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Abdominal Pain: Nursing Diagnoses, Care Plans, Assessment & Interventions

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Maegan Wagner, BSN, RN, CCM

Abdominal pain is the discomfort felt anywhere between the chest and groin. Abdominal pain may be acute or chronic pain with varying degrees of severity and characteristics. 

  • Cramp-like pain. This type of abdominal pain is often accompanied by gas and bloating, often followed by the onset of diarrhea. 
  • Colicky Pain. This type of abdominal pain is described as sharp and abrupt in a spasming pattern. This is often associated with gallstones and kidney stones. 
  • Localized Pain. Localized pain affects a specific part of the abdomen, indicating problems with organs like the gallbladder, stomach, or appendix.
  • Generalized Pain. Diffuse pain felt over a large area of the abdomen may be nonspecific and indicate indigestion, gas, or blockage in more severe cases.

In this article:

Nursing Process

Nurses conduct thorough histories and physical assessments to assist with the diagnosis of abdominal pain. This can include diet, medical and surgical histories, and detailed pain assessments. Nurses prepare patients for diagnostic tests and review results to collaborate with the healthcare team.

Management of abdominal pain will depend on its underlying cause and will include managing fluid and electrolyte imbalances, pain relief, and surgical interventions in severe cases.

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section we will cover subjective and objective data related to abdominal pain.

Review of Health History

1. Complete a comprehensive pain assessment.
It is crucial to examine the characteristics, onset, progression, migration, nature, intensity, location, and triggers of abdominal pain.

2. Identify the abdominal pain’s PQRST.
A helpful tool for precisely describing, evaluating, and documenting a patient’s abdominal pain is the PQRST method of pain assessment. 

  • P = Provocation/Palliation
  • Q = Quality/Quantity
  • R = Region/Radiation
  • S = Severity 
  • T = Timing/Treatment

3. Ask the patient when the pain started.
The onset of abdominal pain might be sudden or gradual. 

With sudden-onset pain, the patient will describe precisely when the pain started and specify what activity was taking place. Sudden-onset pain can be caused by:

  • A colonic diverticulum
  • Gastric or duodenal ulcer
  • Ectopic pregnancy rupture
  • Mesenteric infarction (tissue death due to a decrease in blood supply in the intestines)
  • Ruptured aortic aneurysm 
  • Embolism of an abdominal artery 

Rapid-onset pain starts mild and gradually gets worse. The patient will generally remember the time of the pain’s onset, but with a different accuracy than with pain that started suddenly. Rapid onset pain can be associated with the following:

Pain that gradually worsens for several hours or even days is called progressive-onset pain. The patient has a hazy memory of when the pain initially started. Progressive onset pain can be related to:

  • Cancer
  • Chronic inflammatory processes
  • Large bowel obstruction

4. Investigate if there is a shifting or radiation of the pain.
Pain shifting from the site of onset towards another location in the abdomen is related to acute appendicitis. When the pain of the right lower quadrant (somatic) is replaced by visceral epigastric pain, it is suspected that there is an inflamed peritoneum.

5. Let the patient describe the pain characteristics.
Identifying the type of pain the patient feels is essential to identify the pathologic process causing it. As the patient’s description of the pain must be entirely subjective, the nurse and patient must have open lines of communication to pinpoint the pain’s precise nature. Constant or intermittent abdominal pain might be cramping, dull, sharp, or aching.

6. Assess the pain intensity.
Pain intensity is experienced differently by each person. Let the patient rate the abdominal pain using a 0-10 pain scale or other pain assessment tool.

7. Ask the patient to point out where the pain is.
The location of the abdominal pain can hint at the possible cause. Several types of pain may be caused by various organ involvement. 

  • Visceral pain from stretching the smooth muscle is localized in one of the three midline areas of the abdomen. It can be epigastric, mid-abdominal, and lower abdominal. This type of pain may be harder to pinpoint.
  • On the other hand, somatic pain has a precise location. It is worsened by pressure on the abdominal wall, palpation, or deep inspiration. 

8. Identify if other symptoms accompany the pain.
Making an accurate diagnosis requires considering the symptoms that accompany abdominal pain. The most significant ones include:

9. Review the patient’s medical and surgical history.
History taking offers the nurse and healthcare provider an idea of the possible cause of the pain. Previous and current medical and surgical conditions can result in abdominal pain or complications.

