NursingSKL clinical tip
April 11, 2023
When approaching a patient with non-traumatic abdominal pain, there are a few critical questions to ask. These questions will determine the potential underlying etiology and the stability of the patient.
- Because numerous conditions that cause acute abdominal pain can be life threatening, it is imperative to urgently assess a patient’s vital signs and search for symptoms/signs of hemodynamic instability and sepsis. For instance, a young patient may have a ruptured appendix, or an elderly patient may have a perforated bowel because of diverticular disease. In both of these situations, the patient can become febrile and hemodynamically unstable (low blood pressure and high pulse rate) because of sepsis. Another cause of abdominal pain is a ruptured aortic aneurysm. Here a patient can very quickly become hemodynamically unstable and go into hypovolemic shock. Initially patients may be light headed and dizzy, but they can rapidly lose consciousness.
- The location of the abdominal pain can suggest the etiology of the pathology.
In this particular case, the patient noted left lower quadrant pain. The pain was associated with bloody diarrhea (five bowel movements per day). The pain persisted even after bowel movements. The patient had blood work performed that showed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Their fecal calprotectin was elevated. Colonoscopy demonstrated numerous ulcers and vascular injection. The patient was diagnosed with ulcerative colitis.
Clinical tip: In a patient with abdominal pain, always assess temperature and vascular status (blood pressure and heart rate) as bleeds and infections are differential diagnoses.
In this video, you will learn why it is important to clearly identify the location of abdominal pain.
This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to nursingskl.com to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
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