How do I do a history on Pain??????

steffymo · Oct 30, 2001

So is this for a specific patient or do you have to have an overall care plan?

If it is overall, I would focus more on conditions that cause the abdominal pain.... and there are tons! If it is for a patient, give me more info and I can try to help you.

cateyesrn2003 · Oct 30, 2001

The patient was admitted to the unit Im on on 10/27/01 with abdominal pain ETOH intoxication. :confused:

steffymo · Oct 31, 2001

I am not sure if you are still working on this, but I would look into hepatites or colitus with alcohol. Both are very painful. It may give you somewhere to start from.

JillR · Oct 31, 2001

I work in the Emergency Room and the first things we look at with someone with ETOH and abd pain is pancreatitis. Did they check the amylase and lipase? Other probs, appendicitis, tubal pregnancy, gallstones, kidney stones, hepatitis and many more. good luck.

MollyJ · Nov 1, 2001

Abdominal pain is tricky because it can represent everything from the transient and benign to the serious and life threatening. Having an impaired client with pain complicates assessment (although i realize they aren't still impaired now) and alcohol use and or abuse broadens the differential from the medical perspective.

While you can look in the medical literature and see articles on the differential diagnosis of abdominal pain, that is not particularly your job as a nurse. your job is assessment of the pain and maximizing comfort and assuring appropriate fluid balance status to name a few.

If you have an assessment text book look up pain and abdominal pain as two separate entities. My Mosby's Guide to Physical Examination talks about abdominal pain assessment. It also has an Appendix of Assessment of Pain. Margo McCaffery has a book and multiple articles on the topic. Anyhow my Mosby's offers the following for Review of Related History:

1 Onset, time date duration rhythm

2 Quality of pain

3 intensity

4 Precipitating factors (eating, time to eat, movement etc)

5 location

6 effect of pain on activities of daily living

7 effect of pain on psyche

8 what they've done to help their pain, self care, OTC meds, Prescription drugs, distraction, relaxation, heat.

Remember that if the diagnosis is still pending and their is concern about a surgical or acute abdomen, the doctor may order pain meds sparingly. If the dx is made (ie pancreatitis) pain meds may be given with less concern to this. the rationale is that worsening pain is often the cue for an acute abdomen and if the patient is given narcs, that cue goes away.

If your patient is addicted to alcohol or other drugs, this fact needs to be taken into account for pain management.

Good luck.

bsntorn · Nov 4, 2001

If this is not diagnosed as a specific abdominal pain and you need to find out a history from the patient, then ask, when did it start, what improves it, what makes it worse. Abdominal pain is very general and sometimes the cause remains unknown after many tests. Questions to the patient can sometimes help identify the caus/problem.