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Health Assessement NSG 2317 > Abdomen, Anus, Rectum, Prostate and Genitourinary System > Flashcards

Abdomen, Anus, Rectum, Prostate and Genitourinary System Flashcards

1
Q

What are organs in the abdomen called?

A

Viscera

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2
Q

Differences between solid and hollow viscera

A

Solid keeps their shape
Hollow organs change shape based on what’s inside of them

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3
Q

Name the 6 solid abdominal organs

A
  1. Liver
  2. Spleen
  3. Both kidneys
  4. Pancreas
  5. Uterus
  6. Ovaries
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4
Q

Name a few of the hollow viscera

A

Gallbladder
Stomach
Small intestines
Appendix
Bladder
All of large intestine
Rectum

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5
Q

What major organs are found in the right upper quadrant?

A

Liver
Gallbladder
Right kidney and adrenal gland
Head of pancreas
Parts of the ascending and transverse colon

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6
Q

What major organs are found in the left upper quadrant?

A

Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney and adrenal gland
Parts of transverse and descending colon

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7
Q

What major organs are in the right lower quadrant?

A

Appendix
Right ovary and fallopian tube
Cecum
Right ureter

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8
Q

What major organs are in the left lower quadrant?

A

Left ureter
Left ovary and fallopian tube
Part of descending colon
Sigmoid colon

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9
Q

What’s in the midline suprapubic region of the abdomen?

A

Aorta
Uterus
Bladder (if distended can feel)

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10
Q

Name changes in accumulation of adipose tissue in older adults

A

-Redistribution away from extremities and face to the abdomen and hips
-Women = Increase in suprapubic area due to decreased estrogen
-Men = Increase in abdominal area

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11
Q

In terms of the GI tract what decreases in older adults?

A

Salivation
Gastric acid production
Liver size
Renal function

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12
Q

In terms of GI function what are older adults at an increased risk of?

A

-Aspiration (due to delayed esophageal emptying)
-Dehydration
-Gallstones
-Constipation
-Colorectal cancer

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13
Q

Abdominal Hx questions of note

A

Appetite (anorexia)
Difficulty swallowing (dysphagia)
Nausea/vomiting (Hematemesis, food poisoning)
Bowel habits (melena-blood in the stool presents as black, hepatitis, colorectal cancer)
Medications (liver toxicity)
Alcohol & tobacco (esophagus & liver cancers, cirrhosis of the liver)
Nutrition (malnutrition)
-Food access
-Emotional characteristics (do they eat alone?)
-Recall

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14
Q

For abdominal Hx what is an important finding for food intolerances?

A

Pyrosis (like acid reflux likely from a hiatal hernia)

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15
Q

For abdominal Hx what are important findings for abdominal pain?

A

-Appendicitis
-Cholecystitis (gallbladder inflammation)
-Bowel obstruction
-Organ perforation
-Ulcers

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16
Q

For abdominal past health Hx what are important findings?

A

-Familial adenomatous polyps (FAP)-(A large amount of benign polyps in the abdominal tract that can become malignant
-Abdominal adhesions

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17
Q

Inspection of abdominal contour and symmetry

A

-Scaphoid
Rounded, protuberant can be normal if overweight but if not can indicate ascites, gas, mass if asymmetrical
-Inspect contour at eye level!!! (bend down)

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18
Q

Umbilicus inspection

A

-Color
-Position should be midline
-Orientation usually inverted (if it has changed to everted than look into it unless that is their normal)

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19
Q

Abdominal skin inspection

A

-Color
-Striae (normally 1-6cm)
-Presence of visible veins is abnormal
-Rashes
-Lesions
-Turgor

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20
Q

Extraordinary abdominal skin inspection

A

-Pulsation or movement (look for pulsation of the aorta)
-Hair distribution
-Demeanour
-Ostomies (bypass the colon and rectum to excrete)
& percutaneous tubes (Peg-percutaneous endogastric feeding tubes)

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21
Q

Bowel sound auscultation: What are you listening for, where to start, what end of stethoscope, normal sounds/min.