10. Review the treatments and medication list.
Abdominal pain could be a side effect of a treatment or medication. 

Several prescription and over-the-counter medications can result in cramping or pain in the abdomen. Examples are:

  • Antibiotics
  • Antidiarrheals
  • Aspirin
  • Ibuprofen
  • Iron supplements
  • Laxatives
  • Naproxen

Treatments may include:

11. Track the patient’s family history.
Inquiring into the patient’s family history is crucial because some diseases are hereditary. The patient is at a higher risk if there is a family history of cancers like colon cancer, particularly in a first-degree relative. There may also be a genetic component to gastrointestinal disorders such as colonic polyps and inflammatory bowel diseases (like Crohn’s disease and ulcerative colitis). These conditions are associated with abdominal pain.

12. Record the patient’s social history.
The social history is significant for the abdominal examination as well. Factors like alcohol consumption, tobacco usage, drug use, food access, and living arrangements may influence the patient’s diagnosis.

13. Assess for dietary or food choices and habits.
Food and fluid intake can be related to GI motility and metabolism. Particular food or fluids can cause food poisoning or gas and bloatedness, leading to abdominal pain and discomfort.

14. Inquire about bowel movements and practices.
Bowel movement and practices may affect GI motility (peristalsis) and metabolism. Diarrhea, constipation, or obstipation can cause abdominal pain. The nurse should inquire about how often the patient has a bowel movement and if there are abnormalities in color or consistency.

15. Ask the patient about the aggravating and alleviating factors.
Asking about the aggravating factors can provide information on possible triggers that can worsen abdominal pain. This may involve particular positions, activities, medications, or foods. The nurse can also inquire about treatments that alleviate the pain.

Physical Assessment

1. Follow the IAPP sequence.
Inspection, auscultation, percussion, and palpation are the four main parts of the abdominal examination. The abdominal assessment should be performed with the patient in the supine position. Before percussion and abdominal palpation, auscultation ensures the nurse listens to unaltered bowel sounds. Also, delaying palpation until the end permits additional data collection before potentially aggravating the patient’s pain. 

2. Inspect the abdomen.
Start by looking over the patient’s abdomen. The general abdominal examination can provide numerous hints about the patient’s diagnosis. Note for abdominal distention or abnormal masses. Note medical devices that could be a potential source of pain or infection, such as feeding tubes, drains, or catheters.

3. Listen to the bowel sounds.
To auscultate the bowel sounds, position the stethoscope’s diaphragm on the right side of the umbilicus. After listening for at least two minutes, note the rate. Regular bowel movements often occur at a rate of 2 to 5/min and sound low-pitched and bubbling. The absence of bowel sounds may signify paralytic ileus. Hyperactive sounds (borborygmi) are typically present in small intestine obstruction. 

4. Percuss the abdomen.
Tympany heard over air-filled structures (such as the stomach) may be present due to an underlying mass or organomegaly, which should be considered when percussing. The nurse may be able to describe the change in percussion notes from resonant to dull and then tympanitic. Percussion is also essential to determine the size of the liver.

5. Perform light and deep palpation.

  • Superficial or light palpation starts from the region farthest from the location of the worst pain and proceeds through the nine regions of the abdomen superficially or lightly. Choose any beginning point if there is no pain. 
  • Throughout deep palpation, the provider may use both hands, one to apply pressure and the other to feel. Pressure should be applied steadily and firmly. Pressing too quickly could trap a gas pocket within the intestines and stretch the abdominal wall, leading to false-positive pain. It is vital to press carefully. Tenderness with subsequent guarding may be observed during palpation.

Diagnostic Procedures

1. Assist the patient in laboratory tests and diagnostic procedures.
Laboratory tests and diagnostic procedures depend on the suspected cause, symptoms, and history. These may include:

  • Stool tests
  • Urine tests
  • Pregnancy tests 
  • Blood tests
  • Barium swallow tests
  • Barium enemas
  • Ultrasound
  • Plain radiography of the abdomen
  • CT scan (with or without contrast)
  • MRI
  • Colonoscopy
  • Sigmoidoscopy
  • Endoscopy
  • KUB X-ray (kidneys, ureters, bladder)

Nursing Interventions

Nursing interventions and care are essential for the patients recovery. In the following section you’ll learn more about possible nursing interventions for a patient with abdominal pain.

1. Offer non-pharmacological interventions.
Non-pharmacological therapy plays a significant role in the treatment of abdominal pain. It is a practical, cost-effective approach to reducing the dosage of analgesic drugs required. It decreases the side effects and reduces drug dependence and healthcare costs. Nonpharmacologic interventions may include heating pads, positioning, and distraction.

