The Shadow Health Focused Exam that is abdominal Pain with Esther Park provides nursing students with an excellent case to train their clinical reasoning on assessing standard complaints of the abdomen. Esther Park is a 78-year-old Korean American female who was referred to the physician by her daughter who was concerned about her health because of lower abdominal pain, bloating, and constipation. The given simulation focuses on the systematic evaluation of the gastrointestinal and genitourinary systems and covers the impact of the age-associated changes when it comes to pain perception, cultural elements, and possible complications among the adult age groups.
Clinical reasoning begins with the comprehensive subjective data gathering by structured frameworks. Mrs. Esther provides a history of dull, crampy, painful sensations in the lower abdomen of the past five days, 3-6/10, aggravated by eating or mild physical exercise such as gardening, and relieved in part by rest or warm fluids. She denies bowel problems, loss of appetite, and extreme bloating in a five-day period despite having regular and soft, formed bowels. Other related results are a mild darkening of the urine with reduced frequency, however, without dysuria and hematuria. She has a past medical history of hypertension. The discussion of these details assists in distinguishing between constipation and other conditions.
The primary diagnosis reveals significant abnormalities identified during the objective examination. Vital signs are mild hypertension and tachycardia. Moving on to the physical examination, she presents with a flat, tympanic abdomen in the LUQ, RUQ, and RLQ and dullness on the LLQ. On auscultation, she has normoactive bowel sounds in all four quadrants. Palpation reveals diffuse tenderness in the left lower quadrants and no rebound tenderness.
There is a presence of guarding and a firm tender mass that can be felt in the left lower quadrant, which is characteristic of retained stool. She denies costovertebral angle tenderness (ruling out upper urinary tract infection). Additionally, there is no organomegaly or pulsatile masses. These findings, age-related reduced motility, and potential dehydration indicate a strong possibility of constipation.
The synthesis of subjective and objective data leads to the most probable diagnosis of functional constipation that might be worsened with the low fluid and fiber intake, decreased activity, and changed diet. Critical differentials are partial bowel obstruction, infection of the urinary tract, or medication side effects, but the lack of fever, vomiting, or excruciating pain rules out most of the differential diagnoses. Regardless of geriatric patients with abdominal symptoms, it is always essential to rule out life-threatening causes.
The documentation must be done in the SOAP format, but it should emphasize the subjective constipation, objective dullness on palpation of LLQ, evaluation of constipation, and a specific plan. Promote more fiber and fluids, prescribe laxatives that are gentle, encourage walking, and teach preventive measures. Show compassion all the way and offer culturally competent education without shunning her native food.
To get a favorable score on this, gather all the necessary subjective and objective information, provide comprehensive patient education on bowel health and hydration, and create a holistic care plan. Practicing and rehearsing with Esther Park hones geriatric assessment methods and sharpens the identification of hidden red flags, as well as improves competencies in therapeutic communication vital to providing safe patient-centered care to older adults. With this knowledge, students should be able to get the best possible grades on the simulation.
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References
CDC – Pediatric Assessment: https://www.cdc.go
MedlinePlus – Abdominal Pain: https://medlineplus.gov
NANDA International: https://www.nanda.org
Shadow Health Health Assessment Digital Clinical ExperiencesTM for undergraduate nursing students. (n.d.). www.elsevier.com. https://www.elsevier.com/products/shadow-health/health-assessment
