Download ppt - TAEM10: Acute Abdomen - Nurse

The acute abdomenThe acute abdomen

SUJITRAPORN THABKRONG R.N.,M.N.S.SUJITRAPORN THABKRONG R.N.,M.N.S.

RACHADA-THAPRA MEDICAL CENTERRACHADA-THAPRA MEDICAL CENTER

Acute abdomenAcute abdomen

:: ความสำ�าค�ญความสำ�าค�ญ

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-- Fast assessment Fast assessment

- Fast treatment - Fast treatment

DO NOT WAST TIMEDO NOT WAST TIME

KnowledgeKnowledge

• AnatomyAnatomy

• PhysiologyPhysiology

• PathophysiologyPathophysiology

• Pain Generation & PerceptionPain Generation & Perception

DefinitionDefinition

Acute Abdominal PainAcute Abdominal Pain Chronic Abdominal Chronic Abdominal PainPain

- Arises suddenly- Arises suddenly - - May appear as acute pain May appear as acute pain

initiallyinitially

- Individuals usually present- Individuals usually present - Persists or progresses over - Persists or progresses over

within 48 hrwithin 48 hr weeks or months weeks or months - signs & symptoms occurred- signs & symptoms occurred - Initially chronic abdominal - Initially chronic abdominal

within 7 dayswithin 7 days pain is considered ”acute“ pain is considered ”acute“

until work-up revealsuntil work-up reveals

- Pain lasting ≥ 6 hrs- Pain lasting ≥ 6 hrs otherwise otherwise

- ? Disorder of surgical- ? Disorder of surgical

significancesignificance

PainPain : : Generation & Perception Generation & Perception

VisceralVisceral ParietalParietal ReferredReferred

NociceptiNociceptionon

Dull acheDull ache SharpSharp Dull / SharpDull / Sharp

LocationLocation Midline / Midline / GeneralizedGeneralized

Specific / Specific / LocalizedLocalized

Vague & well Vague & well localizedlocalized

CauseCause

- Stretching- Stretching

- Distension- Distension

- Torsion- Torsion

- Contraction- Contraction

Direct irritation to Direct irritation to the peritoneal the peritoneal

lininglining

Visceral Visceral afferents & afferents & spinal somatic spinal somatic afferents afferents enter spinal enter spinal cord at same cord at same levellevel

Importance of AnatomyImportance of Anatomy & Physiology in Assessment& Physiology in Assessment

