Nurses' Role in Assessing and Managing Abdominal Pain

Introduction

The people who make up a medical setting contribute immensely and provide the professional care they know to patients who visit, whether in a clinic or a hospital. When a patient first walks in, he or she will meet the desk clerk and other staff who help get them settled. However, no one is more important when it comes to first professional contact than nurses. The role of nurses is especially critical when patients are in tremendous pain and agony. This paper explores the different methods and strategies nurses are expected to employ when patients present with abdominal pain. Overall, it becomes clear that nurses supplement and complement care on behalf of physicians and their patients.

Nursing Assessment of Abdominal Pain

Most of the people who come through the doors of a clinic, physician's office, or emergency room do so because of abdominal pain. After the patient is admitted and seen by the nurse, the healthcare professional takes down a personal history before assessing the patient's condition. It is important that the nurse asks questions pertaining to the pain, associated symptoms, past medical and medication history, and social and family history, because all of these factors can contribute to identifying the patient's problem. As noted by Cole (2006), "the history can provide 70 per cent or more of the clues to the diagnosis."

Nurses should also inquire about certain histories associated with acute abdominal pain, such as diabetes, intravenous drug use, or pregnancy. They should also note whether the patient has alcoholic liver disease, heart problems, a history of ingesting multiple medications, or prior surgical procedures. Family history is significant because certain cancers and diseases can have a genetic basis, or a contagious disease may have been passed from a close contact to the patient. Social history is equally important, as a patient's occupation, environment, and stress levels can all have an impact on findings.

Pain Location, Quality, and Characteristics

After the initial assessment, the nurse asks the patient about the location and quality of the pain. Regarding location, the nurse investigates which abdominal quadrant the pain is coming from. Nurses conceptualize the abdominal cavity in four parts: the right upper quadrant, the left upper quadrant, the right lower quadrant, and the left lower quadrant. Each of these regions encompasses certain organs of the abdominal cavity, including the liver, gallbladder, portions of the colon and intestines, the appendix, the stomach, the spleen, and the pancreas.

The right upper quadrant contains part of the ascending and transverse colon, the duodenum, the head of the pancreas, the liver, and the gallbladder. The left upper quadrant contains the left lobe of the liver, the stomach, the spleen, the body of the pancreas, and portions of the ascending and transverse colon. The right lower quadrant contains the cecum, the appendix, and the ascending colon. The left lower quadrant includes the sigmoid and descending colon.

Once the patient points out the location of the pain and the nurse has investigated it, the nurse then asks the patient to describe whether the pain is referred or radiated. Referred pain is felt in a region different from its actual source, while radiated pain travels to other parts of the body. Pain may also be classified as parietal or visceral. Parietal pain is sharp and easily localized, usually resulting from inflammation of the parietal peritoneum, while visceral pain is dull and vague in origin, potentially arising from a solid or hollow organ.

After the type of pain is assessed, the patient is asked to describe the characteristic of the pain — for example, whether it is burning, aching, cramping, or tearing. Burning pain is associated with peptic ulcers, while tearing pain may indicate an ectopic pregnancy, appendicitis, or dissecting aneurysm. Aching pain is linked to constipation or chronic hernia, while cramping pain may result from bowel obstruction or problems with the bile duct or ureters. To further understand the patient's condition, the nurse also asks whether the pain is relieved by eating, vomiting, or passing gas. The intensity of the pain should be recorded on a scale of zero to ten, with zero indicating no pain and ten indicating the most severe pain possible. The timing of the pain should also be noted so that the condition can be assessed as acute or chronic. Ultimately, nurses and the physician may arrive at conclusions covering a range of conditions, from appendicitis to cholecystitis to pancreatitis.

Conclusion

The responsibilities of a nurse are never easy but are very rewarding when it comes to patient care and diagnosis. Nurses act as a liaison between patient and physician by taking down patient history, social history, and assessing the patient's condition. The role nurses play is significant and directly impacts the quality of care patients receive. Nurses aid physicians in determining the cause of pain by localizing where the pain originates, identifying which quadrant and organ is likely responsible, and interpreting the patient's description of the pain. Furthermore, nurses provide both physical and psychological care, as they are the first healthcare professionals patients encounter and the individuals who care for patients before they see the doctor. Overall, in a medical care setting, nurses must treat patients with abdominal pain meticulously and patiently, given the delicate and often distressing nature of the situation.

References

Cole, E., Lynch, A., & Cugnoni, H. (2006). Assessment of patient acute abdominal pain. Nursing Standard, 20(38), 56–64.