When assessing a patient with abdominal pain, it is important to look for other objective findings that could be indicative of the cause of the pain.
provide a constructive peer reply to the following two case studies.
Case study 1
Question 1: What other subjective data would you obtain?
As far as other subjective data gathering goes, the patient’s present level of pain, any additional symptoms they may be experiencing, their current level of activity, and any other information that might aid in better understanding their current condition are examples of additional subjective data that could be gathered. Asking about the current level of pain can give insight into how the pain is impacting the patient’s life and whether it is getting worse (Weber et al., 2010). It is also important to ask about any other symptoms the patient is experiencing, as this can help to rule out other possible causes of the pain (Weber et al., 2010). Additionally, asking about the patient’s current level of activity can help to determine if the pain is impacting their ability to function and whether or not they have had to make any changes to their normal routine (Weber et al., 2010). Finally, any other information that would help to better understand the patient’s current condition is also important to obtain. This could include information about previous medical history, family history, and social history (Weber et al., 2010).
Question 2: What other objective findings would you look for?
When assessing a patient with abdominal pain, it is important to look for other objective findings that could be indicative of the cause of the pain.
Abdominal findings that could be looked for include assessment of the abdomen for tenderness: Tenderness to palpation can help narrow down the possible causes of abdominal pain. For example, pain that is worse with deep palpation may be indicative of peritoneal irritation, while pain that is worse with light palpation may be indicative of gastritis or pancreatitis (Weber et al., 2010). Assessment of the abdomen for masses: Masses can be palpated with the hands or may be seen in imaging studies. They can be indicative of a variety of conditions, including tumors, abscesses, or cysts. Auscultation of the abdomen for bowel sounds (Weber et al., 2010). Bowel sounds can be auscultated with a stethoscope. They can be indicative of a variety of conditions, including obstruction, perforation, or ileus. Palpation of the abdomen for dullness(Weber et al., 2010).: Dullness to percussion can be indicative of a variety of conditions, including ascites, peritonitis, or a tumor. Pelvic findings include Inspection of the vagina for lesions: Lesions can be seen with the naked eye (Weber et al., 2010). They can be indicative of a variety of conditions, including sexually transmitted infections, vaginal atrophy, or cervical cancer. Inspection of the cervix for lesions: Lesions can be seen with the naked eye (Weber et al., 2010). They can be indicative of a variety of conditions, including cervical cancer or human papillomavirus infection.
Inspection of the uterus for size, shape, and position: The size, shape, and position of the uterus can be indicative of a variety of conditions, including uterine fibroids, endometriosis, or pelvic inflammatory disease. Inspection of the adnexa for tenderness and fullness: The adnexa is the structures surrounding the uterus, including the ovaries and fallopian tubes. Tenderness and fullness can be indicative of a variety of conditions, including ovarian cysts, endometriosis, or pelvic inflammatory disease (Weber et al., 2010). Inspection of the rectum and perineum for lesions: Lesions can be seen with the naked eye. They can be indicative of a variety of conditions, including hemorrhoids, perineal abscesses, anal fissures, or anal cancer. Inspection of the anus for lesions: Lesions can be seen with the naked eye (Weber et al., 2010). They can be indicative of a variety of conditions, including hemorrhoids, anal fissures, or anal cancer (Weber et al., 2010).
Question 3: What diagnostic exams do you want to order?
A CT scan is an imaging test that uses X-rays and a computer to take pictures of your abdomen (Mafong et al., 2002). The CT scan can show problems in your abdominal organs, such as a tumor (Mafong et al., 2002). Blood work is often done to check for signs of infection, such as a high white blood cell count. Blood work can also help to rule out other causes of abdominal pain, such as appendicitis or a hernia (Mafong et al., 2002). Urinalysis is a test that checks your urine for signs of infection, such as blood or bacteria.
Question4: Name 3 differential diagnoses based on this patient presenting symptoms?
Pelvic inflammatory disease (PID) is a general term used to describe infection of the reproductive organs. The most common symptom of PID is pelvic pain, which can be sharp or crampy. Other symptoms may include fever, nausea and vomiting, and pain during intercourse (Weber et al., 2010). Ectopic pregnancy is a pregnancy that occurs outside of the uterus. The most common symptom of ectopic pregnancy is abdominal pain, which can be severe (Weber et al., 2010). Other symptoms may include vaginal bleeding and shoulder pain. Ovarian torsion is a condition in which the ovary twists on itself, cutting off its blood supply. The most common symptom of ovarian torsion is severe abdominal pain. Other symptoms may include nausea, vomiting, and fever.