A

-Peristalsis of intestines
-Diaphragm end
-Begin in RLQ
-Normal: 5-30 sounds/min

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22
Q

Vascular sounds auscultation: which places/parts to listen for

A

-Aorta
-Left and right renal arteries
-Left and right iliac arteries
-Left and right femoral arteries

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23
Q

Vascular sounds auscultation: normal sounds to be heard, what end of stethoscope

A

-Place gently over skin
-Normal: no vascular sounds
-Bell end
-Auscultate clockwise!!!

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24
Q

Hyperactive bowel sounds: what is it, normal, abnormal and cause

A

-Increased motility
-Normal: stomach growling
-Abnormal: loud, high-pitched, rushing, tinkling sounds
-Cause: bowel obstruction

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25
Q

Hypoactive or absent bowel sounds: what is it, how long to listen for, causes

A

-Decreased, or absent motility
-Listen for full 5 mins.
-Total absence is rare
-Causes: post-abdominal surgery, inflammation of peritoneum

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26
Q

Describe the sound of a systolic bruit vascular sound

A

Pulsing blowing sound
Pitch dependent on cause

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27
Q

List the 3 causes of systolic bruits

A

-Renal artery stenosis
-Abdominal aortic aneurysm
-Partial occlusion of femoral arteries

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28
Q

Describe the sound of a venous hum vascular sound

A

-Soft, continuous humming noise of medium pitch

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29
Q

Where can a venous hum be heard?

A

Between the xiphoid process and umbilicus

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30
Q

2 causes of a venous hum

A

-Portal HTN
-Liver cirrhosis

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31
Q

Purpose of abdominal percussion

A

-To assess density & location of organs
-Screen for abnormal fluid or masses
-Percuss clockwise!!!

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32
Q

What type of organs would expect to feel tympany vs. dullness?

A

Tympany: hollow organs
Dullness: Solid organs

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33
Q

Abnormal finding for abdominal percussion

A

-Hyper-resonance: very abnormally hollow
-Dullness where there should be tympany could indicate a mass

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34
Q

Light abdominal palpation is meant to assess what?

A

-Texture
-Temperature
-Moisture
-Swelling
-Rigidity
-Pulsation
-Presence of tenderness/pain

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35
Q

Steps of light abdominal palpation

A
  1. Ensure patient is relaxed
  2. Use first 4 fingers together and depress 1 cm
  3. Move fingers in gentle circular motion
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36
Q

Abdominal palpation 5 important findings

A
  1. Involuntary rigidity
  2. Guarding
  3. Tenderness
  4. Masses
  5. Organomegaly (abnormal enlargement of an organ)
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37
Q

Involuntary rigidity

A

Cannot relax abdominal muscles

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38
Q

What can abdominal guarding and tenderness indicate?

A

if in RLQ ->Appendicitis

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39
Q

8 main signs & symptoms of appendicitis

A

Fatigue
Fever
Abdominal pain and tenderness
Dry mouth
Swelling
Diarrhea or constipation
Loss of appetite
Nausea and vomiting

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40
Q

What is albumin?

A

Most common circulating protein found in plasma

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41
Q

What is ascites and what can it be due to?

A

Fluid collection in the peritoneal cavity due to portal HTN and low albumin in the blood

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42
Q

3 causes of ascites

A

Liver cirrhosis
Congestive heart failure
Cancers

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43
Q

Inspection with ascites:

A

-Larger abdominal girth
-Striae
-Jaundice
-Everted umbilicus
-Glistening skin over abdomen
-Tight skin (more stretched)

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44
Q

Auscultation with ascites:

A

-Normal over middle of abdomen when supine where ascites is not
Dull sounds over where the ascites is on the sides because gravity pushes to the sides when supine

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45
Q

Percussion and palpation with ascites:

A

Percussion: dull over fluid (on the sides)
Palpation: Limited because painful and hard to because the skin is so tight

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46
Q

Bowel obstruction findings:

A

-Vomiting and loss of appetite lead to dehydration and loss of electrolytes
-Absence of stool or gas passage
-Distended abdomen (accumulation of fluid and gas in bowel proximal to obstruction)
-Hyperactive in early stages; hypoactive or silent sounds in late obstruction
-Fever
-Hypovolemic shock (decreased BP, increased pulse, cool skin)

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47
Q

You are caring for a patient who is presenting with abdominal swelling, stomach pain, pruritis, and general fatigue. He suffers from chronic liver disease (which causes vasodilation).
-Based on the information above, which VS readings do you think will be altered and why?
-What other S/S might you expect to see?

