Lalaine G.

Nadulpit October 26, 2020

BS Nursing 3A NCM 112- Module 5

You are caring for a 40-year-old male client recently admitted to the emergency
department  (ED) with new onset of diffuse abdominal discomfort and nausea for the past 8
hours. He has a history of hypertension. What questions should be asked when taking the
history of the patient?  What are your priority assessments? What diagnostic test would you
expect? While in the ED, the patient reports that the pain has localized to the right lower
quadrant. Given this new development, what questions will you now ask and what are your
priority assessments? 

What questions should be asked when taking the history of the patient? 
The nurse in-charge may use the SOCRATES pain assessment tool in taking the history
of the patient by asking the site of pain, onset, characteristic of pain, radiation, associated
symptoms, timing or the duration of the pain, exacerbating and relieving factors and, the
severity of pain. Questions regarding the past medical history of the patient related to the
Digestive system or GI tract should also be asked. Prescribed medication taken by the patient
should also be asked as the patient has a history of hypertension. According to a new
research, blood pressure pills with types ACE inhibitors and ARBs (Angiotensin II Receptor
Blockers) can cause swelling in the bowel which inflames the appendix. Food taken by the
patient that triggered the pain or the condition may also be asked.

What are your priority assessments? What diagnostic test would you expect?
Physical examination is one of the priority assessment in pain. The location of the pain
will guide the evaluation of the patient’s condition. An ultrasonography, abdominal x-ray, CT
scan, laparoscopy, urinalysis and WBC count may be used for the diagnosis of the disease.

Given this new development, what questions will you now ask and what are your
priority assessments? 
An acute pain related to obstructed appendix as evidenced by pain in the right lower
quadrant can be diagnosed. The nurse must ask about the location, severity of the pain using
the pain scale and the characteristic of the pain as well as the exacerbating factors that
worsens the pain (e.g coughing, sneezing). The priority assessment would still be focusing on
the pain. The Rovsing’s sign is an assessment done by palpation. If palpation of the left lower
quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient
is said to have a positive Rovsing's sign and may have appendicitis.

References:

Little, E. (2016). Blood pills could cause appendicitis. N.p.: The Sun. Retrieved October 25,
2020, from https://www.thesun.co.uk/archives/health/904974/blood-pills-could-cause-
appendicitis/

Craig, S. (2018). Appendicitis. N.p.: Medscape.com. Retrieved October 25, 2020, from

https://emedicine.medscape.com/article/773895-overview

Hardin, M. (2017). Acute Appendicitis: Review and Update. N.p.: American Family Physician.
Retrieved from https://www.aafp.org/afp/1999/1101/p2027.html

Lamb, P. (2017). The importance of assessing pain in adults (Vols. 111 - 41, pp. 12-17). N.p.:
nursingtimes.net.

Belleza, M. (2017). Nursing Diagnosis for Appendicitis. N.p.: Nurselabs. Retrieved October

26, 2020, from https://nurseslabs.com/appendicitis/