Assessing the Abdomen Essay

APA Format
The Assignment
Analyze the subjective portion of the note. List additional information that should be included in
the documentation.
Analyze the objective portion of the note. List additional information that should be included in
the documentation.
Is the assessment supported by the subjective and objective information? Why or why not?
What diagnostic tests would be appropriate for this case, and how would the results be used to
make a diagnosis? Assessing the Abdomen Essay

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Would you reject/accept the current diagnosis? Why or why not? Identify three possible
conditions that may be considered as a differential diagnosis for this patient. Explain your
reasoning using at least three different references from current evidence-based literature.

The abdomen is assessed using inspection, auscultation and palpation (White 2005). The abdomen is inspected for size and symmetry and is normally rounded, symmetric, protuberant, and soft because of weak abdominal musculature with a slightly greater diameter above the umbilicus than below. The subcutaneous blood vessels in the abdomen may appear distended and blue (Williams & Wilkins 2006). Assessing the Abdomen Essay

Abdominal assessment is complex, largely because of the many vital organs and blood vessels within the cavity of abdomen and its life-sustaining functions, such as digestion and elimination that are performed here (Weber & Kelley 2009). The abdomen houses the several body structures– reproductive (female), gastrointestinal, urinary and lymphatic. Known as the solid or hollow abdominal viscera, these structures include the pancreas, liver, adrenal glands, spleen, ovaries, kidneys, and uterus (solid viscera) and the gallbladder, stomach, small intestine, bladder (hollow viscera) and colon.

During the abdominal assessment, the abdomen is first inspected for rashes and scars. The abdomen is observed for symmetry and visible signs of peristalsis or pulsations. Auscultations are the second component of the abdominal assessment of a client’s bowel status. A “bubbly-gurgly” sound, caused by peristalsis and movement of the intestinal contents, can be heard by placing the stethoscope on each quadrant of abdomen and listening for approximately 1 minute. These sounds should be present in all four quadrants of the abdomen, beginning in the right lower quadrant, and moving clockwise around the four quadrants. When approximately 5 to 20 bowel sounds are heard per minute, the bowel sounds are considered active (Weber 2009). Assessing the Abdomen Essay

The absence of bowel sounds during 1 minute of auscultations in each quadrant is documented as absent bowel sounds. Percussion of abdomen is done in all four quadrants. The predominant abdominal percussion sound in tympany caused by precussing over the air-filled stomach and intensities. Light palpation of the abdomen is done to assess for muscle tone, masses, pulsations, or any signs of tenderness or discomfort. Assessing the Abdomen Essay

A good knowledge of the normal function of the bladder and lower urinary tract is important to gather understanding the effects of abnormal functions. The bladder and lower urinary tract have two main functions, storage of urine at low pressures and periodic elimination of urine.

The bladder is a hollow muscular organ which lies in the anterior part of the pelvic cavity, behind the symphysis pubis. Bladder function comprises cycles of filling and emptying. Urine production by the kidneys is continuous and during the bladder filling phase the rugae flatten and bladder volume increases with very little change in internal pressure (Bartley 2007). This is termed compliance and is possible because the lining layers of transitional epithelial cells can overlap and slip over each other as the volume increases and because of the intrinsic ability of the smooth muscle to maintain constant tension over a wide range of stretch. The voiding phase is initiated voluntarily and can normally be delayed until appropriate circumstances are recognized. When a voiding dysfunction is suspected, or when there is no clear diagnosis, a diagnosis which is often missed is a post-voiding residual volume. All patience attending a continence clinic should have a routine pre and post-voiding bladder scan as part of standard care practice. PVR is the amount of urine left in bladder within 10-15 minutes after voiding and urinary retention is the inability or failure to empty the bladder completely with voiding. Assessing the Abdomen Essay

Application to Surgical Ward
The assessment by nurses refers to the data collection, data analysis, and identification of the problem. Nurses are encouraged to obtain the clinical history of patient from the family members and patient which form the foundation of the assessment. The preliminary assessment is done using the interview technique followed by the physical check-up. The assessment is a process needs to be adopted both pre-operation and post-operation in the surgical ward. For the abdominal assessment pre-operation and post-operation is generalized and remains same, they will be discussed simultaneously. The abdominal assessment, both pre-operative and post-operative has their significance. A surgical pre-operative abdominal assessment is important to determine the presence of an abdominal aortic aneurysm (AAA), which is a potential contraindication of the use of an intra-aorta balloon pump. Abdominal palpitation to detect abnormal widening of an aortic pulsation is suggested to be the most effective method to determine presence of AAA (Elliot et al 2007). The width is compared with the intensity of aortic pulsation to establish the presence of an AAA. Findings from palpation, however, are limited in patients with abdominal obesity. Diagnostic evaluation with ultrasound may also be performed . Assessing the Abdomen Essay

