TAEM10: Acute Abdomen - Nurse

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อาจารย์สุจิตราภรณ์ ทับครอง

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<ul><li> 1. The acute abdomen SUJITRAPORNTHABKRONGR.N.,M.N.S. RACHADA-THAPRAMEDICALCENTER</li></ul> <p> 2. Acute abdomen </p> <ul><li>: </li></ul> <ul><li>. </li></ul> <ul><li>. </li></ul> <ul><li>. </li></ul> <p> 3. - Fast assessment- Fast treatment </p> <ul><li>DO NOT WAST TIME </li></ul> <p> 4. Knowledge </p> <ul><li><ul><li>Anatomy </li></ul></li></ul> <ul><li><ul><li>Physiology </li></ul></li></ul> <ul><li><ul><li>Pathophysiology </li></ul></li></ul> <ul><li><ul><li>Pain Generation &amp; Perception </li></ul></li></ul> <p> 5. Definition </p> <ul><li>Acute Abdominal Pain Chronic Abdominal Pain </li></ul> <ul><li>- Arises suddenly-May appear as acute pain </li></ul> <ul><li>initially </li></ul> <ul><li>- Individuals usually present - Persists or progresses over</li></ul> <ul><li>within 48 hr weeks or months </li></ul> <ul><li>- signs &amp; symptoms occurred- Initially chronic abdominal </li></ul> <ul><li>within 7 days pain is considered acute </li></ul> <ul><li>until work-up reveals </li></ul> <ul><li>- Pain lasting 6 hrs otherwise </li></ul> <ul><li>- ? Disorderof surgical </li></ul> <ul><li>significance </li></ul> <p> 6. Pain:Generation &amp; Perception Visceral afferents &amp; spinal somatic afferents enter spinal cord at same level Direct irritation to the peritoneal lining - Stretching - Distension - Torsion - Contraction Cause Vague &amp; well localized Specific / Localized Midline / Generalized Location Dull / Sharp Sharp Dull ache Nociception Referred Parietal Visceral 7. Importance of Anatomy &amp; Physiology in Assessment LLQ Pain - Diverticulitis - Intestinal Obstruction - Appendicitis - Leaking Aneurysm - Abdominal Wall Aneurysm - Ectopic Pregnancy - Mittelschmerz - Ovarian Cyst - Ovarian Torsion - Salpingitis - Endometriosis - Ureteral Calculi - Renal Pain - Seminal Vesiculitis - Psoas Abscess RLQ Pain - Appendicitis - Intestinal Obstruction - Regional Enteritis - Diverticulitis - Cholecystitis - Perforated Ulcer - Leaking Aneurysm - Abdominal Wall Hematoma - Ectopic Pregnancy - Ovarian Cyst - Ovarian Torsion - Salpingitis - Mittelschmerz - Endometriosis - Ureteral Calculi - Renal Pain - Seminal Vesiculitis - Psoas Abscess LUQ Pain - Gastritis - Pancreatitis - Splenic Enlargement - Splenic Rupture - Splenic Infarction - Splenic Aneurysm - Renal Pain - Herpes Zoster - Myocardial Ischemia - Pneumonia - Empyema </p> <ul><li>RUQ Pain </li></ul> <ul><li>- Gall Bladder </li></ul> <ul><li>- Biliary Tract </li></ul> <ul><li>- Hepatitis </li></ul> <ul><li>- Hepatomegaly </li></ul> <ul><li>Due to CHF </li></ul> <ul><li>- Peptic Ulcer </li></ul> <ul><li>Pancreatitis </li></ul> <ul><li>- Retrocecal</li></ul> <ul><li>Appendicitis</li></ul> <ul><li>- Renal Pain </li></ul> <ul><li>- Herpes Zoster </li></ul> <ul><li>- Myocardial </li></ul> <ul><li>Ischemia </li></ul> <ul><li>- Pericarditis </li></ul> <ul><li>- Pneumonia </li></ul> <ul><li>- Empyema </li></ul> <p>Diffuse Pain - Peritonitis - Pancreatitis - Leukemia - Sickle Cell Crisis - Early Appendicitis - Mesenteric Adenitis - Mesenteric Thrombosis - Gastroenteritis - Aneurysm - Colitis - Intestinal Obstruction - Metabolic Cause - Toxic Overdose - Bacterial Infection 8. The four abdominal regions 9. The nine abdominal regions 10. </p> <ul><li>P = Provoked / Palliative </li></ul> <ul><li>Q = Quality </li></ul> <ul><li>R = Region / Radiation </li></ul> <ul><li>S = Severity </li></ul> <ul><li>T = Timing </li></ul> <p>PQRST MNEMONIC 11. Special Populations : Pediatrics </p> <ul><li>Symptoms( Clues ) </li></ul> <ul><li>- Duration of pain( &gt;24hr ) </li></ul> <ul><li>- Location of pain </li></ul> <ul><li>* Simple periumbilical </li></ul> <ul><li>* Concern Away from umbilicus </li></ul> <ul><li>- Appearance of child </li></ul> <ul><li>- Vomiting </li></ul> <ul><li>* Green / yellow </li></ul> <ul><li>* Dark / blood </li></ul> <ul><li>- Diarrhea </li></ul> <ul><li>* Viral cause? </li></ul> <ul><li>* Blood </li></ul> <ul><li>- Fever </li></ul> <ul><li>* May or may not be a problem </li></ul> <ul><li>- Groin pain</li></ul> <ul><li>* ? Testicular torsion </li></ul> <ul><li>Infants / Young children </li></ul> <ul><li>- Crying, facial expression,</li></ul> <ul><li>curling up </li></ul> <ul><li>Toddlers </li></ul> <ul><li>- Often talk about their pain </li></ul> <ul><li>Adolescents </li></ul> <ul><li>- May be reluctant to talk about</li></ul> <ul><li>their pain </li></ul> <ul><li>Consider the following: </li></ul> <ul><li>- Viral gastroenteritis </li></ul> <ul><li>- Food related illness </li></ul> <ul><li>- Poisoning( i.e., soap, lye, meds ) </li></ul> <ul><li>- Surgical( i.e., adhesions ) </li></ul> <ul><li>- Medical( i.e., type1DM ) </li></ul> <p> 12. Special Populations : Obesity </p> <ul><li>Palpation of abdomen </li></ul> <ul><li>- Imagine shape &amp; size of organs </li></ul> <ul><li>- Mark costal margins, iliac spine &amp; pubis </li></ul> <ul><li>* Allow one to know where the</li></ul> <ul><li>true anterior abdominal wall is</li></ul> <p> 13. Special Populations : Geriatrics </p> <ul><li>Abdominal Pain statistics: </li></ul> <ul><li>- Gallstones( 10-30% ) </li></ul> <ul><li>- Intestinal Obstruction( 25% ) </li></ul> <ul><li>- Strangulated Hernia( 20% ) </li></ul> <ul><li>- Perforation : PUD( 10% ) </li></ul> <ul><li>- Perforation : Diverticulitis( 5-10% ) </li></ul> <ul><li>- Appendicitis( 5% ) </li></ul> <ul><li>- Rupture of AAA( 2% ) </li></ul> <ul><li>Considerations : </li></ul> <ul><li>-immune function </li></ul> <ul><li>-Co-morbid conditions </li></ul> <ul><li>* DM, HT, malignancy </li></ul> <ul><li>-Physiologic reserve </li></ul> <ul><li>* CAD, pulmonary disease </li></ul> <ul><li>-Asymptomatic pathologies </li></ul> <ul><li>-Sensorium </li></ul> <ul><li>- Poor historians </li></ul> <ul><li>- Previous surgeries </li></ul> <p> 14. Fast Assessment Action Data Nsg. Evaluation Nsg. Assessment Nsg. Care Plan Fast Treatment Evaluation Nsg. Intervention Nsg. Diagnosis 15. Nurses role </p> <ul><li>Fast assessment Fast treatment </li></ul> <ul><li> Nursing Diagnosis </li></ul> <ul><li>- Quick survey </li></ul> <ul><li>- Vital signs </li></ul> <ul><li>- Cardiac monitor &amp; Pulse oximeter </li></ul> <ul><li>- Oxygen administration </li></ul> <p> 16. </p> <ul><li>Nurses role </li></ul> <ul><li>- I.V.Fluid / Blood administration </li></ul> <ul><li>- Blood / Urine samples </li></ul> <ul><li>- N.P.O. </li></ul> <ul><li>- Alert the Physician </li></ul> <ul><li>- N.G. tube/Intermittent suction preparing </li></ul> <p> 17. Nurses role </p> <ul><li>- Pain Medication as order </li></ul> <ul><li>- Nonpharmacologicinterventions</li></ul> <ul><li>[positioning, back rubs, heating pads] </li></ul> <ul><li>- Emotional Support </li></ul> <ul><li>- Family support </li></ul> <ul><li>- Document Everything do </li></ul> <p> 18. </p>