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Initial Grading Reminder
CTCAE grading of abdominal bloating:
- Grade 1: Mild symptoms; intervention not indicated
- Grade 2: Moderate symptoms; medical intervention indicated
- Grade 3: Severe symptoms; surgical intervention indicated
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Assessment and Grading
Characterize the symptom (onset, pace)
Ask the patient:
“Have you had any issues with bloating in your abdomen (belly) in the past? Any Crohn’s disease or cancer metastases to your bowel? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Has your diet changed in the past day? What have done/taken to treat it thus far? Do you drink a lot of carbonated beverages? Are you passing gas?”
Suddenly would be more consistent with peritoneal signs.
Grade the symptom
Ask the patient:
“How would you rate your abdominal (belly) bloating (mild, moderate, or severe)? Is it affecting your ability to function?”
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Patient Query Regarding Other Symptoms/Red Flags
Ask the patient:
“Do you have any changes in your bowel movements? Any abdominal pain/tenderness, nausea, fever, or change in appetite?
Do you have any yellowing of the skin or whites of your eyes, abdominal (belly) pain, sleepiness, or is your thinking foggy?
Do you have new or worsening shortness of breath, increased fatigue or chest pain? Does your heart feel like it is racing or skipping a beat?”
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Patient Factors to Consider That Affect the Approach to Intervention
Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?
Telephone Triage: Suggested Intervention
If the abdominal bloating is moderate or worse (or worsening), the patient should be seen.
If any of the red-flag symptoms are present, the patient should be seen immediately. Patients with severe shortness of breath or any chest pain should go to the ED.
In-Office Triage: Nursing Assessment of Potential Causes
[tab category='GI' header="GI Toxicity - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']
[tab category='Cardiotoxicity' header="Cardiotoxicity - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']
Differential Diagnosis
What do you suspect is the cause of abdominal bloating?
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