Triaging the Mysteries of Abdominal Pain
By Marci Lawing, RN
Stomach pain is something almost everyone experiences from time to time. Abdominal pain is a common reason patients call nurse triage yet each call is as challenging as the next. There are so many possible causes of abdominal pain that the nurse must be diligent in asking the right questions and performing a detailed assessment being careful not to skip or miss those questions that may indicate the patient needs to be seen immediately.
Take for instance, the 44-year-old that calls with moderate, intermittent pain that has been present for one hour in the right lower sided. Let’s take a look at this first from the patient’s view and then the nurse’s.
What the patient thinks : In today’s world of easy internet accessibility, many patients have already Googled their symptoms prior to calling nurse triage. They have used an online symptom checker to try and determine what ailment is causing their discomfort and some have even tried the care advice recommended. Patients report online searches of symptoms for many reasons. Some look to the internet first out of convenience, others are trying to save time and money among other reasons.
What the triage nurse thinks : While nurses performing telephone triage do not diagnose patients, they do develop working diagnoses in order to narrow down the search for the proper protocol to assess their patients. While triaging her patient, the nurse keeps in mind that any pain located between the bottom of the rib cage and the groin crease is considered abdominal pain. She visualizes her landmarks – Location : RUQ = liver and gallbladder. Epigastric = stomach, duodenum, esophagus, pancreas. LUQ = spleen, stomach. Periumbilical = early appendicitis. RLQ = ileum, appendix, ovary. Suprapubic = bladder, rectum, uterus. LLQ = sigmoid colon, ovary.
Experience has taught the nurse to assume nothing and rule out the most emergent symptoms first. She knows the most common cause of acute onset abdominal pain is Gastroenteritis and that appendicitis accounts for a small percentage of patients presenting with abdominal pain to the emergency rooms; none the less, the nurse will rule out appendicitis first every time before moving on to less urgent causes for her patient’s abdominal pain.
A list of potentially life-threatening possibilities runs through her head; could this be appendicitis? An abdominal aortic aneurysm? How about a bowel obstruction, or testicular torsion?
Once the nurse is comfortable that her patient is not having life threatening abdominal pain, other potential reasons are explored. Acute abdominal pain can be caused by many things, including overeating, hunger pains, a GI virus. Perhaps this patient has food poisoning or is constipated.
Knowing that abdominal pain can be acute or chronic/recurring leads the nurse to ask about factors such as medication use, food intake and even stress, anxiety and worry.
Conclusion : While patients might use the internet as a tool for obtaining a possible diagnosis for their symptoms, the triage nurse realizes that it is not nearly as important that the patient be able to give his symptoms a proper diagnosis as it is to know if those symptoms require immediate care or can safely be managed at home.