Nursing Care Plan (NCP) for Abdominal Pain

Nursing Care Plans

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Study Tools For Nursing Care Plan (NCP) for Abdominal Pain

Abdominal Pain – Assessment (Cheatsheet)

Outline

Lesson Objective for Nursing Care Plan: Abdominal Pain:

Upon completion of this nursing care plan for abdominal pain, nursing students will be able to:

Identify Underlying Causes:
- Develop the ability to perform a comprehensive assessment to identify potential underlying causes of abdominal pain, considering factors such as gastrointestinal, genitourinary, gynecological, and musculoskeletal origins.
Differentiate Acute vs. Chronic Pain:
- Acquire the skills to differentiate between acute and chronic abdominal pain based on the duration, onset, and characteristics of pain. Understand the significance of each type in guiding appropriate interventions.
Implement Pain Assessment Tools:
- Utilize various pain assessment tools and scales to systematically evaluate the intensity, location, quality, and exacerbating or alleviating factors associated with abdominal pain. Apply appropriate tools based on patient characteristics and preferences.
Collaborate in Diagnostic Evaluation:
- Collaborate with healthcare providers in the diagnostic evaluation of abdominal pain, including ordering and interpreting relevant laboratory tests, imaging studies, and diagnostic procedures. Understand the importance of a multidisciplinary approach.
Develop Individualized Care Plans:
- Formulate individualized nursing care plans for abdominal pain based on the identified causes and contributing factors. Integrate pharmacological and non-pharmacological interventions, patient education, and follow-up assessments.

Pathophysiology of Abdominal Pain:

Inflammation and Irritation:
- Abdominal pain can result from inflammation and irritation of structures within the abdominal cavity, such as the gastrointestinal tract, peritoneum, or organs like the liver and pancreas.
Muscular Contractions:
- Pain may originate from abnormal muscular contractions, spasms, or stretching of the abdominal wall muscles. Conditions like colic or muscle strain can contribute to this type of pain.
Ischemia and Infarction:
- Lack of blood supply (ischemia) or tissue death (infarction) in abdominal organs, such as the intestines, can lead to severe abdominal pain. Conditions like mesenteric ischemia or appendicitis may cause this type of pain.
Obstruction:
- Partial or complete blockages within the gastrointestinal tract can result in abdominal pain. Obstruction may occur due to factors like tumors, adhesions, or impacted fecal material.
Stretching of Hollow Organs:
- Pain may arise from the stretching of hollow organs, such as the gallbladder or urinary bladder. Conditions like gallstones or urinary obstruction can cause distension and subsequent pain.

Etiology of Abdominal Pain:

Gastrointestinal Causes:
- Abdominal pain may originate from various gastrointestinal conditions, including gastritis, peptic ulcers, gastroenteritis, inflammatory bowel disease (IBD), or appendicitis.
Genitourinary Causes:
- Conditions affecting the genitourinary system, such as urinary tract infections (UTIs), kidney stones, or pelvic inflammatory disease (PID), can contribute to abdominal pain.
Gynecological Causes:
- Gynecological issues, including menstrual cramps, ovarian cysts, endometriosis, or ectopic pregnancy, may lead to abdominal pain in female patients.
Hepatobiliary Causes:
- Disorders affecting the liver, gallbladder, or bile ducts, such as cholecystitis, gallstones, or hepatitis, can result in abdominal pain.
Musculoskeletal Causes:
- Abdominal pain may also have musculoskeletal origins, including muscle strain, trauma, or inflammation of the abdominal wall muscles.

Desired Outcomes for Abdominal Pain Nursing Care:

Pain Relief and Comfort:
- Achieve effective pain relief, aiming for the patient’s comfort and improved quality of life. Utilize pharmacological and non-pharmacological interventions tailored to the specific cause of abdominal pain.
Identification and Management of Underlying Cause:
- Identify and manage the underlying cause of abdominal pain, addressing the specific etiological factors. Collaborate with healthcare providers to implement targeted interventions based on diagnostic findings.
Prevention of Complications:
- Prevent complications associated with the underlying cause of abdominal pain. This may include early recognition and management of conditions such as infection, inflammation, or organ dysfunction to minimize potential harm.
Normalization of Physiological Functions:
- Aim for the normalization of physiological functions related to the underlying cause of abdominal pain. This may involve addressing gastrointestinal, genitourinary, or other organ system dysfunctions to restore optimal health.
Patient Education and Empowerment:
- Provide comprehensive patient education on the nature of the abdominal pain, its underlying cause, and strategies for self-management. Empower patients to recognize symptoms, adhere to treatment plans, and seek timely medical attention if needed.

