Management of Abdominal Pain

In the pain assessment process, I would ask John the following questions;

o What were you doing when the pain began?

o What was its cause?

o Where are you experiencing the pain?

o Is the pain shifting? Did it begin elsewhere and now located in a different region?

o What makes it severe? (Stang et al., 2014)

o For how long have you been experiencing the pain?

o Had the pain occurred again or do you experience such kind of pain?

o Is it gradual or sudden

o How severe is the pain based on the scale of zero to ten?

o What relieves your pain?

o What does the pain feel like? Is it burning, sharp, or crushing?

o Does the pain interfere with your activities? How is the pain when worse? Do you require sitting down, standing, or lying down?

o Is the pain continuous?

o Doe the pain lead to other problems? What are the associated signs and symptoms?

The observations concerning John’s behaviours would include;

o The presented signs and symptoms such as the physical appearance of the region developing the pain and touch to feel the warmth in the location generating the pain (Eccleston et al., 2016).

§ There would be the observation of John’s behaviour when the pain becomes worse and his posture and movements when it becomes severe.

The three (different) applicable assessment tools that would be utilized in the evaluation of different pain elements and reflection on the influence of the pain for John would be;

o The FLACC is a pain assessment tool. The tool would influence John’s pain since it will focus on assessing his behaviour by looking at his face, legs, activity, cry, and consolability. (FLACC) (Di Saverio et al., 2014)

§ The rationale for the above assessment process using the FLACC tool is that by observing John's behaviour based on the facial look, movement of legs, his activity, the possibility of cry, and ability to console, it will be possible to understand the nature of his pain.

o PQRST pain assessment approach would be applicable; whereby John will be asked questions on the basis of palliation or provocation, quality and quantity, region or radiation, severity scale, and timing (Walker, & Greene, 2013).

§ The responses to these questions will enhance the accurate description, documentation, and evaluation of the patient’s pain. John will be required to answer all questions correctly.

§ The choice of the PQRST pain assessment tool and the implemented method is based on the effectiveness of this method in identifying the necessary pain medication and assessing the response to his treatment (Walter et al., 2013).

o The Indiana Polyclinic Combined Pain Scale (IPCPS). The tool is applicable through allowing the patient rate the pain based on the scale given ranging from zero for no pain and ten for the worst imaginable pain (Stang et al., 2014).

§ John would be required to rate his pain, rate the impact of the pain on his daily activities, and state the frequency of the pain.

§ The selection of this tool was based on how it involves the patient to describe his pain. It is an accurate method of evaluating and noting down John’s pain.

Part B: Type of Pain

The type of pain that John is experiencing is abdominal pain

o John claims to have initially experienced the pain around the umbilicus, although it is currently through the abdomen (Boelens et al., 2013).

o He feels severe pain in the abdomen through some light touch.

o John vomited some amount of yellowish fluid.

The six (6) physiological changes associated with the pain that might be expected to be exhibited by John are;

o Widening of the eyelids or dilatation of John’s pupils

§ The severity of pain makes ones sight difficult (Korterink et al., 2015)

§ The eyes show when a patient is in a serious medical condition, as it was the case with John.

o Changes in his heart rate and blood pressure

§ As the pain elevates, John breaths deeply and the heart functionality or workload becomes high (Groß, & Warschburger, 2013)

o The rise in the respiratory depth or rate

§ The oxygen supply during severe pain is lower than how it is consumed in John's body.

o Sweating

§ As John tries to cope with the pain, all the body systems tend to function, therefore the secretion of sweat. Also, the severe pain making the region to burn (Rutten et al., 2015).

§ Changes in the body temperature and heart rate leads to John’s sweating

o Changes in the body temperature and skin

§ As the pain changes from mild to severe, the skin changes the rate at which it burns

o improved muscle tone

§ The muscle spasm caused by the tissue damage in the abdomen makes John develop fatigue (Walter et al., 2013).

Section 2:

Part A: Management Plan

John’s pain management entails starting with the recognition of the nature of pain.

Based on John’s declaration that he feels continued and severe pain across his stomach, it is necessary to diagnose her and understand the condition of the pain.

Given that there are different sources of pain, it is necessary for the nursing practitioner to understand the specific source of the abdominal pain in order to choose how to manage it (Kulik, Uleryk, & Maguire, 2013).

Effective management of severe pain has to reflect on the symptoms presented

John needs to go through a thorough pain assessment as this would assist in identifying the particular source of the pain (Castro et al., 2013).

The medical evaluation would also help in making some informed decisions on the appropriate interventions and therapies.

After understanding the cause and nature of John’s pain, physical therapy will be conducted by touching the abdomen and massaging through to make the abdominal muscles straight.

Abdominal massage would also be vital for John’s reduced pain

John would be allowed to lie down flat and still for the abdomen to be calm and to enhance his relaxation.

John would require having someone close to supporting him when in need of moving from one location to the other, hence the provision of social support (Johnson et al., 2013).

While talking with John, it would be vital to show concern for him to feel valued

John would be required to engage in simple exercises such as deep breathing and meditation, which will minimize the tightness of the abdominal muscles, therefore the reduced pain.  

Deep breathing will also be helpful for John to avoid thinking much about the experienced pain and will enable him to consume the required level of oxygen and as the air circulates in the entire body, his temperature would also reduce (van der Veek et al., 2013).

Psychological relaxation and company would be effective in reducing his pain experience; whereby, psychological interventions will be conducted under a psychologist, hence the reduce stress and elimination of the feeling of social isolation.

