The Narcotic Bowel Syndrome - Assignment Example

Title: Name Course Tutor Date Case 1: History Call to: A 22 year old woman who is complaining of severe abdominal pain. The woman was previously well and has no pregnancy. She has an IUD insitu, therefore unsure of LMP. Has NKDA and is currently under medication of Efexor 75mg for depression. Pmx: Nil Family Hx: Her mother Vital Signs: Oxygen saturation- 98 Per cent on room air. Temperature- 36.5 degrees Celsius Respiratory rate 22/ min Blood pressure 90/60 Pulse rate 110 bpm with amplitude of 1. Skin color: Pale Stamina: Weak Pain Score: 7/10 Provisional Diagnosis Provisional diagnosis: PV bleeding Differential diagnosis: Ectopic pregnancy, Threatened abortion, normal pregnancy, STDS- gonorrhea, Chlamydia, Trichonomas; pelvic Inflammatory Disease, Tubo-Ovarian Abscess, Ovarian Torsion, Ovarian Cyst, bacterial Vaginosis, Epidemiology/ etiology/pathophysiology Abdominal pain is a common complaint among women with data suggesting that approximately 25 percent of adult populations report to have abdominal pains (Silen, 1991). The prevalence is across all races, ethnicities and geographical locations. Women record a higher rate of abdominal pain than men. The abdominal pains accounts for a 10 per cent of all the hospital emergences. Sometimes abdominal pain may be related to acute trauma. The common causes of abdominal pains in adults include cholecystitis, malignancy and bowel obstruction. A large portion of the population of the patients with the abdominal pains , paramedics are concerned on the ways they can use safely in order observe the patients safely or the recurrent symptoms can be used to treat or subsidies the pain before the patient is recommended for further investigation for treatment (Grunkemeier DM, 2007). Abdominal pain is often followed by other symptoms which makes it not specific and thus allot of caution is required. A combination of accurate history of the patient’s condition and physical examination yields better results to the physicians. Investigations The investigations carried out on the metabolic causes in the lab are associated with the abnormalities that are in the first tests. DKA is an etiology sign as a result of the integration of increased sugar levels in the body and the metabolic acidity. Much caution should be employed since patients with diabetes produce DKA The general appearance and the vital signs will help narrow the differential diagnosis of the woman. The woman shows no signs of being pregnant; she is currently under medication as a result of depression. The location of pain guides the remainder of the physical examination. Once the woman has gained stability, the differential diagnosis is applied to identify further symptoms for proper management of the abdominal pain. Ectopic pregnancy should be considered since the woman is of a child bearing age and she has a PV bleeding and she complained of abdominal pain. Uncontrolled GI Bleed is a condition by peptic ulcer and the woman is under medication due o depression. In most of the cases patients with under depression experience abdominal pains due to alteration in the level of their consciousness. Abdominal organs traumatic rapture need to be examined as a result of rampant history of patients with traumas and this may lead syncope and hypotension. Patients who record immediate abdominal pain with no history of frequent abdominal pain, examining ruptured aneurysm are a must. You need to ask the family member who in this case is a mother whether they have had cases of AAA. The immediate severe abdominal pain is as a result of renal colic. A high percentage of patients with abdominal pain vomit, and therefore the clinicians should wear appropriate personal protective equipment to protect against splashing of vomits. Treatment Pain Management: The pain score of the patient is high and therefore she needs analgesia and can be administered without tampering with the physical assessment of the woman peritoneal symptoms. Response: The woman should be with the caretaker to give her safe from more depression. Airway: Ensure that the woman’s airway is maintained Breathing: Ensure that the woman is breathing normally with no signs of hindrances in her breathing system. Exposure/ Examination: The woman has shown some vital signs and the physician should minimize the investigation to the ones that had been identified to avoid anxiety from the patient. Proper investigation under the pre-hospital conditions provides a supportive perspective in the analysis of the patient’s history therefore ensuring the right information is obtained. Charting: It’s very vital to document information of the patient. I.e. location and description of the pain, the treatment given and if the treatment effects. Transport: The patient records a high level score in pain and analgesia should be administered in order to arrange for a quick transportation to hospital for proper assessment. (Ma, 2004) The medicine administered will not obstruct further