2. Administer medications as needed.
Medications depend on the source of the abdominal pain and related symptoms.

  • Proton pump inhibitors or antacids reduce or neutralize stomach acid 
  • Antispasmodics relieve spasming due to irritable bowel syndrome
  • Loperamide stops diarrhea
  • Bismuth-containing products coat the stomach to reduce nausea, indigestion, and diarrhea
  • Stool softeners and laxatives relieve constipation
  • Antiemetics relieve nausea and vomiting
  • Simethicone helps the body pass gas easier
  • Opioid analgesics relieve severe abdominal pain

3. Rest the bowel.
Giving the digestive system a rest from ingesting anything by mouth is known as bowel rest. Sometimes, bowel rest involves refraining from all oral intake. The diet is usually advanced as tolerated, from clear liquids to bland foods, before returning to a normal diet. Bowel rest allows the intestines to recover from an infection, disease, trauma, or injury.

4. Insert a nasogastric tube.
This is a common intervention for patients with bowel obstruction as it allows the stomach to decompress. 

5. Ensure proper hydration.
Constipation can occur due to insufficient water to move waste through the intestines. Abdominal pain, bloating, and stomach cramps may result. Dehydration involves more than just a deficiency in water consumption. The body lacks the proper electrolyte balance when dehydrated.

6. Warm the GI tract.
Warm fluid consumption stimulates the digestive system and helps speed the elimination process by causing the intestines to contract. 

7. Consider natural remedies.
Peppermint, chamomile, and ginger are the three natural remedies most frequently used to alleviate abdominal pain. They reduce GI upset and symptoms like nausea.

8. Avoid triggers.
Limit the consumption of alcohol, coffee, caffeinated tea, and spicy food because these are gastric irritants and can exacerbate abdominal pain.

9. Encourage the BRAT diet.
Encourage the BRAT diet for vomiting, diarrhea, and GI upset. Begin with clear liquids when the patient can eat again, then move on to bland foods like bananas, rice, applesauce, or toast. None of these foods have salt or spices, which can further irritate the stomach, and they are low in fiber making stools firmer. 

10. Promote ambulation. 
Ambulation increases blood flow. It helps wounds and injuries heal more quickly (especially post-abdominal surgery). Movement promotes peristalsis and improves overall abdominal muscle tone and strength.

11. Treat the underlying cause.
Abdominal pain can encompass discomfort from the esophagus to the pelvis. Most patients only require symptom relief, and many instances of abdominal pain will resolve without lasting effects. If abdominal pain is persistent or recurrent, this warrants further investigation. Mild to moderate causes of abdominal pain may include conditions like:

  • Irritable bowel syndrome
  • Gastroenteritis (stomach flu)
  • Constipation 
  • Poor diet choices/gastric irritants
  • Acid reflux

More serious causes of abdominal pain include:

  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Peritonitis
  • Ruptured spleen
  • Hernias
  • Endometriosis
  • Cancer
  • Bowel obstruction
  • Gallstones
  • Kidney stones
  • Pelvic inflammatory disease
  • Crohn’s disease/ulcerative colitis

12. Teach the patient about pain management.
Adequate information about pain management ensures the proper use of pain relievers as well as abstaining from foods or triggers that cause abdominal pain.

Nursing Care Plans

Once the nurse identifies nursing diagnoses for abdominal pain, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for abdominal pain.

Acute Pain

Acute abdominal pain may or may not be life-threatening. If severe, ongoing, and accompanied by other symptoms, intervention is recommended.

Nursing Diagnosis: Acute Pain

  • Disease processes
  • Inflammatory processes
  • Infection 
  • Pathological processes

As evidenced by:

  • Reports of pain 
  • Appetite changes
  • Altered physiological parameters
  • Diaphoresis 
  • Distraction behavior
  • Expressive behavior
  • Facial grimacing/crying
  • Guarding behavior
  • Positioning to ease pain 
  • Protective behavior

Expected outcomes:

  • Patient will report abdominal pain of 2/10 or less by discharge.
  • Patient will report relief from nausea, cramping, gas, etc., by discharge.

Assessment:

1. Conduct a comprehensive pain assessment.
Identifying the location, intensity, frequency, and characteristics of pain is critical in determining the underlying cause of abdominal pain and the effectiveness of the current treatment regimen.

2. Review and assess diagnostic studies.
Ultrasounds, abdominal x-rays, and CT scans may be performed to help diagnose the underlying condition.

Interventions:

1. Provide medications as ordered.
Analgesics and sedatives are provided for pain management and relief. Medications to relieve gas, nausea, constipation, and diarrhea may also relieve pain.

2. Assist to a position of comfort.
Abdominal pain may be relieved with a specific position that promotes comfort. A knee-to-chest or side-lying position tends to decrease the intensity of abdominal pain. Raising the head of the bed may also relieve symptoms.

