rigorous farming schedule. He would go on to live pain- free until about 2 weeks ago when he presented in the emergency department of a private clinic in the neighboring Guadalajara district. He presented with a right, lower abdominal pain described on assessment as ‘radiating, throbbing, continuous and stabbing at intervals.’ Elanga, visibly pale and fatigued, described how the pain had started 3 days before presentation accompanied by fainting spells, general body weakness, and vomiting. Pain is worsened by walking or sudden movement of the lower limb and is not managed by any local traditional pain remedy. He denies tingling sensations in the lower limb, brute force, or numbness in any part of the body. Before the presentation and after initially hesitating, Elanga took a few tablets of ‘pain medications’ procured from a local chemist in his home district. Elanga’s wife could only identify one of these ‘tablets’ as Paracetamol (Acetaminophen). He had reportedly taken about 8 tablets of these drugs over the past 5 days. Elanga appears to have complete control of his lower limbs but describes a radiating pain sensation originating from the pelvis region. He is pale and fatigued and described pain sensations on a scale of 8 with 10 as ‘excruciating pain’ and 0 as ‘no pain.’ Vital signs ● Blood Pressure: 140/88 mmHg. ● Pulse: 87 b/min. Although an active smoker, the patient had no prior history of illicit drug use or surgery, no family history of bleeding urine, or chronic allergies. Physical examination of the lower abdomen revealed a noticeable distention and tenderness of the hypogastric region and bowel sounds rated at 11 per minute. The patient’s elimination pattern showed a urinary catheter of 121 cc/6 hours with a reddish-yellow color, stained with blood spots, and with a characteristic smell and liquid consistency. Laboratory results ● Hemoglobin: 11 g/dL (ref. 13-18 g/dL). ● Erythrocytes: 3940000 (ref. 4300000-6000000). ● Random Blood Sugar (GDA): 174 g/dL (ref. 70–140G/ dL). ● Chloride: 96.3 mmol/L (ref. 98–108 mmol/L). Diagnostic tests Ultrasound examination showed a bladder mass with features suggesting malignancy. Working diagnosis ● Diabetes complications of the limb. ● Acute pain associated with bladder malignancy. Nursing pain assessment report ● Temperature: 36.7 deg.C. ● Pain (numeric scale): 8/10. The nursing pain assessment classification based on the Indonesia Nursing Diagnosing Standard is acute abdominal pain secondary to bladder cancer. Therapy plan 1. Medications: ○ PZ 10 tpm infusion. ○ IV Ondansetron 4mg twice daily. ○ IV Ceftriaxone 1g 12 hourly. ○ PO Tranexamic acid 500mg 8 hourly.
6 hourly post-medication pain assessment. 2. Nursing intervention plans include pain management, identification of pain location, duration, frequency, and scale, the use of collaborative analgesia if necessary, and a subsequent referral to an oncology clinic in a tertiary healthcare institution. 3. 72 hours after medication commencement, pain assessment for Elanga had significantly improved. Nursing care records reported how Elanga showed a significant reduction in pain sensation, described the pain as 4 out of 10, and showed an increased range of movement of the lower limbs. At this time, blood pressure was 127/86 mmHg and pulse stabilized at 78–85 beats/minute. Elanga’s case described the typical pain assessment care and interventions initiated by primary healthcare professionals using standardized, locale-specific pain assessment tools. Treatment goals accomplished by collaborative pain care in this care include the reduction of pain stimulus, treatment of underlying conditions, and a referral if necessary. Self-Assessment Quiz Question #6 As identified in the case study, what is considered the primary cause of Elanga’s recurrent acute lower abdominal pain?
a. Subsistence farming. b. Bladder malignancy. c. Drug abuse. d. Brute force to the lower abdomen.
Self-Assessment Quiz Question #7 Which of these describes the need to include tranexamic acid in Elanga’s therapy plan?
a. Recurrent pain. b. Bleeding urine. c. Family history of malignancy. d. Illicit drug use.
Self-Assessment Quiz Question #8 Which of the following is identified as Elanga’s medical history?
a. Ibuprofen. b. Diclofenac. c. Ondansetron. d. Acetaminophen.
Self-Assessment Quiz Question #9 Which of the following validates the inclusion of Ondasetron in Elanga’s therapy plan? a. Painful bleeding urine. b. Acetaminophen abuse. c. Recurring vomiting. d. Decreased lower limb movement range.
Self-Assessment Quiz Question #10 Which of the following might be considered a risk factor in Elanga’s case? a. His rigorous farming schedule. b. His nationality. c. Poor access to healthcare. d. His pulse rate.
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Book Code: PYCA2725
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