Q. Patient complaining of pain after lightly palpating first quadrant, you stop... have patient medicated. When you go to reassess, patient still in pain, what do you do? Invoke CDM? How would you document that?
Another great question Christina!!! You are doing your homework!!! I wish everybody would get into the study mode!
Ok... this question is a little tricky... here is my take on this
Abdominal assessment should be done sequentially.... in close proximity to each other. Observe, auscultate, palpate right after.
The video in Abdominal assessment goes over and the PCS Run Down video also has some excerpts of what to say and how to say to illicit pt participation. If the patient has had abdominal surgery, sure they are guarded, but it becomes essential to do an abdominal assessment to check for complications.
If you use the grid and the mnemonics HIPPI COW PTSD, then a few quick things mentioned on the grid, usually you've already taken care of the pain long before you get to the abdominal assessment. Do other assessments first, then do the abd assessment when the pain med is already working. You will tweak the pain talk at the start of the PCS (some of the videos cover this topic) and let the pt know that you will be assessing his abd a little later and you want to make sure they have adequate pain relief. You will also give the a preview stating that it will be a gentle palpation.
If the patient is still guarded, you don't have much of a choice than to invoke CDM so you don't cause emotional/physical jeopardy.
You document your story according to the critical elements (mnemonics). After writing a sentence about auscultation and crossing out "A" in SODA POP, when you get to "P", you will write what happened... simply your story in simple words.
Patient was guarded and refused palpation of abdomen. Pain medication was given by the nurse at 0810, an hour before abdominal assessment. Adequate time was allowed after administration of pain medication before abdominal assessment was initiated. Patient was informed about complications of abdominal surgery and importance of a thorough nursing assessment. Patient still continued to refuse palpation. CDM was invoked and palpation was omitted to avoid emotional/physical jeopardy. The CE was also informed about the omission of critical element "Palpation" at that time. The assigned RN was also made aware.