CONTINUING PROFESSIONAL DEVELOPMENT
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Assessment of the patient with acute abdominal pain
NS344 Cole E et ai (2006) Assessment of the patient with acute abdominal pain. Nursing Standard. 20, 39,67-75. Date of acceptance: October 10 2005.
Abdominal pain has many causes, from simple to complex presentations. Patients with abdominal pain may have a number of physiological and psychological needs. Nurses have a key role to play in patient assessment, history taking and management
• Identify the main causes of abdominal pain and differential diagnoses. • Ask relevant questions of a patient presenting with abdominal pain. • Discuss the appropriate investigations and nursing care requited. • Understand the principles of symptom management. Introduction A nurse is the first healthcare professional many patients with abdominal pain may encounter, whether in an A&E department, walk-in centre, outpatient clinic, primary care setting ot surgical ward. Traditional professional working boundaries are no longer fixed in the current healthcare climate (Coombs and Ersser 2004). Many nurses of all levels arc involved inthe initial assessment and treatment of a patient before a medical consultation. It is therefore desirable that in addition to traditional nutsing assessments, registered nurses are able to ask the correct questions, initiate tests and implement first-line treatments to ensure a timely and effective experience for the patient. Abdominal pain is one of the most common reasons that people seek medical care (Kelso and Kugelmas 1 997). It may be difficult to establish the cause of the abdominal pain because of the diversity of clinical signs and symptoms. However, the history can provide 70 per cent or more of the clues to the diagnosis and must be taken accurately and carefully (Birkitt and Quick 2002, Talley and O'Connor 2006). The conditions that cause abdominal pain may be acute or non-acute. june 7 :: vol 20 no 39 :: 2006 67
Elaine Cole is lecturer practitioner, Accident and Emergency (A&E)/Trauma, City University and Barts and the London NHS Trust; Antonia Lynch is consultant nurse, A&E; Helen Cugnoni is consultant in emergency medicine, Barts and the London NHS Trust, London. Email: firstname.lastname@example.org
Accident and emergency nursing; Gastrointestinal system and disorders; Pain and pain management These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For related articles and author guidelines visit our online archive at www.nursing-standard.co.uk and search using the keywords.
Aims and intended learning outcomes
The aim of this article is to assist nurses in the assessment of abdominal pain in adults presenting to the accident and emergency (A&E) department and other acute settings. Through a structured approach to history taking and pain assessment, nurses should be able to differentiate abdominal pain caused by acute rather than non-acute conditions. Within a contemporary, interprofessional healthcare environment, this will aid rapid and effective treatment. After reading this article you should be able to: > Describe the anatomy and physiology of organs associated with abdominal pain. NURSING STANDARD
learning zone adult nursing
Anatomy and physiology Disorders ofthe abdomen may involve one or more organs within the abdommal cavity. This cavity contains the stomnch, spleen, hver., gall bladder, pancreas, kidneys, small intestine and large intestine. Additionally, some abdominal organs are contained within the pelvis: the bladder, caecum, appendix, sigmoid colon, rectum and tema le reproductive organs. When assessing a patient with abdominal...