NURS1002: Abdominal Assessment and the Investigation of Abdominal Pain in a Self-caring Elderly Person - Nursing Assessment Answers

Topic:Abdominal assessment and the investigation of abdominal pain in a self-caring elderly person

Body of report: Use the assessment rubric and ‘Assessment 1 Information’ Lecture to guide the content of the report.

The body of the report should address the following in relation to a self-caring elderly person experiencing abdominal pain:

• Explain the rationale and aims of performing an abdominal assessment
• Discuss appropriate health history questions relevant to this physical assessment (subjective data)
• Outline the physical assessment processes used to gather objective data during an abdominal assessment, including normal findings
• Identify two (2) potential abnormal findings which may be associated with the presenting complaint (abdominal pain) in an elderly person

Conclusion: Summarise what the report was aboutProvide a summary of the body of the assessment.

Introduction

Health issues become critical or serious in nature for elderly people. The quality of life is hampered and could not perform daily routine functions properly. One who suffers from a particular type of diseases gets used to of it and trained himself or help for self-care. Self-caring elderly people face problems pertaining to treatment and medicines. They need proper attention and care. Sometime it is very difficult to find out the root cause of the disease among people above 50 years of age as their immune system become weak and do not have capacity to fight against the antigens. The report presented here discuss the various health related issues in relation with abdominal assessment.

Rationale and aim of medical assessment

It is essential to undertake medical assessment by the health professionals to find out the reasons behind abdominal pain in self caring elderly people. Within the given community they might have experienced severe abdominal pain earlier also with varying level of pain intensity. At this age, various factors interact to give rise to abdominal pain. For example, if a person had history of gastric cancer and had completed the whole treatment cycle. Now it could be It could be one of the possibility that cancerous cells have spread to surrounding body parts and resulted into abdominal pain. Hence it is necessary to carry out complete and proper abdominal assessment. The problem stated above is more common among elder people (Gretschel et al, 2006). People who suffer from critical illness for a longer time duration they start taking care of themselves and gained experience.

Subjective data and normal findings

At the time of assessment, a patient must be asked various health related questions to analyze the actual situation. It could be started by asking medical history and treatment taken. Along with this, the current health situation would be assessed by taking a note of treatment and medicines. Without taking proper medical information, it become difficult for the medical team to provide exact treatment and solution. People also become health conscious and start visiting hospitals if not get proper care.

The right treatment definitely helped to relieve the pain though he followed all the given instructions by the doctor. During hospital visit, a patient could be asked the following questions for the clarification purpose by a senior physician-

• When you had abdominal pain?
• What medications you had taken earlier?
• How long have you adhere to the current treatment?
• When do you feel severe abdominal pain?
• Which body posture give you more relaxation from pain?
• Do you feel pain while walking?
• Are you carrying any laboratory diagnosis report?
• Have you experienced the same pain earlier in your life?
• Have you had history of diabetes or any other disease?
• Which body part is mostly affected during pain?
• Have you undergone any surgical procedure?
• Have you history of any cancer form?
• Do you have history of alcohol abuse?

It is highly likely that patient might be taking some form of medicine to control acute pain five years ago like morphine is given for severe abdominal pain which is sue to gastric cancer. Another possibility could be related with the medical history of cancer or any other disorder responsible for ill health. It is a big question to find out the reason of having acute abdominal pain. A patient must be discussed for medications given as part of analgesic ladder management of pain. At the first point, intensity of pain would be assessed and then only treatment can be finalized. The next prescription would depend upon current treatment whether he is taking any non-steroidal anti-inflammatory drugs (NSAID) or not.

If pain increases or persist then a weak opioid is prescribed to control mild to moderate pain. Second stage uses opioid (weak), paracetamol, adjuvant and non-steroidal anti-inflammatory drugs. If patient is not able to tolerate pain after second stage of treatment then given advanced medications- strong dosage of opioid, paracetamol, adjuvant, NSIAD and paracetamol. The drug choice is decided based upon severity of pain not the stage (Balboni, Paulk & Balboni, 2010).

