Abdominal pain??

[turtles]

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 to other quadrants. Pain on VAS scale was 9 out of 10 and increased on palpation, BS present x4, BP-110/78, O2S - 98%, P-89, T- 36.6, R - 17. No constipation or gas. Hx of cirrhosis of the liver and is a Type 1 diabetic. His BS was 21.5. He appeared slightly jaundiced. After assessment I gave him 60cc of insulin and transferred him to ER. They admitted him with abdominal pain with unknown cause and are doing further tests.

So does anyone have any ideas what this man could be suffering from? (I figured it may have had something to do with his liver) and whether I could have done anything else/better in my assessment? thanks for your advice....

[turtles]

ok - sorry to freak everyone out - I meant 6 units and there was a RN right there so I know I didn't do anything wrong. It's been a very long day and I'm churning out assignments and essays so I have to apologize that my brain is fuzzy right now. Anyway thankyou for your comments and I will have his results tomorrow so I'll let whoever is interested know.

[ND76]

Whew! Thank god!

[1st edition]

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

[MIA-RN1, RN]

i guess pancreatitis. Very painful.

[augigi, CNS]

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.

[Creamsoda, ASN, RN]

In Canada a BG of 21 is high, so we would give the insulin. A normal range would be between 4-7

[EricJRN, MSN, RN]

Oops. Duplicate post.

[TrudyRN]

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?

[sequelae]

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

[Elvish, BSN, DNP, RN, NP]

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.

[Antikigirl, ASN, RN]

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! :)

[EricJRN, MSN, RN]

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?