NURS 6512 Assessing the Abdomen 

Sample Answer for NURS 6512 Assessing the Abdomen  Included After Question

THE ASSIGNMENT

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by the subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

BY DAY 7 OF WEEK 6

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A Sample Answer For the Assignment: NURS 6512 Assessing the Abdomen 

Title: NURS 6512 Assessing the Abdomen 

Assessment of the Abdomen and Gastrointestinal System

The abdominal compartment situated between the thorax and pelvis houses the gastrointestinal system as well as other organs such as the kidneys and spleen. The abdomen and the gastrointestinal system encounter physiologic disturbances resulting in several pathologies that range in severity from mild to life-threatening. Consequently, clinical assessment of the abdomen and gastrointestinal system is imperative to assist in prompt diagnosis of these pathologies and initiation of the necessary therapeutic approaches. This paper will explore a case study concerning LZ, a 65-year-old African American male who presents to the emergency department with a two-day history of epigastric pain radiating to the back. The subsequent paragraphs will explore subjective and objective details as well as the assessment of this case scenario.

Subjective

LZ presents with a sudden onset two-day history of intermittent epigastric pain that radiates to the back. The pain has persisted despite the use of proton pump inhibitors. However, he reports an increase in severity and vomiting although there is no associated fever or diarrhea. Epigastric abdominal pain is a non-specific symptom that may indicate both gastrointestinal and non-gastrointestinal etiologies. Consequently, further evaluation is required, and the additional history to inquire about the history of presenting illness includes the following: The character of the pain must be mentioned since some pathologies present with sharp pain while others present with a colicky pain.

Similarly, it is important to ask about the timing of the pain. For instance, if it is worse at any particular time of the day. Factors aggravating and relieving the pain provide an important clue to the underlying etiology. Consequently, it is worth inquiring about the effects of a change of position on the pain. For instance, if it is worse or better in any distinct position. Similarly, noting the impact of eating on the pain is equally important.

Associated factors are crucial as most pathologies that present with epigastric pain also manifest with other symptoms. Apart from fever and diarrhea, questions regarding symptoms such as cough, chest pain, nausea, anorexia, hematuria, hematemesis, bloating, belching, nocturnal pain, indigestion, weight loss, dizziness, diaphoresis, anxiety, and alterations in bowel habits must be raised. LZ also vomited after taking his lunch.

Subsequently, additional questions to ask include the number of episodes, constituents, amount, and the color of the vomitus, if other family members who ate the same meal vomited, and associated factors since vomiting is a non-specific symptom. Other parts of history that are considered significant include history of medication use particularly NSAIDs, steroids, and anticonvulsants among others, history of trauma, nutritional history including the diet and caffeine intake, and family history of similar presentation.

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Additionally, LZ has a positive history of hypertension, hyperlipidemia, and GERD as well as a history of alcohol and smoking. The aforementioned factors are regarded as significant risk factors underlying several gastrointestinal pathologies. Consequently, it is important to quantify both smoking and alcohol intake and determine if the blood pressure and hyperlipidemia are well controlled. Finally, it is necessary to ask if he is stressed following divorce.

Objective

The analysis of the vital signs demonstrates that LZ with a blood pressure of 91/60 mmHg is hypotensive since he is a known hypertensive patient on metoprolol. Similarly, he is overweight which carries moderate health risks. The respiratory, dermatological, and cardiovascular systems revealed no abnormalities. Nevertheless, exhaustive examination with regards to inspection, palpation, auscultation, and percussion is crucial, particularly for the chest. auscultation particularly for the chest Findings noted on the abdominal exam include tenderness in the epigastric area with guarding although no masses or rebound tenderness.

Additional features that are crucial to highlight in the physical examination include the general exam which focuses on the general appearance of the patient. Similarly, a detailed abdominal examination including comprehensive findings on auscultation, inspection, palpation, and percussion is crucial since different diseases present with different abdominal signs. Finally, a neurological examination is also significant as vomiting can be a manifestation of neurologic disease.

NURS 6512 Assessing the Abdomen 
NURS 6512 Assessing the Abdomen 

Assessment

Investigations necessary to assist in the diagnosis of his condition and rule out other causes of epigastric pain include both laboratory and radiological studies. Laboratory investigations include complete blood count with differential, urea, creatinine, and electrolytes, liver function tests, coagulation profile, serum amylase, and lipase levels, ESR/CRP, procalcitonin, blood glucose levels, LDH, lactate levels, serum triglycerides, calcium levels, stool for H. pylori antigen, and serum gastrin levels. The abovementioned laboratory tests are vital in evaluating the common causes of epigastric pain radiating to the back such as acute pancreatitis and peptic ulcer disease (Patterson et al., 2022).