Subjective Data:

Abdominal pain
Decreased appetite
Nausea
Rebound tenderness
Muscle tension
Restlessness

Objective Data:

Constipation
Diarrhea
Electrolyte imbalances
Guarding
Vomiting

Nursing Assessment for Abdominal Pain:

Pain Characteristics:
- Assess the characteristics of abdominal pain, including location, intensity, duration, and any exacerbating or alleviating factors. Utilize pain scales to quantify pain severity and monitor changes over time.
Medical History:
- Obtain a detailed medical history, focusing on pre-existing conditions, gastrointestinal disorders, genitourinary issues, gynecological history (for females), recent trauma, surgical history, and any medications taken.
Nutritional Assessment:
- Evaluate the patient’s nutritional status, dietary habits, and recent intake. Consider factors such as food allergies, intolerances, or changes in diet that may contribute to abdominal discomfort.
Gastrointestinal Symptoms:
- Inquire about associated gastrointestinal symptoms, such as nausea, vomiting, changes in bowel habits, bloating, or difficulty swallowing. Document the onset and progression of these symptoms.
Genitourinary and Gynecological Symptoms:
- For female patients, assess genitourinary and gynecological symptoms, including urinary frequency, dysuria, menstrual history, and any abnormal vaginal discharge or bleeding.
Physical Examination:
- Perform a thorough physical examination, including an abdominal assessment to identify signs of tenderness, distension, masses, or guarding. Assess vital signs and look for signs of dehydration or shock.
Diagnostic Tests:
- Collaborate in obtaining diagnostic tests, such as blood work (complete blood count, metabolic panel), imaging studies (ultrasound, CT scans), or diagnostic procedures (endoscopy) as directed by healthcare providers.
Psychosocial Assessment:
- Consider the psychosocial aspects of abdominal pain, including stressors, anxiety, or emotional factors that may contribute to or exacerbate the pain. Assess the impact of pain on the patient’s daily activities and overall well-being.

Nursing Interventions and Rationales

Nursing Intervention	Rationale
Assess pain	We must have a detailed baseline to treat appropriately and know if it has changed. For example, a sudden relief of pain in a patient with appendicitis indicates rupture and an emergency.
Control pain	Patients who are in pain have trouble participating in care, relaxing, sleeping, and healing. Do what is necessary to proactively treat the patient’s pain and notify the provider of changes or an inability to provide adequate relief. Examples: repositioning, heat/cold, medications (muscle relaxants, analgesics), and other as clinically appropriate
Assess bowel movements (color, consistency, frequency, amount)	Assessing bowel movements will aid in making clinical decisions. It is essential to report bowel movement characteristics and frequency accurately. It also ensures accurate intake and output recording.
Ensure adequate hydration; may require intravenous fluids	Patients with abdominal pain may have a diminished appetite, be NPO, or not want to drink fluids. Assess and promote appropriate fluid balance, which may require notifying the provider of a decreased oral intake and the need for intravenous fluids to maintain fluid balance.
Assess bowel sounds	It is essential to know the patient’s quality as a baseline and routinely reassess to detect changes. If a patient has bowel sounds but now does not, it is essential to detect and notify the provider, as they may not experience any symptoms.
Facilitate normal bowel patterns	Abdominal pain can be due to issues with the GI tract. It is essential to proactively address nausea, vomiting, constipation, and diarrhea as clinically appropriate.
Record intake and output	Patients with abdominal pain may not be taking in the necessary amount of fluids or foods. Their urinary and/or bowel output may also be lacking. Accurate I&O is essential for appropriate clinical decision-making.
Prevent infection	Pathogens (gastroenteritis, for example) can be the cause of abdominal pain. It is essential to promote adequate hand hygiene and infection prevention to prevent spreading it to others or prevent the issue from resolving.
Assess abdominal distention, report changes in size and quality as appropriate	Patients may be experiencing abdominal distention as part of the underlying disease process.

