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    Abdominal Pain Management

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    Teenu Joby
    This document provides a protocol for nurses to assess and manage adult patients presenting with abdominal pain. It outlines criteria for escalating care including immediate life-threatening conditions. Nurses should perform a primary survey and full history and examination looking for any red flags. Based on findings, nurses initiate interventions such as IV access, fluids and analgesia. They also order relevant investigations and notify doctors if patients meet escalation criteria or have concerning signs identified. The protocol aims to identify serious underlying causes early while providing symptom relief.

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    Abdominal Pain Management

    Uploaded by

    Teenu Joby
    83 views3 pages
    This document provides a protocol for nurses to assess and manage adult patients presenting with abdominal pain. It outlines criteria for escalating care including immediate life-threatening conditions. Nurses should perform a primary survey and full history and examination looking for any red flags. Based on findings, nurses initiate interventions such as IV access, fluids and analgesia. They also order relevant investigations and notify doctors if patients meet escalation criteria or have concerning signs identified. The protocol aims to identify serious underlying causes early while providing symptom relief.

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    Abdominal pain management

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    This document provides a protocol for nurses to assess and manage adult patients presenting with abdominal pain. It outlines criteria for escalating care including immediate life-threatening conditions. Nurses should perform a primary survey and full history and examination looking for any red flags. Based on findings, nurses initiate interventions such as IV access, fluids and analgesia. They also order relevant investigations and notify doctors if patients meet escalation criteria or have concerning signs identified. The protocol aims to identify serious underlying causes early while providing symptom relief.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    83 views3 pages

    Abdominal Pain Management

    Uploaded by

    Teenu Joby
    This document provides a protocol for nurses to assess and manage adult patients presenting with abdominal pain. It outlines criteria for escalating care including immediate life-threatening conditions. Nurses should perform a primary survey and full history and examination looking for any red flags. Based on findings, nurses initiate interventions such as IV access, fluids and analgesia. They also order relevant investigations and notify doctors if patients meet escalation criteria or have concerning signs identified. The protocol aims to identify serious underlying causes early while providing symptom relief.

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    Adult Emergency Nurse Protocol

    ABDOMINAL PAIN SESLHDPR/383


    Aim:
    • Early identification and treatment of life threatening causes of Abdominal Pain, escalation of care for patients at risk.
    • Early initiation of treatment / clinical care and symptom management within benchmark time.
    Assessment Criteria: On assessment the patient should have abdominal pain and one or more of the following signs /
    symptoms:
     Pain to the abdomen (localised)  Pale, lethargic  Fever or chills
     Diarrhoea or constipation  Urinary symptoms  Vomiting, nausea or anorexia
    Escalation Criteria: Immediate life-threatening presentations that require escalation and referral to a Senior Medical Officer (SMO):
     Acute confusion / agitation  Hyperactive / absent bowel sounds  Abdominal distension / rigidity
     Recent abdominal or gynecological
     Pain has characteristics of ACS  Blood in Stool - Malaena
    surgery
     Hypotension and tachycardia  Haematemesis  Suspected ectopic pregnancy

