasis, bowel obstruction, or irritable bowel syndrome (IBS). Each condition requires specific diagnostic testing in order to form an accurate diagnosis.
1) Ureterolithiasis occurs when kidney stones form in the ureters. The patient reports the sudden onset of excruciating intermittent colicky pain that can progress to a constant pain (Dains, et al, 2016). The pain is in the lower abdomen and flank and radiates to the groin. The patient with ureterolithiasis may also have nausea, vomiting, abdominal distention, chills, and fever (Dains, et al, 2016). Hematuria and urinary frequency can also be present. A urinalysis can be done to determine urine pH and the presence of crystals can help identify stone composition. A definitive diagnosis is made via noncontrast-enhanced helical computed tomography (CT) scan. NURS 6512 Week 6 : Abdominal Assessment
2) Bowel obstruction occurs in newborns, the elderly, and those with recent GI surgery (Dains, et al, 2016). According to Mayo Clinic (2018), causes of intestinal obstruction may include adhesions in the abdomen that form after surgery, an inflamed intestine (Crohn’s disease), diverticulitis, hernias, and colon cancer. The patient usually presents with sudden onset of cramp pain. Vomiting usually occurs early with small intestinal obstruction and late with large bowel obstruction. Obstipation occurs with a complete obstruction, but diarrhea can be present with a partial obstruction (Dains, et al, 2016). Hyperactive, high-pitched bowel sounds can be present with a small bowel obstruction. A mass may be palpable in a lower obstruction. Abdominal distention can be present. Definitive diagnosis is made with abdominal x-rays, CT scan, or MRI.
3) Irritable bowel syndrome (IBS)– is a common disorder that is characterized by abdominal cramping, abdominal pain or discomfort, bloating, and altered bowel habits, consisting of diarrhea or constipation or alternating between diarrhea and constipation (Hurd, et al., 2013). The patient with IBS will have a normal bowel examination and the stool will be negative for blood. If the onset of IBS is at middle age or older, if the stool is positive for blood, if there is a family history of colorectal cancer or polyps, or if the patient fails to show improvement of symptoms after 6 to 8 weeks of therapy a proctosigmoidoscopy or barium enema (BE) should be considered (Dains, et al). NURS 6512 Week 6 : Abdominal Assessment