ABDOMINAL PAIN

A. Obtain and record telephone triage assessment that includes:

• Provoking factors (what makes it worse/better)
• Quality of pain
• Region/radiation
• Severity of pain
• Time (onset, duration)
• Treatment (what has the patient already tried)

B. Risk Factors which increase the acuity abdominal pain:

• History of abdominal surgery
• Diabetes
• Chronic/congenital illness
• Age fragile patient (<1 year old or > 60 years old)

C. See Immediately

Triage nurse should advise the use of an ambulance when the patient's current status is life threatening, may deteriorate enroute to hospital, or parental anxiety level is too high to safely drive child to closest ED

• Recent abdominal trauma
• Pain is localized to lower abdomen (either side) for > 1-2 hours
• Child is inconsolable or constant crying for > 2 hours
• Marked change in activity level for more than 1 hour:
  • refuses to walk
  • lying w/ knees drawn up to chest
  • painful to climb stairs
  • walks bent over, holding abdomen
• Severe pain if patient walks up/down stairs or rides in the car
• Rapidly increasing pain
• Pain in scrotum or testicle
• Grossly bloody bowel movements or jelly-like stools
• Vomiting blood or bile on more than one occasion
• Possibility of ingestion or poisoning (plant, chemical, medicine, foreign body)
• Unusually heavy vaginal bleeding and/or chance of pregnancy

D. See Within 12 - 24 Hours:

• Pain lasts longer than 24 hours
• Urinary symptoms are present (frequency, burning, hematuria, etc)
• Severe nausea/vomiting/diarrhea with risk of dehydration
• Fever >101 degrees F (38.3 degree C), cough, weakness, sore throat
• Persistent nausea/vomiting/diarrhea unresponsive to home care
• Vaginal or urethral discharge
• Weight loss

E. Home Care Advice:

• Encourage lying down and resting
• Have vomiting pan handy
• Suggest having child sit on toilet and try to pass a bowel movement
• Offer clear liquids only and slowly progress to a bland diet for 12-24 hours
  • May use rehydrating fluid solution for infants and small children
• Recommend taking medications which may cause stomach upset with food

F. Call Back If:

• Patient becomes worse, develops new symptoms or if symptoms change
• Severe pain present after one hour of rest
• Constant pain persisting for longer than two hours
• Intermittent pain for longer than 24 hours
• Pain worsens with heat or activity
• Urine, stool, emesis contains blood
• Fever
• Persistent vomiting or diarrhea
• Increased parental concern, anxiety, or with new questions

(Briggs, 1997; Brown, 1994; Kitt et al, 1995; Schmitt, 1994; Simonsen, 1996 )

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