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Case Study: Abdominal Pain in a 20-Year-Old Female College Student, Assignments of Nursing

This case study examines the case of a 20-year-old female college student presenting with abdominal pain, nausea, vomiting, and weight loss. It explores the importance of a thorough physical exam, including a focused assessment of the gastrointestinal and genitourinary systems, and the role of diagnostic testing in identifying potential causes of abdominal pain. The case study also discusses potential diagnoses, such as appendicitis, gastroenteritis, and pregnancy, and the importance of considering differential diagnoses based on the patient's symptoms and medical history.

Typology: Assignments

2023/2024

Available from 11/16/2024

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Case Study: Week 3 Assignment Alexandra Clark Walden University NURS 6512-Dr. Lenora Wade June 16th, 2024

Case Study : “20 y/o female college student has had abdominal pain for the last 2 weeks. Some mornings she has nausea and vomiting, but today she is here with abdominal cramps and nausea. She has lost 8 pounds while has no appetite. She has been having diarrhea for the last few days. No past medical/surgical History or relevant social history.” Chief Complaint: A chief complaint is defined as “A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words” (Verhovshek, 2018). Evaluating the patient’s chief complaint may lead the healthcare provider towards obtaining an accurate history, determining proper diagnostic testing that may be needed, developing a diagnosis, and formulating a treatment plan (Nierenberg, 2020). The patient from this case study presents with a chief complaint of abdominal cramping and nausea. She has had abdominal pain over the past two weeks and nausea and vomiting in the mornings. Overall she has lost a total of eight pounds and reports loss of appetite. She also has experienced diarrhea over the last few days. It would be important to evaluate the chief complaint of abdominal pain by investigating the following factors related to pain; onset, quality, site, radiation, time course, other symptoms associated with pain, and provocative or palliative factors (Kendall & Moreira, 2022). Physical Exams and Diagnostic Testing: For this patient, I would recommend that a complete head to toe physical exam be completed at the bedside. The provider should then switch to a focused assessment of the gastrointestinal/genitourinary systems based on the patient’s symptoms. A complete set of vitals signs including; heart rate, respiratory rate, SpO2 levels, blood pressure, and temperature should be obtained. A fever would raise the suspicion of infection or inflammation related diagnoses (Kendall & Moreira, 2022). By inspecting the patient’s positioning can clue in potential causes of the pain such as “a patient that is restless and curled up could be renal colic or a patient that is lying still with knees bent could indicate peritonitis'' (Kendall & Moreira, 2022). The abdominal examination should typically consist of four components including; inspection, palpation, percussion, and auscultation (Mealie et al., 2024). If the patient presents with distention of the abdomen it could be related to conditions such as small bowel obstruction, masses, tumors, constipation, pregnancy, hepatomegaly, splenomegaly, or abdominal aortic aneurysm (Mealie et al., 2024). The provider should auscultate for at least two minutes during auscultation to assess for frequency and pitch of bowel sounds. It is most common for two to twelve medium pitched gurgles to be heard per minute (Kendall & Moreira, 2022). Laboratory studies could include complete blood counts, electrolytes, metabolic panels to test for kidney and liver function and urinary analysis and urine pregnancy test (Groves & Groves, 2022). Image studies if warranted could include abdominal ultrasound, x-ray and abdominal CT scans. Results & Potential Diagnosis: As the provider reviews the patient’s past medical history, chief complaint, and current physical exam, potential diagnoses are created. Moving forward with diagnostic testing such as lab work and imaging it allows for the provider to pinpoint or rule out potential or significant medical

problems. For example, if the patient’s urine pregnancy test is positive and all other lab work and vital signs are within normal range the provider would want to refer this patient to an OBGYN provider for evaluation of pregnancy. Pregnant patients would present with fewer clinical findings and may lack peritoneal signs (Kendall & Moreira, 2022). Another diagnostic finding would include a positive Rovsing’s sign leading to a confirmed abdominal ultrasound and CT scan of appendicitis. A Rovsing’s sign consists of pain in the right lower quadrant elicited by palpation of the left lower quadrant (Echevarria et al., 2023). This would lead to the diagnosis of appendicitis, inflammation of the appendix which requires surgical intervention for removal of the appendix to prevent rupture leading to infection (Echevarria et al., 2023). The patient could also be experiencing a gastroenteritis viral infection and dehydration due to loss of appetite, nausea, vomiting, and diarrhea. A rapid stool test would be able to detect rotavirus or norovirus, however, a stool culture would take several days to obtain results (Stuempfig & Seroy, 2023). References: Echevarria, S., Rauf, F., Hussain, N., Zaka, H., Farwa, U., Ahsan, N., Broomfield, A., Akbar, A., & Khawaja, U. A. (2023). Typical and atypical presentations of appendicitis and their implications for diagnosis and treatment: a literature review. Curēus. https://doi.org/10.7759/cureus. Groves, M., & Groves, M. (2022, March 16). Explaining unexplained abdominal pain | Mid- Atlantic Emergency Medical Associates. Mid-Atlantic Emergency Medical Associates. https://www.mema.net/explaining-unexplained-abdominal-pain/ Kendall, J., & Moreira, M. (2022, September 12). Evaluation of the adult with abdominal pain in the emergency department - Uptodate Free. Retrieved June 16, 2024, from https://pro.uptodatefree.ir/Show/ Mealie, C. A., Ali, R., & Manthey, D. E. (2024, May 25). Abdominal examination. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459220/ Nierenberg, R. J. (2020). Using the chief complaint driven medical history: theoretical background and practical steps for student clinicians. MedEdPublish, 9, 17. https://doi.org/10.15694/mep.2020.000017. Stuempfig, N. D., & Seroy, J. (2023, June 12). Viral gastroenteritis. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK518995/ Verhovshek, J. (2018, June 7). Chief complaint is a must have - AAPC Knowledge Center. AAPC Knowledge Center. https://www.aapc.com/blog/42585-chief-complaint-required/