Analyze the objective portion of the note

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Reference no: EM132854709

Lab Assignment: Assessing the Abdomen

  • A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer-the real cause of the cramping.
  • Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
  • In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

Question 1: Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Question 2: Analyze the objective portion of the note. List additional information that should be included in the documentation.

Question 3: Is the assessment supported by the subjective and objective information? Why or why not?

Question 4: What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?

Question 5: Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Reference no: EM132854709

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