Advanced Nursing Practices: Assessment, Diagnosis, and Management

Running Head: ADVANCED NURSING PRACTICES
ADVANCED NURSING PRACTICES
Name of the Student
Nam of the University
Author note

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Table of Contents
Assessment of the patient and pathophysiology of the disease.......................................................2
Differential diagnoses......................................................................................................................3
Investigation....................................................................................................................................6
Confirmed Diagnoses......................................................................................................................7
Management plan.............................................................................................................................7
References......................................................................................................................................10

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Assessment of the patient and pathophysiology of the disease
The patient of the case study is 25 years old female who took admission in the emergency
department because of severe abdominal plan. The patient had been suffering from severe
abdominal pain since the last two years.
Subjective symptoms
The subjective symptoms at the time of her admission in the emergency department was
“gastro” like waves of pain in the region of the lower abdomen and two episodes of watery
diarrhea. She told the physician that she did not vomit but also agreed that she lost his appetite of
eating anything. After the patient was admitted to the hospital her vital signs were checked. The
respirator rate, concentration of dissolved oxygen and respiratory rate were normal but the blood
pressure got reduce to a certain extent.
Objective symptoms
The blood pressure became 108/60, the concentration of dissolved oxygen was 98% and
respiratory rate was 20. Her body temperature was slightly elevated. However the heart rate had
increase a lot (112 beats per minute) where the normal value of heart rate is 70 beats per minute.
She was suffering from dry mucous membrane. The color of the skin and conjunctiva had turned
pale. She was also suffering from diminished bowel systems. The past medical history shows
that she had suffered from benign positional vertigo. Her abdominal pain was severe that she was
sent to the triage category 3. There she was asked for urine test. The pathophysiology behind
abdominal pain is that the pain can be due to visceral pain, somatic pain or referred pain.
Visceral pain occurs from abdominal viscera that are innervated by the fibers of autonomic nerve
and react mainly to the sensations and contraction of the muscles. The pain is not due to pain or
limited irritation. Visceral pain is usually unclear, gray, and disgusting. It is badly restricted and
tend to be denoted to zones equivalent to embryonic cause of the exaggerated structure. Pain in
the stomach, liver, duodenum as well as pancreas causes upper abdominal pain. Pain in the
middle abdomen happens because of small intestine, proximal colon, the appendix. The pain in
the lower abdomen happens because of pain in distal colon and GU tract. The somatic
pain happens from the region of parietal peritoneum that is innervated by somatic nerves. The
pain happens as the react to frustration from any infection, chemical or an inflammatory process.

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Referred pain is perceived from any distant source. Some examples of this pain includes scapular
pain because of biliary colic and groin pain because of renal colic. The other reason of the
abdominal pain is peritonitis which means the irritation of the peritoneal cavity. The causes of
peritonitis is damage of the gastrointestinal tract, appendicitis, pancreatitis and pelvic
inflammatory disease. According to the information of the case study, she was told to do her
urine test. The report of the review of the gastrointestinal system, she had suffered from frequent
diarrhea.
Investigations
After her admission in the hospital she had to undergo several tests. Almost all of the
reports were normal bur the concentration of white blood cell was 12.1 which is slightly higher
than the normal value. This is indicating that the immune system is working properly. The value
of calcium (2.32) is slightly higher than normal which mean that she was suffering from
dehydration. The value of albumin (2.31) was also a little bit higher which means that she may
have crohn’s disease. Her treatment should have started as soon as possible.
Differential diagnoses
1.Ectopic Pregnancy – The ectopic pregnancy can be defined as the condition when the fertilized
ovum gets implanted and matured outside endometrial cavity of uterus and the most common site
of their maturity is the fallopian tube (Perkins et al., 2015).The ectopic pregnancy is the
complication of the pregnancy which happens when the embryo gets attached outside of the
uterus. If the condition are left without any treatment, it may even cause death of the mother
because of the rupture of the implantation site (Li et al., 2015). Normally unto 10% of women
suffering from ectopic pregnancy do not show any symptoms, they do not have any medical
marks or symptoms. However the sigs of this disease includes increased hCG, sudden vaginal
bleeding and sudden pain in the lower abdominal region and pelvic region (Taran et al., 2015).
Reason for diagnosis
The reasons of the patient for diagnosing ectopic pregnancy is that her subjective
symptoms of being active sexually without contraception since 2 months. The usual period