Assisting John to walk around will enable him to straighten his entire body, and this will aid in making her abdomen relaxed.

Allowing John to stay in a friendly environment where he would catch some sleep easily would be effective in reducing his experience of pain.

John would need to join a support team where other people with such nature of pain are engaged in therapy programs to eliminate their pain (Di Saverio et al., 2014).

Patient education about the means of coping with pain and practices that John would engage in for the reduced pain is vital.

John would need to be informed about the right position to remain at when experiencing the abdominal pain

He would also need to learn how he should eliminate the abdominal pain through the intake of water (Honjo et al., 2015). Taking much water might assist John to experience effective digestion in the body, therefore the reduced pain in the abdomen.

John also needs to learn that sharing his problem and seeking support from the neighbours and friends is necessary although he stays alone with his family members staying in a different state.

John should learn the likely triggers of the abdominal pain and the pain syndrome.

Learning about the relaxation techniques would be helpful to John to eliminate his abdominal pain. 

Part B: Medications

The table of medications that John is currently prescribed:

Medication

1. Mode of action

2. Rationale for use

Tramadol 50 mg IV 4/24 prn

Enhances long-time pain treatment

The medication is effective in treating moderate and severe pain (Rutten et al., 2015).

Morphine 5-10 mg IV 4/24 prn

Immediate relieves acute pain and cures chronic severe pain effectively

It belongs in the opioid/ narcotic class of drugs, therefore, actively (Walter et al., 2013)

Paracetamol 1g 4/24 oral

The painkiller operates in treating of pains and aches, such as a headache as experienced by John (Korterink et al., 2015)

It is a known pain killer and would be useful to eliminate the likely pain that John would experience during the surgery.

Targin:  oxycodone/naloxone

Five mg/2.5 mg BD oral

The drug is used in treating severe pain

It relieves the pain within 24 hours. The medication is effectively used in lessening of constipation.

Ibuprofen 400mg 6 /24 oral  

The drug will treat minor pains experienced by John, especially the headache (Korterink et al., 2015)

It is a fast-acting drug in relieving pains temporarily and has minimal side effects

References

Boelens, O. B., van Assen, T., Houterman, S., Scheltinga, M. R., & Roumen, R. M. (2013). A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome. Annals of surgery, 257(5), 845-849.

Castro, J., Harrington, A. M., Hughes, P. A., Martin, C. M., Ge, P., Shea, C. M., ... & Cohen, M. B. (2013). Linaclotide inhibits colonic nociceptors and relieves abdominal pain via guanylate cyclase-C and extracellular cyclic guanosine 3′, 5′-monophosphate. Gastroenterology, 145(6), 1334-1346.

Di Saverio, S., Sibilio, A., Giorgini, E., Biscardi, A., Villani, S., Coccolini, F., ... & Catena, F. (2014). The NOTA Study (Non-Operative Treatment for Acute Appendicitis): a prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Annals of surgery, 260(1), 109-117.

Eccleston, C., Palermo, T. M., de C Williams, A. C., Lewandowski, A., Morley, S., Fisher, E., & Law, E. (2016). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. The Cochrane Library, CD003968.

Groß, M., & Warschburger, P. (2013). Evaluation of a cognitive-behavioral pain management program for children with chronic abdominal pain: a randomized controlled study. International journal of behavioral medicine, 20(3), 434-443.

Honjo, H., Mike, M., Kusanagi, H., & Kano, N. (2015). Adult intussusception: a retrospective review. World journal of surgery, 39(1), 134-138.

Johnson, T. J., Weaver, M. D., Borrero, S., Davis, E. M., Myaskovsky, L., Zuckerbraun, N. S., & Kraemer, K. L. (2013). Association of race and ethnicity with the management of abdominal pain in the emergency department. Pediatrics, peds-2012.

Korterink, J. J., Diederen, K., Benninga, M. A., & Tabbers, M. M. (2015). Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PloS one, 10(5), e0126982.

Korterink, J. J., Rutten, J. M., Venmans, L., Benninga, M. A., & Tabbers, M. M. (2015). Pharmacologic treatment in pediatric functional abdominal pain disorders: a systematic review. The Journal of Pediatrics, 166(2), 424-431.

Kulik, D. M., Uleryk, E. M., & Maguire, J. L. (2013). Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. Journal of clinical epidemiology, 66(1), 95-104.

Rutten, J. M., Korterink, J. J., Venmans, L. M., Benninga, M. A., & Tabbers, M. M. (2015). Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review. Pediatrics, peds-2014.

Stang, A. S., Hartling, L., Fera, C., Johnson, D., & Ali, S. (2014). Quality indicators for the assessment and management of pain in the emergency department: a systematic review. Pain Research and Management, 19(6), e179-e190.

Van der Veek, S. M., Derkx, B. H., Benninga, M. A., Boer, F., & de Haan, E. (2013). Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial. Pediatrics, peds-2013.

Walker, L. S., & Greene, J. W. (2013). Children with recurrent abdominal pain and their parents: more somatic complaints, anxiety, and depression than other patient families?. In Family Issues in Pediatric Psychology (pp. 77-90). Routledge.

Walter, S. A., Jones, M. P., Talley, N. J., Kjellström, L., Nyhlin, H., Andreasson, A. N., & Agréus, L. (2013). Abdominal pain is associated with anxiety and depression scores in a sample of the general adult population with no signs of organic gastrointestinal disease. Neurogastroenterology & Motility, 25(9), 741-e576.