When examining a patient with abdominal pain the nurse in charge should assess?

Abdominal pain is discomfort felt anywhere between the chest and groin. Abdominal pain may be acute or chronic pain with varying degrees of severity and characteristics. 

• Cramp-like pain. This type of abdominal pain is often accompanied by gas and bloating followed by the onset of diarrhea. 
• Colicky Pain. This type of abdominal pain is described as sharp and abrupt in a spasming pattern. This is often associated with gallstones and kidney stones. 
• Localized Pain. Localized pain affects a specific part of the abdomen, indicating problems with organs like the gallbladder, stomach, or appendix.
• Generalized Pain. Diffuse pain felt over a large area of the abdomen may be nonspecific and indicate indigestion, gas, or blockage in more severe cases. 

Causes of abdominal pain may include conditions like irritable bowel syndrome, gastroenteritis, and constipation. More serious causes of abdominal pain include appendicitis, cholecystitis, endometriosis, cancer, bowel obstruction, gallstones, kidney stones, and pelvic inflammatory disease. 

Diagnosing abdominal pain requires a complete history and physical examination along with diagnostic tests such as abdominal x-ray, ultrasound, and CT scans to further assess and monitor treatment.

The Nursing Process

Nurses conduct thorough histories and physical assessments to assist with the diagnosis of abdominal pain. This can include diet, medical and surgical histories, and detailed pain assessments. Nurses prepare patients for diagnostic tests and review results to collaborate with the healthcare team.

Management of abdominal pain will depend on its underlying cause and will include managing fluid and electrolyte imbalances, pain relief, and surgical interventions in severe cases.

Nursing Care Plans Related to Abdominal Pain 

Acute Pain Care Plan

Acute abdominal pain may or may not be life-threatening. If severe, ongoing, and accompanied by other symptoms, intervention is recommended.

Nursing Diagnosis: Acute Pain

Related to:

• Disease processes
• Inflammatory processes
• Infection 
• Pathological processes

As evidenced by:

• Reports of pain 
• Appetite changes
• Altered physiological parameters
• Diaphoresis 
• Distraction behavior
• Expressive behavior
• Facial grimacing/crying
• Guarding behavior
• Positioning to ease pain 
• Protective behavior

Expected Outcomes:

• The patient will report abdominal pain of 2/10 or less by discharge
• The patient will report relief from nausea, cramping, gas, etc., by discharge

Acute Pain Assessment

1. Conduct a comprehensive pain assessment.
Identifying the location, intensity, frequency, and characteristics of pain is critical in determining the underlying cause of abdominal pain and the effectiveness of the current treatment regimen.

2. Review and assess diagnostic studies.
Ultrasounds, abdominal x-rays, and CT scans may be performed to help diagnose the underlying condition.

Acute Pain Interventions

1. Provide medications as ordered.
Analgesics and sedatives are provided for pain management and relief. Medications to relieve gas, nausea, constipation, and diarrhea may also relieve pain.

2. Assist to a position of comfort.
Abdominal pain may be relieved with a specific position that promotes comfort. A knee-to-chest or side-lying position tends to decrease the intensity of abdominal pain. Raising the head of the bed may also relieve symptoms.

3. Insert nasogastric (NG) tube.
With certain diagnoses such as a bowel obstruction, bowel rest and the insertion of an NG tube are required to decompress the stomach.

4. Assist in surgical intervention.
Depending on the underlying cause, surgery may be indicated in patients with abdominal pain. Assist and prepare the patient for surgery as ordered.

Dysfunctional Gastrointestinal Motility Care Plan

Dysfunctional gastrointestinal motility is related to the absence, decrease, or increase in peristalsis. Abdominal pain may be an accompanying result.

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility

Related to: 

• Food intolerance
• Ingestion of contaminated materials
• Malnutrition
• Disease processes
• Anxiety
• Stressors

As evidenced by:

• Abdominal cramping 
• Abdominal pain 
• Absence of flatus 
• Acceleration of gastric emptying 
• Altered bowel sounds
• Diarrhea
• Constipation
• Nausea
• Vomiting
• Distended abdomen

Expected Outcomes:

• The patient will exhibit normal bowel sounds and remain free of abdominal pain and distention

Dysfunctional Gastrointestinal Motility Assessment

1. Assess abdominal symptoms.
Along with abdominal pain, assess for additional symptoms such as nausea, vomiting, and indigestion. Inquire how long symptoms have been present and precipitating factors.

2. Assess dietary habits.
A thorough intake of the patient’s daily food and liquid habits can provide information on potential causes of dysfunctional GI motility and subsequent pain.

3. Assess bowel habits.
Assess how frequently the patient has bowel movements along with consistency, color, and odor. This information can help diagnose conditions such as inflammatory bowel disease.

Dysfunctional Gastrointestinal Motility Interventions

1. Administer medications as ordered.
An array of medications may be required depending on the patient’s symptoms. These may include antidiarrheals, antibiotics, antacids, proton-pump inhibitors, and more.

2. Encourage the patient to ambulate.
Ambulation and exercise can help increase gastrointestinal motility to relieve pain and symptoms.

3. Provide dietary education.
Depending on the symptoms and causes, dietary education can be tailored. Patients with constipation may need to add fiber supplements while those with diarrhea may need to cut out dairy, sugar, and caffeine to reduce triggers.

4. Obtain a stool sample.
Stool samples can provide insight into certain infectious processes as well as the presence of blood, bile, and more.

Risk for Deficient Fluid Volume Care Plan

Patients with abdominal pain tend to have no appetite with inadequate fluid intake which increases the risk of dehydration.

Nursing Diagnosis: Risk for Deficient Fluid Volume

Related to: 

• Fluid loss through vomiting or diarrhea
• Aversion to food
• Decreased fluid intake 
• Disease processes

As evidenced by:

A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet and nursing interventions will be directed at preventing symptoms.

Expected Outcomes:

• The patient will maintain adequate hydration and fluid balance as evidenced by intake and output and vital signs within normal limits
• The patient will consume at least 500 mL of fluid per day

Risk for Deficient Fluid Volume Assessment

1. Assess intake and output.
The risk of deficient fluid volume is observed through imbalanced intake and output. Closely monitor all sources of intake and output and document accordingly.

2. Assess for signs of dehydration.
Dehydration can result from deficient fluid volume. This can be assessed through the skin and mucous membranes.

3. Monitor lab values.
Hematocrit, electrolytes, urinalysis, and BUN and creatinine levels may be abnormal in the instance of deficient fluid volume.

Risk for Deficient Fluid Volume Interventions

1. Provide intravenous fluids as ordered.
IV fluids and electrolytes may be prescribed to maintain hydration status to prevent fluid volume deficit and decrease the risk for imbalances.

2. Encourage other sources of fluid intake.
Free water may be unappealing to pediatric patients or difficult for a patient with swallowing abnormalities. Offer other sources of fluids such as jello, popsicles, soups, fruits, and Pedialyte.

3. Provide parenteral or enteral nutrition.
If a patient is NPO for an extended period, nutrition and fluids may be administered through other routes to support hydration.

References and Sources

1. Abdominal Pain. Cleveland Clinic. April 18, 2022. https://my.clevelandclinic.org/health/symptoms/4167-abdominal-pain
2. Abdominal Pain. MedlinePlus [Internet]. Phillips (MD): National Library of Medicine (US); [updated 2022 Feb 7]. Available from: https://medlineplus.gov/ency/article/003120.htm
3. Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, Ph.D., FAADN, CNE. 2020. Elsevier, Inc.
4. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.

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