Gastrointestinal and Musculoskeletal Systems
Gastrointestinal
Abdominal pain may present as a major symptom or cause for a wide range of pathologies. As a result, assessing abdominal pain requires the collection of relevant information to reach a proper diagnosis. According to Mehta (2016), demographic information, including gender and age, are significant history points for information that should be collected when assessing abdominal pain. Consequently, information regarding a description of the pain should be collected. This includes a description of the site, radiation, character, intensity, onset, frequency, associated features, time duration and precipitating or relieving factors (Mehta, 2016). Other complaints related to the gastrointestinal system should be considered during the assessment of abdominal pain. Such complaints include back pain, anorexia, vomiting, nausea and altered bowel habits, among others. Other complaints such as thoracic complaints including breathlessness, genitourinary problems including foul discharge and constitutional symptoms such as weight loss are relevant information when assessing abdominal pain (Mehta, 2016). Additionally, past history information, including similar episodes and admissions, pre-existing illnesses such as diabetes, heart disease and liver disease, as well as surgical history, obstetric history for women and medication history and allergies present as relevant information when assessing abdominal pain (Mehta, 2016).
Masses in the abdomen can be assessed through physical examination or through the use of imaging modalities such as a CT scan and ultrasound. During a physical examination, the abdomen is inspected for obvious masses such as pregnancy, hernia and distended bladder, among others, and on confirmation, such masses should be examined. Additionally, one can assess masses in the abdomen through palpation, auscultation, and percussion (Reuben, 2016). A digital rectal examination can also be used to assess masses in the abdomen. Findings from an assessment of masses in the abdomen can be documented as bruits and rubs on auscultation, normal or abnormal abdomen contour on inspection, and resonance, tympany and dullness sounds on percussion (Reuben, 2016). Additionally, findings can be documented as palpable organomegaly on palpation.
I previously encountered a patient presenting with abdominal pain where I palpated a mass. My findings were that there was a tender mass on the right lower quadrant of the abdomen. Tenderness and rebound tenderness on application and release of pressure was evident. Involuntary guarding was also evident on deeper palpation of the mass. The findings on palpation were consistent with acute appendicitis.
Musculoskeletal
According to Mohammed et al. (2020), rheumatoid arthritis and osteoarthritis are the two common forms of arthritis, a disease of the joints. On one hand, rheumatoid arthritis occurs after the joints are attacked by the immune system, causing inflammation, hence the thickening of the tissues that line the joints. The consequent symptoms are pain and swelling at and around the joints, causing permanent disability. Environmental and genetic factors have been identified as the common etiological factors for rheumatoid arthritis (Mohammed et al., 2020). For instance, women have been found to be more likely to develop rheumatoid arthritis than men, and advanced age, between the age of 40 and 60 years, increases one’s likelihood of developing rheumatoid arthritis. Additionally, the presence of smoking and family history are environmental factors that predispose one to rheumatoid arthritis (Mohammed et al., 2020).
In contrast, osteoarthritis is a degenerative disease characterized by the breaking down of cushions or cartilages at the joints, consequently leading to stiffness, swelling and pain. Some etiological factors of osteoarthritis include gender, age, genetics, race, obesity and overuse of or injury at the joint (Mohammed et al., 2020). Physical examination by assessing the range of motion of the joints is used to diagnose osteoarthritis, and this diagnosis can be confirmed through imaging modalities such as MRI or X-ray. Additionally, while rheumatoid arthritis mostly affects the small joints of the feet and hands, osteoarthritis mostly affects weight-bearing joints such as those of the hips and knees (Mohammed et al., 2020).
References
Mehta, H. (2016).  Clinical Pathways in Emergency Medicine, 329–345.  https://doi.org/10.1007/978-81-322-2710-6_26 (Links to an external site.)
Mohammed, A., Alshamarri, T., Adeyeye, T., Lazariu, V., McNutt, L., & Carpenter, D. O. (2020). A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data.  Preventive Medicine Reports,  20, 101242.  https://doi.org/10.1016/j.pmedr.2020.101242 (Links to an external site.)
Reuben, A. (2016). Examination of the abdomen.  Clinical Liver Disease,  7(6), 143-150.  https://doi.org/10.1002/cld.556
Student # 2
Aimee Alonso
St Thomas University
NUR-418-AP2
Rafael Rojas
9/12/2022
 Part 1 GI system:
The gastrointestinal system is formed by a group of organs which objective is to digest the aliments and transform it into energy sources and substances essential for the body function. The digestive system also gets rid of the substance that the body no longer need. This system is composed by, mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anus. In addition, it includes the salivary glands, liver, gallbladder, and pancreas, which produce digestive juices and enzymes used during digestion.
In nursing, it is important to know how to assess the digestive system since is different from the rest of the body. When a patient conducting a physical assessment in a patient complaining of pain, the first step is to find the location of the pain severity and aggravating factors. Next we have to find valuable information about patient present and past medical history, surgery history, hernias, previous diagnosis. We ask about bowel and urinary habits and if the patient is a female in the child-bearing age it is important to discard a pregnancy or if pregnancy is present, we need to rollout any rupture of membranes or any complication. Make a comprehensive list of relevant information to gather when assessing abdominal pain (Wahila et al.,2018).
After we complete the chief complaint, we proceed to inspect the abdomen looking for any redness bruise, swelling etc. the following step is to auscultate following by percussion. Right after we do palpation starting for the forest quadrant were the pain is located, we feel for any mass that might indicate hernia or malignancy. In case that a mass is found we assess the supraclavicular and inguinal nodes, inspect for any scar or indication of past surgeries, asymmetrical movement to the eye level etc. After, we proceed to refer the patient for other exams like abdominal CT scans, ultrasounds, Mantoux test and any other exam indicated by the physician to discard malignancy or further investigation. Physical examination is very important because we are able to see and feel what the patient might not tell you. Not to long ago I had a patient being evaluated for kidney transplant that denied any concerned medical history and malignant diagnosis when being screened for transplant and when I brought him to the office I was able to find an abdominal mass located on his left upper quadrant and turned out to be malignant. Unfortunately, this patient was unable to continue with transplant evaluation until he get that issue taking care of and confirm benign.
Part 2 Musculoskeletal:
Osteoarthritis (OA) is the most common form of arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases, it also causes reduced function and disability; some people are no longer able to do daily tasks or work.
Rheumatoid arthritis is a disease in which the joints become inflamed, causing pain, deformity and difficulty in movement, although it can also affect other parts of the body. It is a chronic disease, with a low frequency of spontaneous healing, although with proper treatment good control of the disease is achieved in most cases.
While OA usually develops after years of wear and tear on cartilage, people with RA may have it earlier in life due to causes such as sports injuries that result in damage to the cartilage, joints, or ligaments (2021).
References
Wahila, R., Odimba, E., & Ngoma, C. (2018). Developing a pain assessment tool for patients after major abdominal surgery. British Journal of Nursing (Mark Allen Publishing), 27(9), 503–507.  https://doi.org/10.12968/bjon.2018.27.9.503 (Links to an external site.) .
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June,2022. What’s the Difference Between Rheumatoid Arthritis and Osteoarthritis?,   Healthline  https://www.healthline.com/health/rheumatoid-arthritis/ra-vs-oa#treatment
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