In recent times, recognizing the significance of the assessment by nurses, they are encouraged to identify the deficiency in their knowledge and to promote its application in their respective wards. Abdominal assessment by nurses in surgical ward both, preoperative and post operative has the potential to increase the comfort of patient along with accurate identification of the problem area. Surgical ward nurses play an important role in abdominal assessment preoperative and postoperative (O’Laughlen 2009). Nurses have to continuously observe and assess the patient’s condition closely. For an instance, in the case of non-catheterized patients, nurses should note the time when the patient first passes the urine after surgery. It is possible for retention of urine to occur, particularly in case of abdominal, genitourinary and gynecological surgery procedures have been undertaken. The patients of abdominal surgery are being examined for the palpation of the lower abdomen and the bladder is felt as full and rising up to the umbilicus. Relief of passing a catheter into the bladder and withdrawing it once the bladder is emptied may be required if the patient can’t be persuaded to pass urine normally. This all requires the nurse in the surgical ward to be attentive towards the patient and to possess the knowledge to identify this situation. The knowledge of nurses in assessing the abdomen of the patient is sometimes inadequate which may lead to the emergency situations. The skilled and trained nurses are efficient in recognizing the post-operative symptoms of discomfort in patients and to differentiate it from any abnormal symptoms. Assessing the Abdomen Essay

The abdominal assessment port operation requires the nurse to carefully observe to ensure that the patient is capable of passing urine in the normal way as soon as possible (Hohenfellner & Santucci 2007). The certain area where the vigilant and trained nurses make a difference are for an instance, an assessment of patient’s level of comfort in terms of body temperature, pain and nausea can be made and, where appropriate, treated. Body temperature usually alters significantly as a result of exposure of tissue during surgery and the administration of cold intravenous fluids. Discomfort, pain and nausea are postoperative experiences which skilled nurses can help to significantly alleviate. Assessing the Abdomen Essay

The observing nurse’s interpretation of the patient’s experience has an influence on the care given. Research indicates that some nurses overestimate the patient’s pain experience whilst others may underestimate the severity of pain. Harrison (1991) suggests that in order to accurately assess patient’s pain, nurses need to be self-aware of their own attitude towards the pain and adapt their care accordingly. Research has demonstrated that more experienced a nurse is, the more accurate is her description of the patients comfort level (Harrison 1991). This highlights the importance of the role played by nurses in identifying the accurate reason of discomfort to patient by physical assessment. In surgical ward, nurses with the training in abdominal assessment can increase the chances of speedy recovery of the patient postoperative and also can assess the exact organ of problem with their skills in abdominal assessment. Assessing the Abdomen Essay

As the patient recovers from the immediate post-operative period, the nursing care required should be aimed to move the patient towards a maximum state of independence of medical and nursing interventions. Much of the nursing care in this period is still aimed at preventing complications by closely observing the patient’s condition so as to take immediate action should a complication occur (Crouch & Meurier 2005). In this period of time, nurses should support the patient in caring for his physical and mental well-being. Recent trends have seen an increasing use of non-operative care of patients with abdominal assessment of injury. In these patients, monitoring for deterioration is essential, as is the ability to activate surgery and care for patients accordingly. Assessing the Abdomen Essay

With the high use of non-operative management techniques for solid organ injury, the role of monitoring the patients with abdominal injury is pivotal. Nurses must be cognizant of the clinical signs of abdominal injury, especially hemorrhage and act on these immediately (Pudner 2000). Specific aspects of nursing care for patients identified with trauma in abdominal assessment include pain monitoring, management and postoperative care. Abdominal assessment patients often experience severe pain, as both are the result of primary trauma and surgical intervention for repair (Sawyer 1988). Assessing the Abdomen Essay

