Symptom: Pain, Abdominal

Initial Grading Reminder

CTCAE grading of abdominal pain:

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADLs
Grade 3: Severe pain; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Where is the pain located? Have you had any pain in your abdomen (belly) before?

“Suddenly” would be more consistent with peritoneal signs. Hepatitis often presents as pain on the right side and sometimes the back.

Grade the symptom

Ask the patient:

How would you rate your abdominal (belly) pain: is it mild, moderate, or severe? Is it limiting your ability to do the things you want to do or take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

When is the last time you had a bowel movement? Was it normal? Are you passing gas? Any nausea, fever, or decreased appetite? Do you have any yellowing of the skin, severe abdominal (belly) pain, sleepiness, or is your thinking foggy? Do you have any shortness of breath, fatigue, chest pain, abdominal (belly) pain, or does your heart feel like it is racing or skipping a beat?

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?

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    Suggested Intervention

    Patients with moderate or worse abdominal pain should be seen.

    Patients with any of the red-flag peritoneal signs should be seen immediately.

    Patients with chest pain and/or severe shortness of breath should go to the ED.

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    Nursing Assessment of Potential Causes

    [tab category='GI' header="GI Toxicity - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize'][tab category='Hepatotoxicity' header="Hepatotoxicity - 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 the abdominal pain?