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Diagnosis

A nursing diagnosis is a basis for establishing and carrying out a nursing care plan. After performing a proper assessment, formulate a nursing diagnosis based on problems associated with abdominal pain. This will be your clinical judgment about the patient’s health conditions or needs.

Select the appropriate nursing diagnostic label from the NANDA-I list of approved nursing diagnostic statements that best identify with the patient’s signs and symptoms. One or more nursing diagnoses may be given.

Implementation

Implementations are actions and activities you will take to achieve the nursing plan goals.
In the case of abdominal pain, an implementation may include:

Encourage evacuation
Encourage eating
Administer medications as prescribed
Provide fluids
Educate the patient and family members

Evaluation of Abdominal Pain Nursing Care:

Pain Relief and Management:
- Evaluate the effectiveness of pain relief interventions and the patient’s overall comfort. Use pain assessment tools to quantify changes in pain intensity and ensure that the chosen interventions are providing adequate relief.
Resolution of Underlying Cause:
- Assess the progress in identifying and managing the underlying cause of abdominal pain. Collaborate with healthcare providers to review diagnostic findings and ensure that appropriate interventions have been implemented.
Prevention of Complications:
- Monitor for the prevention or early recognition of complications related to the underlying cause of abdominal pain. Evaluate the patient’s response to interventions aimed at minimizing potential harm and addressing complications.
Normalization of Physiological Functions:
- Evaluate the normalization of physiological functions related to the underlying cause of abdominal pain. Assess improvements in gastrointestinal, genitourinary, or other organ system functions and address any persisting dysfunctions.
Patient Education and Self-Management:
- Assess the patient’s understanding of the nature of abdominal pain, its causes, and the strategies for self-management. Evaluate the patient’s ability to recognize symptoms, adhere to treatment plans, and seek timely medical attention if needed.

References

Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition
Abdominal Pain in Elderly Persons
Pathophysiology of abdominal pain
Abdominal Pain – Vanderbilt Scholl of Medicine

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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Abdominal Pain

Acute Pain: Abdominal pain can be severe and distressing. This diagnosis addresses the patient’s immediate pain management needs.
Anxiety: Patients with abdominal pain may experience anxiety due to the uncertainty about the cause of pain and potential severity. This diagnosis addresses their emotional well-being.
Ineffective Coping: Prolonged or severe abdominal pain can lead to difficulty coping with the situation. This diagnosis focuses on assessing and improving coping strategies.

Transcript

Hey guys, let’s look at abdominal pain for a patient and how we’re going to put that into a nursing care plan.

First, we’re going to collect our data. Remember, our data is just our assessment, so subjective from the patient and objective from the nurse. A patient with abdominal pain, that’s having symptoms, the subjective data for this patient is likely going to be the pain, maybe they have a decreased appetite, and how about some nausea? Those kinds of things are going to be all their subjective data.

For objective data, maybe they feel really restless. This is what the nurse is observing. Let’s say we see on this patient, that the patient is having some guarding of the abdomen. Maybe some rebound tenderness when they’re pushed down. Maybe we see, or assess the patient and realize they’re constipated or have constant vomiting or diarrhea. These kinds of things will be our objective data.

My hypothetical patient for our care plan will say that they’re having abdominal pain and it’s from excessive vomiting. We have to analyze the information. This is going to help us to diagnose and prioritize. So what is the problem? Well, the problem is the pain and the problem is that they are having some excessive vomiting. So, what needs to be improved? What can we do to improve or what needs to be improved to help the patient, is going to be the pain, right, but more than that, we need to, for this patient, we need to fix the vomiting, so that can help fix the pain. What is our priority? So, our priority is going to be to stop the vomiting and to help that abdomen just not be so tender right, so stop that vomiting, which is going to help with the pain for this patient and relieve that pain.

