Summary: Detailed Pain Assessment

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Detailed pain assessment should be done using mnemonic PQRST: P3- positional, palliating, provoking factors; Q- quality; R3-region, radiation, referral; S- severity; T3- temporal factors (time of onset, progression, and past episodes) (Macaluso & McNamara, 2012). Every patient with abdominal pain should be asked following questions to obtain detail history: time of onset of pain and duration of pain, was sudden or gradual, ask to point at the pain site, quality and severity of pain, is it radiating, what makes it worse and what makes it better, prior episodes of pain like this, is patient able to pass gas or stool. Additionally also ask about associated symptoms such as fever, chills or sweating, urinary symptoms (dysuria, hematuria, hesitancy), anorexia, …show more content…
However, conditions like diabetes, cardiovascular disease, past abdominal surgeries, smoking history, alcohol abuse and NSAID abuse or over use can play role in causing abdominal pain (Bryan, 2014). Obtain and review recent vital sign to find out the cause of the pain, most of the time vital signs come out normal but that does not rule out serious diagnosis. Fever is usually absent in almost 30% of patients with appendicitis and acute cholecystitis (Macaluso & McNamara, 2012). Tachypnea could be related to chest related problems or metabolic acidosis problems like ischemic bowel disease and diabetic ketoacidosis (Macaluso & McNamara, 2012). Furthermore, many medical conditions can cause acute abdominal pain, such as diabetic ketoacidosis, hypercalcemia, Addison’s disease and sickle cell crisis. Sometimes abdominal pain could be from uremia, lead poisoning, methanol intoxication, hereditary angioedema and porphyria. So reviewing of patient’s current medication is crucial, pay attention to medications that can disturb gastric mucosa such as steroids, nonsteroidal anti- inflammatory drugs (NSAID), immunosuppressive agents and
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