Acute Abdominal Pain: Manage Without Delay

Chris Pasero, MS, RN-BC

Disclosures

August 02, 2013

Discussion: Nursing Actions

Continue to monitor and report changes. Monitoring the patient and reporting changes are important and expected nursing activities, but they do not address relief of this patient's severe pain.

Document the physician's decision to delay pain management until evaluation is complete. The refusal to provide pain management orders for any patient with pain must be documented in the medical record, because this decision has legal implications. It is important to document the physician's statement and any nursing actions that were taken to advocate for pain relief for the patient. The administration or support of any nonpharmacologic methods must be documented as well. Although documentation in the medical record is an essential action, it is not the best action in addressing this patient's severe pain.

Provide evidence that analgesics do not mask a diagnosis. The provision of research and evidence-based guidelines is always the best action in situations that require a change in long-standing erroneous beliefs and practices. For many years, it was routine practice to withhold analgesics in patients presenting with nontraumatic undifferentiated acute abdominal pain, based on the belief that pain relief would interfere with accurately identifying the cause of the abdominal pain. However, decades of research in children and adults show that this practice is unjustifiable. Accepted evidence-based pain and emergency department policy statements and guidelines recommend the provision of analgesia during the diagnostic evaluation.

Request pain management orders promptly after the physician reviews the lab work and CT scan results. This would be a critical action if the physician cannot be convinced that the diagnosis will not be masked by analgesia. In such case, the nurse should immediately report the physician's actions to a nursing supervisor, who should in turn discuss the issue with the physician and advocate for analgesia for the patient. If this is unsuccessful, the supervisor should follow the hospital's established chain of command to ensure that the appropriate medical authority is notified.

Other actions may include the provision of a report to the hospital ethics committee and the risk management department, because this practice is not only unethical but also opens the door to liability issues related to the undertreatment of pain and the potential for inaccurate diagnosis, leading to unnecessary surgery. Later actions include the development of an institutional policy that addresses the appropriate provision of analgesia during diagnosis to help prevent future similar incidences.

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