NURS 6512 Week 7 Discussion: Assessing the Abdomen

Assessing the Abdomen: NURS 6512

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.

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 Assessing the Abdomen: NURS 6512 Discussion, you will consider case studies that describe 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 conditions.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

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Assessing the Abdomen: NURS 6512 Case 1: Abdominal Pain

A 12-year-old female complains of malaise with abdominal pain pointing to the right lower quadrant. The patient has been vomiting and feeling nauseated for several days. The abdominal pain has been insidious and now is more pronounced. Both parents are with the child and are concerned because she has not been eating and has had a fever for the past 3 evenings.

Assessing the Abdomen: NURS 6512 Case 2: Gastrointestinal Pain

A 50-year-old male complains of burning pain starting at the abdomen and rising to the middle of his chest. He describes the pain as a gnawing feeling that begins after meals, especially when lying down.

Assessing the Abdomen: NURS 6512 Case 3: Nausea and Vomiting

A 20-year-old female complains of nausea and has vomited three times over the past 48 hours. The patient also experienced a low-grade fever this morning. She states that she recently ate shellfish at a new restaurant with two friends who are suffering from similar symptoms.

SOAP Note

Abdominal Assessment
SUBJECTIVE:
• CC: “My stomach hurts, I have diarrhea and nothing seems to help.”
• HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
• PMH: HTN, Diabetes, hx of GI bleed 4 years ago
• Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
• Allergies: NKDA
• FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
OBJECTIVE:
• VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Skin: Intact without lesions, no urticaria
• Abd: soft, hyperctive bowel sounds, pos pain in the LLQ
• Diagnostics: None
ASSESSMENT:
• Left lower quadrant pain
• Gastroenteritis
• PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future

To prepare:

With regard to the case study you were assigned:

• 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 you were assigned.

• 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.

Note: Before you submit your initial post, replace the subject line (“Week 7 Discussion”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain which physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject, and why. Identify the most likely condition, and justify your reasoning.

Note: Before you submit your initial post, replace the subject line (“Week 7 Discussion”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
Post A 1 page paper APA format
1. a description of the health history you would need to collect from the patient in the case study to which you were assigned. (case 2)
2. Explain which physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.
3. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Important note (Remember to focus on the appropriate body systems for the clinical scenarios instead of focusing on the whole body system- Usually a complete physical exam is done during an annual wellness visit. This is not a wellness exam .
2. Your diagnosis for the clinical scenario must have a rationale and reasoning as to why
Remember to link the diagnosis to patients symptoms and clinical exam findings along with the rationale)

Assessing the Abdomen: NURS 6512 Course Readings

· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 4, “Vital Signs and Pain Assessment” (pp. 50-63)
This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.

o Chapter 17, “Abdomen” (pp. 370-415)

In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment on the abdomen.
· Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 3, “Abdominal Pain” (pp. 11-32)

This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.
o Chapter 10, “Constipation” (pp. 110-117)

The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.
o Chapter 12, “Diarrhea” (pp. 133-147)

In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.
o Chapter 29, “Rectal Pain, Itching, and Bleeding” (pp. 344-356)

This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.
· Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
o Chapter 7, “Admitting a Patient to the Hospital” (pp. 143–188)
Note: Download this Adult Examination Checklist and Abdomen Physical Exam Summary to use during your practice abdominal examination.
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for abdominal assessment. In Mosby’s guide to physical examination(7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Abdominal Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Abdomen. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Abdomen Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Craig, M., & Infante, S. (2011). Abdominal mysteries: Pain, peritonitis, pancreatitis. Nephrology Nursing Journal, 38(2), 173–186.

Retrieved from the Walden Library databases.

This article explains various types of abdominal pain. The authors detail the etiologies, symptoms, and treatment for the abdominal pain described.
· Mills, A. M., & Chen, E. H. (2011). Abdominal pain in special populations. Emergency Medicine Reports, 32(7), 81–91.

Retrieved from the Walden Library databases.

The authors of this article explore the characteristics and diagnoses associated with abdominal pain in patients with special conditions. The article also provides recommendations for emergency department staff when encountering abdominal pain.
· University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved fromhttp://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on gastrointestinal radiology.

NURS 6512 Week 7 Quiz

Question 1 A patient suspected of having a peptic ulcer would receive further routine evaluation with all of the following except:

Question 2 Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats per minute, and increasing dyspnea are signs of:

Question 3 A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is:

Question 4 Auscultation of borborygmi is associated with:

Question 5 When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

Question 6 Mrs. G. is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy due to changes in the colorectal areas, such as:

Question 7 An umbilical assessment in the newborn that is of concern is:

Question 8 In order to assess for liver enlargement in the obese person, you should:

Question 9 A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured?

Question 10 Visible intestinal peristalsis may indicate:

Question 11 Which abdominal organs also produce hormones and function as endocrine glands?

Question 12 A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

Question 13

A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child s diaper. Nephroblastoma is likely for this child when your physical examination of the abdomen reveals a(n):

Question 14 What condition is associated with purplish striae?

Question 15 When using the bimanual technique for palpating the abdomen, you should:

Question 16 Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

Question 17 Ms. Green is an 85-year-old female patient with dementia who presents to the emergency department with her daughter because of a change in function. Which pain assessment scale would be the best choice?

Question 18 Body language that leads you to suspect the person is in pain is:

Question 19 Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis for which she is given antiinflammatory medication. To assess her right knee pain, you should ask her if:

Question 20 The Joint Commission (TJC, formerly The Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) requires that:

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