TAEM10: Acute Abdomen - Nurse

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Text of TAEM10: Acute Abdomen - Nurse

  • 1. The acute abdomen SUJITRAPORNTHABKRONGR.N.,M.N.S. RACHADA-THAPRAMEDICALCENTER

2. Acute abdomen

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3. - Fast assessment- Fast treatment

  • DO NOT WAST TIME

4. Knowledge

    • Anatomy
    • Physiology
    • Pathophysiology
    • Pain Generation & Perception

5. Definition

  • Acute Abdominal Pain Chronic Abdominal Pain
  • - Arises suddenly-May appear as acute pain
  • initially
  • - Individuals usually present - Persists or progresses over
  • within 48 hr weeks or months
  • - signs & symptoms occurred- Initially chronic abdominal
  • within 7 days pain is considered acute
  • until work-up reveals
  • - Pain lasting 6 hrs otherwise
  • - ? Disorderof surgical
  • significance

6. Pain:Generation & Perception Visceral afferents & spinal somatic afferents enter spinal cord at same level Direct irritation to the peritoneal lining - Stretching - Distension - Torsion - Contraction Cause Vague & well localized Specific / Localized Midline / Generalized Location Dull / Sharp Sharp Dull ache Nociception Referred Parietal Visceral 7. Importance of Anatomy & Physiology in Assessment LLQ Pain - Diverticulitis - Intestinal Obstruction - Appendicitis - Leaking Aneurysm - Abdominal Wall Aneurysm - Ectopic Pregnancy - Mittelschmerz - Ovarian Cyst - Ovarian Torsion - Salpingitis - Endometriosis - Ureteral Calculi - Renal Pain - Seminal Vesiculitis - Psoas Abscess RLQ Pain - Appendicitis - Intestinal Obstruction - Regional Enteritis - Diverticulitis - Cholecystitis - Perforated Ulcer - Leaking Aneurysm - Abdominal Wall Hematoma - Ectopic Pregnancy - Ovarian Cyst - Ovarian Torsion - Salpingitis - Mittelschmerz - Endometriosis - Ureteral Calculi - Renal Pain - Seminal Vesiculitis - Psoas Abscess LUQ Pain - Gastritis - Pancreatitis - Splenic Enlargement - Splenic Rupture - Splenic Infarction - Splenic Aneurysm - Renal Pain - Herpes Zoster - Myocardial Ischemia - Pneumonia - Empyema

  • RUQ Pain
  • - Gall Bladder
  • - Biliary Tract
  • - Hepatitis
  • - Hepatomegaly
  • Due to CHF
  • - Peptic Ulcer
  • Pancreatitis
  • - Retrocecal
  • Appendicitis
  • - Renal Pain
  • - Herpes Zoster
  • - Myocardial
  • Ischemia
  • - Pericarditis
  • - Pneumonia
  • - Empyema

Diffuse Pain - Peritonitis - Pancreatitis - Leukemia - Sickle Cell Crisis - Early Appendicitis - Mesenteric Adenitis - Mesenteric Thrombosis - Gastroenteritis - Aneurysm - Colitis - Intestinal Obstruction - Metabolic Cause - Toxic Overdose - Bacterial Infection 8. The four abdominal regions 9. The nine abdominal regions 10.

  • P = Provoked / Palliative
  • Q = Quality
  • R = Region / Radiation
  • S = Severity
  • T = Timing

PQRST MNEMONIC 11. Special Populations : Pediatrics

  • Symptoms( Clues )
  • - Duration of pain( >24hr )
  • - Location of pain
  • * Simple periumbilical
  • * Concern Away from umbilicus
  • - Appearance of child
  • - Vomiting
  • * Green / yellow
  • * Dark / blood
  • - Diarrhea
  • * Viral cause?
  • * Blood
  • - Fever
  • * May or may not be a problem
  • - Groin pain
  • * ? Testicular torsion
  • Infants / Young children
  • - Crying, facial expression,
  • curling up
  • Toddlers
  • - Often talk about their pain
  • Adolescents
  • - May be reluctant to talk about
  • their pain
  • Consider the following:
  • - Viral gastroenteritis
  • - Food related illness
  • - Poisoning( i.e., soap, lye, meds )
  • - Surgical( i.e., adhesions )
  • - Medical( i.e., type1DM )

12. Special Populations : Obesity

  • Palpation of abdomen
  • - Imagine shape & size of organs
  • - Mark costal margins, iliac spine & pubis
  • * Allow one to know where the
  • true anterior abdominal wall is

13. Special Populations : Geriatrics

  • Abdominal Pain statistics:
  • - Gallstones( 10-30% )
  • - Intestinal Obstruction( 25% )
  • - Strangulated Hernia( 20% )
  • - Perforation : PUD( 10% )
  • - Perforation : Diverticulitis( 5-10% )
  • - Appendicitis( 5% )
  • - Rupture of AAA( 2% )
  • Considerations :
  • -immune function
  • -Co-morbid conditions
  • * DM, HT, malignancy
  • -Physiologic reserve
  • * CAD, pulmonary disease
  • -Asymptomatic pathologies
  • -Sensorium
  • - Poor historians
  • - Previous surgeries

14. Fast Assessment Action Data Nsg. Evaluation Nsg. Assessment Nsg. Care Plan Fast Treatment Evaluation Nsg. Intervention Nsg. Diagnosis 15. Nurses role

  • Fast assessment Fast treatment
  • Nursing Diagnosis
  • - Quick survey
  • - Vital signs
  • - Cardiac monitor & Pulse oximeter
  • - Oxygen administration

16.

  • Nurses role
  • - I.V.Fluid / Blood administration
  • - Blood / Urine samples
  • - N.P.O.
  • - Alert the Physician
  • - N.G. tube/Intermittent suction preparing

17. Nurses role

  • - Pain Medication as order
  • - Nonpharmacologicinterventions
  • [positioning, back rubs, heating pads]
  • - Emotional Support
  • - Family support
  • - Document Everything do

18.