nursing:abdopain
ED nurse initiated Rx of the patient with abdominal pain
introduction
patients with abdominal pain often waiting excessive long periods in ED waiting rooms awaiting a cubicle to be free
their time to diagnosis could be reduced and their symptoms partly relieved by nurse initiated ED Rx, although it is recognised that these presentations can be complex and warrant timely medical assessment to properly exclude important red flags.
the following is a suggested framework for ED's who have nurses accredited to undertake ED nurse initiated treatment including the ordering of pathology tests.
specific history and examination
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patient should be kept nil orally until notified otherwise by medical staff
patients with vomiting and diarrhoea need to be considered infectious until proven otherwise, and infection precautions instituted
most elderly patients are normally dehydrated, acute illness exacerbates this, increasing falls risk and delirium risk, and nearly all will benefit from 1L N saline over 2 hours as soon as possible - exceptions are acute blood loss where blood transfusion is more appropriate, and those on fluid restriction (eg. dialysis patients or florid cardiac failure)
specific nurse initiated Rx for adults with abdominal pain
red flags to escalate medical referral
hypotension
pregnancy
epigastric pain radiating through to back, particularly in the elderly (?AAA)
ECG changes suggestive of AMI
fever
severe pain
haematemesis or melaena
blood glucose > 25 or diabetic with ketones in urine
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upper abdominal pain
DDx includes biliary disease, pancreatitis, gastritis, peptic ulcer, AAA, AMI, lower lobe pneumonia, pyelonephritis
ECG if diabetic or elderly
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iv access, commence N Saline 2hrly rate
take blood for FBE, U&E, LFTs, lipase, glucose, and
if child-bearing age, a HCG
if on warfarin, an INR
if GIT bleeding, coagulation profile plus group and hold
lower abdominal pain
DDx includes diverticulitis (esp. LIF), appendicitis (RIF), ovarian cyst, ectopic pregnancy, PID, dysmenorrhoea, UTI, pyelenephritis (esp. if flank pain and fever), renal colic, urinary retention, bowel obstruction, sigmoid volvulus (nursing home residents), and constipation.
iv access, commence N Saline 2hrly rate
take blood for FBE, U&E, glucose, CRP, and:
if child-bearing age, and not already had an US confirmed pregnancy, a HCG
if on warfarin, an INR
patients with known AF should also be considered for a serum lactate level (discuss with ED doctor)
urinalysis and urine pregnancy test (if child bearing age and not known to be pregnant)
consider bladder scan to exclude retention if unable to void
nursing/abdopain.txt · Last modified: 2015/01/20 04:14 by gary1