Acute Pain Clinical Assignment Sample

Australian Indigenous Health

Introduction to Australian Indigenous Health

The patient in the given case study is a 32-year-old male who was brought into the emergency care unit after having severe epigastric pain. The patient was having severe pain episodes from 5 am. He was conscious and alert. Apart from the pain, he was also having cramping of the abdominal muscles. The patient also had several episodes of vomiting and was observed to be having severe dehydration. The appearance of the patient was pale and he was in severe distress as well. The patient has had several episodes of pancreatitis in the past and also underwent cholecystectomy 10 years ago. He has been admitted to the emergency care unit for the management of the same, on several previous occasion. The person works in an IT company and he stays alone in his rented apartment. The patient was conscious enough to make a call to get an ambulance as he is fully aware of his condition and has dealt with the same issue multiple times before. The main issue in the case study can be noted as the ongoing pain and the vitals noted to be abnormal than usual readings.

Collecting Clues

At the time of the admission, the patient was pale looking and was having severe abdominal pain and cramping. He was also having nausea. The respiratory parameters were intact. The saturation was maintained at 98% at room air. However, the patient was having a low respiration rate of 15 breaths per minutes. The patient might be having difficulty in breathing due to severe pain he was going through. The pale looking of the skin can be attributed to the frequent episodes of vomiting the patient was having and due to the same, he was also dehydrated. The cardiac parameters of the patient were not that normal. The patient was having a high heart rate of 60 per minute. Both observational, as well as peripheral heart rate readings, depicted a high reading. The blood pressure reading was also measured to be of hypotensive one. The blood pressure readings were 105/60mm Hg. These abnormal readings can be attributed to the patient having a vascular involvement. In cases of pancreatitis and epigastric pain, the patient might be having the involvement of vascular structure in the gastric region that might be ruptured and bleeding internally (Boumitri, 2017). This can also lead to an intra-abdominal abscess and thus leading to the patient having these abnormal readings of the parameters. As the patient is having normal respiratory parameters and no rise in body temperature, the chances of infection can be ruled out.

Concept Map

Identify problems/issues

The main issue in the given case scenario is the patient having acute pain. The pain should be managed as it is adding to the discomfort of the patient. The other major concern is abnormal vitals (Crockett, 2018). The patient is having hypotension along with tenderness in the epigastric region. This can be attributed to the presence of an active infection or injury in the region. Due to this, there is low blood circulation in the region which can give rise to various other complications. The pain in the area can also pose as a hurdle in managing the patient as it will be restricting the movement of the musculature as well. The low peripheral pulses are also an indicator of reduced or hampered circulation in the peripheral region. As the patient has been admitted with recurrent episodic events it is also vital to rule out any possible chances of injury or rupture of the musculature in the vicinity of the area that is tender on palpation (Greenberg, 2016). Low blood pressure readings can also be caused due to vascular comprise brought about by leaking in the epigastric region, which might have obstructed the blood flow in the region. The tenderness in the area is also an indicator of an acute injury that can be external or internal.

Establishing goals

The main goal in the given case scenario is pain management. The pain parameter is high which can pose as an obstacle in managing the condition of the patient. pain reduction is also crucial from providing the patient with comfort and ease. This will also help in relieving the additional stress on the patient. The next main goal of the patient is managing the vitals. It is important to keep the vitals stable in order to prevent the patient from going into any kind of septic shock. Vitals are also a direct indicator of the clinical presentation of a patient. the abnormal parameter should be evaluated on an hourly basis to monitor for any change and response as per the treatment interventions applied (Shah, 2018). Dehydration is another issue that has to resolve as it can tamper with the fluid imbalance in the patient. This can further lead to fluctuation in the blood pressure as well as the urine output of the patient.

Take action

The patient can be managed with pain medications. However, as the patient was admitted before as well, low dosages should be delivered to avoid the patient getting an addiction to the medication. As the patient is responsive, he can be assessed for pain severity with the help of pain assessment tool such as visual analog scale (Drewes, 2017). This will help in tapering off the pain medication in accordance with the pain perceived by the patient. thus, promoting safe medication administration. Hourly vitals monitoring is crucial for managing the patient and applying early prevention strategies. The main vitals to be monitored can be peripheral pulses, heart rate, respiration rate, blood pressure, inputs and outputs and so on. As the area of pain is very tender on touch, detailed scanning of the musculature should be carried out to rule out the presence or absence of any injury or trauma (Portelli, 2017). The diagnostic scanning can also help note the internal development of the tissues and their response to the treatment management applied for treating the patient.

Conclusion on Australian Indigenous Health

Patient’s vitals are to be monitored at all time to note for any deviation. As the patient has had previous episodic events proper diagnostic investigations should be carried out, along with detailed physical examination in order to rule out the chances of internal trauma or injury to the patient. Prioritizing treatment plan in accordance with the clinical presentation is of vital importance is providing the patient with holistic care support.

References for Australian Indigenous Health

Boumitri, C., Brown, E., & Kahaleh, M. (2017). Necrotizing pancreatitis: current management and therapies. Clinical Endoscopy, 50(4), 357.

Crockett, S. D., Wani, S., Gardner, T. B., Falck-Ytter, Y., Barkun, A. N., Crockett, S., ... & Gupta, S. (2018). American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology, 154(4), 1096-1101.

Drewes, A. M., Bouwense, S. A., Campbell, C. M., Ceyhan, G. O., Delhaye, M., Demir, I. E., ... & Neoptolemos, J. P. (2017). Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology, 17(5), 720-731.

Greenberg, J. A., Hsu, J., Bawazeer, M., Marshall, J., Friedrich, J. O., Nathens, A., ... & McLeod, R. S. (2016). Clinical practice guideline: management of acute pancreatitis. Canadian Journal of Surgery, 59(2), 128.

Portelli, M., & Jones, C. D. (2017). Severe acute pancreatitis: pathogenesis, diagnosis and surgical management. Hepatobiliary & Pancreatic Diseases International, 16(2), 155-159.

Shah, A. P., Mourad, M. M., & Bramhall, S. R. (2018). Acute pancreatitis: current perspectives on diagnosis and management. Journal of Inflammation Research, 11, 77.

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