3. Insert nasogastric (NG) tube.
With certain diagnoses such as a bowel obstruction, bowel rest and the insertion of an NG tube are required to decompress the stomach.

4. Assist in surgical intervention.
Depending on the underlying cause, surgery may be indicated in patients with abdominal pain. Assist and prepare the patient for surgery as ordered.

Dysfunctional Gastrointestinal Motility

Dysfunctional gastrointestinal motility is related to the absence, decrease, or increase in peristalsis. Abdominal pain may be an accompanying result.

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility

  • Food intolerance
  • Ingestion of contaminated materials
  • Malnutrition
  • Disease processes
  • Anxiety
  • Stressors

As evidenced by:

  • Abdominal cramping 
  • Abdominal pain 
  • Absence of flatus 
  • Acceleration of gastric emptying 
  • Altered bowel sounds
  • Diarrhea
  • Constipation
  • Nausea
  • Vomiting
  • Distended abdomen

Expected outcomes:

  • Patient will exhibit normal bowel sounds and remain free of abdominal pain and distention.

Assessment:

1. Assess abdominal symptoms.
Along with abdominal pain, assess for additional symptoms such as nausea, vomiting, and indigestion. Inquire how long symptoms have been present and precipitating factors.

2. Assess dietary habits.
A thorough intake of the patient’s daily food and liquid habits can provide information on potential causes of dysfunctional GI motility and subsequent pain.

3. Assess bowel habits.
Assess how frequently the patient has bowel movements along with consistency, color, and odor. This information can help diagnose conditions such as inflammatory bowel disease.

Interventions:

1. Administer medications as ordered.
An array of medications may be required depending on the patient’s symptoms. These may include antidiarrheals, antibiotics, antacids, proton-pump inhibitors, and more.

2. Encourage the patient to ambulate.
Ambulation and exercise can help increase gastrointestinal motility to relieve pain and symptoms.

3. Provide dietary education.
Depending on the symptoms and causes, dietary education can be tailored. Patients with constipation may need to add fiber supplements while those with diarrhea may need to cut out dairy, sugar, and caffeine to reduce triggers.

4. Obtain a stool sample.
Stool samples can provide insight into certain infectious processes as well as the presence of blood, bile, and more.

Imbalanced Nutrition: Less Than Body Requirements Care Plan

Abdominal pain may be associated with other symptoms like loss of appetite, nausea, and weight loss.

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements Care Plan

  • Abdominal pain
  • Food aversion
  • Pathological processes
  • Inflammatory processes
  • Loss of appetite
  • Nausea and vomiting

As evidenced by:

  • Body weight below the ideal weight range for age and gender
  • Constipation
  • Diarrhea
  • Food intake less than recommended daily allowance
  • Hypoglycemia
  • Abnormal bowel sounds
  • Poor appetite

Expected outcomes:

  • Patient will progressively gain weight towards the desired goal. 
  • Patient will be free of signs of malnutrition. 
  • Patient will be able to consume adequate caloric intake without discomfort.

Assessment:

1. Conduct a nutritional screening.
Abdominal pain is associated with poor nutrition and nutrient deficiency. A complete nutritional screening will assess physical findings, lab results, diet history, weight/BMI, and access to quality food.

2. Assess laboratory values.
Prealbumin and albumin, C-reactive protein, and white blood cell count may indicate inflammatory responses associated with imbalanced nutrition and abdominal pain.

3. Assess for any barriers to eating.
Barriers to eating, such as nausea and vomiting, pain, and low socioeconomic status, can affect the patient’s nutritional intake.

Interventions:

1. Promote an environment conducive to eating.
Unnecessary environmental stimulants can aggravate pain experiences and affect the patient’s appetite and nutritional intake.

2. Monitor the patient’s weight gain and muscle mass.
Imbalanced nutrition increases the patient’s risk of developing conditions like decreased weight, decreased bone mass, and muscle weakness.

3. Promote oral hygiene.
Oral health and hygiene affect the patient’s functional ability to eat and their appetite.

4. Encourage the patient to avoid high-fiber, raw, and spicy foods.
These types of food can aggravate abdominal pain, reduce appetite, and affect the patient’s overall nutritional intake.

5. Provide small frequent feedings with bland ingredients.
Small frequent feedings with bland ingredients like pain rice, oatmeal, toast, crackers, and clear soup are less likely to upset the patient’s stomach and cause abdominal pain.

6. Refer the patient to a dietitian or nutritionist.
A dietitian can help formulate an appropriate meal plan for patients with poor nutritional intake due to gastrointestinal issues like abdominal pain.

