Mr. Villegos is a 46 year old man with no medical history except alcoholism for the past 20+ years. When asked last week during his Receiving Screening by medical staff, he stated that he has been sober for the past two years prior to incarceration, although he did disclose at that time that he drank pretty steadily for about a week prior to his arrest. Last night he submitted a Health Services Request to be seen for a complaint of abdominal pain that had been ongoing for about 8 hours. Mr. Villegos is seen this morning in Nursing Sick Call, which is within 24 hours of receipt of the Health Services Request.
What questions will you ask Mr. Villegos?
Describe the pain
Location, duration, quality (diffuse/ache, stabbing, sharp), intensity (pain scale), is it constant or intermittent?, anything make it better?, anything make it worse?, does it move?, what were you doing when you first noticed the pain?, ever had this pain before? (if yes, gather history).
Mr. Villegos states that he was just laying on his bunk when he first noticed it as “like an ache” in the center of his belly. It then became more sharp over the next several hours. It was a 7-8/10 pain scale at its worst. Currently it is a 2-3/10. It does feel like it comes and goes, but then he states it is more like it eases and then becomes more sharp, and really never goes away. He has never felt anything like this before.
Ask him again for his medical history
Mr. Villegos repeats the history given during Intake. He has no chronic medical problems, just alcoholism, and he has not had a drink in two years, except for the week before his arrest. He has no allergies.
Any problems with bowel movements or urination
Ask about color and consistency of stool, and color, frequency, hesitation or any pain/burning with urination.
Mr. Villegos states that his bunkmate thinks it is constipation, as he did not have a bowel movement for two days, but he did have a “normal” one this morning before being called to Nurse Sick Call. It was soft, brown and he had no difficulty with its passage. He states that he thinks the pain eased with the bowel movement, but it is still there. He denies any changes to urination.
Ask if anyone else in the housing unit is sick
Mr. Villegos knows of no one else who is sick in the unit currently, but he thinks someone else was having bowel problems a few days ago.
Next, conduct a physical evaluation of Mr Villegos
Obtain vital signs
HIs vital signs included the following: Blood pressure – 128/82; pulse 88; respirations – 16; oxygen saturation – 98% and temperature 99.2℉. He describes his pain currently as a 2-3/10.
Lungs: clear bilaterally without adventitious sounds
Heart: regular rate and rhythm, S1 and S2 heard with no murmurs, gallops or rubs.
Abdomen: soft, tender to palpation upper left and right quadrants [using a four quadrant system], most tender in the epigastric area. Mr. Villegos also states that there is tenderness in the lower quadrants as well, but not as much as the upper quadrants. Bowel sounds are auscultated in all four quadrants and they are unremarkable.
Mr. Villegos is suffering from abdominal pain from an unknown source. It eases and worsens, but never totally goes away, according to the patient. He is not having diarrhea, and he did have a bowel movement that morning that was “normal” for him. He stated that he thought the pain lessened with the bowel movement. He is currently describing the pain as a 2/10. HIs vital signs are within normal parameters, except for a slightly elevated temperature. He did not state specifically that he was having reflux, but he did describe pain in the epigastric area. He did not associate the pain with anything, including eating or drinking. Per the nursing guideline you have, you can give over the counter medication for constipation and diarrhea, and for acid reflux. You can also contact the provider.
What are you going to do?
Depending upon your scope of practice, you can recheck Mr. Villegos in a few hours, or you must contact the provider. This is based on the facts stated in your assessment, that Mr. Villegos is presenting with minimal pain. He had a bowel movement this morning that was “normal” for him, and never complained of diarrhea. Even though he stated he did not have any symptoms of reflux, he might be experiencing it based upon the pain described. Always err on the side of caution. You decide/or the provider contacted decides that it would be best to reassess Mr. Villegos that evening. You discuss the treatment plan with Mr. Villegos, and he agrees. You provide patient education regarding the signs and symptoms to report immediately to custody/medical staff, including increased pain or a change in location of the pain, and Mr. Villegos verbalizes comprehension. He returns to his housing unit.
About four hours later, the officer from Mr. Villegos’ unit calls a man-down (medical emergency) and reports that Mr. Villegos is writhing on his bed in pain and moaning. You go to the unit and find Mr. Villegos as the officer described.
What do you do?
Evaluate Mr. Villegos before moving him to the medical unit. Mr. Villegos is able to tell you that the pain is 12/10!, the worst he has ever felt, and it feels “like someone is sticking a knife through his chest from front to back.” He points to the epigastric area. His vital signs are as follows: blood pressure – 150/110; pulse – 120; respirations – 22; oxygen saturation – 97% and temperature 98.9℉. He does not allow you to touch his abdomen or epigastric area because of the pain.
Then what do you do?
Mr. Villegos is brought to the medical unit via stretcher, and you ask that emergency medical services be activated. You obtain a blood sugar (WHY?), it is 387, and you contact your on-call provider. Mr. Villegos is diagnosed in the emergency department with acute pancreatitis. After a five-day hospital stay, he is discharged back to your facility.
Abdominal pain is one of the most frequent complaints we receive from our patients in corrections. Its presence may indicate that the patient is suffering from a condition that is not serious, or it may indicate a life-threatening condition that requires immediate intervention, and so it is vitally important that the correctional nurse have excellent skills in assessing and evaluating the patient with a complaint of abdominal pain, and the identification of abnormal findings that must be discussed with a provider.
Check out our posts about Abdominal Assessment on CorrectionalNurse.Net
Classes available at The Correctional Nurse Educator include Abdominal Assessment: Basic Assessment for the Correctional Nurse; Abdominal Assessment: Nausea and Vomiting for the Correctional Nurse; Abdominal Assessment: Constipation and Diarrhea for the Correctional Nurse; Abdominal Assessment: Upper Abdominal Pain for the Correctional Nurse; and Abdominal Assessment: Lower Abdominal Pain for the Correctional Nurse.
*As always, your company or facility policies, procedures and Nursing Protocols/Guidelines take precedence over any written recommendations on this website.