Abdominal Pain & Trauma PDF

Abdominal Pain & Trauma Dr.Sibi Peter,PhD,RN,CCRN Etiology and Pathophysiology Acute Abdominal Pain Chronic Abdominal Pain  Acute abdominal pain is a  Chronic abdominal pain may symptom associated with originate from abdominal tissu...

Abdominal Pain & Trauma Dr.Sibi Peter,PhD,RN,CCRN Etiology and Pathophysiology Acute Abdominal Pain Chronic Abdominal Pain  Acute abdominal pain is a  Chronic abdominal pain may symptom associated with originate from abdominal tissue damage. structures or may be referred  from a site with the same or a It can arise from damage to similar nerve supply. abdominal or pelvic organs and blood vessels.  Certain causes (e.g., hemorrhage, obstruction, perforation) can be life threatening because large fluid losses from the vascular space lead to shock and abdominal compartment syndrome. Etiology and Pathophysiology  Abdominal Compartment Syndrome is organ dysfunction caused by intraabdominal hypertension.  Perforation of the GI tract also results in irritation of the peritoneum (serous membrane that forms the lining of the abdominal cavity) and peritonitis. Etiology and Pathophysiology Common Causes Acute Abdominal Pain Chronic Abdominal Pain  Abdominal compartment  IBS syndrome   Diverticulosis Acute pancreatitis  Appendicitis  PUD  Bowel obstruction  Chronic Pancreatitis  Cholecystitis  PID  Diverticulosis   Vascular Insufficiency Perforated gastric or duodenal ulcer  Ruptured ectopic pregnancy  Gastroenteritis Clinical Manifestations Pain is the most common symptom of an abdominal problem  The patient may complain of:  Nausea  Vomiting  Diarrhea  Constipation  Flatulence  Fatigue  Fever  Increased abdominal girth Diagnostic Studies  Acute Abdominal Pain  CBC  Urinalysis  Abdominal X-ray  EKG  Ultrasound or CT scan  Pregnancy test is performed in women of childbearing age with acute abdominal pain to rule out ectopic pregnancy.  Careful use of pain medications (e.g., morphine) provides pain relief without interfering with diagnostic accuracy when patients have non traumatic, acute abdominal pain. Diagnostic Studies  Chronic Abdominal Pain  Endoscopy  CT scan  MRI  Laparoscopy  Barium Studies Nursing Assessment  TAKE VITAL SIGNS  Relationship of pain to IMMEDIATELY meals, defecation, and  Increased Pulse activity   Factors that increase or Decrease BP  Increased Temp decrease pain  Changes in bowel  Complete history & physical movements or bladder examination habits  Inspect, Auscultate and  Accompanying symptoms Palpate the abdomen**  Sequencing of symptoms  Description of pain  Ex. Pain before or after  Frequency, Timing, Duration, and vomiting Location Nursing Assessment (cont’d) You need to note the patients position:  Fetal posture is common with peritoneal irritation (e.g., appendicitis)  Supine posture with outstretched legs is seen in visceral pain  Restless and a seated position commonly occur with bowel obstructions and obstructions from kidney stones and gallstones. Nursing Assessment (cont’d) Assessment Findings Abdominal/ Gastrointestinal Hypovolemic Shock  Diffuse, localized, dull, burning, or  Decrease BP sharp abdominal pain or tenderness  Decrease Pulse  Rebound tenderness  Tachycardia  Abdominal distension  Cool, clammy skin  Abdominal rigidity  Decreased LOC  Nausea and vomiting   Decrease Urine output Diarrhea  (