assessment because it’s meant to reduce pain. Case 2: History: Call to: A 34 year old pregnant woman who is G1P0 36 week’s gestation, complaining of moderate constant abdominal pain. The woman is booked at a local maternity hospital to birth her baby because of an uneventful pregnancy. She has been attended to by antenatal clinician. She is taking multivitamins and all the blood tests, screening and ultrasounds done on her are up to date. She has NKDA and no PV loss visible. PMx: Nil Family Hx: Husband has no any record of illness in the period of her pregnancy Vital signs: Oxygen saturation: 99 per cent on room air Temperature- 36.8 degrees Celsius Respiratory Rate- 21 per minute Blood Pressure- 75/50 Pulse rate- 120 bpm with amplitude of 1-2 Skin color- Pale Pain score level – 6/10 Fundal Height - appropriate Abdomen – tender and rigid Provisional Diagnosis: Muscle Strain Differential diagnosis: Appendicitis, muscle strain, cholecystitis, aerotic, location of the pain, peptic ulcer, Epidemiology/ Etiology/ Pathophysiology The woman has a muscle strain due o her pregnancy condition and the pale condition indicates that she has poor circulation of blood in her body. (Choung RS, 2009) Abdominal pains are normally as a result of body organ inflammation and stretching, the duct being blocked, body structure swelling and loss of blood supply to an organ. Moderate abdominal pain calls for the clinician to focus on the common conditions that cause abdominal pain when a woman is pregnant and other serious conditions. Since the woman has moderate abdominal pain, cases of serious condition such as aortic dissection to the woman should be ruled out. (Panchal SJ, 2007) The clinician should consider assessing whether the woman has muscle strain as a result of pregnancy. Statistics indicate that women with moderate abdominal pain comprise a 10 per cent of all the emergences reported to hospitals. Appendicitis is one of the conditions that have a high rate of being misdiagnosed but measures have been established to curb with the situation. Peptic ulcer is a condition that is found on the stomachs walls and is linked with the upper abdominal pain. It is frequent to persons of ages between the ages of 30-50. The pain starts moderately and is usually controlled by anti-acids. The clinicians need to be careful in case of internal hemorrhage since the patient may be anemic. Ectopic pregnancy occurs between 2-12 weeks which is fetal implantation outside the uterus with lower abdominal pain. (Sperber AD, 2008) Bladder infection has been found to be a common cause of abdominal pain and mostly in women. This pain is vastly found on the lower abdominal quadrants. Investigations The patient’s records pain score above moderate and therefore there is no apparent life threatening symptoms from the patient. Therefore, the clinician needs to continue with evaluating the location of the pain and the adversity of its effects. The patient needs to be in a supine position and not in a sitting position when doing examination on her. Do further examination of her skin color. When locating the location of the pain with your hands, you need to touch her gently not to hurt the patient. After the abdominal pain location is obtained, observe the appearance of the abdomen .i.e. scaphoid, indrawn, distended or rounded. Treatment Response: Keep the first priority as wanting to know the general indicators of patient’s condition. Using the AVPU assess the woman’s level of consciousness. Even if the woman is with her husband, information needs to come from the woman herself. Airway and Breathing: The airway should be clear and patent. The patients need to have adequate breathing since abdominal pains hinder adequate inhalation of fresh air. The clinician need to provide supplemental oxygen to the patient if she records a decrease in the effectiveness of her breathing. Bag-mask device will be used if the patients breathing condition worsens and she need to be appropriately assisted in her breathing to keep her warm. Circulation: From the vital symptoms the clinician finds out that her skin color is pale and this means there is a poor circulation in her body. The patient needs to be kept warm to sustain her condition. Transport Abdominal pain in cases of pregnant women needs to be addressed with caution and a quick transport is needed to a trauma centre (Ma, 2004). Transporting the patient should take the shortest time possible in order to assess the patient’s condition. Case 3: History Call to: A woman is in labor that is 41 weeks gestation G3P2. The woman has had an uneventful pregnancy and is booked into local private maternal hospital to birth her baby. Antenatal care has been attended to by an obstetrician. The blood tests, screening and ultrasounds are up-to-date and NAD. Current condition of the woman: she commences involuntary pushing and a bottom of the emerges PMx: The woman has fibroids The woman is asthmatic She is taking multivitamins and Ventolin PRN She is allergic to Penicillin