On the other hand, imaging tests include ECG to rule out pericarditis, abdominal ultrasound to check for gallstones, liver or renal problems, abdominal X-ray which may reveal pneumoperitoneum in the case of a perforated ulcer, Chest X-ray and CT thorax, abdomen and Pelvis to identify possible pancreatitis and abdominal aortic aneurysm (Patterson et al., 2022). Finally, endoscopy is critical as both GERD and peptic ulcer disease are possible differentials.

Abdominal aortic aneurysm, acute pancreatitis, and perforated peptic ulcer are among the potential diagnosis for LZ’s presentation. Abdominal aortic aneurism refers to focal dilatation of the abdominal aorta to more than 1.5 times its ordinary diameter (Sakalihasan et al., 2018). Predisposing factors for this condition include advanced age, smoking, arterial hypertension, and hypercholesterolemia which LZ possesses (Sakalihasan et al., 2018). It is usually asymptomatic but may present with epigastric pain radiating to the back and pulsatile abdominal mass. A perforated peptic ulcer is another possible cause of his symptoms. Peptic ulcer disease shares similar risk factors as GERD including alcohol use and smoking.

Psychological stress probably due to divorce is also a risk factor. The patient usually presents with epigastric pain which may radiate to the back. However, if perforated, features of peritonitis such as tenderness and guarding may be evident with no palpable mass (Malik et al., 2022). Acute pancreatitis similarly manifests with severe epigastric pain radiating to the back, abdominal tenderness, guarding, and nausea and vomiting (Shah et al., 2018). Additionally, LZ has a history of alcohol use and hyperlipidemia which may precipitate pancreatitis.

The other possible differential diagnoses for his condition include causes of acute abdomen particularly those causing epigastric pain such as acute mesenteric ischemia, myocardial infarction, acute gastritis, and Mallory Weiss syndrome (Patterson et al., 2022). For instance, acute mesenteric ischemia may present with epigastric pain, diarrhea, nausea and vomiting, and signs of peritonitis while Mallory Weiss syndrome manifests with epigastric pain/back pain, hematemesis, and signs of shock. Finally, myocardial infarction at times manifests as epigastric pain accompanied by nausea and vomiting, dizziness, dyspnea with exertion, and diaphoresis (Saleh & Ambrose, 2018). This is a potential differential diagnosis as LZ has risk factors for cardiovascular disease such as hypertension, smoking, alcohol use, and hyperlipidemia.

Conclusion

Meticulous evaluation of the abdominal and gastrointestinal systems is essential as it may point out an underlying diagnosis. Abdominal pain is a very non-specific symptom and may result from gastrointestinal or non-gastrointestinal causes. However, severe epigastric pain radiating to the back may be an indication of abdominal aortic aneurysm, acute pancreatitis, and perforated peptic ulcer.

References

Malik, T. F., Gnanapandithan, K., & Singh, K. (2022). Peptic ulcer disease. https://pubmed.ncbi.nlm.nih.gov/30521213/

Patterson, J. W., Kashyap, S., & Dominique, E. (2022). Acute Abdomen. https://pubmed.ncbi.nlm.nih.gov/29083722/

Sakalihasan, N., Michel, J.-B., Katsargyris, A., Kuivaniemi, H., Defraigne, J.-O., Nchimi, A., Powell, J. T., Yoshimura, K., & Hultgren, R. (2018). Abdominal aortic aneurysms. Nature Reviews. Disease Primers, 4(1), 34. https://doi.org/10.1038/s41572-018-0030-7

Saleh, M., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7, 1378. https://doi.org/10.12688/f1000research.15096.1

Shah, A. P., Mourad, M. M., & Bramhall, S. R. (2018). Acute pancreatitis: current perspectives on diagnosis and management. Journal of Inflammation Research, 11, 77–85. https://doi.org/10.2147/JIR.S135751

A Sample Answer For the Assignment: NURS 6512 Assessing the Abdomen 

Title: NURS 6512 Assessing the Abdomen  

Gastrointestinal disorders are common encounters in nursing practice with considerable public health impacts. Nurses and other healthcare providers should perform comprehensive history taking and physical examinations to develop accurate diagnoses and care plans. Therefore, this essay examines J.R.’s case study. J.R. presented to the hospital with complaints of having generalized abdominal pain that began three days ago. He has been experiencing diarrhea that has been unresponsive to any treatments adopted by the patient.  The essay analyzes additional subjective and objective information that should be obtained from the client if subjective and objective data supports the assessment, diagnostic tests, and possible differential diagnoses.