Vital sign monitoring is the mainstay of nursing management in patients with abdominal trauma, and all patients should have appropriate monitoring (Heath 1995). It is also essential that all patients should receive urinalysis after incurring abdominal trauma in order to assess the injury to the bladder and abdomen in general. Where the patient has undergone a trauma laparotomy, postoperative care is standard for any patient who has undergone an abdominal surgical procedure. The specific nursing care element depends on what organ has been injured and the surgical procedure that has been undertaken to repair the injury (Brooker & Nicole 2003). Careful attention must be paid to those general nursing care elements that all patients require. Assessing the Abdomen Essay

It can be concluded by stating that abdominal assessment; both preoperative and postoperative are significant to ascertain the discomfort of the patient and also to identify minimal signs of upcoming problem. The problems which may appear post-operative can be avoided if the surgical ward nurses are trained in the abdominal assessment. The nursing staff in the surgical ward plays an important role in the correct diagnosis and identification of any abnormal symptoms. Nurses become pivotal in performing the assessment of the patients as they supervise and monitor the patient directly, both in pre-operative and post-operative cases. As demonstrated by several researches, nurses have the capability to perform accurate assessment, be it abdominal or respiratory once they are being provided the adequate training. Assessing the Abdomen Essay

Various researchers have indicated the significance of the trained and skilled nurses in avoiding the last minute rush by identifying the abnormal or other than normal symptoms. Hence, it becomes vital for the nurses to be educated about the procedure of abdominal assessment and apply it in the surgical ward to improve the functionality of their role.

Older adults have decreased salivation leading to dry’ mouth. Correct 9. The Symptoms occurring with lactose intolerance include bloating and flatulence. 10. Methods to enhance abdominal wall relaxation during examination include positioning the patient with the knees bent. Review questions: 1 . The sequence of techniques used during an examination of the abdomen is: ; Inspection ; Auscultation ; Percussion ; Palpation 2. Venous pattern, peristaltic waves, and abdominal contour can be noted through inspection of a patients abdomen. . Assessing the Abdomen Essay Right, upper quadrant tenderness may indicate pathology in the liver, pancreas, or ascending colon 4. Hyperactive bowel sounds are high-pitches, gushing, and tinkling 5. The absence of bowel sounds is established after listening for 5 full minutes 6. Auscultation of the abdomen may reveal bruits of the Aortic, renal, iliac and femoral arteries 7. The normal range of liver span in the right matriculated line in the adult is 6-12 CM 8. The left upper quandary contains the spleen 9. A female patient has striate on the abdomen.

Which color indicates long- standing striate? Silvery white 10. Auscultation the abdomen is begun in the right lower quadrant because bowel sounds are always normally present here. 11. A dull percussion note forward of the left medically line is indicative The four layers of large, flat abdominal muscles form the ventral abdominal wall and are joined at the midlines by a tendentious seam, the lineal alba. ; The ovaries are normally palpable only on biannual examination during the pelvic examination. ; The small intestine is located in all four quadrants. Assessing the Abdomen Essay
It extends from the pyloric valve of the stomach to the locale valve in the right lower quadrant ; The spleen is a soft mass of lymphatic tissue on the posterior wall of the abdominal cavity, immediately under the diaphragm. ; The aorta is just to the left of midlines in the upper part of the abdomen. It ascends behind the peritoneum, and at CM below the umbilicus it bifurcates into the right and left common iliac arteries opposite the 4th lumbar vertebra. ; The pancreas is a soft, elaborated gland located behind the stomach. It stretches obliquely across the posterior abdominal wall to the posterior abdominal quadrant. Assessing the Abdomen Essay

The kidneys are retaliations, Or posterior to the abdominal contents. They are well protected by the posterior ribs and musculature. The 12th rib forms an angle with the vertebral column, the esoterically angle. Right Upper Quadrant Left Upper Quadrant ; Liver ; Gallbladder ; Duodenum Stomach ; Spleen ; Head of Pancreas ; Left Lobe of Liver ; Body of Pancreas ; Right Kidney and Adrenal ; Left Kidney & Adrenal ; Hepatic flexure of Colon ; Splenetic flexure Of Colon ; opt. Of ascend/Trans. Colon ; Opt. Of Trans. Desk. Loon Right Lower Quadrant Left Lower Quadrant ; Scum ; Appendix ; part of desk. Colon ; Sigmoid colon ; Right ovary & tube ; Left ovary & tube ; Right router ; Left router ; Right spermaceti’s cord ; Left spermaceti’s cord Midlines Aorta Uterus (if enlarged) Bladder (if distended) ; The enlarging uterus displaces the intestines upward and posterior. Bowel sounds are diminished. The appendix may be displaced upward and to the right, but appendicitis-related pain would still be felt in the RL. Us objective Data: ; Appetite? Any changes in appetite or change in weight? Anorexia is loss of appetite from GIG disease as a side effect to some medications, pregnancy or mental health disorders. ; Dysphasia: occurs with disorders of the throat or esophagi. Difficulty swallowing. ; Food intolerance: Are there any foods you can’t eat? What happens when you eat them? Lactose Into. ; Abdominal Pain: may be visceral from an internal organ (dull); parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement); Acute pain needing urgent diagnosis from appendicitis, collectivists, bowel obstruction or perforated organ. Assessing the Abdomen Essay

