Lab Assignment: Assessing the Abdomen

Abdominal pain can result from various sources, including injuries and other pathologies such as infection. A comprehensive assessment is integral to help determine the sources of the pain and intervene accordingly to promote better health outcomes.

Lab Assignment: Assessing the Abdomen

The abdominal assessment follows the four physical assessment techniques: auscultation, percussion, palpation, and observation, and entails a series of questions to aid in diagnosis and management. This essay analyzes a patient presenting with abdominal pain, subjective and objective data, current diagnosis, additional tests, and differential diagnoses for the patient.

Additional Subjective Data

It is also essential to understand the pain rating and if it has ever occurred before. Other information includes aggravating and relieving factors for the pain. Pain characteristics include crushing, compression, or sharp pain (Ball et al., 2019). Voiding pain, characteristics, and frequency. Characteristics of vomitus could also help create a definitive diagnosis. Other questions include the ability to initiate and maintain feeds.

Additional Objective Data

Additional objective data include assessing current pain characteristics, abdomen distention, engorged veins, and pain in other abdominal quadrants (Ball et al., 2019). In addition, the care provider should assess for pulsation around the navel or bruits in the major abdominal blood vessels.

Assessment and Subjective and Objective Data

In most cases, Abdominal Aortic Aneurysms (AAA) are asymptomatic, and some of the symptoms include pulsating pain near the navel, back pain, and deep constant pain in the abdomen (Golledge. 2019). The subjective and objective data do not support this assessment. A perforated ulcer is characterized by severe, sudden, and sharp abdominal pain that does not radiate to any body part (Stern et al., 2021).

The pain starts immediately and persists. The pain intensifies with coughing, sneezing, or walking and thus make it difficult to carry out activities of daily living. The skin also appears clammy and pale, all absent in this patient. Pancreatitis presents with abdominal pain radiating to the back, which is synonymous with patient assessment data. Other symptoms include nausea and vomiting, diarrhea, fat in stool, and tender and swollen abdomen.

Diagnostic Tests

When a patient presents with abdominal pain, additional tests to assist with a diagnosis include an ultrasound to determine changes in abdominal viscera characteristics. WBC to rule out inflammation, lipase amylase to determine injury to the pancreas and diagnose or rule out pancreatitis, liver function tests to determine liver involvement, serum electrolytes to diagnose or rule out metabolic causes, urinalysis helps rule out urogenital causes, and ECG to rule out cardiovascular pain causes (Ball et al., 2019).

An abdominal CT or X-ray will help rule out or diagnose an abdominal aortic aneurysm. Another test is blood sugar tests, including fasting and random blood sugars and HbA1c tests. These tests will help determine problems with pancreas functions (Mederos et al., 2021).

Current and Differential Diagnosis

I would reject the current diagnosis based on the patient’s presentations. More than half the patients with aneurysms present with no symptoms, and severe sharp pain in the abdomen, back, or chest indicates a rupture or the aneurysm is about to rupture.

The patient reports pain radiating to the back, nausea and vomiting, and a tender abdomen with guarding hence a diagnosis of pancreatitis (Golledge, 2019). Pancreatitis interferes with hormone production, thus problems with glucose regulation and fat metabolism. However, additional tests are necessary to make a definitive diagnosis.

One differential diagnosis is perforated peptic ulcers. Peptic ulcers result from corrosion and infection of the stomach walls by Helicobacter pylori (Stern et al., 2021). Peptic ulcer perforation results from prolonged inflammation of the skin leading to a hole and the spillover of gastric contents into the peritoneum.

The contents are acidic and lead to peritoneum inflammation hence the excruciating and disabling pain. The condition only occurs after a prolonged period with poor peptic ulcer control. It presents hypogastric pain of sudden onset, usually severe and persistent (Stern et al., 2021). However, the patient presents with intermittent pain radiating in nature, ruling out the disease.

The second differential diagnosis is viral hepatitis, an inflammation of the liver from viral infection. The condition has an acute onset, often after a viral infection. Hepatitis B is the most common viral hepatitis and presents with abdominal pain, especially in the upper right quadrant, fatigue, nausea, and vomiting (Razavi, 2020). Other presentations include low-grade fever, loss of appetite, and joint pain. The pain is persistent and non-radiating, eliminating peptic ulcer as a diagnosis.

The third differential diagnosis is septic peritonitis. Septic peritonitis is the inflammation of the peritoneum from infection by bacteria or fungi. Brown et al. (2021) note that the condition often results from aseptic abdominal surgeries or perforated ulcers. The condition is severe and often requires patient admission for inpatient management.

The condition presents with pain, but the pain is non-localized and in all four quadrants. Other symptoms are abdominal pain, nausea, vomiting, bloating, loss of appetite, and fever (Brown et al., 2021). Individuals with peritonitis may have fluid accumulation leading to pain in activities such as rising from sitting conditions and abdominal edema hence difficulty palpating abdominal viscera. In addition, the pain in peritonitis does not radiate to the back. Therefore the patient’s presentations eliminate the acute peritonitis.

References

  • Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel\’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
  • Brown, D., Vashisht, R., & Alvarado, J. A. C. (2021). Septic Peritonitis. In StatPearls [Internet]. StatPearls Publishing.
  • Golledge, J. (2019). Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nature Reviews Cardiology, 16(4), 225-242. https://doi.org/10.1038/s41569-018-0114-9
  • Mederos, M. A., Reber, H. A., & Girgis, M. D. (2021). Acute pancreatitis: a review. JAMA, 325(4), 382-390. https://doi.org/10.1001/jama.2020.20317
  • Razavi, H. (2020). Global epidemiology of viral hepatitis. Gastroenterology Clinics49(2), 179-189. https://doi.org/10.1016/j.gtc.2020.01.001
  • Stern, E., Sugumar, K., & Journey, J. D. (2021). Peptic ulcer perforated. In StatPearls [Internet]. StatPearls Publishing.

Lab Assignment Instructions: Assessing the Abdomen

A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with AAA ; however, as a precaution, the doctor ordered a CTA scan.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible

TO PREPARE

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

  • With regard to the Episodic note case study provided:
    • Review this week’s Learning Resources, and consider the insights they provide about the case study.
    • Consider what history would be necessary to collect from the patient in the case study.
    • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
    • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

THE ASSIGNMENT

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by the subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Assignment 1 Abdominal Case

ABDOMINAL ASSESSMENT

Subjective:

CC: “My stomach has been hurting for the past two days.”

HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain. 

PMH: HTN

Medications: Metoprolol 50mg

Allergies: NKDA

FH: HTN, Gerd,  Hyperlipidemia

Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female 

Objective:

  • VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Skin: Intact without lesions, no urticaria
  • Abd: abdomen is tender in the epigastric area with guarding but without mass or rebound.
  • Diagnostics: US and CTA 

Assessment:

  1. Abdominal Aortic Aneurysm (AAA)
  2. Perforated Ulcer
  3. Pancreatitis

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.