    Primary Survey:
    • Airway: patency • Breathing: resp rate, accessory muscle use, air entry, SpO2.
    • Circulation: perfusion, BP, heart rate, temperature • Disability: GCS, pupils, limb strength
    Notify CNUM and SMO if any of the following red flags is identified from Primary Survey and Between the Flags criteria 1
     Airway – at risk  Breathing – respiratory distress  Circulation – shock / altered perfusion
    • Partial / full obstruction • RR < 5 or >30 /min • HR < 40bpm or > 140bpm
    • SpO2 < 90% • BP < 90mmHg or > 200 mmHg
     Disability – decreased LOC  Exposure • Postural drop > 20mmHg
    • GCS ≤ 14 or a fall in GCS by 2 • Temperature <35.5°C or >38.5°C • Capillary return > 2 sec
    points • BGL < 3mmol/L or > 20mmol/L
    History:
    • Presenting complaint
    • Allergies
    • Medications: Anticoagulant Therapy, Anti-hypertensives, Diabetic meds, Analgesics, Inhalers, Chemotherapy, Non-prescription
    meds, any recent change to meds
    • Past medical past surgical history relevant
    • Last ate / drank and last menstrual period (LMP) / bowel motion
    • Events and environment leading to presentation
    • Pain Assessment / Score: PQRST (Palliating/ provoking factors, Quality, Region/radiation, Severity, Time onset)
    • Associated signs / symptoms: nature of pain / radiation, nausea, vomiting, nature of stool, symptoms of pregnancy, urinary
    symptoms and weight loss or anorexia.
    • History: family, trauma and travel (gastroenteritis and infectious colitis)
    Systems Assessment:
    Focused abdominal assessment:
    • Inspection: Scars, masses, distention, bruising, discoloration, midline pulsations, devices and movement of patient
    • Auscultation: Bowel sound; hyperactive, reduced or absent
    • Palpation: tenderness, guarding, rebound tenderness, masses, pulses – signs of peritonism; Identify location of pain
    Notify CNUM and SMO if any of the following red flags is identified from History or Systems Assessment.
     Referred pain – shoulder / back  Hyperactive or absent bowel sounds  Confirmed pregnancy / +ve BHCG
     Abdominal distension  Peritonism – rigidity / guarding  Severe, sudden or constant pain
     Elderly > 65 years  Fever  Decreased urine output – oliguria
     Multiple / complex comorbidities  Previous abdominal surgery  Alcoholism
     Immunosuppressed  Acute confusion / agitation
    Investigations / Diagnostics:
    Bedside: Laboratory / Radiology:
    • BGL: If < 3mmol/L or > 20mmol/L notify SMO  • Pathology: Refer to local nurse initiated STOP - FBC, UEC, LFTs
    • ECG: [as indicated] look for Arrhythmia , AMI  Urine βHCG and Quantitative ßHCG if positive
    • Urinalysis / MSU (if urinary symptoms) Group and Hold (if bleeding suspected)
    Blood Cultures (if Temp≥38.5 or ≤35°C)

    Abdominal Pain – Adult Emergency Nurse Protocol SESLHD T14/36288 Review date: June 2021 Page 1
    Adult Emergency Nurse Protocol
    ABDOMINAL PAIN SESLHDPR/383
    • Radiology: Discuss with SMO

    Nursing Interventions / Management Plan:


    Resuscitation / Stabilisation: Symptomatic Treatment:
    • Oxygen therapy and cardiac monitor [as indicated] • Antiemetic: as per district standing order
    • IV Cannulation (16-18gauge if unstable) • Analgesia: as per district standing order
    • IV Fluids: Sodium Chloride 0.9% 1 L IV stat versus • IV Fluids: as per district standing order
    over 8 hours (discuss with SMO)
    Supportive Treatment:
    • Nil By Mouth (NBM) • Bowel chart [as indicated]
    • Monitor vital signs as clinically indicated • Fluid Balance Chart (FBC)
    (BP, HR, T, RR, SpO2) • Consider devices: IDC, Nasogastric tube [as indicated]
    • Monitor pain assessment / score • ECI Patient Factsheet

    Practice Tips / Hints:


