Accessing the Abdomen

Review the Episodic note case study provided below for this week’s Assignment.With regard to the Episodic note case study provided:Review this week’s Learning Resources, and consider the insights they provide about the case study.Consider what history would be necessary to collect from the patient in the case study.Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. This means differential diagnosis related to abdominal pain.THE ASSIGNMENT IS BELOWAnalyze the subjective portion of the note. List additional information that should be included in the documentation.Analyze the objective portion of the note. List additional information that should be included in the documentation.Is the assessment supported by subjective and objective information? Why or why not?What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.By Day 7 of Week 6Submit your Lab AssignmentWeek 6: Assessment of the Abdomen and Gastrointestinal System (Case Study)Subjective:CC: “My stomach has been hurting for the past two days.”HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain.PMH: HTNMedications: Metoprolol 50mgAllergies: NKDAFH: HTN, Gerd, HyperlipidemiaSocial Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 femaleObjective:VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbsHeart: RRR, no murmursLungs: CTA, chest wall symmetricalSkin: Intact without lesions, no urticariaAbd: abdomen is tender in the epigastric area with guarding but without mass or rebound.Diagnostics: US and CTAAssessment:Abdominal Aortic Aneurysm (AAA)Perforated UlcerPancreatitisBELOW IS THE REQUIRED READINGLearning ResourcesRequired Readings (click to expand/reduce)Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Chapter 6, “Vital Signs and Pain Assessment”This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.Chapter 18, “Abdomen”In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.Chapter 3, “Abdominal Pain”This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.Chapter 10, “Constipation”The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.Chapter 12, “Diarrhea”In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.Chapter 29, “Rectal Pain, Itching, and Bleeding”This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.The sections below explain the procedural knowledge needed to perform gastrointestinal procedures.Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514-520)Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.Chabok, A., Thorisson, A., Nikberg, M., Schultz, J. K., & Sallinen, V. (2021). Changing paradigms in the management of acute uncomplicated diverticulitis. Scandinavian Journal of Surgery, 110(2), 180-186. https://doi.org/10.1177/14574969211011032Hussein, A., Arena, A., Yu, C., Cirilli, A., & Kurkowski, E. (2021). Abdominal pain in the elderly patient: Point-of-care ultrasound diagnosis of small bowel obstruction. Clinical Practice and Cases in Emergency Medicine, 5(1), 127-128. https://doi.org/10.5811/cpcem.2020.11.50029.Please make sure to use APA format 7th edition, add 4 references not more than 5 years old. Please make sure to put in-text citations, and make sure to go through the rubic, it should carry a title page CORE SKILL: abdominal pain is triaged by LOCATION plus ONSET plus the presence of peritoneal signs. And the specific lesson embedded in this case is that the DIAGNOSIS DRIVES THE WORKUP — an AAA is not a diagnosis you confirm casually.
THE EXAM SEQUENCE IS DIFFERENT HERE and graders check it: INSPECT → AUSCULTATE → PERCUSS → PALPATE. Auscultation comes BEFORE palpation because palpating first alters bowel sounds. Palpate the tender area LAST. This single ordering point is worth free marks.
ABOUT THIS CASE — AAA: the classic triad is abdominal/back pain, a PULSATILE ABDOMINAL MASS, and hypotension. Risk factors: age >65, male, smoking (the strongest modifiable risk factor), hypertension, atherosclerosis, family history. A RUPTURING AAA is a surgical emergency with very high mortality. NOTE THE CLINICAL REASONING PROBLEM IN THE STEM: a patient diagnosed with AAA who is stable enough for CTA is being evaluated for operative planning — but if the patient were unstable, imaging delay would be inappropriate and bedside ultrasound plus immediate surgical consult would be indicated. Also flag: CTA uses IODINATED CONTRAST, so renal function and contrast allergy must be assessed — and in a hypotensive patient, contrast nephropathy risk rises. Critiquing the documentation on these grounds is exactly what the “lab assignment” format is asking for.
MIDEPIGASTRIC PAIN DIFFERENTIAL — build it systematically: AAA; PANCREATITIS (epigastric pain radiating to the BACK, relieved by leaning forward; lipase is more specific than amylase; Cullen’s and Grey Turner’s signs in hemorrhagic disease; causes — gallstones and alcohol account for most); PEPTIC ULCER DISEASE (and PERFORATION — sudden severe pain, rigid board-like abdomen, free air under the diaphragm on upright film); GASTRITIS/GERD; MYOCARDIAL INFARCTION — an inferior MI can present as epigastric pain with nausea, and this is a classic miss, especially in women, older adults, and patients with diabetes. GET AN EKG. Also: mesenteric ischemia (pain OUT OF PROPORTION to exam findings — the key phrase), biliary disease, bowel obstruction.
PERITONEAL SIGNS: guarding, rigidity, REBOUND tenderness, and — more reliable and kinder — pain on percussion or with a jarring maneuver. Rovsing’s, psoas, obturator, Murphy’s sign (RUQ), McBurney’s point (RLQ).
FOR THE ASSIGNMENT (which is a critique of a documented note): assess whether the subjective is complete (OLDCARTS, full ROS, meds, allergies, social/family history), whether the objective supports the assessment, whether the diagnostic tests ordered are APPROPRIATE and JUSTIFIED, and whether you accept or reject the stated diagnosis. Then supply your own 3–5 differentials with rationale. Explicitly identify what is MISSING — vital signs, EKG, lab values, a full abdominal exam. Missing data is a finding.
DIAGNOSTICS TO KNOW: CBC, CMP, lipase, LFTs, lactate (ischemia), urinalysis, hCG in any woman of childbearing age (ectopic pregnancy is on every female abdominal-pain differential), upright chest/abdominal film for free air, ultrasound (first-line for biliary and for AAA at the bedside), CT with contrast.

Expert Help With This Assignment — On Your Terms