Nursing Care for a Patient with Abdominal Pain

This document discusses nursing care for a patient with abdominal pain. It covers systematic assessment, priorities of treatment, and discharge planning. The document also includes references for further reading.

Running Head: NURSING CARE
NURSING CARE
Name of the Student
Name of the University
Author Note

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Introduction
John Hayes is a patient who, owing to pain in the right upper quadrant of the
abdomen, was admitted to the emergency department. At the moment of entry, the
temperature reported by the nurse was 36.5 and the respiration rate was 28. As recorded by
the nurse, the blood pressure was 100/60, a reduced blood pressure. The patient's pain score
was 9/10 indicating the pain's seriousness. The 15-year-old GCS or Glassgow Coma Score
showed reduced head injury (Aggarwal, Manrai and Kochhar 2014).
Systematic Assessment
As John was suffering from pain in the upper abdomen, the evaluation to be
performed for the patient involves abdominal evaluation, which is an indication of
gallbladder stone or peptic ulcer, gastritis or hepatitis, and liver abscess. Therefore, the
evaluation needed to diagnose the situation of the patient includes non-imaging tests, imaging
tests, and ultrasound imaging. Therefore all these evaluations of the diagnosis are under the
abdominal evaluation (Aggarwal, Manrai and Kochhar 2014).
ABDO
Since the patient suffered from correct upper abdominal pain, amylase tests,
urinalysis, white blood cell count, ECG, and liver function tests are a variety of helpful
diagnostic exams (Yadav and Lowenfels 2013). The liver function tests are by far the most
helpful laboratory tests on a preliminary basis as some defects indicate hepatobiliary disease
to the patient. In addition, the unusual functioning of the liver parenchyma or the biliary
process may also be pointed out (Aggarwal, Manrai and Kochhar 2014). The outcomes of
urinalysis, serum amylase concentration and ECG can identify kidney, pulmonary defects and
pancreatic abnormalities. This can be used to identify the existence or lack in the gallbladder
of any type of calcifications. The liver function tests should be useful for the patient as they
can assist identify the defects in the liver of the patient (Nesvaderani, Eslick and Cox 2015).
CNS
The Glassgow Coma Scale of 15 and have a pupil size of 3 along with the normal
weakness of the left arm. The patient becomes severe upon exertion while walking and have
pain in the limbs while walking up and down the stairs. The pain score was 6/10 that cannot
be relieved by taking rest (Yadav and Lowenfels 2013).

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CVS
The blood pressure was 100/60 along with the temperature being 36.5 degrees. The
pressure showed that the patient was suffering from hypotension that is very much common
for the older patients. At certain times it is required to treat the condition when it is with other
conditions like infection. Hypotension can result from lack of exercise, dehydration, or due to
use of certain factors (Zerem 2014).
RENAL
After the non-imaging exams, the imaging tests that the nurses should initially carry
out also involve abdomen and chest radiographs (Majumder and Chari 2016). These
techniques are a very fast and cheap way to evaluate the patient in the abdomen and intestine
for the sources of pain. These radiographs can also assist detect any calcifications in the liver,
appendix, ureter, and pancreas (Marik and Bellomo 2015). These techniques can be used for
abdominal pain as gallstones cause radiopaque calcifications and can be identified using
radiographs. Computer tomography is a stronger calcification detection method compared to
simplex-rays and can therefore detect more sensitively the existence of gallstones. The
cholesterol stones as well as the stones containing gas can also be detected (Aggarwal,
Manrai and Kochhar 2014). In addition, it can find the gallstone place and also confirm
whether or not the stone is in the gallbladder. These methods can be used in the therapy of the
patient's gallstones as they can assist clinicians identify the stone's place and also detect the
stone's sort. Ultimately, this will assist physicians deliver the correct kind of intervention that
John Hayes needs. It can also assist identify if the stone is in the bladder, kidney or appendix
of John (Marik 2016).
RESP
John's body temperature was normal at 36.5 degrees. The P102 was also evaluated
after John was admitted to the hospital along with the respiratory rate and blood pressure
reported as 28 and 100/60, respectively. The nurse should therefore take care that the patient
restores the standard breath rate of 12-20 breaths per minute (Tenneret al. 2013). The nurse
should take the blood pressure under ordinary intervention has to restrict the patient's form by
performing certain job that creates exhaustion in him.

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Priorities of Treatment
The therapy priorities will include the activities needed to be taken by John's nurses
when he is hospitalized. This shows the position of the registered nurse or RN working and
managing all the activities that John has to take (Zerem 2014).
Aggressive Fluid Resuscitation is the method of replenishing the body fluids that are
lost in the process of sweating, fluid shifts or bleeding (Majumder and Chari 2016). This can
be done by the process of oral hydration, intravenous therapy, or by the direct injection into
the subcutaneous tissue. The main aim of the phase is to correct the problem of
hypotension. The first choice of the treatment is the use of the intravenous crystalloid process
(Tracy and Morrison 2013). The drug that can apply to the intervention is dopamine or
epinephrine upto 60 mL/kg as boluses of 20 mL/kg by IV push, to achieve desired heart rates
and blood pressure. The other elements should include saline or albumin 15 mL/kg per hour
infusion as aggressive resuscitation, as compared to controlled resuscitation, which they
defined as 5-10 mL/kg per hour. The monitoring should be as per the condition of the patient
and the state of John. At previous times this process was associated with the improvement of
the rate of the survival. The Early Goal Directed Therapy (EGDT) the fluids should be given
within the first 6 hours of the septic shock until CVP or the Central Venous Pressure that
helps in the improvement of the blood lactate levels along with urine output and the oxygen
saturation level (Yadav and Lowenfels 2013). This can be applied to the patient John who
was admitted to the hospital in order to reduce the pain and also to revive the amount or
volume of fluid that is lost due to the condition of the acute pancreatitis.
The pain scale that is being used is the VAS OR NRS. As the patient's main diagnosis
demonstrates, the patient is 130 kg and lives by himself (Greenberg et al. 2016). It will be
beneficial as they do not need to strain their limbs and can easily access medical therapy as
well.As they remain all alone, hence it is the nurse's responsibility to educate them about the
disease and to encourage them to learn about the disease's self-management (Marik 2016).
Thus the important aspect of treatment should be pain management among the patient (Tracy
and Morrison, 2013).The pain management can be done by the use of the certain drugs such
as the use of the opioid and the non-opioid drugs that are to be given after the diagnosis of the
physician. The medicine that is administered for the pain management includes ibuprofen
that has the oral route of administration. The drug should be taken in 200 to 400 mf after
every 4 to 6 hours as per the need of the patient. The monitoring should be as per the

