Protocol for Abdominal Pain

Purpose:

1. To rapidly identify potentially seriously ill patients with complaints of abdominal pain.

2. To expedite Emergency Services Physicians evaluation and initiation of treatment.

Assessment:

(If bed available triage will do abbreviated assessment, which includes Chief Complaint, Vital Signs, Medical History, Domestic Violence question, Medications, and completion of form.)

Below should be used for the bedside nurse or if no beds available.

1. History

2. Description of present symptoms

3. If male, penile discharge or bleeding

4. Dysuria, frequency, urgency, or retention.

5. Vaginal pressure

6. History of or strong suspicion of kidney stones.

7. Severe pain as reason for presenting to the ED

Criteria for Intervention

Female of childbearing age with potential for pregnancy, any person with complaint of significant abdominal pain, any person who appears ill and significant vaginal bleeding.

1. Clean-catch, mid-stream urine specimen

1. Not menstruating
2. Fever < 100 degrees � no chills
3. No vaginal discharge

2. Mini-catheter or straight catheter urine specimen

1. Menstruating
2. Fever > 100 degrees with chills
3. Vaginal discharge
4. Disabled/incompetent to collect clean-catch urinalysis

Interventions

1. Collect urine; hold culture and sensitivity

2. Urine pregnancy test on all females ages 12-50 unless they have had a hysterectomy.

3. Do dipstick urine and record results on point-of-care sheet and place with chart

4. If mini-catheter is indicated, notify charge nurse to locate a room for procedure and have patient wait in waiting room until room is available for catheter.

5. Blood work for complete blood count and comprehensive medical panel If patient has fever >101

1. Use Fever protocol (Need rectal Tylenol)
2. Blood cultures drawn and hold at small-volume nebulizer

6. Nothing by mouth

Re-evaluation

The triage nurse or nurse assigned will re-evaluate all patients waiting according to nursing judgment, vital signs, and patient condition.

Documentation

1. Complete physician order sheet and place it with the chart. If the patient is going to the waiting room, place chart with orders with registration clerks.

2. Complete history and assessment if no bed available in the ED.

3. Lab work drawn/sent and time.

References

• Grossman VGA. Quick Reference to Triage; Philadelphia: Lippincott, Williams & Wilkins; 1999.
• Emergency Nurses Association. Triage: Meeting the Challenge. Park Ridge, IL: Emergency Nurses Association; 1998.

Prepared 04/19/2001 by Mary G. Kelley, MS, RN, CEN, GNP-C
Revised 06/14/01 by Margie K. Brundage RN, CEN
DEPARTMENT/DIVISION Department of Emergency Services DATE 9/01

Source: St. Mary�s Hospital, Tucson, AZ.