abdominal pain

Examinee Checklist
ENTRANCE:
•Examinee knocked on the door before entering.
•Examinee introduced self by name.
•Examinee identifi ed his/her role or position.
•Examinee correctly used patient’s name.
•Examinee made eye contact with the SP.
HISTORY:
•Examinee showed compassion for your pain
@ If the patient does not allow you to touch his abdomen because of
severe pain, say, “I know that
you are in pain, and I want to help you, but I need to examine you to
be able to locate the source of pain and give you the right treatment.”
I will be as quick and gentle as possible.”
@ You may place your hand on the patient’s shoulder or arm but not on
his leg or hand when you are trying to console him
@ “I know that you are in pain.” “Is there anything I can do for you to
help you feel more comfortable?”
•Onset
•Constant/intermittent
•Frequency
•Progression
•Severity on a scale
•Location
•Radiation
•Quality
•Alleviating factors
•Exacerbating factors
•Types of food that exacerbate pain
•Relationship of food to pain
•Nausea/vomiting
•Description of vomitus
•Blood in vomitus
•Diarrhea/constipation
Past medical history
•Previous episodes of similar pain
•Weight changes
•Appetite changes
•Change in stool color
•Current medications
•Past medical history
•Past surgical history
•Family history
•Occupation
•Alcohol use
•Illicit drug use
•Tobacco
•Sexual activity
•Drug allergies
Physical Examination:
•Examinee washed his/her hands.
•Examinee asked permission to start the exam.
•Examinee used respectful draping.
Examinee did not repeat painful maneuvers.
Exam Component Maneuver
•CV exam Auscultation
•Pulmonary exam Auscultation
•Abdominal exam Inspection, auscultation, palpation (including Murphy’s sign),
percussion
Closure:
•Examinee discussed initial diagnostic impressions.
•Examinee discussed initial management plans:
•Follow-up tests: Examinee mentioned the need for a rectal exam.
Examinee asked if the patient has any other questions or concerns.
Sample Closure:
Mrs. Smith, there are a number of disorders that can cause pain similar to what you
have described. Pain of this
type is most commonly due to an ulcer, an abdominal infection, or a gallstone. We
will have to run some tests to
confi rm the diagnosis and to rule out more serious illness. These tests will include a
rectal exam, an ultrasound
examination of your abdomen, blood tests, and possibly upper endoscopy, which
involves examining your stomach
by means of an optical instrument passed through your mouth. Once we have made
the diagnosis, we will be
able to treat your condition and help alleviate your pain. Do you have any questions
for me?
CHALLENGING QUESTIONS TO ASK
“My father had pancreatic cancer. Could I have it too?”
SAMPLE EXAMINEE RESPONSE
“It’s highly unlikely, as your symptoms are very unusual for pancreatic cancer.
Regardless, some routine blood
and x-ray tests should help us exclude that as a possibility.”