Ineffective Tissue Perfusion

Abdominal pain may be associated with poor blood and oxygenation to the gastrointestinal organs. When left untreated, tissue perfusion complications can arise, including ischemia and organ failure.

Nursing Diagnosis: Ineffective Tissue Perfusion

  • Abdominal pain
  • Inflammatory process
  • Disease process

As evidenced by:

  • Hypoactive or absent bowel sounds
  • Bloating
  • Abdominal rigidity
  • Constipation
  • Abdominal pain
  • Nausea and vomiting
  • Malnutrition
  • Weight loss
  • Fatigue

Expected outcomes:

  • Patient will remain free from nausea, vomiting, or abdominal discomfort. 
  • Patient will verbalize improved comfort and show no signs of tissue perfusion complications like ischemia and organ failure.

Assessment:

1. Assess, inspect, palpate, and auscultate the abdomen.
Decreased abdominal perfusion initially presents with increased bowel sounds. Then, bowel sounds become absent. A thorough examination of the abdomen through inspection, auscultation, palpation, and percussion allows the identification of tissue perfusion problems like peritonitis and bowel obstruction.

2. Assess lab results.
To determine the underlying causes of severe abdominal pain that could affect perfusion, the nurse will review the results of liver enzymes, kidney function, and occult blood testing.

3. Assess diagnostic imaging results.
Ultrasonography is typically the first imaging test indicated for a patient suffering from abdominal pain. It can help visualize abdominal organs, including the kidneys and liver, and determine the cause of the abdominal pain.

Interventions:

1. Keep the patient on NPO until a diagnosis is confirmed.
Patients experiencing abdominal pain due to unknown causes are kept NPO to prevent aggravation of the pain and prevent complications like the regurgitation of gastric contents and subsequent pulmonary aspiration due to nausea and vomiting associated with abdominal pain.

2. Monitor the patient’s intake and output and administer fluid replacement as needed.
Abdominal pain with other symptoms like nausea and vomiting, hypotension, and tachycardia suggests blood and fluid loss in the gastrointestinal tract and requires aggressive fluid resuscitation.

3. Encourage slow progression of the patient’s dietary intake after an NPO status.
When the patient with abdominal pain is allowed to eat, encourage the patient to start with clear liquids before progressing to bland or soft foods. This is essential to ensure the return of gastrointestinal function, reduce the incidence of food intolerance, and prevent the recurrence of abdominal pain.

4. Document bowel movements.
The nurse or delegated team member should accurately document bowel movements. Days without a bowel movement could signal an obstruction, while blood in the stool signals colitis, GI bleeding, bowel ischemia, and more.

5. Encourage rest after meals.
Rest after meals maximizes blood flow to the stomach for proper digestion.

Risk for Deficient Fluid Volume

Patients with abdominal pain tend to have no appetite with inadequate fluid intake which increases the risk of dehydration.

Nursing Diagnosis: Risk for Deficient Fluid Volume

  • Fluid loss through vomiting or diarrhea
  • Aversion to food
  • Decreased fluid intake 
  • Disease processes

As evidenced by:

A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet and nursing interventions will be directed at preventing symptoms.

Expected outcomes:

  • Patient will maintain adequate hydration and fluid balance as evidenced by intake and output and vital signs within normal limits
  • Patient will consume at least 500 mL of fluid per day

Assessment:

1. Assess intake and output.
The risk of deficient fluid volume is observed through imbalanced intake and output. Closely monitor all sources of intake and output and document accordingly.

2. Assess for signs of dehydration.
Dehydration can result from deficient fluid volume. This can be assessed through the skin and mucous membranes.

3. Monitor lab values.
Hematocrit, electrolytes, urinalysis, and BUN and creatinine levels may be abnormal in the instance of deficient fluid volume.

Interventions:

1. Provide intravenous fluids as ordered.
IV fluids and electrolytes may be prescribed to maintain hydration status to prevent fluid volume deficit and decrease the risk for imbalances.

2. Encourage other sources of fluid intake.
Free water may be unappealing to pediatric patients or difficult for a patient with swallowing abnormalities. Offer other sources of fluids such as jello, popsicles, soups, fruits, and Pedialyte.

3. Provide parenteral or enteral nutrition.
If a patient is NPO for an extended period, nutrition and fluids may be administered through other routes to support hydration.

References

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  13. Victoria State Government. (2022, February 8). Abdominal pain in adults. Better Health Channel – Better Health Channel. Retrieved March 2023, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/abdominal-pain-in-adults
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Maegan Wagner, BSN, RN, CCM
Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.