Question 5: Give rationales for each differential diagnosis.
Pelvic inflammatory disease (PID) is a possible diagnosis due to the presence of symptoms such as abdominal pain, nausea and vomiting, and a new sexual partner (Mafong et al., 2002). PID is caused by infections of the reproductive organs, which can lead to inflammation of the Fallopian tubes, ovaries, and uterus (Mafong et al., 2002). PID can be treated with antibiotics (Mafong et al., 2002).
Appendicitis is a possible diagnosis due to the presence of symptoms such as abdominal pain, nausea, and vomiting. Appendicitis is a condition in which the appendix becomes inflamed and can cause severe pain. Appendicitis is treated with antibiotics and sometimes surgery (Mafong et al., 2002).
Urinary tract infection (UTI) is a possible diagnosis due to the presence of symptoms such as abdominal pain and difficulty urinating. A UTI can occur when bacteria enter the urinary tract and cause an infection. UTIs are treated with antibiotics (Weber et al., 2010).
Irritable bowel syndrome (IBS) is a possible diagnosis due to the presence of symptoms such as abdominal pain and cramping. IBS is a condition that affects the large intestine and can cause abdominal pain and cramping. IBS is treated with diet and lifestyle changes.
Case Study 2
Neck swelling
Additional Subjective Data to Obtain
Further subjective data that I would obtain from the woman is asking if she has complications with hearing and eyesight. Furthermore, I would ask if she has had symptoms such as headache, nose bleeding, nasal discharge, or swollen lymph nodes. I would also ask if there are any of her parents or grandparents that have ever developed similar symptoms. I would also ask whether the swelling is painful and restricting ahead movements (Quintanilla-Dieck & Penn, 2018). I will also ask if she has ever had an injury to the neck.
Additional Objective Data to obtain
I would palpate her cranium for further objective data to inspect abnormalities such as skin breakdown or hair loss. Also, I would assess the asymmetry of the head and whether the swelling is affecting the eyes and the ears by checking visual and audio capacity (Judson, 2019). I would also assess the salivary glands, lymph nodes, and thyroid nodules since they could be the cue for the swelling. Furthermore, I would examine facial expressions to denote any verve problems.
What Diagnostic exams would you order
I would order a complete blood count. This test would check the overall health and detect various diseases such as infections (Quintanilla-Dieck & Penn, 2018). A total blood count that reveals aberrant elevations or reductions in cell counts may suggest that a patient has an existing health issue that requires further assessment. Other test includes imaging studies. Computed tomography (CT) has become essential for evaluating neck inflammatory conditions. CT helps to locate the site and extent of the disease and assists in the judgment call for proper surgical or medicinal management (Quintanilla-Dieck & Penn, 2018). Furthermore, I would order a biopsy. That is done by surgically removing a sample from the swollen tissues to examine the cells. This test is ideal for checking whether the swelling is malignant or benign.
Three Differential Diagnoses and their rationales
Goiter
A goiter can be caused by a general swelling of the thyroid or by uneven cell development that results in the development of lumps in the thyroid gland. The patient could have this condition since the objective assessment revealed diffuse thyroid gland enlargement. A goiter can get linked with either no changes in thyroid function or an elevation or reduction in thyroid hormone levels (Quintanilla-Dieck & Penn, 2018).
Lymphoma
Lymphoma is a malignancy of the lymph system that is a component of the immune system. The lymphatic system comprises the lymph gland, spleen, thymus glands, and bone marrow (Yamashita et al., 2021). All these issues, as well as many other body organs, can be affected by Lymphoma. The patient could have Lymphoma since she has similar symptoms that indicate this malignant condition (Quintanilla-Dieck & Penn, 2018). These signs include sudden body weight loss without ant diet restriction, fever since her assessment stated a temperature of 99.2, and swelling of the lymph nodes in the neck region.
Thyrotoxicosis
This condition is characterized by releasing too many thyroid hormones (T3 and T4) in the body. When released in excess, it causes an imbalance in the body’s metabolism, causing it to be elevated (Quintanilla-Dieck & Penn, 2018). This woman could have this condition since it caused tachycardia (racing heart), fever, unexplainable weight loss, and nervousness. All these symptoms were present in the 42-year-old African American woman.
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