Case Study Module 6
Patient-Centered Assessments Southern New Hampshire University
NUR-320
Sarah Davison
March 17, 2015
Scenario: An emergency department nurse is caring for a 44-year-old woman with LLQ abdominal pain and is brought to the emergency department by her husband. Explain what type of assessment is most critical for this patient, providing a rationale for your response. Discuss the questions the nurse would ask, prioritizing these questions from most concerning to least concerning. Use your Jensen (2014) text to support your rationale. Submit your completed assignment here.
Case Study Module 6 Abdominal pain accounts for 5% of all emergency department (ED) visits and
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(Jarvis, 2012).
• Have you had any recent trauma or injury to you abdomen?
Rational: History of hospitalizations for GI problems may reveal an exacerbation of a previously diagnosed condition (Jensen, 2015). Abdominal surgeries increase risk for adhesions, infections, obstructions, and malabsorption (Jensen, 2015).
Physical Assessment After obtaining vital signs, a physical assessment would include inspection, auscultation, percussion and palpation of the abdomen. Inspection consists of visual examination of the abdomen noting its shape, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration (Walker, 1990). Abnormalities detected on inspection combined with the patient’s history provide clues to intra-abdominal pathology (Diekmann, n.d). Auscultation of the abdomen is performed before percussion and palpation which can alter bowel motility (Jensen, 2015). Auscultation allows detection of altered bowel sounds, rubs, or vascular bruits. Normal peristalsis creates bowel sounds that may be altered or absent by disease. Percussion is performed to identify organ size and detect the presence of fluid, gas or masses. Palpation includes both light and deep techniques (Jensen, 2015). Light palpation detects areas of tenderness, distention, ascites, presence of masses, and bladder distention; whereas deep palpation, an advanced skill assesses
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(n.d.). ABDOMINAL PAIN. Retrieved March 15, 2015, from http://sfghed.ucsf.edu/Education/Lectures/Syllabus/AbdominalPain.pdf
Gerber Zimmermann, P. (2002, December 1). Triaging lower abdominal pain. Retrieved March 16, 2015, from http://www.modernmedicine.com/modern-medicine/content/triaging-lower-abdominal-pain?page=full
Hammond, MD, N., Nikolaidis, MD, P., & Miller, MD, F. (2010). Left Lower-Quadrant Pain: Guidelines from the American College of Radiology Appropriateness Criteria. Am Fam Physician, 82((7)), 766-770.
Jarvis, C. (2012). Abdomen. In Physical examination & health assessment (6th ed.). St. Louis, Mo.: Elsevier/Saunders.
Jensen, S. (2015). Abdominal Assessment. In Nursing health assessment: A best practice approach (Edition 2. ed.). Philidelphia, PA.Wolters Kluwer.
Left Lower Quadrant Pain - Symptoms, Causes, Treatments - Causes. (2014, June 26). Retrieved March 15, 2015, from http://www.healthgrades.com/right-care/digestive-health/left-lower-quadrant-pain--causes
Walker, H. (1990). Chapter 93Inspection, Auscultation, Palpation, and Percussion of the Abdomen. In Clinical methods: The history, physical, and laboratory examinations (3rd ed.). Boston:
The SMART goal for the patient’s diagnosis of diarrhea is that the patient will defecate formed, soft stool every 1 to 3 days and will express relief of cramping with little or no diarrhea. The intervention to meet this smart goal is the administration of fidaxomicin, a narrow spectrum antibiotic, to treat the infection of Clostridium difficile (Sears, 2013). Another nursing intervention for the treatment of diarrhea is assessing the patient for sodium and potassium loss, as well as explaining the prevention methods to avoid the spread of excessive diarrhea (Mitchell, 2014). The nurse must also provide proper skin integrity care to the peritoneal are and make the environment safe and easy for access to the bathroom. The SMART goal for the patient’s diagnosis of acute pain is that the patient will state relief of pain in abdominal area after treatment with opioids in a 24hr period. The nursing intervention for acute pain is the administration of opioids as well as positioning to keep patient in as much comfort as possible and take pressure off of the abdominal area. The nurse must also assess the patient’s vital signs and pain level
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Certain hernia’s can be seen and felt protruding through the stomach or outer abdominal wall. However, since an inguinal hernia occurs inside the abdomen, there are very few signs to tell if a patient ...