    • Abdominal aortic aneurysm (AAA) should be considered in the patient aged >60 who presents with abdominal, flank or back
    pain. The symptoms of a ruptured AAA may mimic renal colic, diverticulitis, or gastrointestinal haemorrhage. Risk factors for
    AAA include smoking, male, elderly, caucasian, atherosclerosis, hypertension, family history of AAA, other peripheral artery
    aneurysm (iliac, femoral, popliteal) (5)
    • Acute cholecystitis risk factors include; elderly, female, obesity, diabetes mellitus, profound weight loss, fasting or family history
    (7)
    • Acute Pancreatitis: Signs and symptoms to consider: Abdominal pain-upper or generalised, typically severe, may radiate to
    back, nausea, vomiting and diaphoresis, abdominal tenderness, abdominal distension.
    • Epigastric pain can indicate gastric ulcer (long-term), pancreatitis, perforated oesophagus, Mallory-Weiss tear, cholelithiasis or
    AMI (2)
    • Referred right scapula pain can indicate gallbladder or liver disease (2) Referred left scapula pain can indicate cardiac, GIT,
    pancreatic or splenic disease (2); Referred scrotal or testicular pain can indicate renal colic or uretheral (2)
    • Left upper quadrant pain can indicate splenic infarct or injury, pyelonephritis or renal colic (2);
    • Right upper quadrant pain can indicate cholelithiasis, cholecystitis, pyelonephritis, renal colic, hepatitis and appendicitis (in
    pregnancy) (2)
    • Left and right lower quadrant (LLQ) (RLQ) can indicate diverticulitis, gynecological issues (ovarian torsion, cyst, PID or ectopic
    pregnancy) Crohn’s, ulcerative colitis, renal colic, appendicitis (RLQ) malignancy or hernia (2)
    • Cullen’s sign: periumbilical discoloration (2)
    • Grey Turner’s sign: bruising of the flanks, indicating haemorrhagic pancreatitis (3);
    • Murphy’s sign: RUQ tenderness on inhalation during palpation (97% sensitivity in acute cholecystitis) (7)
    • Bowel Sounds: hyperactive bowel sounds may indicate early bowel obstruction (2); Absent or diminished bowel sounds may
    indicate constipation, a bowel obstruction, perforated viscus (2)
    • Anorexia is a common symptom of an acute abdomen (2)
    • Atypical presentations or a pain free abdomen can occur in the elderly, immunocompromised, or pregnant patients(2)
    Further Reading / References:
    1. SESLHDPR/283 Patient with Acute Condition for Escalation (PACE): Management of the Deteriorating Adult Maternity
    Inpatient
    2. BMJ Assessment of Acute Abdomen
    3. ECI Patient Factsheet- Abdominal Pain
    4. ECI Abdominal Emergency Resource Tool
    5. ECI Abdominal Aortic Aneurysm Resource Tool
    6. ECI Acute cholecystitis Resource Tool
    7. ECI Acute Pancreatitis Resource Tool

    Acknowledgements: SESLHD Adult Emergency Nurse Protocols were developed and adapted with permission from:
    • Murphy, M (2007) Emergency Department Toolkits. Westmead Hospital, SWAHS
    • Hodge, A (2011) Emergency Department, Clinical Pathways. Prince of Wales Hospital SESLHD.

    Revision and Approval History


    Date Revision No. Author and Approval
    September 2013 0 Developed by Lauren Neuhaus - Nurse Educator, Emergency St George Hospital.
    December 2013 1 Edited by Leanne Horvat - Clinical Stream Nurse Manager, Emergency / Critical Care & Emergency

    Abdominal Pain – Adult Emergency Nurse Protocol SESLHD T14/36288 Review date: June 2021 Page 2
    Adult Emergency Nurse Protocol
    ABDOMINAL PAIN SESLHDPR/383
    Stream CNC/ NE Working Group SESLHD

    February 2014 2 Endorsed by: SESLHD Emergency Clinical Stream Committee on 20 February 2014
    May 2014 3 Endorsed by: SESLHD District Clinical & Quality Council meeting on 14 May 2014 (T14/36288)
    September 2014 4 Endorsed by: SESLHD District Drug & QUM Committee meeting on 11 September 2014
    November 2017 5 Reviewed by Lauren Neuhaus – Acting Clinical Nurse Consultant, Emergency St George Hospital.
    January 2018 5 Processed by Executive Services prior to submission to DQUM.
    February 2018 5 Endorsed by: SESLHD Drug & Quality Use of Medicine Committee
    April 2021 6 Reviewed by Kate Jarrett- Clinical Nurse Consultant, Emergency St George Hospital
    May 2021 6 Approved by Executive Sponsor.

    June 2021 6 Endorsed by: SESLHD Quality Use of Medicine Committee

    Abdominal Pain – Adult Emergency Nurse Protocol SESLHD T14/36288 Review date: June 2021 Page 3

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