Additional Subjective Information

Additional subjective information should be obtained to guide the development of an accurate diagnosis. First, information about the things that might have led to the abdominal pain should be obtained. This includes data such as diet, alcohol consumption, or possible trauma that could have led to the symptoms. Information about previous experiences of stomach pain should also be obtained. A previous history of stomach pain will help the nurse determine if the condition is acute or chronic. In addition, the nurse should determine if JR experienced a similar pain when he experienced gastrointestinal bleeding four years ago. Information on previous treatments for the GI bleed should be obtained to guide the current management. The nurse should also seek information about the characteristics of stomach pain (Maret-Ouda et al., 2020). For example, information on whether the pain radiates elsewhere should have been obtained to rule out causes such as pancreatitis.

Information about the character of the diarrhea should also be obtained. Information such as blood-stained diarrhea would help the nurse to develop a potential diagnosis of gastrointestinal tract bleeding. Associated symptoms such as vomiting should also be obtained. This is important because symptoms such as projectile vomiting will indicate potential problems such as pyloric stenosis. Information about changes in the client’s weight over the past few months should also be obtained. Unintentional weight loss could indicate other health problems such as cancer of the gastrointestinal system. Information on changes in appetite should also be sought. Early satiety could indicate problems such as hypertrophic pyloric stenosis. The nurse should also obtain information about the factors that relieve, precipitate, or worsen the stomach pain. For example, a diagnosis of peptic ulcer disease will be made if the symptoms worsen 15-30 minutes after eating (Sverdén et al., 2019). A diagnosis of gastroesophageal reflux disease will be made if the symptoms worsen when JR lies down and improves with sitting upright.

Additional Objective Information

The nurse should obtain additional objective information from JR to make an informed diagnosis and develop a patient-centered care plan. Firstly, information about JR’s general appearance should be documented. This includes information such as his grooming, weight, alertness, and orientation. A comprehensive review of all the body systems should have also been done. For example, the assessment of the respiratory system is inadequate. Information such as the presence or absence of nasal flaring, wheezes, crackles, rhonchi, and peripheral or central cyanosis should have been documented (Katz et al., 2022). The assessment of the cardiovascular system should have extended to information such as the presence or absence of jugular venous distention or peripheral edema.

The information in the assessment of the gastrointestinal system is inadequate. Additional information such as the presence or absence of abdominal scars, organomegaly, pulsations, ascites, and visible blood vessels should have been documented. This is important because information such as palpable abdominal pulsations would indicate aortic abdominal aneurysm. Information about any abdominal pain on palpation and the location of the pain should have also been obtained and pain rating on a pain rating scale.  The nurse should have also assessed the skin for capillary refill, turgor, cyanosis, and edema (Haque & Bhargava, 2022). Low capillary refill and poor skin turgor could indicate problems with circulation and hydration.

If Subjective and Objective Data Supports the Assessment

Subjective assessment data is the information a patient gives about their health problems. Subjective data supports JR’s assessment. Some of the subjective data include his chief complaints, history of the chief complaints, past medical history, medications, allergies, family, and social history. Objective data refers to the information that the healthcare provider obtains during assessment. Healthcare providers use methods such as inspection, palpation, percussion, and auscultation to obtain objective data (Malik et al., 2023). Objective data supports JR’s case study. Examples of objective data in the case study include vital signs and findings reported in the assessment of the heart, lungs, skin, and abdomen.

Appropriate Diagnostic Tests

 Some diagnostic tests should be performed to develop JR’s accurate diagnosis. An occult stool test should be performed to determine if the client’s problem is due to an infection and rule out GI bleeding. A complete blood count test would also be performed to rule out an infection. Stool culture might also be performed to determine the accurate cause of JR’s problem. Antigen tests might also be performed to detect antigens associated with parasites and viruses that cause gastrointestinal problems such as gastroenteritis. A fecal fat test might be needed to rule out malabsorption problems in the client (Chen et al., 2021). Radiological investigations such as abdominal ultrasound and x-rays might be performed to rule out causes such as appendicitis and carcinoma.

