Complete Shadow Health Abdominal Pain Assessment for Danny Rivera. Acute appendicitis presentation — McBurney point tenderness, rebound tenderness positive, WBC 14.8, low-grade fever 38.1°C. Complete abdominal examination, OLDCARTS pain evaluation and surgical referral documented. Used in GCU, Chamberlain and Aspen programs.
Danny Rivera is a young adult male presenting with acute right lower quadrant pain that began periumbilically and migrated over 18 hours, with nausea, anorexia and low-grade fever. The Shadow Health Abdominal Pain Assessment covers a comprehensive abdominal interview, four-quadrant examination using the correct auscultation-first sequence, peritoneal sign assessment including rebound tenderness, guarding, Rovsing's sign, psoas sign and obturator sign. Differential diagnosis addresses appendicitis versus mesenteric lymphadenitis versus Crohn disease. The urgent management plan includes IV access, NPO status, imaging referral and surgical consultation documentation.
Pain began periumbilically and migrated to the right lower quadrant over 18 hours — the classic Rovsing migration pattern. McBurney point tenderness and rebound tenderness are both positive. WBC is 14.8 with a left shift. Students must document all findings and link them to the clinical impression.
Shadow Health specifically tests whether students use the correct abdominal exam sequence: inspection, auscultation, percussion, palpation — in that order. Starting with palpation is a common student error that reduces scores. The Danny Rivera case requires all four steps documented in sequence.
Five peritoneal signs are assessed and documented individually: McBurney point tenderness, Blumberg sign (rebound tenderness), Rovsing's sign, psoas sign, and obturator sign. Each must be performed correctly and documented with positive/negative result and clinical significance.
Differential diagnosis addresses appendicitis versus mesenteric lymphadenitis versus Crohn disease versus ovarian pathology. The management plan documents NPO status, IV access, imaging referral (CT abdomen/pelvis with contrast), and surgical consultation with the clinical reasoning documented in the EHR.
Inspection: abdomen flat, no distension, voluntary guarding noted. Auscultation: bowel sounds decreased in RLQ. Percussion: tympanic throughout except RLQ dullness. Palpation: maximal tenderness at McBurney point (1/3 distance from ASIS to umbilicus), involuntary guarding, rebound tenderness positive.
Blumberg (rebound): positive. Rovsing's sign: positive (RLQ pain with LLQ pressure). Psoas sign: positive (pain with right hip extension). Obturator sign: negative. WBC 14.8 with left shift. Temperature 38.1°C. Findings collectively consistent with acute appendicitis.
Primary: acute appendicitis — supported by migration pattern, McBurney tenderness, rebound, leukocytosis, anorexia, nausea. Alternative: mesenteric lymphadenitis — possible but less consistent with peritoneal signs. Crohn disease — possible but no diarrhea, no prior episodes. Differential is documented with reasoning for and against each.
NPO status initiated immediately. IV access established. IV fluid resuscitation documented. CT abdomen and pelvis with contrast ordered and clinical indication documented. Surgical consultation placed. Pain management documented with rationale for timing relative to exam completion.
Provider note documents the OLDCARTS history, exam findings in correct sequence, all peritoneal signs with results, lab interpretation, differential with ranked probability, and the management plan with orders. Shadow Health scores the EHR note separately from the interview and exam.
Surgical referral is documented with the clinical indication — suspected acute appendicitis with peritoneal signs and leukocytosis — and the urgency level. Disposition is emergent surgical evaluation. Patient and family education on the diagnosis, next steps, and surgical consent process is documented.
Every document on NursingProxy is written by a board-certified PMHNP-BC — not AI, not tutors, not crowdsourced answers. When you access the Danny Rivera documents you receive a full abdominal OLDCARTS interview transcript, four-quadrant exam findings, all peritoneal sign documentation (McBurney, Blumberg/rebound, Rovsing, psoas, obturator), CBC and lab interpretation, differential diagnosis with appendicitis vs alternatives, and urgent surgical referral management plan. Each file is verified to meet the grading criteria used by nursing programs that assign this case.
Students use these materials to check their own work, understand what the platform rewards, and ensure their submission is complete before the deadline. The documents reflect what a competent, thorough nurse would actually produce — not generic template answers.