I'm a new grad and I received feedback from a palliative doctor today that I need to fine tune my ability to recognize when a patient is going through an acute abdominal situation vs. disease progression.
I know for acute abdominal pain (eg-bowel perforation), to look for: abdominal distension, sharp pain, possibly nausea/vomiting, decreased bowel sounds
But how is that different from constipation, ascites, or those who have pain management issues to the abdomen?
Nov 20, '13
Was their feedback because you missed identifying an acute situation, or because you brought what you thought was an emerging issue to their attention and it turned out to be "normal" disease progression?
Nov 20, '13
The perforation signs you mentioned can also indicate cancer.
Nov 21, '13
The MD was probably being a pain....but....questions like...it this pain like your usual pain? Is it in the same place? Have you had this pain before? When was your last BM? How is this pain different. Do they have a temp? To actually diagnose the two....is the MD's job. That is what he is paid for.
Nov 21, '13
Quote from Esme12
To actually diagnose the two....is the MD's job. That is what he is paid for.
That's kind of where I was going with my question to the OP, as well. If she brought pain to the MD's attention and the MD chastised her because this was chronic disease-progression type pain, that to me is the MD's issue more than OP's. If OP missed a change in pt status from chronic to acute pain (by failing to assess via the questions you listed, etc.), then I agree with the MD.
Nov 21, '13
The assessment of acute abdominal pain versus cancer pain is a medical diagnosis and should be done by an MD. I would imagine that most acute abdominal conditions arise more abruptly, but not always . . . cancer can often cause perforation or blockage.
Nov 27, '13
Hi sorry! This was my first time posting and I didn't realize there were responses.
I work in palliative home care and I sent two patients with cancer (2 different occasions) to the palliative tertiary unit in the hospital. They both had abdomen pain that we couldn't manage at home. When they arrived in the hospital, the doctor suspected there was a perforation somewhere (but in the end both chose comfort measures). The doctor felt because it happened twice, I should have better assessment skills to recognize these were emergency situations rather than something less emergent like uncontrolled pain... if that makes sense.
I did end up asking for help today at palliative rounds to differentiate. Another doctor explained it to me that for an acute abdomen pain, it's a term they use for emergency situations that require surgical intervention (eg- perforated viscus). She said the patients normally describe the pain as something different from their "normal" cancer pain, client does not want to be moved/touched due to pain, the abdomen would be firm, distended and bounces back when you palpate, decreased/no bowel sounds, and it's a rapid change from their baseline (eg within hours).
In the end, the palliative team said I did the right thing sending them to the hospital and the two cases were complex (isn't that always the case hah) that masked the acute abdomen pain (eg ascites, pain management issues with their "normal" cancer pain, etc).
Thank you for your help!
Nov 28, '13
So what does he think was wrong with your assessment skills? You identified an urgent problem and sent them to the unit. For the docs to figure that out.
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