Week 3 Discussion

Esperanza has been admitted to a medical-surgical unit with a chief complaint of “pain of unknown origin.” She is 39 years old, married, has two teenage children, and works with her husband in their landscaping business. As you prepare for the admission assessment, her mother, who brought Esperanza to the hospital, tells you that they fear that Esperanza has “empacho.” Esperanza agrees.

During the assessment, you ask Esperanza to describe the pain in her own words. She begins to sob and says that she finds it hard to describe the pain. She says that she has given birth twice and that this pain is worse, but it only happens after she eats dinner and goes away after a few hours. She is not in severe pain at present but complains of a constant slight ache in her stomach.

Question 1

What questions should you ask as part of your pain assessment?

Question 2

What tools are available to assist with pain assessment? Which one would you choose?

Question 3

In answer to your assessment questions, Esperanza points to her right upper quadrant and states that the pain starts after she eats a heavy dinner but not every evening. The pain episodes began a month ago. She says the pain begins suddenly, lasts for 2 to 4 hours, and is a sharp “crampy ache.” It does not radiate to other places but stays over her right upper quadrant. She says she has tried over-the-counter antacids, laxatives, and herbal remedies but none of these makes the pain better. She usually goes to bed with a heating pad until it subsides. She is unable to help her kids during these episodes because she must lie very still, and this upsets her. You ask her to rate her pain on a numeric scale with 0 being no pain and 10 being the worst pain. She says that at this time her pain is at a 2 but that during these episodes it is “above a 10.” She also feels nauseated, sweaty, and weak during these painful episodes.

Is she feeling acute pain or persistent pain? Explain.

Question 4

As you continue your assessment, you focus on the abdomen. From the health history, you learn that Esperanza prepares her family’s largest meal in the evening and that the pain episodes occur about an hour after eating and last for 2 to 4 hours. She says she is nauseated with these episodes and has occasionally vomited. She has not noticed any weight loss. She has had two episodes of diarrhea. On inspection, you see that her abdomen is slightly obese and symmetric but not rounded; the skin is smooth with striae on the lower abdomen and is absent of scars, bruises, or lesions. Bowel sounds are present in all quadrants and normal. Percussion reveals no abnormalities. Her abdomen is soft on light palpation, and she guards when you touch the right upper quadrant area. You omit deep palpation at this time, but check for rebound tenderness, which is not present, and the iliopsoas muscle test, which is negative. However, Murphy’s sign (inspiratory arrest) is present.

What do these findings suggest?

Question 5

Is Esperanza experiencing visceral pain, deep somatic pain, or cutaneous pain?

Question 6

While auscultating Esperanza’s heart you hear a murmur; this one is due to mitral regurgitation.

What characteristics of a murmur should you evaluate?

**Please be sure to include 2 references  in APA format within the last 5 years and respond to at least 2 participating classmates, with a substantial descriptive answer.**