You are a trip leader for an outdoor adventure company. On day 4 of a two week fall backpacking trip in the Appalachians one of your students, a 27 y/o women approaches you complaining of mild abdominal pain (3), cramping, and spotting. Sharon reports that she has been feeling nauseous for the past week on awakening and considered not coming on the trip. She says the pain and spotting started the day before yesterday. Her period is almost two months overdue but says that's normal for her when she plays sports or exercises; however, she never has cramps. She has been sexually active in the three months prior to the trip and regularly uses a diaphragm; she reports that intercourse has been painful during the week prior to the trip. Since yesterday she has soaked three maxi-pads. Her lower pelvic region is soft, non-tender with no rebound pain. Her pulse is 84 & regular, respirations are 20 and easy, her skin is pink, warm, & dry, oral temperature is 97.8º F, and her BP and O2 Sat were not taken.
Six hours later she reports that the pain has increased (6) and localized to her lower right quadrant and she has soaked three more pads. Her lower right quadrant is slightly tender. Her pulse is 92 & regular, respirations are 26 and easy, her skin is pale, cool, & moist, oral temperature is 97.4º F, and her BP and O2 Sat were not taken.
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