Overview
This guide outlines key questions and clinical indicators ER nurses should use to assess abdominal pain, prioritize care, and escalate if necessary, with special attention to life-threatening emergencies and critical triage decisions.
Importance of High-Quality Assessment
- Prompt, targeted questions enable faster, more accurate provider decisions.
- Recognizing severe cases early ensures urgent care for life-threatening conditions such as ruptured organs or ectopic pregnancy.
- Effective triage impacts imaging needs and patient monitoring.
Identifying Medical Emergencies in Abdominal Pain
- High-risk causes include ruptured appendix, perforated bowel, leaking abdominal aortic aneurysm, mesenteric ischemia, bowel obstruction, torsion, and sepsis.
- Any perforation or rupture is an immediate emergency.
- Escalation is required for signs of peritonitis: severe diffuse pain, guarding, rebound tenderness, rigid abdomen, hypotension, or altered mental status.
Key Questions to Ask About Abdominal Pain
- Location: Site directs suspicion (e.g., RLQ for appendicitis, RUQ for gallbladder/liver, epigastric for ulcers/pancreatitis).
- Onset: Sudden onset suggests rupture/torsion; gradual suggests infection/inflammation.
- Radiation: Right shoulder for gallbladder, back for pancreatitis or aneurysm.
- Aggravating/Relieving Factors: Worse with food indicates gallbladder/ulcer; relief with gas suggests obstruction.
- Nature: Sharp, cramping, burning, constant/intermittent—helps narrow differential.
- Context: Activities, food/drink, alcohol intake.
- Recurrence: Previous episodes, prior diagnoses.
Assessment of Associated Symptoms
- Fever/chills suggest infection or inflammation.
- Nausea, vomiting, diarrhea, constipation—frequency, color, last bowel movement, gas passage.
- Stool/vomit color: Black or red for GI bleed, green for obstruction, gray/pale for liver/gallbladder.
- Severe constipation: Hard, pellet-like stools.
- Dehydration: Mucous membranes, skin turgor, orthostatic vitals.
Physical Examination & Pain Mapping
- Visualize abdomen by quadrants and regions for diagnosis clues.
- Referred pain may obscure the true origin.
- Always consider the full clinical context and patient presentation.
Special Considerations in Female Patients
- Always ask about pregnancy possibility—ectopic pregnancy is life-threatening.
- Inquire about menstrual cycle, vaginal bleeding/discharge, and urinary symptoms.
- UTI and pelvic infections can present as lower abdominal pain.
Patient History Essentials
- Recurrence and prior diagnoses clarify urgency.
- Surgical history increases risk for obstructions.
- Medications: Chronic NSAID use raises ulcer risk.
- Alcohol, smoking, and drug use inform risk for GI disease.
- Pair history with physical exam and vital signs.
Recommendations / Advice
- Escalate immediately if peritonitis or critical findings are present.
- Always include thorough GI assessment and targeted questions in triage.
- Maintain vigilance for atypical presentations and high-risk conditions.