Assessment of the Abdomen and Gastrointestinal System
Additional subjective history should be assessed by asking specific, focused assessment questions that point out the possible changes in the client’s digestion, appetite, and bowel movements, including the color, consistency, frequency, and regularity. Further questions include cases of bloody stools, exacerbation of abdominal pain, and rectal bleeding. Additional questions should also determine if the patient experienced any fever and chills, malaise or fatigue that can be associated with nausea and diarrhea. The assessment should focus on identifying if the patient has experienced any changes, either positive or negative, within one year. Such questions are critical during the review of the patient’s system.
The patient’s objective health history is essential and should focus on collecting vital signs, physical assessment findings, the overall assessment of the patient, and the lab diagnostics findings. The objective should also focus on determining the characteristics of the abdomen and establish its status, i.e., whether it is flat or obese, distended, or non-distended. Additional assessment should also be performed on the patient’s mucous membranes to identify if they exhibit any dryness which is an indication of dehydration given that the patient has diarrhea and nausea but without vomiting.
Based on the assessment note, as well as the additional information provided in the objective, the client exhibits apparent symptoms of gastroenteritis. These symptoms may include abdominal pain, nausea, vomiting, diarrhea, fever, and hearing hyperactive bowel sounds on auscultation (Dains, Baumann, and Scheibel, 2019). Based on the assessment of diarrhea accompanied by a fever of 99.8 temperature, the information confirms that the client has an infection.
Further diagnostic tests are recommended to get a better diagnosis. These tests include the fecal occult blood test/Hemoccult test, stool culture, endoscopy, computed tomography scanning, leukocytes, and biopsy (Dains, Baumann, and Scheibel, 2019; Colyar, 2015). The Hemoccult test can be used to rule out bloody stool, while leukocytes will screen for inflammatory diarrhea. Positive results on both the Hemoccult test and leukocytes would confirm the diagnosis of inflammatory diarrhea. A stool culture would help in identifying and isolating pathogens that will be useful in determining the exact diagnosis and the appropriate drugs for specific macro-organisms. Performing an endoscopy is essential in the diagnosis of acute diarrhea, and the findings will confirm if it is non-infection acute diarrhea, including cancer, inflammatory bowel disease or ischemic colitis. The computed tomography scan will be used to rule out other causes that may imitate diverticulitis, given the patient’s left lower quadrant pain (Dains, Baumann, and Scheibel, 2019). Therefore, the current diagnosis cannot be accepted as the final diagnosis.
The current diagnosis is acceptable as a likely differential diagnosis, with more diagnostic tests recommended to achieve a more definitive concluding diagnosis. Additional tests and evaluations recommended include diverticulitis, bowelCancer, Ulcerative colitis, and Crohn’s disease.
• Diverticulitis: It is the most common cause of left lower quadrant pain. Its clinical symptoms include left lower-quadrant pain, nausea and vomiting, and fever (Hammond, Nikolaidis, & Miller, 2010). • Bowel cancer: Colon/Bowel cancer is selected because of the patient’s abdominal pain and the likely changes in the client’s stool due to diarrhea and as well as the presence of blood in the feces. Some of the common symptoms of bowel cancer include rectal bleeding, abdominal pain, loss of weight, loss of appetite, changes in bowel movement, and fatigue (Walter et al., 2016).• Ulcerative colitis: Ulcerative colitis is a disease associated with the inflammation of the colon, the rectum or both, and causes rectal bleeding tenesmus, and the passage of mucus. Other symptoms include abdominal crampingand diarrhea caused by increased colon involvement (Dains, Baumann, and Scheibel, 2019).• Crohn’s disease: Crohn disease is a disease associated with the inflammation of the digestive tract. Some of the clinical signs include abdominal cramping, tenderness, rectal bleeding, and diarrhea (Dains, Baumann, and Scheibel, 2019). It is also associated with chronic bloody diarrhea, fever, and weight loss.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Hammond, N. A., Nikolaidis, P., & Miller, F. H. (2010). Left lower quadrant pain: guidelines from the American College of Radiology appropriateness criteria. American family physician, 82(7), 766-770.
Walter, F. M., Emery, J. D., Mendonca, S., Hall, N., Morris, H. C., Mills, K., … & Rutter, M. D. (2016). Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study. British journal of cancer, 115(5), 533.