ABDOMINAL PAIN ( INTERVENTION )

I. A 65- YEAR OLD MALE PRESENTS WITH GENERALIZE ABDOMINAL PAIN OF GRADUAL ONSET.

II. Immediate question:

A. ABCs/ Patients Stabilization
* - Is the air way intact?- manage appropriately.
* - What are the Vital sign?
- Does the patient looks acutely ill or toxic? Quick assessment of mental status. Is the patient OBTUNDED? Asses peripheral pulse. Initiate IV and administer fluid bolus if appropriate : CARDIAC MONITOR, PULSE OXIMETER, , SUPPLEMENTAL OXYGEN.

B. What was the timing of onset of symptoms?
- Sudden vs. Gradual, preceded bu anorexia,N/V, CONSTIPATION , diarrhea, fever waxing AND WANNING,OR STEADY.

C. WHERE DOES IT HURT? - Generalized pain, Peritonitis,ischemic bowel,Epi-gastric: Gastritis,duodenal/ gastric ulcer, pancreatitis,aortic pathology , early appendicitis, inferior MI, liver or biliary tract disease. RUQ- liver, or Biliary tract disease, inferior pneumonia or MI, occasionally renal. LUQ- SPLEEN ( SPECIALY IF TRAUMA) , sometimes RENAL,.. LLQ- Diverticular disease , colitis, gynecologic,or genitourinary. RLQ- Appendicitis or gynecologic source.Radiation from BACK/FLANK: RENAL SOURCE. Radiation from abdomen to back: PANCREATITIS /AORTIC ANEURYSM.

D. ARE THERE GENITOURINARY COMPLAINTS?
- Dysuria , Hematuria, Back pain, Penile discharge/ bleeding. sexual history,.

D. WHAT IS THE QUALITY OF THE PAIN?
- Burning/ Epigastric, consider gastritis or peptic ulcer, penetrating or boring, consider pancreatitis,. pain out of proportion to physical findingss, consider ischemic bowel. patient cant find comfortable position or withing on gourney,think colic,. patient avoiding movement, consider peritoneal irritation.

F. ARE THERE ARE GI COMPLAINTS?
- N/V, diarrhea, hematochezia, hamatemesis, prior history of same symptoms, any relation to food.

G. RESPIRATORY COMPLAINTS?
- COUGH, SOB, pleuritic pain.

H. ANY HISTORY OF TRAUMA OR PRIOR SURGERY?

I. OTHER PAST MEDICAL HISTORY? Ex. AAA, BOWEL OBSTRUCTION, CAD, DIABETES, INFLAMATORY BOWEL DISEASE etc.....

J. ADDITIONAL SOCIAL HISTORY.
- Foreign travel, recent questionable food sources, diet history,drug abnuse, possibility of accidental food poison / medicine ingestion.


III. DIFFERENTIAL DIAGNOSIS

A. GENDER / AGE- NEUTRAL
1. Appendicitis- pain preceded by nausea, anorexia, fever , pain open vague initially, then localized to RLQ.

2. BILIARY TRACT DISORDER - Cholelithiasis / cholecystitis , hepatitis,
3. PEPTIC ULCER- Think Viscus perforation or hemorrhage if completely ill.
4. GASTRITIS- Food or medication related: VIRAL
5. PANCREATITIS- ETOH/ Diabetes history: rule out gallstone.
6. BOWEL OBSTRUCTIONS- Distinguish from ILEUS.
7. GENITOURINARY OR RENAL DISORDER -calculi, pyelonephritis, infection of the urethra, bladder and reproductive organs.
8. THORACIC DISEASES- Inferior pneumonias pulmonary embolism, atypial cardiac angina/MI.
9. DIVERTICULITIS - Severe, cramping, LLQ, pain associated with bloody diarrhea.
10. INFLAMMATORY BOWEL DISEASE- Crohn`s disease , ulcerative colitis,( cramping episodic, recurrent pain associated with diarrhea, sometimes bloody).
11. SICKLE CELL CRISIS.
12. DIABETIC KETOACIDOSIS -
13. IRRITABLE BOWEL SYNDROME - Strictly a diagnosis of exclusion. symptoms often only briefly present : a variety of symptoms, often crampy, pain with intermittent diarrhea, and constipation.
14. MESENTERIC ADENITIS , GASTROENTERITIS, CONSTIPATION. DIAGNOSES OF EXCLUSION.....


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HEALTH PROMOTIONS AND ILLNESS PREVENTION

" Determining the Child`s Developmental stage is often the primary focus of a health interview. For instance, during her child`s 24 month check up a mother might ask if it is normal that her child cannot yet pedal a tricycle.This question, or any other questions about the child`s developmental progress, cannot be answered without a full understanding of the average ranges of motor coordination.
Parenting style and competence are major influences on the behavioral and mental health of children. In addition to reassurance that their child is doing well, parents also need periodic anticipatory guidance regarding their child`s development. For example, it would be important to discuss additional home safety with a parent when a child is approaching the age for creeping. Parent should be CAUTIONED to think about FENCING open stairways and clearing cleaning compounds out of bottom cupboards.Parents of a child who is almost 1 year old will appreciate being cautioned that their child`s appetite may decrease during the coming year: armed with this knowledge, they will not interpret a child`s rejection of food as a beginning of of a feeding problem but will it see it as a usual step in development. The parent of the child approaching the PUBERTY generally welcomes a discussion on how to prepare a child for this challenging growth phase.
If anticipatory guidance is not offered at appropriate time, it can be useless. Information given too early is forgotten by the time it is needed. Given too late, parent may have already addressed or ignored the issue, possibly not in the GROWTH enhancing way for their child. To be able to supply anticipatory guidance this way at the appropriate time or to plan nursing care to meet the need of the CHILDREN AND THE FAMILIES, you must be able to recognize the predictable stages of growth and development from NEW BORN TO YOUNG ADULT.., through which each child passes..... "

courtesy : (MATERNAL AND CHILD HEALTH NURSING BY ADELE P."