Family Hx: Vital signs: Oxygen saturation – 99 percent on room air Temperature – 36.9 degrees Celsius Respiratory rate- 20 / min Blood pressure- 110/70 Pulse rate- 95bpm with amplitude of 2 Time in labor- 2hrs Contractions – 5 minutely and moderate in strength Fundal height- Appropriate Fetal heart- 130bpm Membranes- Ruptured and clear liquor draining Provisional Diagnosis Provisional Diagnosis: Premature rupture of the membranes Differential diagnosis: obstetric and fetal assessment, premature rupture of membranes, abdominal pain during pregnancy, trauma, Epidemiology/ Aetilogy/ pathophysiology The situation here is critical because there are two patients that are involved in the emergency response. This comes to the knowledge of the paramedics that there must be proper management of the two patients. The paramedics must make tough decision in order to save both lives. The woman has developed premature rupture of membranes which is one of the most recorded emergencies in hospitals. During pregnancy, the fluids that come out of the vagina are forming the ruptured membranes until a further evaluation by a clinician proves it otherwise. Ultrasound estimation of the fluids is done to do the diagnosis. Ectopic pregnancy calls for surgical management and therefore the patient need o are administered some anaestalgia to reduce pain and a complete blood count is needed to know the condition of the patient. (Wilder-Smith OH, 2010) Abdominal pain is found to both pregnant and non pregnant women. In pregnant women, abdominal pain may be caused by the contractions of the uterus as a result of labor. The woman has been in labor for long hours and since the gestation period of the woman is more than 35 weeks , the clinicians must assess their skills on doing the caesarean delivery. Investigations The woman commences involuntary pushing and a bottom of the baby emerges. The clinician should conduct a visual evaluation of the perennial area when the contractions from the woman are 5 minutes apart. The patient is best evaluated when she is lying flat and exposed from below the tits to the waistline. Fetal Assessment: The clinicians need to know if the pregnancy is viable, and whether the patient and the baby can be cared for in that institution or if the patient needs to be transported to another higher level hospital with good delivery facilities? The paramedics need to assess the expertise of the nurses who are able to take high risks. Treatment Response: The patient should be kept warm under the care of the delivery nurse Basic care of the patient will include the ABC’s i.e. airway, breathing and circulation. Airway: since the back of the child is the first to emerge the delivery is imminent and this means that the infant’s airway must be maintained. This is achieved by pushing the vaginal canal away from the child’s face. A patient with an altered level of consciousness needs a proper and well managed airway. Administering high flow oxygen at 15l/min is required to provide assistance in the ventilator system. Circulation: the clinician should be keen in skin color, temperature and the condition of the patient that is life threatening including of the vaginal bleeding. In case of shock , the patient is placed in a supine position , legs have to be elevated, body temperature conditioned and the paramedic should continue administering oxygen. The supine hypertensive syndrome is suppressed by placing the patient in the left lateral position. Fluids: Since fluid is observed and shows that is from the premature rupture of membranes, a sterile speculum examination should be carried out. From this evaluation the clinician should point out whether there is dilation in the cervix. The management of the delivery becomes difficult when the cervix is closed. Transport The pregnant woman needs to be transported in the left lateral decubitus position apart from when the patient is being loaded into the ambulance by the paramedics (Ma, 2004). The patient should be accompanied by at least two clinicians and a delivery nurse. If the patient has an unstable condition and the baby goes rigid, an obstetrician should be on board to help in virginal delivery Bibliography Choung RS, L. I. (2009). Am J Gastroenterol. . Opioid bowel dysfunction and narcotic bowel syndrome: a population-based study , 1199–204. Grunkemeier DM, C. J. (2007). Clin Gastroenterol Hepatol. The narcotic bowel syndrome: clinical features, pathophysiology, and management. , 1126–39. Ma, O. C. (2004). Emergency Medicine Manual. New York: McGrawHil. Panchal SJ, M.-S. P. (2007). Int J Clin Pract. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burde , 1181–7. Silen. (1991). Cope’s Early Diagnosis of the Acute Abdomen. New York: Oxford University Press. Sperber AD, M. C. (2008). Gastroenterology. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. , 75–84. Wilder-Smith OH, S. T.-N. (2010). J Pain Palliat Care Pharmacother. . Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study , 119-28. . Read More