Treatments for Mittelschmerz
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Abdominal Pain in Lower Quadrants:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and possibly a blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may be a life-threatening emergency that requires urgent surgical intervention
-
Place nasogastric tube for obstruction or persistent vomiting
-
Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
-
Direct treatment toward the specific condition
-
Consider gynecology or surgery referral
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain in Upper Quadrants:
Treatment
(In a Page: Signs and Symptoms)
-
Rule out or treat serious causes of pain (e.g., bowel obstruction, cholangitis, MI, PE)
-
Urgent surgical intervention may be indicated for aortic aneurysm, splenic infarct, perforated viscus, and intestinal obstruction or infarct
-
Esophagitis, gastritis, PUD, and GERD are primarily treated with lifestyle changes (e.g., avoid causative foods or medications) and PPIs or H2 blockers
–Rule out malignancies in older patients or those with suggestive histories
-
Pancreatitis: Aggressive IV hydration for lost fluids and third spacing; antibiotics; nasogastric tube insertion if vomiting; bowel rest; and narcotics for pain
-
Gastroenteritis: Rehydration, correct electrolytes
-
Intestinal obstruction: Bowel rest, surgery
-
Cardiac and pulmonary etiologies are treated per protocols (e.g., supplemental O2, aspirin, β-blocker, nitrates for MI;
O2, heparin and/or thrombolytics for PE; O2, appropriate
antibiotics for pneumonia)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain with Rebound Tenderness:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and/or blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may represent a life-threatening emergency that requires urgent surgical intervention
Place nasogastric tube for obstruction or persistent vomiting
Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
Direct treatment toward the underlying condition
–Definitive surgical repair of ruptured aneurysm, bowel perforation, ectopic pregnancy, or other pathology
–Bowel rest and possible colon resection for diverticulitis or bowel obstruction
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Pain:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
If concerned about “surgical abdomen,” consult surgery
–Appendicitis, ovarian torsion, hydrometrocolpos
-
Treat infections with antibiotics
-
Eliminate offending carbohydrate in intolerance
–Lactase supplementation for lactose intolerance
-
Irritable bowel syndrome or functional pain
–Identifying stressors may be helpful
–Antispasmodics have similar action to placebo
–Tricyclic antidepressants at low doses are helpful
particularly if pain is associated with diarrhea
-
Counseling may be needed for chronic pain
-
Stop offending drugs if possible
-
Constipation
–Disimpaction if significant fecal mass
–Stool softeners/laxatives, increased dietary fiber
-
Drain abscess
-
PUD/GERD: Acid blockade therapy
-
Pancreatitis: Bowel rest, pain management
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Abdominal pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access.
Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal pain:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access.
Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Help the patient find a comfortable position to ease his distress. A supine position, with his head flat on the table, arms at his sides, and knees slightly flexed, will relax the abdominal muscles. Monitor him closely because abdominal pain can signal a life-threatening disorder.
ALERT: Be particularly vigilant for such indications as tachycardia, hypotension, clammy skin, abdominal rigidity, rebound tenderness, a change in the pain’s location or intensity, or sudden relief from the pain, which indicate a ruptured abdominal aortic aneurysm. Notify the physician immediately and prepare the patient for emergency surgery. Initiate oxygen therapy, verify that a patent I.V. line is in place, and administer fluids or blood products as ordered.
Withhold analgesics to avoid masking symptoms that may help to determine the diagnosis; also, withhold food and fluids because the patient may require surgery. Prepare for I.V. infusion and insertion of a nasogastric or other intestinal tube. Peritoneal lavage or abdominal paracentesis may also be required.
Patient teaching
Inform the patient that pain relief medications may not be ordered immediately because such agents can mask findings that would facilitate diagnosis. Analgesics can also interfere with surgical medications and might therefore be withheld until it’s determined whether surgery will be necessary. Teach the patient how to use positioning to help alleviate discomfort. Inform him about what to expect from diagnostic testing, which may include pelvic and rectal examinations, X-rays and computed tomography scans, barium studies, and collection of blood, urine, and stool samples. Ultrasonography, endoscopy, and biopsy may also be performed. If surgery is needed, provide preoperative teaching.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Abdominal pain:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access. Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Abdominal pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Place the patient in a position of comfort.
▪ Monitor him for tachycardia, hypotension, clammy skin, abdominal rigidity, rebound tenderness, a change in the pain's location or intensity, or sudden relief from the pain since abdominal pain can signal a life-threatening disorder.
▪ Administer analgesics, as ordered, and evaluate their effect.
▪ Withhold food and fluids because surgery may be needed.
▪ Prepare for I.V. infusion and insertion of a nasogastric or other intestinal tube.
▪ Anticipate the need for peritoneal lavage or abdominal paracentesis.
▪ Prepare the patient for diagnostic procedures, such as a pelvic and rectal examination; blood, urine, and stool tests; imaging studies; barium studies; ultrasonography; endoscopy; and biopsy.
Patient teaching
▪ Explain the diagnostic tests the patient will need.
▪ Explain the underlying disorder and treatment plan.
▪ Explain which foods and fluids the patient shouldn't have.
▪ Tell the patient to report any changes in bowel habits.
▪ Instruct the patient how to position himself to alleviate symptoms.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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