Abdominal trauma in forensic nursing, comment

This article speaks a lot of truth for the field in which I currently work in. As a Critical Care Nurse in a Trauma 1 hospital I see a lot of abdominal issues that may or may not be trauma related. However the assessments and sequence of assessments tend to be the same (if indicated.) We see a lot of GI bleeds which may or may not be extremely painful. Auscultation of bowel sounds, palpation etc are all part of our core assessment. Using forensic assessment is almost 100% of the assessment process as well. Its funny how we do things out of instinct and training now, then read an article that reminds us of where we learned it from previously, as part of our education.

Original Post:
July 31, 2009
ABDOMINAL TRAUMA IN FORENSIC NURSING

  The primary components of health assessment are the health history and the physical examination. Since forensic nurses may need to perform specific exams related to each individual case, abdominal assessments may be indicated where there is some nature of trauma involved. Subjective and objective data are utilized in order to obtain data required for the specific case involved. Just as nursing assessment are used in hospitals, the same assessment is utilized in forensic nursing assessments.

  Forensic nursing assessment as with general nursing assessment is initiated by observing the client’s general behavior and position. The nurse assesses the client for any marked restlessness, rigid posture or knees drawn up. Facial grimacing and rapid, uneven or grunting respirations are also noted.

  The abdomen is observed to detect any erythema or bruises. The nurse also documents any signs of abdominal distention, tautness, scars, lacerations or open wounds. Auscultation is then performed to assess if bowel sounds are present or absent. Percussion of the abdomen, liver and spleen are indicated in order to assess the level of trauma sustained. Palpation of the abdomen, umbilicus, liver, gallbladder, spleen and kidneys are noted to assess any tenderness, hypersensitivity or rigidity. The client may respond to pain by using muscle guarding, facial grimaces or pulling away from the nurse. Spleen and kidney tenderness may indicate trauma.

  The nurse should use a pain scale in order to assess the degree of pain the client exhibits. Examples of pain scales can include descriptive or numeric pain intensity scale. The McGill Pain Questionnaire is another resource to indicate pain quality descriptors using 4 major groups ie: descriptive, affective, evaluative and miscellaneous which aids clients in describing their pain.  These groups are then totaled in order to indicate the description of pain the client is experiencing.

  Although all assessments of abdominal trauma are useful in determining the degree of trauma sustained, the nurse should be aware that findings detected during an exam may warrant the use of additional tests. The client may need to be transported to the nearest hospital for further evaluation.

  Abdominal assessments regardless of injury should be performed in a setting that is conducive to the client’s safety, privacy and dignity.

  Abdominal assessment techniques utilized in Chapter 20 of Health Assessment for Nursing Practice, Wilson & Giddens is an excellent resource for any nurse to familiarize themselves with the proper sequence of assessments.

Forensic Nursing Certificate Program that includes Health Assessment

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