So we’re going to ask our “how” questions now, and this is going to help us to plan, implement and evaluate. How did we know it was a problem? Remember, this is where you link your data. So, all your assessment that you have on your patient that you saw in clinical, you’re going to link that data together, and that’s how you knew it was a problem. My hypothetical patient knew what their problem was, because they said that they’d been vomiting for over 24 hours, something like that. So that’s going to be what my problem is, or the patient’s problem, the vomiting that is causing the abdominal pain.

How would I address it? We have to find the cause, right? Just in general, for any abdominal pain patient, you have to find what the cause is, because then you can fix that, and then it will fix the pain. This could vary. We could address it with, if it’s constipation causing abdominal pain, then a laxative, if we have electrolyte balances, we’re going to fix that. We could try positioning, heat, or analgesics. So, for vomiting,we’re going to address it by helping to hopefully stop the vomiting and treat their symptoms, other symptoms that could be making this worse. Then how would I know it gets better? Well, the patient is going to hopefully stop all the excessive vomiting, right? Then the pain will be better, which is what we want.

So, here are high level nursing concepts. For my patient, I’m going to say comfort, right, because they’re having the pain. Elimination because we are vomiting so much and then, patient education, always a good one to have. Alright, so now let’s use whatever sheet you use or whatever form and we’re going to transcribe and put it into a care plan.

So here, our problems and priorities are comfort, elimination, and patient education. We are going to take our assessment data. We’re going to provide an intervention to help fix that data. Then, we’re going to explain why that intervention should work. That’s our rationale, is the why. Then our expected outcome, what do we expect to have happen from this?

So, our comfort. This patient was guarding, they were tender, maybe they were moaning. That’s my data that I collected. I am going to intervene by turning the patient, changing positions, maybe applying heat, if they would like that. My rationale is just that these things can help with the pain and provide comfort. So, my expected outcome would be that the patient will be relieved of the pain or at least that they would be, just more comfortable. So, that’s my expected outcome.

Now let’s look at elimination. My patient has been vomiting for over 24 hours. That’s my data and that’s a problem with elimination, so I need to intervene. Zofran, hopefully we have it ordered, so if ordered, any of this in your care plan, if you’re giving a medication, you would put it as ordered, because you’re not prescribing medications, the doctor is, so we would give Zofran, hopefully I have it ordered, and that will help the patient. Let’s look at the why, or our rationale. So the rationale is that it’s going to stop the vomiting, which is going to help with the pain. And then, our expected outcome is that the elimination will be altered, relieving the pain.

Alright. so our patient education is just some data that we could give to help educate this patient on the abdominal pain, the vomiting, all of that. Perhaps some diet changes for my patient. We would maybe need to educate them on a bland diet, right. Just to help kind of let that gut to rest a little bit if they’re able to eat. Hand hygiene, especially because of all the vomiting, we don’t know what it’s from, if it is viruses and bacteria, but good hand hygiene to help prevent it from spreading. So, for our diet changes, having them drink plenty of water, if they can, and especially Gatorade to help with that electrolyte replacement, and telling them a lot about washing hands just to prevent the spread of infection from whatever’s causing the vomiting.

And also just to add here, because I left it off, is that bland diet just to help their gut heal and rest.

So, the reason why our rationale, like I said, we’re replacing loss fluids. We’re replacing those electrolytes with Gatorade and the bland diet is going to help that gut heal and then infection prevention. So that’s why we’re telling them to wash their hands, right? So, our expected outcomes, anytime you have patient education, the patient is going to be able to verbalize an understanding of the items that you’ve covered. And, that is our outcome. To know that the patient will hopefully be successful.

Alright guys, let’s review our key points here. So, we are going to collect our information and that is always your assessment data. Your subjective and objective facts about the patient. We’re going to analyze that information, so that we can diagnose and prioritize. We are going to ask how, and then it’s going to help us to plan, implement and evaluate. Then we’re going to translate. Translating should be as concise terms. Transcribe whatever form you use for your care plans. Just get it on paper and link all your pieces together.

Alright, that was it for our abdominal pain for nursing care plans, go check out all of our great nursing care plans that we have available for you and how to write a nursing care plan. We love you. Now, go out and be your best selves today and as always, happy nursing!