Medical history also includes information about hospital stay and medical procedure. Patient suffering from acute pain are very often suggested or recommended for midline myelotomy. It is an effective way of treating abdominal pain for those who are suffering from gastric cancer. This is a minimum invasive procedure where pain signals reaching brain are blocked. The procedure is performed by a lesion created in spinal cord. It takes time to administer the drug as this involves various steps. It took around 24 hours to get back to normal situation and patient kept under observation for next 24 hours (American Cancer Society, 2016). The most important thing is patient recall power if it doesn’t happen then the treating doctor recommended for new medical test which might put him under heavy financial loss.

It is very important to obtain patients consent for physical assessment. Patient at older age might not be agree or comfortable for the examination. Hence He/she must be aware of the whole treatment procedure for good understanding level for medical checkup. The whole medical process must be explained and discussed with the patient. For example, GI endoscopy includes insertion of camera with a flexible probe to look into stomach and esophagus. The insertion procedure put a patient at higher level anxiety. Different clinical procedure requires particular patient positioning. For example, pain control therapy requires proper positioning of patient on stomach to make lesion in stomach. It requires a needle to make lesion in spinal cord to block the pain stimulus (Mack, Cronin & Keating, 2012). Sometime patients become afraid of this and deny at the last moment. So a patient must be aware of this procedure.

Inspection

Robert was assessed physically for the following signs and symptoms-

• Weight Loss
• Discoloration of skin and eye
• Fatigue
• Nausea or vomiting
• Blood pressure
• Bloody stools
• Acute pain
• GI endoscopy
• Biopsy

Weight loss and yellowish color of skin and eyes are signal of abnormal health condition. And blood pressure measurement is another important aspect. These all factors contribute for poor quality of life but as of now pain control is the main concern (Corey & Dwayne, 2006).

Auscultation

Auscultation practices depend upon skills and experience of medical professional. It is an essential process to get information about lungs, heart and gastrointestinal tract. A stethoscope is used to listen internal sounds of the body and then look back into the medical history to relate it with any abnormalities. If a person is having abdominal pain then listening sounds of gastrointestinal tract would definitely give an overview of the health condition. Abnormal bowel sound could be related with incomplete digestion, celiac disease, colitis, irritable bowel syndrome and excess gas which could lead to abdominal pain (Corey & Dwayne, 2006).

Percussion

Abdominal condition is assessed through percussion. It is a proved method to have an idea of organomegaly which is related to enlargement of tissues. Percussion gives an impression of pathological tissue or healthy cells. A medical professional comes to know about the disease problem at first glance. Different sounds generated by the procedure assists to relate the disease pathology with the symptoms. For example, organomegaly might be due to abnormal cells growth of underlying cells or tissues. At this stage, it is difficult to comment upon the cause of the disease as this is just clinical assessment.

Palpitation

A noticeably irregular heartbeat could be due to illness or agitation. It could be because of heart attack, anemia, blood pressure which might be ruled out through further investigations and laboratory diagnosis. The anxiety level increases during acute pain as the patient feels stress. Palpitation can also be related with abdominal pain.

Findings

Based upon physical and clinical assessment it becomes easy to rule out the possibility of disease status. If the assessment report denotes presence of enlargement of an organ then it might appear that few cells have spread to other body parts and causing severe pain. It generally happens among people over 50 years of age. The cells underlying bladder and urethra grows and expand in surrounding tissues causing abdominal pressure. The basis of abnormal tissue growth would depend upon metastatic nature of cells. It is evident that bladder cancer has an impact on urethral activity and increases the chances of spread of cancerous cells in urethra. There could be different types of urethral cancerous cells, for example, transitional carcinoma cells, squamous cell carcinoma etc. Metastatic cells travelling to other parts disturbs the normal functions of vital organs. The cells growth is creating pressure and resulting into abdominal pain. The other possibility could be indigestion problem which results into vomiting and high blood pressure. This could also lead to bloody stool.

Conclusion

The occurrence rate of abdominal pain is high among elderly patient due to gastric cancer. Despite taking essential medications to slow down the growth of cancerous cells, chances of acute pain increases. Pain control (morphine) and surgical procedure will give stability to the patient. Patient experiencing abdominal pain with having history of cancer is an example of relapse case progressing towards an advanced stage. It is the responsibility of the health professionals to communicate right information with him so that he feels positive about treatment. The actual treatment would be decided by discussing all the points with the patient and family members. The stage of the cancer development is important to define to start the chemotherapy.