Abdominal pain?? - page 2

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Hi everyone, Today I did an assessment on a patient in an institution I am doing clinical at, let me know what you think: Male in mid 40s, presenting with Left upper quadrant abd. pain. radiating... Read More

  1. by ND76
    Nov 14, '06
    From: TN, US ; Joined: Mar '05; Posts: 76; Likes: 14
    Whew! Thank god!
  2. by 1st edition
    Nov 14, '06
    Joined: Jun '06; Posts: 66; Likes: 1
    I would like to have clarification also on the BS. One would not admin ANY insulin w/ BS 21. Liver is on the Rt side, pancreas on Lt
  3. by MIA-RN1
    Nov 14, '06
    Occupation: Nursing isn't a job--its a calling! Joined: May '05; Posts: 1,356; Likes: 40
    i guess pancreatitis. Very painful.
  4. by augigi
    Nov 14, '06
    Occupation: Medical Device co. Specialty: 10 year(s) of experience in Critical care, cardiothoracics, VADs ; Joined: Nov '05; Posts: 1,470; Likes: 48
    Depends what units you're using for blood sugar - here in Australia, we'd definitely treat a blood sugar of 21.5 (mmol/L)!! But in the US, that'd be called 215.

    I'd be thinking pancreatitis or gallbladder, but impossible to tell without more info.
  5. by Creamsoda
    Nov 14, '06
    Joined: Feb '04; Posts: 737; Likes: 866
    In Canada a BG of 21 is high, so we would give the insulin. A normal range would be between 4-7
  6. by EricJRN
    Nov 14, '06
    Occupation: Nurse Educator Specialty: 13 year(s) of experience in NICU ; From: TX, US ; Joined: Nov '05; Posts: 8,750; Likes: 1,692
    Oops. Duplicate post.
  7. by TrudyRN
    Nov 14, '06
    Joined: Jul '06; Posts: 1,394; Likes: 217
    It could be stomach, bowel, heart, pulmonary, pericarditis, spleen, pancreas, autonomic neuropathy from the DM, even renal.

    Any vomiting? Any lab results besides the 215 blood sugar? did they do any imaging or x rays?
  8. by sequelae
    Nov 14, '06
    Joined: Nov '06; Posts: 33; Likes: 4
    could it be he has hepatomegaly? im not sure but isnt that the pain could be visceral in nature? when it is enlarged as in hepatomegaly, the nerve endings gets "irritated?" it MIGHT be it
  9. by ElvishDNP
    Nov 14, '06
    Joined: Nov '06; Posts: 20,715; Likes: 23,951
    I would also like to know amylase/lipase since it could be pancreatitis.

    Also, folks in DKA will sometimes present with sx similar to acute abdomen that resolve once the DKA is resolved. Even though the BG was only 215, not nearly as high as I've seen, there can still be ketoacidosis. Just a thought.
  10. by Antikigirl
    Nov 14, '06
    Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415
    Okay...abdomen. First remind yourself of how many organs can cause direct pain in the abdomen, then take reffered pain from other organs/muscles/nerves. Abdomen..the big void of uncertainty! You will find this especially significant when it comes to women! Man when we get a female abdominal pain pt...we groan because it can be soooo much!

    So basically you did very well by getting them to the ER for tests, because tests are about the only way the MD is going to figure out what is wrong! It isn't really a matter of 'what is wrong' from the RN perspective as much as it is "get the right help from someone that can Dx this properly so they can get help according to what IS wrong". You did well, and I am sure a GI specialist was called in to help Dx it!

    It could be one thing or chain reaction of several things...you just never know. So lump that into your labs, tests, and assessment and work on getting the help needed for a quick and correct Dx by a qualified MD! We aren't MD's...so it is our jobs to advocate for getting one so they can give us the info WE need to do OUR jobs!
  11. by EricJRN
    Nov 14, '06
    Occupation: Nurse Educator Specialty: 13 year(s) of experience in NICU ; From: TX, US ; Joined: Nov '05; Posts: 8,750; Likes: 1,692
    We keep referring to a blood glucose of 215, but I think 21.5 mmol/L would be much higher than 215 mg/dL. Anyone know how it converts?
  12. by cardiacRN2006
    Nov 14, '06
    Joined: Jan '05; Posts: 4,765; Likes: 2,554
    21.5 mmol/L (387 mg/dL)

    Multiply by 18

    What are mg/dl and mmol/l? How to convert? Glucose? Cholesterol?




    So, IMO, 6 units is not enough for a BS of 387.
    Last edit by cardiacRN2006 on Nov 14, '06 : Reason: Because I can't spell
  13. by Antikigirl
    Nov 14, '06
    Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415
    My hospital is doing this wierd thing with diabetics. Not only do you do a certain sliding scale with novolog back up, but now you have to count carbs a pt eats and divide it by 15 and the number gotten is the amount of units of novolog insulin to give. It is driving me nuts!

    I can't be assured that that patient ate that much (maybe a family member ate some?), subjective between people on guessing anyway, and what do you do in cases of emisis? Oh and don't get me started on NPO status but they snuck in a snack a family member brought! UHGGGGGGGGG. I think it is insane and a huge liablity!

    Anywhoooo..when I hear of CBG I hear it as say 215, and know it is high and look at my orders on sliding scale for what range the MD wants insulin tx on, and it is written how much. Norm for fasting is above 120 high, below 80 low. But I had to giggle and grown when I couldn't remember the unit of measurement anymore because it is just how our glucometers work...LOL!

    So I looked it up! MG/DL for us...if you need a different scale or what not...lab is called in for a blood draw. If we get results above 350 or below 65 a blood draw is done and needs to be ordered by our policy (and MD notified).

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