Chronic pain from gastric ulcers on empty stomach; pain of duodenal ulcers 2-3 hours after a meal. ; Nausea/vomiting is common w/Gal disease, many meds and pregnancy. ; Hemstitches occurs w/ stomach or duodenal ulcers and esophageal avarice. ; GIG upset and diarrhea occur when exposed to new local pathogen in developing countries. ; How often do you have a bowel movement? Assess usual bowel habits. Black stools may be tarry due to occult blood (enamel) from GIG bleed, or non tarry from iron meds. Gray stools occur w/hepatitis.

Red blood in stools occurs with GIG bleeding or localized bleeding around the anus. ; Peptic ulcer disease occurs w/frequent use of nonessential anti- inflammatory drugs, alcohol, smoking, and H. Pylori. ; Nutritional assessment via 24-hour recall Aging adult: Assess for nutritional deficit; limited access to grocery store, income, or cooking facilities; physical disability, social isolation. 24 hour recall may not be sufficient because daily pattern may vary. Attempt a week long diary. Meds: Consider GIG side effects, nausea, anorexia, dry mouth. Assessing the Abdomen Essay

Bowel movements, constipation. Objective Data Preparation: ; The lighting should include a strong overhead light and a secondary standard light. ; The person should have emptied their bladder ; Warm room to avoid muscle tensing ; Position the person supine, w/head on pillow, knees bent, or on pillow & arms at sides or over chest. Not overhead because this tenses ABA muscles. ; To avoid ABA tensing, the stethoscope indices must be warm ; Inquire about painful areas ; use distraction. Enhance muscle relaxation through breathing and emotive magma. Assessing the Abdomen Essay

Contour: ; Stand on the person’s right side and look down on the abdomen. Then stoop to gaze across the abdomen. Your head should be slightly higher than the abdomen. Et contour describes the nutritional state and normally ranges from flat to rounded. ; Symmetry ; Shine a light across the abdomen toward you lengthwise across the person, should be symmetric bilaterally. Even small bulges are highlighted by shadow. Step to the foot of the bed to recheck symmetry. ; Ask the person to take a deep breath to further highlight any change. Assessing the Abdomen Essay

The abdomen should stay smooth and symmetric or ask the person to perform a sit-up without pushing up w/hands. Abnormal findings: ; Sapphic abdomen caves in. ; Protuberant indicates ABA distension ; Bulges, masses ; Hernia-protrusion of abdominal viscera through abnormal opening in muscle wall ; Sister Mary Joseph nodule is a hard nodule in umbilicus that occurs with metastasis cancer of the stomach, large intestine or pancreas ; Note any localized bulging. Hernia or enlarged Liver or Spleen may show. Umbilicus ; Normally it is midlines and inverted with no signs of disconsolation, inflammation or hernia ; Averted with Cities or underlying mass. ; Deeply sunken with obesity ; Enlarged, averted with umbilical hernia ; Bluish pharmaceutical color occurs w/interpersonal bleeding(Cullied sign) ; Skin ; The surface is smooth and even, with homogeneous color. This is a good area to judge pigment because it is protected from the sun. ; One common pigment change is striate (liana lubricants) silvery white, linear jagged marks. Assessing the Abdomen Essay

