ACUTE ABDOMINAL PAIN P 1015 1017 ETIOLOGY Symptom associated with tissue injury o Abdominal or pelvic organs or blood vessels COMMON CAUSES Abdominal compartment syndrome Acute pancreatitis Appendicitis Bowel Obstruction Cholecystitis Diverticulitis Gastroenteritis Pelvic inflammatory disease Perforated gastric or duodenal ulcer Peritonitis Ruptured abdominal aneurysm Ruptured ectopic pregnancy LIFE THREATENING CAUSES Hemorrhage obstruction perforation CLINICAL MANIFESTATIONS girth DIAGNOSTIC STUDIES o Large fluid loss from vascular space shock and compartment syndrome o GI tract perforation peritoneum irritation and peritonitis Pain obviously the most common problem Nausea vomiting diarrhea constipation flatulence fatigue fever and an increase in abdominal Complete history and physical examination rectum pelvis and abdomen Description of pain frequency timing duration and location Accompanying and sequencing symptoms pain before or after vomiting positions of comfort o Fetal position peritoneal irritation o Supine position with outstretched arms visceral pain o Seated and restless position bowel kidney stone or gallbladder obstruction CBC urinalysis abdominal x ray electrocardiogram ultrasound and CT Pregnancy test to rule out pregnancy Diagnostic laparoscopy to inspect abdominal organs obtain biopsy specimens perform ultrasounds and provide treatments open surgery if not effective COLLABORATIVE MANAGEMENT Goals identify and treat cause then monitor and treat complications o Major complication shock Carefully administer pain medications because it is the number one diagnostic symptom NURSING ASSESSMENT Immediate vital signs Intake and output Inspect abdomen for changes Auscultate bowel sounds o Increased HR and decrease BP indicated hypovolemia o Increased temperature may indicate inflammation or infection o Distention masses abnormal pulsation symmetry hernias rashes scars and pigment o Diminished or absent indicates bowel obstruction acute peritonitis or paralytic ileus Palpitation should be gentle note rebound tenderness Determine onset location intensity duration frequency and character of pain o Has the pain spread or moved Does anything make it better or worse o Associated with nausea vomiting bowel bladder habits or vaginal discharge NURSING DIAGNOSES Acute pain r t inflammation of the peritoneum and abdominal distention Risk for deficient fluid volume r t collection of fluid in peritoneal cavity secondary to inflammation or infection Imbalance nutrition less than body requirements r t anorexia nausea and vomiting Anxiety r t pain and uncertainty of cause or outcome of condition PLANNING Resolutions of inflammation Relief of abdominal pain Freedom from complication especially hypovolemic shock Normal nutritional status NURSING IMPLEMENTATION Provide medications and comfort measures Management of fluids electrolytes pain and anxiety Ongoing assessment of vital signs I O LOC for signs of hypovolemia EMERGENCY MANAGEMENT PREOPERATIVE CARE Etiology o Inflammation appendicitis cholecystitis crohn s disease gastritis pancreatitis pyelonephritis and ulcerative colitis o Vascular ruptured aortic aneurysm and mesenteric vascular occlusion o Gynecologic pelvic inflammatory disease ectopic pregnancy and ovarian cyst o Infectious E coli Giardia and Salmonella o Other obstruction or perforation of internal organ GI bleeding or ischemia and trauma Assessment findings o Diffuse localized dull burning or sharp abdominal pain or tenderness o Rebound tenderness o Abdominal distention or rigidity o Nausea vomiting diarrhea or hematemesis o Melena o Hypovolemic shock Increased HR Cool clammy skin Decreased BP pulse pressure level of consciousness and urine output Interventions o Initial Obtain blood for CBC and electrolyte levels Obtain urinalysis Ensure patient airway Administer oxygen via nasal cannula or non rebreather IV assess with two large bore IV catheters Infuse warm normal saline or lactated ringers Amylase levels pregnancy tests clotting studies and type and cross match Insert indwelling urinary catheter Insert NG tube as needed o Ongoing monitoring Monitor vital signs LOC oxygen saturation and I O Assess quality and amount of pain Assess amount and character of emesis Anticipate surgical intervention Keep NPO POSTOPERATIVE CARE NG tube to low suction to empty stomach and prevent gastric dilation o Upper GI drainage dark brown red first 12 hours then light yellowish brown or greenish Continued dark red color may indicate hemorrhage Coffee ground granules can be caused by acidic gastric secretions mixing with blood Antiemetics may be ordered for nausea and vomiting Swallowed air and reduced peristalsis from decreased mobility manipulation of organs and anesthesia abdominal distention and gas pains o Early ambulation o Metoclopramise Reglan or alvimopan Enereg to promote peristalsis AMBULATORY AND HOME CARE Teaching activity modification care of incision diet and drug therapy o Clear liquids then slow progression to regular diet o Early ambulation slow activity progression with planned rest periods o No heavy lifting o Notify health care provider fever vomiting pain weight loss incisional drainage and change in bowel function CHRONIC ABDOMINAL PAIN P 1017 May originate from abdominal structures or from site with the same similar nerve supply Common causes o Irritable bowel syndrome o Diverticulitis o Peptic ulcer disease o Chronic pancreatitis o Hepatitis o Cholecystitis o Pelvic inflammatory disease o Vascular insufficiency Diagnosis o Thorough history and description of pain characteristics o Character and severity of pain location duration and onset Relation of pain to meals defecation and activity Factors that increase or decrease pain Dull aching or diffuse o Endoscopy CT scan MRI laparoscopy and barium studies Treatment o Comprehensive and directed at palliation and symptoms o Nonopioid analgesics antiemetic and psychologic or behavioral therapies