We have documented that there is no weight loss, nausea, or vomiting. That despite his complaints of not being able to eat, he has not lost weight. He denies any blood per rectum. On physical examination, his abdomen is also benign, it is slightly rounded but firm. I do not detect any mass and there is no guarding or
Hinkle, Janice L, Cheever, Kerry H. (2014). Brunner &Suddarth’s textbook of Medical-Surgical Nursing. Philadelphia: Wolters Kuwer/Lippincott Williams &Wilkins.
Abdominal Compartment Syndrome (ACS) is a sustained intra-abdominal pressure greater than 20 mm Hg. This syndrome is associated with organ failure or dysfunction. If ACS is not recognized and treated promptly it can result in mortality. Cases that are not recognized and treated promptly have a 90% to 100% mortality rate. 46.8% pediatric doctors can recognized ACS, this is not near the percentage that it needs to be. Only 51% of pediatric doctors have had to treat a child with ACS so it is not an extremely common disease. ACS can be diagnosed bedside by measuring the IAP of the patient. In a case study concerning a 13 year old boy, he was brought to the emergency room after being kicked by a horse. The patient was taken into surgery for an exploratory
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Potter, P.A., Perry, A.G., Stocker, P.A., & Hall. (2017). Fundamentals of Nursing (9th ed.). St. Louis, MO:
Methods : Fifty patients with abdominal CT scans were chosen from a database of liver cirrhosis patients. Given its significance in malnutrition, the image slice at the L4- L5 inter-vertebral space was selected. The skeletal muscles at this level (erector spinae, psoas major, rectus abdominus, quadratus lumborum and external and internal oblique muscles) were highlighted and selected using both Slice-O-Matic and Adobe Photoshop. The skeletal muscle area was then calculated using both softwares by two independent observers and the results were compared.
This will allow them explore stressors, try various treatments, and continue her evaluation when necessary. Stress can worsen pain, whether the source is functional or organic. Children with chronic pain can be depressed or anxious as a result of their pain and their efforts to get relief. Many children benefit from relaxation and behavioral therapies to address these aspects of their pain. Also, during periods of change or stress in families, it can be hard to spend enough time with the child. In some cases, the child will develop chronic or recurrent abdominal pain related to her need for attention. It may be helpful to schedule time daily that is devoted solely to this child. Scheduled time is preferable to time spent together when the child complains of pain. In addition, older children and adolescents with functional abdominal pain can learn brief muscle relaxation techniques such as deep breathing exercises. These techniques should be performed for 10 minutes at least twice every day, and can also be used during times of pain. A family member can act as "coach" if necessary, provided this attention does not provide positive reinforcement for the pain (Medline plus,
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Urinary Tract Infections (UTIs) Symptoms, Causes, Treatment - What is a urinary tract infection (UTI)? - MedicineNet. (n.d.). Retrieved March 22, 2016, from http://www.medicinenet.com/urinary_tract_infection/page2.htm
This piece of work will be based on the pre-assessment process that patients go through on arrival to an endoscopy unit in which I was placed during my second year studying Adult Diploma Nursing. I will explore one patient’s holistic needs, identifying the priorities of care that the patient requires; I will then highlight a particular priority and give a rationale behind this. During an admission I completed under the supervision of my mentor, I was pre-assessing a 37 year old lady who had arrived at the unit for an upper gastrointestinal endoscopy. During the pre-assessment it was important that a holistic assessment is performed as every patient is an individual with unique care needs as the patient outlined in this piece of work has learning disabilities it was imperative to identify any barriers to communication (Nursing standards 2006). There were a number of nursing priorities identified, the patient also has hypertension.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
Mrs S. is an 88 years old female patient who lives on her own, and was admitted into a rehabilitation ward following a hip operation due to a fall at home. She has a past medical history of Congestive Cardiac Failure (CCF), diverticulitis, and asthma. Also, Mrs S presented with rapid weight loss, palpitation, feeling tired, peripheral oedema, fatigue, difficulty breathing when lying flat in the bed, waking up at night with shortness of breath and anxiety. In addition to all that she had a pressure sore in her bottom that was not broken. In order to have good holistic care of Mrs S, the nursing process was used as identified by Sibson. Sibson (2010) identifies four key steps to the nursing process, which are assessment, planning, implementation and evaluation; which are important for ensuring a quality standard of nursing care.