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They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching as in pregnancy or excessive eight gain. Recent striate are pink or blue then turn white. ; Redness with localized inflammation ; Jaundice shows best in natural daylight ; Skin glistening and taut with cities ; Striate look purple-blue w/Cushing syndrome (excess directionally hormone that causes the skin to be fragile and easily broken Normal findings ; Pigmented nevi (moles) – circumscribed brown muscular or popular areas common on the abdomen. A surgical scar alerts you to the possible presence of underlying adhesions and excess fibrous tissue. ; Unusual color or change in shape of mole. . Patchier Coetaneous magnolias (spider nevi) occur with portal hypertension or liver disease ; Lesions, rashes ; Underlying adhesions are inflammatory bands that connect opposite sides of serous surfaces after Normal findings trauma or surgery ; Veins are not seen, but a fine venous network may be visible in thin persons. Good skin tutor reflects healthy nutrition. Prominent, dilated veins occur with portal hypertension, cirrhosis, cities, or even cabal obstruction. Veins are more visible in malnutrition as a result of thinned adipose tissue. Poor tutor occurs with dehydration, which often accompanies GIG disease. Pulsation and Movement ; Normally u see the pulsations from the aorta beneath the skin in the epigenetic area, particularly in thin people with good muscle wall relaxation. Respiratory movement also shows in the abdomen, particularly in males. Waves of peristalsis sometimes are visible in very thin people. Assessing the Abdomen Essay

They ripple slowly across the abdomen. ; Marked pulsation of aorta occurs with widened pulse pressure (hypertension, aortic insufficiency thrombosis’s and aortic aneurysm) ; Marked visible peristalsis, together with a distended abdomen, indicates intestinal obstruction Calculates Bowel Sounds & Vascular Sounds Depart from the usual examination sequence and calculate the abdomen next. This is done because percussion and palpation can increase peristalsis, which can give a false interpretation Of bowel sounds. Use the diaphragm indices because bowel sounds are often high-pitched. Assessing the Abdomen Essay

Hold the stethoscope lightly against the skin, pushing too hard may stimulate bowel sounds. Begin in the RL at the locale valve area because bowel sounds are normally are always present here. Bowel Sounds ; Note character & frequency ; They originate from the movement of air and liquid through the stomach and large/small intestine. Depending on the time elapsed since eating, a wide range of normal sounds can occur. ; Bowel sounds are high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5-sax’s per minute. Don’t bother to count them. Because sounds radiate widely over the abdomen, the gurgle you hear in the in the RL may originate in the stomach. Therefore listening in all 4 quandaries is not necessary. Just judge if they are present and hypo/hyper active ; One type of hyperactive bowel sound is common is hyperventilates or stomach growling called boroughs. Assessing the Abdomen Essay A silent abdomen is uncommon; you just listen for 5 minutes before deciding if bowel sounds are completely absent. ; Hyperactive bowel sounds are loud, high-pitched, rushing, tinkling sounds signaling increased motility. Hypoactive or absent bowel sounds follow abdominal surgery or w/ inflammation of the peritoneum. Vascular Sounds ; As u listen to the abdomen, note the presence of any vascular sounds or bruits. Using firmer pressure, check over the aorta, renal arteries, iliac, and femoral arteries, especially in people with hypertension. Usually no such sound is present. About 4-20% of healthy people <40 may have a normal bruit riginating from the celiac artery. It is systolic, med to low-pitched and heard between the xiphoid process and the umbilicus. Do not auscelate for correct placement of nasogastric tube. ; A systolic bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of an artery ; Venous hum and peritoneal friction rub are rare General Tympany: ; Percuss to assess the relative density of abdominal contents, to locate organs, and to screen for abnormal fluid or masses ; First percuss lightly in all 4 quadrants to determine the prevailing amount of tympany and dullness. Move clockwise. Tympany should predominate because air in the intestines rises to the surface when the person is supine. Dullness occurs over a distended bladder, adipose tissue, fluid, or mass. Hyperresonance is present with gaseous distention Liver Span: ; Measure the height of the liver in the MCL. For consistent placement of MCL landmark, remember to palpate the acromioclavicular and sternoclavicular joints and judge the line at a point midway between the ;o. ; Begin in the area of lung resonance and percuss down the interspaces until the sound changes to a dull quality. Mark the spot, usu in the 5th intercostal space. Assessing the Abdomen Essay

