I’m working on a nursing discussion question and need an explanation and answer to help me learn.

Kellian Giufurta. 

• Module 4 Discussion

The right upper quadrant (RUQ) of the abdomen comprises of numerous structures including the liver, gallbladder, kidney, pancreas, part of the colon, small intestine, and upper stomach (Revzin et al., 2017). When a patient has complaints of RUQ pain, further assessment is warranted to avoid serious complications. Complaints of abdomen pain can be vague, therefore proper data collection is necessary to make an accurate diagnosis and aid in appropriate treatment.

• Subjective data involves the patient’s perception and experience surrounding her chief complaint. The advanced nurse practitioner (APN) should explore the patient’s past medical history, pertinent family history, and social history. Subjective data surrounding past medical history and family history should involve questions such as “have you ever felt this pain before?” and “has anyone in your family had similar problems?” These two questions can indicate whether the patient is predisposed to a certain illness and classify the pain as acute or chronic. Timing, duration, aggravating, and alleviating factors are also imperative subjective date. For instance, the patient should be asked to rate how intense her pain is on a numerical scale, how this pain affects her daily living, and does the pain happen at a certain time during the day such as after meals. Social history includes matters surrounding lifestyle choices, religious practices and beliefs, substance use, and past employment conditions. Accompanied symptoms of fever, nausea and vomiting, stool abnormalities, urinary issues, loss of appetite, and radiating pain should be explored. Both over the counter and prescription medication use must be looked into carefully as well.   

In addition to a full examination, additional objective data would focus on inspection, palpation, auscultation, and percussion of the abdomen. Specific location to any irregularities would guide further assessment. Signs of dehydration or malnourishment would be considered in the color/condition of the skin, mucus membranes and urinary analysis. Respiratory rate, fever, and pulse are applied for suspicion of infectious etiology (AL Basher, 2017).

           Differential diagnoses I would consider in this case include gallstones, peptic ulcer disease, functional dyspepsia, and cholecystitis since the symptoms stated are consistent with such diagnoses. Laboratory tests that would rule out the differential diagnosis include Basic Metabolic Panel (BMP) to evaluate liver functions, kidney function and electrolyte status, Complete Blood Count (CBC) to rule out anemia and infection, a urinalysis to assess for kidney status and urinary tract infection, stool culture for the presence of pathogens and incidence of occult blood.

           Additional diagnostic studies for the patient include conducting imaging tests such as ultrasound, X-ray, or CT scan to help get a clear picture of the organs in the abdomen and check for abnormalities such as gallstones. If gallstones are present, a cholecystography may be warranted. Based on risks versus benefits, an endoscopy can be suggested if peptic ulcer disease is believed. If it is determined that the patient is suffering from peptic ulcer disease, medications would include pain relievers, anti-acids to help neutralize stomach acid, acid blockers, or proton pump inhibitors to reduce the amount of acid in the stomach.

           Potential complications for the treatments include constipation or diarrhea as a result of using anti-acids. The patient will require education on healthy nutrition, adequate hydration, foods to avoid and lifestyle patterns such as eliminating alcohol. The patient should be instructed to notify the APN if she notices blood in her stool, cannot tolerate food, has signs of anemia such as dizziness, and if symptoms worsen. A gastrointestinal consultation would be necessary if the patient did not respond to treatment and/or if the problem is concluded to be chronic.  

References

AL Basher, S. H. M. (2017). Study of Patients with Right Upper Quadrant Pain using Ultrasonograhpy (Doctoral dissertation, Sudan University of Science and Technology).

Revzin, M. V., Scoutt, L. M., Garner, J. G., & Moore, C. L. (2017). Right upper quadrant pain: ultrasound first!. Journal of Ultrasound in Medicine, 36(10), 1975-1985.