Acute abdomenal pain.pptx injuries aspect

Injuries mediological aspects

1. Acute Abdomen a l p a i n

2. Acute abdomen a l p a i n Is the most common presenting surgical emergency. It has been estimated that at least 50% of general surgical admissions are emergencies and 50% of them present with acute abdominal pain.

3. Acute abdomen a l p a i n ‘Acute abdomen’ is a term used to include a spectrum of surgical, medical and gynecological conditions, ranging from the minor to the life-threatening, which require hospital admission, investigation and treatment.

4. C n o t The mortality rate varies with age, being the highest at the extremes of age. Most common causes in any population will vary according to age, sex and race, as well as genetic and environmental factors.

5. Acute pain, which usually occurs in response to tissue injury, results from activation of peripheral pain receptors and their specific A delta and C sensory nerve fibers (nociceptors). Chronic pain related to ongoing tissue injury is presumably caused by persistent activation of these fibers . P a t h o p h y s y o l o g y

6. Causes- Gastrointestinal- 1-Gut Acute appendicitis Intestinal obstruction Perforated peptic ulcer Diverticulitis Inflammatory bowel disease 2-Liver and biliary tract cholecystitis cholangitis Hepatitis 3-Pancreas Acute pancreatitis 4-Spleen spontaneous rupture

7. The acute abdomen may be caused by an infection, inflammation, vascular occlusion, or obstruction. The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting. C o n t

8. in? Dyspepsia (indigestion) is a common symptom characterised by discomfort or pain in the upper abdomen. It typically occurs after eating or drinking. Symptoms may include early satiation uncomfortable fullness bloating nausea vomiting belching, flatulence, heartburn, regurgitation and diarrhoea. S i n g and s y m ptoms

9. Characteristics of abdominal pain Site Time and mode of onset Severity Nature/Character Progression Radiation Duration Cessation Exacerbating/relieving factors Associated symptoms

10. Symptoms--Pain Onset Sudden : perforation of bowel. Slow onset : inflammation of visceral peritoneum Severity Patient asked to rate pain from 1-10 Character Aching-dull pain poorly localized Burning- peptic ulcer symptoms Stabbing-ureteric colic Gripping-smooth muscle spasm e.g. intestinal obstruction worse by movement .

11. Symptoms--Pain Progression -Constant e.g. peptic ulcer -Colicky e.g. seconds(bowel), minutes(ureteric colic) or tens of minutes ( gallbladder) Radiation of the pain Back: duodenal ulcer, pancreatitis, aortic aneurysm Scapula: gall bladder Sacroiliac region: ovary Loin to groin: ureteric colic Groin: testicular torsion

12. C o n Cessation - Abrupt ending- colicky pains Resolving slowly-inflammatory pain, biliary pain Exacerbating/relieving factors- Movement/Rest-inflammatory conditions Food- peptic ulcers

13. Physical Examination Abdomen *Inspection *Palpation *Percussion *Auscultation

14. Physical Examination Inspection -movement with respiration -distension, peristalsis, mass, scars and any obvious cough impulse at hernia site Palpation *Superficial palpation -tenderness, rebound tenderness, guarding, rigidity, masses , hernial orifices *Deep palpation -organomegaly

15. Physical Examination Percussion - Tympanic note: intestinal obstruction -Dullness over bladder: acute retention Auscultation - Silent abdomen: peritonitis -Increase bowel sound: intestinal obstruction

16. Investigation CBC Urea, electrolyte, creatinine, glucose LFT Lipase Urinalysis CXR CT SCAN U/S Angiography Pregnancy test

17. Treatment 1. Relieve the pain 2. IV fluids and nasogastric suction 3. Antibiotics 4. Surgery if indicated

18. Acute Pain Nursing Assessment Nurses play a vital role in the assessment of pain. Assess acute pain: 1. Perform a comprehensive assessment of pain. Determine the location, characteristics, onset, duration, frequency, quality, and severity of pain via assessment. 2. Pain should be screened every time vital signs are evaluated. Pain is a “fifth vital sign” and should be added to routine vital signs assessment. 3. Assess the patient’s ability to explore a range of techniques to control pain ( non-pharmacological)

19. P a i n r e l a t e d t o i n f l a m m a t i o n , o e d e m a , d i s t e n t a i o n o f t h e p a n c r e a s a n d p e r i t o n e a l i r r i t a t i o n I n e f f e c t i v e b r e a t h i n g p a t t e r n r e l a t e d t o s e v e r p a i n p u l m o n a r y i n f i l t r a t e s . n u t r t i o n a l s t a t u s l e s s t h a n r e q u a r e d re l a t e d t o i n a d e q uate nutrition inta k e N u rsing diagnosis

20. Nursing Interventions for Acute Pain Provide measures to relieve pain before it becomes severe. It is preferable to provide an analgesic before the onset of pain or before it becomes severe when a larger dose may be required. Provide nonpharmacologic pain management. Nonpharmacologic methods in pain management may include physical, cognitive-behavioral strategies, and lifestyle pain management.  Provide cognitive-behavioral therapy (CBT) for pain management. These methods are used to provide comfort by altering psychological responses to pain.  Cognitive-behavioral interventions include

21. C o n t Provide cutaneous stimulation or physical interventions The way it works is by distracting the client away from painful sensations through tactile stimuli.  Massage . Heat and cold applications.  Acupressure .. Immobilization . Provide pharmacologic pain management as ordered. Administer nonopioids including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as  aspirin  or ibuprofen, as ordered. 

22. C o n t Administer opioids as ordered. Opioids are indicated for severe pain and can be administered orally, IV, or epidurally. Opioids for moderate pain.  These include codeine, hydrocodone, and tramadol (Ultram) which are combinations of nonopioid and opioid. Opioids for severe pain.  These include morphine, hydromorphone. Most of these are controlled substances due to potential misuse. Evaluate the effectiveness of analgesics as ordered and observe for any signs and symptoms of side effects. The patient’s effectiveness of pain medications must be evaluated individually since they are absorbed and metabolized differently.

23. untreated, an acute abdomen may result in the following: Sepsis. Necrosis and/or gangrene of bowel. Fistula. Death. Complications

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