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condition of the patient and the state of John. The pain scale that is to be used by the clinician
for the measurement of the pain is the VAS and the NRS. These scales are subjective for the
treatment of the patient and also the pain management. The pain assessment can be worst,
least, or average pain that would have occurred in the last function 24 hours or in the last
week. This can be applied to the patient as he had a fall that has caused John an injury which
is enhanced by the continuous use of stairs by the couple. This increased the strain in the
limbs of John that acted as a co-morbidity along with the problem of pancreatitis.
As the patient has a history of pulmonary embolus, this will assist the patient (Yadav
and Lowenfels 2013).The other is the use of the nasogastric tube in the case of vomiting (Wu
and Banks 2013). It is very essential for the treatment of the patient as they carry medicine
and food into the stomach via the nose. It will be used for John as he has lost a lot of food and
thus to give him some extra calories (DiMagno and DiMagno 2013).The tube is not just
required for the nourishment but is also needed to maintain the mucosal function of the gut. It
helps to avoid he delay and thus enables nutritional support. Along with this, the cost of the
process is also very less and the availability is not restricted like that of endoscopy or
fluoroscopy. The patients who are suffering from acute pancreatitis will be transferred to the
medical facility in which they will be able to get adequate monitoring as well as intensive
medical care. The use of the nasogastric tube in the patients with pancreatitis is not needed
unless there is vomiting or paralytic ileus. However, it is a safer and tolerated in the patients
that have pancreatitis. Research study has shown that the tube is needed for a routine clinical
management.
The nurse should also efficiently interact with the patient to determine whether or not
the therapy plan is working (Working and APA 2013). Communication between the nurse
and the patient allows the nurse to understand whether the patient responds with the method
of therapy or is satisfied with the services. They can also understand if the person wants
certain adjustments to the therapy plan or faces certain difficulties with the healthcare
facilities supplied by the healthcare personnel (Tenner et al. 2013). Also, the RN should
consider the ethical problems linked to John's therapy. Since John was an elderly patient, the
nurse should consider the fact that John and his wife Beryl remain all alone with the therapy
method. The nurse must always respect the patient's autonomy (Janisch and Gardner 2016).
This can be achieved by providing patients with information about their clinical procedures,

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therapy line, and any changes in the specified therapy method. The next ethical principle to
be taken into account by nurses is to maintain confidentiality with regard to patient data and
details. Patients' information need to be kept confidential for adequate patient therapy and
assessment (Lee et al. 2014).
Whenever the clinicians have to create the patient's choice, they should make the
patient's situation autonomous and invite them to take part in the decision making process
(Lee, Sissoko and Hartshorn 2016).The nurse should ask John to ask his son to enter the
therapy process so that they can take the choice on their behalf whenever a circumstance
occurs when John and his spouse are impaired or unable to make the choice. This will assist
the patient remain engaged and enable their family member to participate in the decision-
making process of the therapy process (Tracy and Morrison 2013).
Discharge Planning
John's discharge planning will require the patient's education on the disease. This will
assist the patient understand the signs, symptoms, triggers, and avoidance steps that the
patient needs to prevent reoccurrence of the same scenario (Desai et al. 2014). This will assist
improve the result of the patient and also assist to some extent in preventing the disease. The
next stage in the planning of discharge will require involving the patient's self-management
process. This will require eating tiny meals and restricting the diet that the patient must
follow (Wronka 2016). The nurse must also advise the patient to decrease alcohol
consumption and should ask patients to continue their vitamin supplements in order to
recover more quickly.
Under the Social Justice Framework, social justice principles are involved in the
process of providing efficient and compact healthcare services and procedures. It includes
creating a supportive atmosphere and helping to promote diversity (Wronka 2016). Social
justice principles involve managing job inequities in healthcare facilities based on mortality
and morbidity rates in conjunction with social, economic, political and cultural variables
(Desai et al. 2014). In this case, the SJF-based discharge planning should include the justice
that should be done to John. Thus, as per the SJF, the nurses should create the discharge plan
to preserve and preserve all the patient's privileges as well. This will encourage patients to
react better and also assist the patient to receive better therapy. This will also yield a
favourable result for the patient and create a powerful relationship with the nurse and hospital
(Ratts et al. 2016).

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The Social Justice framework in this case can be applied when the patient was being
admitted to the hospital and there the nurse or the organization staff has done something that
is ethically against the wishes of the patient (Desai et al. 2014). Then the Social Justice
Framework will be applicable to all the staff and the healthcare professionals who are
working in that hospital. This will help John to take steps against the hospital staff and the
healthcare professionals if he feels that his rights are violated by them (Ratts et al. 2016).

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