Then find the ABA tympani and apercus up in the MIMIC_. Mark where the sound changes from tympani to a dull sound, normally at the right costal margin. ; Measure the distance bet the two marks; the normal liver span in the adult ranges from 6-12 CM. The height of the liver span correlates with height of the person. Males have a larger span (10. CM) than females (CM). ; One variation occurs in people with chronic Emphysema, in which the liver is displaced downward by the hyperinflation lungs. ; An enlarged liver span indicates liver enlargement or hypnotherapy. Accurate detection of liver borders is confused by dullness above the 5th intersects space, which occurs with lung disease, pleural effusion or consolidation. ; Accurate detection at the lower border is confused when dullness is pushed up with cities or pregnancy or with gas distension in the colon which obscures the lower border. Splenetic Dullness: ; Often the spleen is obscured by stomach contents, but you may locate it by percussion for a dull note from the 9-1 lath intercessor space just behind the left medically line. Assessing the Abdomen Essay

The area of splenetic dullness normally is not wider than CM in the adult & shouldn’t encroach on the normal tympani over the gastric bubble. Now apercus in the lowest interstate in the left anterior auxiliary line. Tympani should result. Ask the person to take a deep breath. Normally tympani remains thru full inspiration. ; A dull note forward of the medically line indicates enlargement Of the spleen, as occurs with mono, trauma, and infection. ; In this site, the anterior auxiliary line, a change in percussion from tympani to a dull sound with full inspiration is a positive spleen percussion sign, indicating supplemental. Assessing the Abdomen Essay

This method detects mild-to-moderate supplemental before the spleen becomes palpable, as in mono, malaria, or peptic cirrhosis. Esoterically Angle Tenderness: ; Indirect fist percussion causes the tissues to vibrate instead of producing a sound. To assess kidney place one hand over the 12th rib at the esoterically angle on the back. Thump that hand with the lunar edge of your other fist. The person us feels a thud but no pain ; Sharp pain occurs with inflammation of the kidney or parenthetic area. Assessing the Abdomen Essay

Palpate Surface and Deep Areas: Perform palpation to judge the size, location, and consistency of certain organs -Bend person’s knees -Keep your palpating hand low and parallel to abdomen Teach person to breathe slowly; in through nose, and out through mouth -Keep your own voice low and soothing; conversation may relax person -Try “emotive imagery,” e. G. , you might say, “Now I want you to imagine you are dozing on beach, with sun warming your muscles and sound of the waves lulling to sleep. -?perform palpation just after auscultation -Keep stethoscope in place and curl your fingers around it, palpating as you pretend to calculate Light and deep palpation ;Begin with light palpation ;With first four fingers close together, depress skin about 1 CM ;Make gentle tarry motion, sliding fingers and skin together ;Then lift fingers (do not drag them) and move clockwise to next location around abdomen ;Objective is not to search for organs but to form an overall impression of skin surface and superficial musculature. Assessing the Abdomen Essay

This cavity contains the stomnch, spleen, hver., gall bladder, pancreas, kidneys, small intestine and large intestine. Additionally, some abdominal organs are contained within the pelvis: the bladder, caecum, appendix, sigmoid colon, rectum and tema le reproductive organs. When assessing a patient with abdominal pain, it is essential that the nurse understands abdominal anatomy and knows the position of the abdominal organs, Duringclinical exammation the abdomen is often divided into four quadrants: right upper quadrant, left upper quadrant, right lower quadrant and left lower quadrant (Higure 1). Patients may be able to localise the position of their abdominal pain within the four quadrants and this enables the nurse to decide which organs or structures may be involved. Figure 2 shows the location of some of these organs or structures. The structures located within the right upper quadrant are: right lobe of the hver; gall bladder; head of pancreas; duodenum; sections of the ascending and transverse colon.  Assessing the Abdomen Essay
Which vital signs did you record? What other tests did you perform? What was your rationale? If you were teaching a nursing or medical student could you explain what you were looking for? Vital signs Monitoring the patient’s vital signs allows the nurse to record an admission baseline, detect abnormalities that may Indicate a disease process and, importantly, spend time observing the patient. All patients with acute abdominal pain should have the following vital signs recorded. Témperafí/re This should be taken for every patient with abdominal pain. A raised temperature may suggest the presence of a bacterial infection or an inflammatory process such as appendicitis. The degree of temperature together with other observations such as heart rate and respiratory rate will indicate if the patient is septic and in need of urgent medical management (Kinnear 2004). Note that older patients with abdominal pain caused by an infectious process may not present with a raised temperature. Immune response appears to decline with age and this may increase the risk of infectious diseases and their complications (Miller 1996). Assessing the Abdomen Essay