Acute Abdomen for Certified Emergency Nursing (CEN)

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Study Tools For Acute Abdomen for Certified Emergency Nursing (CEN)

Abdominal Pain – Assessment (Cheatsheet)
Abdominal Anatomy (Image)
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Outline

Acute Abdomen

 

Definition/Etiology:

5-10% of ER visits are for abdominal pain.

 

Compared with younger patients, the elderly have a 6-8x increase in mortality with an acute abdomen.

 

Causes include:

  • Ectopic pregnancy / placental abruption
  • Pelvic inflammatory disease
  • Ovarian torsion
  • Endometriosis
  • Testicular torsion
  • Nephrolithiasis
  • AAA
  • MI
  • Splenic rupture
  • Sickle cell crisis
  • Black widow bite (or other spider)
  • Appendicitis / Peritonitis
  • Mesenteric ischemia
  • Bowel perforation (covered separately)
  • Volvulus / bowel obstruction
  • Gallbladder / pancreatitis
  • Cancer
  • Diverticular disease
  • Food-borne illness
  • Adhesions
  • Irritable bowel syndrome
  • Opiate withdrawal
  • Toxic ingestion
  • Pyelonephritis
  • Incarcerated hernia
  • Intra-abdominal abscess

 

Pathophysiology:

Abdominal pain can have many causes.  In general:

  • Ischemic tissue (incarcerated hernia, mesenteric ischemia)
  • Blood or bowel contents in the peritoneum
  • Rupture (AAA, ectopic, etc)
  • Obstruction (crampy, spasming, trying to move)

 

Clinical Presentation:

High-risk features:

  • Sudden, severe onset
  • Constant, unremitting
  • Recent surgery
  • Age >65
  • Immunocompromised
  • Major comorbidities (CAD, DM, cancer)
  • Tense, rigid abdomen
  • Involuntary guarding
  • Shocky
  • Pregnant
  • Alcoholic

 

Take a good history. Have a system:

  • Onset
  • Location
  • Duration
  • Character
  • Aggravating
  • Relieving
  • Treatments
  • Severity

 

Collaborative Management:

Labs:

  • CBC, CMP, amylase, lipase
  • Blood cultures, lactate
  • Type and cross
  • Urinalysis, HCG

 

Imaging:

  • FAST exam
  • Formal abdominal ultrasound
  • CT abdomen/pelvis

 

Other:

  • NPO
  • Nasogastric tube / stomach decompression / LIWS
  • Pain management

 

Evaluation | Patient Monitoring | Education:

  • Frequent vitals
  • Monitor NG output
  • Make sure it’s on LIWS
  • Pain management
  • Watch for shock
  • Two large bore peripherals

 

Linchpins: (Key Points)

  • Assume it’s bad.
  • Practice your physical assessment.
  • Take a good history.
  • Try to figure it out before looking at the CT report.

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Transcript

For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/

References:

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