Jumat, 15 April 2011

Abdominal Pain Nursing Care Plan - Acute Pain

Abdominal Pain Nursing Care Plan - Acute Pain


Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.


Abdominal Pain Nursing Care Plan - Acute Pain

Nursing Assessment:
  1. General:
    Anorexia and malaise, fever, tachycardia, diaphoresis, pale, abdominal rigidity, failure to issue a rectal feces or flatus, increased bowel sounds (early obstruction), decreased bowel sounds (advanced), retention of urination and leukocytosis.
  2. Specific:
    • Small intestine
      • Weight, such as cramping abdominal pain, distension increased
      • mild distension
      • Nausea
      • Vomiting: at the beginning containing food is not digested and kim; water and then vomit contains bile, black and faecal
      • Dehydration
    • Colon
      • mild abdominal discomfort
      • severe distension
      • Vomiting latent faecal
      • latent Dehydration: acidosis rarely


Nursing Diagnosis and Nursing Intervention for Abdominal Pain Nursing Care Plan - Acute Pain

Pain related to distention, rigidity

Goal: pain is resolved or controlled

Criteria for outcome: patients revealed a decrease discomfort; expressed pain at tolerable levels, indicating relaxed.

Intervention:
  • Maintain bed rest in a comfortable position, do not support the knee.
  • Assess the location, weight and type of pain
  • Assess effectiveness and monitor side effects anlgesik; avoid morphine
  • Provide a planned rest period.
  • Review and recommend doing lathan active or passive range of motion every 4 hours.
  • Change positions frequently and give her back rubbing and skin care.
  • Auscultation bowel sounds; kekauan or notice increasing pain; give enema slowly when ordered.
  • Give and recommend alternative pain relief measures.