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ER Nurse approach to a patient with abdominal pain:

Poke with needle. Send a bunch of tubes to the lab, including urine. Wait for tests to come back, including whatever imaging the provider orders. Give meds as prescribed. Chart.

Nurse Practitioner approach to a patient with abdominal pain:

After a 5 minute interview and assessment, is this something that will kill or maim the patient?

Order IV, CBC, CMP, Amylase and Lipase, UA (HCG if childbearing age female), Coags as appropriate. Consider US of GB for RUQ pain, KUB for constipation, CT with PO contrast for possible obstruction or appendicitis, CT with IV contrast to rule out aneurysm, mesenteric ischemia, CT with no contrast for possible kidney stones. Medicine for pain, nausea, and infection. Interpret results as they come in, document appropriately, and make a decision regarding disposition.


Here lately, I've been focusing on coming up with 3 differential diagnoses for every patient that walks into my triage office, and ordering tests to rule out the most life-threatening. I gotta say, it is super difficult making the mental change from RN to NP. The nest year plus is gonna be REALLY interesting. Fortunately, I'm doing about a third of my clinical hours in my final semester where I'll probably end up working, so I'll see how to do the job from the student side of things.

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