Diffuse PainDiffuse Pain- Peritonitis- Peritonitis

- Pancreatitis- Pancreatitis

- Leukemia- Leukemia

- Sickle Cell- Sickle Cell

CrisisCrisis

- Early- Early

AppendicitisAppendicitis

- Mesenteric- Mesenteric

AdenitisAdenitis

- Mesenteric- Mesenteric

ThrombosisThrombosis

- Gastroenteritis- Gastroenteritis

- Aneurysm- Aneurysm

- Colitis- Colitis

- Intestinal- Intestinal

ObstructionObstruction

- Metabolic - Metabolic CauseCause

- Toxic - Toxic OverdoseOverdose

- Bacterial- Bacterial

InfectionInfection

RUQRUQ PainPain- Gall Bladder- Gall Bladder

- Biliary Tract- Biliary Tract

- Hepatitis- Hepatitis

- - HepatomegalyHepatomegaly

Due to CHFDue to CHF

- Peptic Ulcer- Peptic Ulcer- PancreatitisPancreatitis

- Retrocecal - Retrocecal

Appendicitis Appendicitis

- Renal Pain- Renal Pain

- Herpes Zoster- Herpes Zoster

- Myocardial- Myocardial

IschemiaIschemia

- Pericarditis- Pericarditis

- Pneumonia- Pneumonia

- Empyema- Empyema

LUQ PainLUQ Pain- Gastritis- Gastritis

- Pancreatitis- Pancreatitis

- Splenic- Splenic

EnlargementEnlargement

- Splenic Rupture- Splenic Rupture

- Splenic - Splenic InfarctionInfarction

- Splenic - Splenic AneurysmAneurysm


- Herpes Zoster- Herpes Zoster

- Myocardial- Myocardial

IschemiaIschemia

- Pneumonia- Pneumonia

- Empyema- Empyema

RLQ PainRLQ Pain- Appendicitis- Appendicitis



- Regional - Regional EnteritisEnteritis

- Diverticulitis- Diverticulitis

- Cholecystitis- Cholecystitis

- Perforated Ulcer- Perforated Ulcer

- Leaking - Leaking AneurysmAneurysm

- Abdominal Wall- Abdominal Wall

HematomaHematoma

- Ectopic- Ectopic

PregnancyPregnancy

- Ovarian Cyst- Ovarian Cyst

- Ovarian- Ovarian TorsionTorsion

- Salpingitis- Salpingitis

- Mittelschmerz- Mittelschmerz

- Endometriosis- Endometriosis

- Ureteral Calculi- Ureteral Calculi


- Seminal - Seminal VesiculitisVesiculitis

- Psoas Abscess- Psoas Abscess

LLQ PainLLQ Pain- Diverticulitis- Diverticulitis



- Appendicitis- Appendicitis

- Leaking Aneurysm- Leaking Aneurysm

- Abdominal Wall- Abdominal Wall

AneurysmAneurysm

- Ectopic- Ectopic

PregnancyPregnancy

- Mittelschmerz- Mittelschmerz

- Ovarian Cyst- Ovarian Cyst

- Ovarian- Ovarian TorsionTorsion

- Salpingitis- Salpingitis

- Endometriosis- Endometriosis

- Ureteral Calculi- Ureteral Calculi


- Seminal Vesiculitis- Seminal Vesiculitis

- Psoas Abscess- Psoas Abscess

The four abdominal regionsThe four abdominal regions

The nine abdominal regionsThe nine abdominal regions

PP = Provoked / Palliative = Provoked / Palliative

QQ = Quality = Quality

RR = Region / Radiation = Region / Radiation

SS = Severity = Severity

TT = Timing = Timing

“ “ PQRST ”PQRST ” MNEMONICMNEMONIC

Special Populations : PediatricsSpecial Populations : Pediatrics

• Infants / Young childrenInfants / Young children - Crying, facial expression, - Crying, facial expression,

curling upcurling up• ToddlersToddlers - Often talk about their pain- Often talk about their pain• AdolescentsAdolescents - May be reluctant to talk about - May be reluctant to talk about

their paintheir pain

• Consider the following:Consider the following: - Viral gastroenteritis- Viral gastroenteritis

- Food related illness- Food related illness

- Poisoning- Poisoning ( (i.e., soap,i.e., soap, lye, medslye, meds))

- Surgical- Surgical ( (i.e., adhesionsi.e., adhesions))

- Medical - Medical ((i.e., type1DMi.e., type1DM))

• Symptoms Symptoms ((CluesClues)) - Duration of pain - Duration of pain ((>24hr>24hr))

- Location of pain- Location of pain

* Simple – periumbilical* Simple – periumbilical

* Concern – Away from umbilicus* Concern – Away from umbilicus

- Appearance of child- Appearance of child

- Vomiting- Vomiting

* Green / yellow* Green / yellow

* Dark / blood* Dark / blood

- Diarrhea- Diarrhea

* Viral cause?* Viral cause?

* Blood* Blood

- Fever- Fever

* May or may not be a problem* May or may not be a problem

- Groin pain - Groin pain

* ? Testicular torsion* ? Testicular torsion

Special Populations : ObesitySpecial Populations : Obesity

• Palpation of abdomenPalpation of abdomen

- Imagine shape & size of organs- Imagine shape & size of organs

- Mark costal margins, iliac spine & pubis- Mark costal margins, iliac spine & pubis

* Allow one to know where the * Allow one to know where the

true anterior abdominal wall is true anterior abdominal wall is

Special Populations : GeriatricsSpecial Populations : Geriatrics

• Considerations :Considerations :

- - immune functionimmune function

- Co-morbid conditions- Co-morbid conditions

* DM, HT, malignancy* DM, HT, malignancy

- Physiologic reserve- Physiologic reserve

* CAD, pulmonary disease* CAD, pulmonary disease

- Asymptomatic pathologies- Asymptomatic pathologies

- Sensorium- Sensorium

- Poor historians- Poor historians

- Previous surgeries- Previous surgeries

• Abdominal Pain statistics:Abdominal Pain statistics:

- Gallstones - Gallstones ((10-30%10-30%))

- Intestinal Obstruction - Intestinal Obstruction ((25%25%))

- Strangulated Hernia - Strangulated Hernia ((20%20%))

- Perforation : PUD - Perforation : PUD ((10%10%))

- Perforation : Diverticulitis - Perforation : Diverticulitis ((5-5-10%10%))

- Appendicitis- Appendicitis ( (5%5%))

- Rupture of AAA - Rupture of AAA ((2%2%))

Fast Assessment

Action

Data

Nsg. Evaluation

Nsg. Assessment

Nsg. Care Plan

Fast Treatment

Evaluation

Nsg. Intervention

Nsg. Diagnosis

Nurse’s roleNurse’s role

Fast assessment –Fast treatmentFast assessment –Fast treatment

เฉพาะหน้�า ตามเฉพาะหน้�า ตาม NursingNursing DiagnosisDiagnosis

- Quick survey- Quick survey

- Vital signs- Vital signs

- Cardiac monitor & Pulse oximeter- Cardiac monitor & Pulse oximeter

- Oxygen administration- Oxygen administration


- I.V.Fluid / Blood administration- I.V.Fluid / Blood administration

- Blood / Urine samples- Blood / Urine samples

- N.P.O.- N.P.O.

- Alert the Physician- Alert the Physician

- N.G. tube/Intermittent suction preparing- N.G. tube/Intermittent suction preparing


- Pain Medication as order- Pain Medication as order

- Nonpharmacologic interventions - Nonpharmacologic interventions

[positioning, back rubs, heating [positioning, back rubs, heating pads]pads]

- Emotional Support- Emotional Support

- Family support- Family support

- Document Everything do- Document Everything do

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