Accepting or Rejecting the Current Diagnosis

I will accept the current diagnosis of left lower quadrant pain. The objective findings reveal the presence of left lower quadrant pain. This provisional diagnosis should guide the additional investigations performed to develop an accurate diagnosis. I also accept gastroenteritis as the other diagnosis for JR. Patients with gastroenteritis experience symptoms such as diarrhea, abdominal pain and cramping, nausea, vomiting, and loss of appetite (Chen et al., 2021).  JR has these symptoms; hence, gastroenteritis is his other provisional diagnosis.

Three Possible Differential Diagnoses

Diverticulitis is the first differential diagnosis that should be considered for JR. Diverticulitis is an inflammation of the sigmoid colon that causes left lower quadrant pain. The pain worsens when a patient eats. The accompanying symptoms include diarrhea, constipation, bloating, nausea, and the passage of bloodstained stool (Sugi et al., 2020). Diagnostic investigations will rule in or out diverticulitis as the cause of JR’s problems.

The second differential diagnosis that should be considered for JR is peptic ulcer disease. Peptic ulcer disease is a condition that develops from the destruction of the stomach wall lining by pepsin or gastric acid secretion. It affects the distal duodenum, lower esophagus, or jejunum. Patients often experience epigastric pain 15-30 minutes after a meal. A diagnosis of duodenal ulcer disease is made if the patient reports epigastric pain 2-3 hours after a meal (Malik et al., 2023; Sverdén et al., 2019). The additional symptoms that patients with peptic ulcer disease experience include bloating, abdominal fullness, nausea and vomiting, hematemesis, melena, and changes in body weight.

Gastritis is the last differential diagnosis that should be considered for JR. Gastritis develops from the inflammation of the gastric mucosa. Factors such as infections, smoking, taking too much alcohol, prolonged use of aspirin and non-steroidal anti-inflammatory medications, and immune-mediated reactions might cause gastritis. Patients who are affected by gastritis experience a range of symptoms. They include stomach pain or upset, hiccups, belching, abdominal bleeding, nausea and vomiting, feeling of fullness, loss of appetite, and blood in stool or vomitus (Maret-Ouda et al., 2020; Rugge et al., 2020). Therefore, additional investigations should be performed to develop JR’s accurate diagnosis and treatment plan.

Conclusion

In summary, JR’s subjective and objective data is inadequate. Additional subjective and objective data should be obtained to guide the treatment plan. Subjective and objective data supports JR’s assessment. I accept the current diagnosis of left lower quadrant pain and gastroenteritis.. Different diagnostic investigations should be performed to rule in and out different differential diagnoses in the case study. The three differential diagnoses that should be considered for JR include gastritis, peptic ulcer disease, and diverticulitis.

References

Chen, P. H., Anderson, L., Zhang, K., & Weiss, G. A. (2021). Eosinophilic Gastritis/Gastroenteritis. Current Gastroenterology Reports, 23(8), 13. https://doi.org/10.1007/s11894-021-00809-2

Haque, K., & Bhargava, P. (2022). Abdominal Aortic Aneurysm. American Family Physician, 106(2), 165–172.

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American Journal of Gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538

Malik, T. F., Gnanapandithan, K., & Singh, K. (2023). Peptic Ulcer Disease. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK534792/

Maret-Ouda, J., Markar, S. R., & Lagergren, J. (2020). Gastroesophageal Reflux Disease: A Review. JAMA, 324(24), 2536–2547. https://doi.org/10.1001/jama.2020.21360

Rugge, M., Sugano, K., Sacchi, D., Sbaraglia, M., & Malfertheiner, P. (2020). Gastritis: An Update in 2020. Current Treatment Options in Gastroenterology, 18(3), 488–503. https://doi.org/10.1007/s11938-020-00298-8

Sugi, M. D., Sun, D. C., Menias, C. O., Prabhu, V., & Choi, H. H. (2020). Acute diverticulitis: Key features for guiding clinical management. European Journal of Radiology, 128, 109026. https://doi.org/10.1016/j.ejrad.2020.109026

Sverdén, E., Agréus, L., Dunn, J. M., & Lagergren, J. (2019). Peptic ulcer disease. BMJ, 367, l5495. https://doi.org/10.1136/bmj.l5495