A

1.BP decreased: because of vasodilation
2. HR increased: to compensate for vasodilation
3. RR increased: can’t expand lungs as much so breathe more to try to get enough air
4.Temp. decreased: from vasodilation
-Jaundice because liver disease
-Dyspnea (SOB because decreased expansion)

48
Q

for older males does the prostate gland enlarge or decrease in size and what causes this change in size?

A

-Prostate gland enlarges d/t hormonal imbalances that causes the production of adenomas

49
Q

When does the prostate start to enlarge and why is it bad

A

-The prostate starts to enlarge after the age of 40
-An enlarged prostate causes the production of adenomas that compress the urethra making it harder to urinate

50
Q

What does an enlarged prostate increase your risk of and at what age?

A

Prostate and colorectal cancer - risk factor is being a male over 50

51
Q

Hx for anus, rectum, prostate

A

Usual bowel routine (constipation, dyschezia)
Changes in bowel habits (gastroenteritis, colitis, IBS, parasite)
Rectal bleeding, blood in stool (GI bleed, cancer, infection)
Medications (constipation, melena)
Rectal conditions (hemorrhoids, fecal incontinence)
Family Hx (colon, rectal, prostate cancer)
Self-care behaviours (low-fiber diet)

52
Q

Definition of constipation

A

3 stools or less in a week

53
Q

Dyschezia

A

Pain with defecation usually from hemorrhoids and/or constipation

54
Q

Gastroenteritis

A

Inflammation of the intestines and stomach

55
Q

Colitis

A

Inflammation of the colon

56
Q

Common condition from parasites:

A

Travellers diarrhea

57
Q

How do iron pills affect stool?

A

Can cause black stool (not melena because it’s not tarry)

58
Q

Bristol Stool Chart - type 1

A

-Separate hard lumps, like nuts
-Hard to pass
Severe constipation

59
Q

Bristol Stool Chart - type 2

A

-Sausage-shaped but lumpy
Mild constipation

60
Q

Bristol Stool Chart - type 3

A

-Like sausage but with cracks on the surface
Normal

61
Q

Bristol Stool Chart - type 4

A

-Like sausage or snake
-Smooth and soft
Normal

62
Q

Bristol Stool Chart - type 5

A

-Soft blobs with clear-cut edges
-Passed easily
Lacking fibre

63
Q

Bristol Stool Chart - type 6

A

-Fluffy pieces with ragged edges
-Mushy stool
Mild diarrhea

64
Q

Bristol Stool Chart - type 7

A

-Watery/entirely liquid
-No solid pieces
Severe diarrhea

65
Q

Anal inspection

A

-Spread buttocks to observe perianal region
-Either left lateral, lithotomy or standing positions

66
Q

Anus description

A

-Moist
-Hairless
-Coarse folded skin
-Increased pigmentation

67
Q

How should the sacrococcygeal area be?

A

Smooth and even

68
Q

Valsalva manoeuvre

A

-Hold breath and bear down: anal opening should open and tighten up
-Should produce no breaks in skin integrity or protrusion
(Older adults have less ability for anus to tighten up as much)

69
Q

Hemorrhoids

A

Flabby papules that are painless

70
Q

Cause of hemorrhoids

A

-Varicose veins from increased portal venous pressure
-Low fiber diet
-Pregnancy
-Chronic liver disease

71
Q

External hemorrhoids

A

-Below anorectal junction and covered by anal skin
-If thrombosed: contains clotted blood and is painful, swollen, shiny, blue, itchy (pruritis), bleeding during defecation

72
Q

Internal hemorrhoids

A

-Above anorectal junction and covered by mucous membrane
-Red mucosal mass seen during Valsalva manoeuvre

73
Q

Fecal impaction

A

Complete colon blockage from hard immovable stool in the rectum

74
Q

Who’s at higher risk for fecal impaction?

A

Community-dwelling older adults

75
Q

What can fecal impaction cause?

A

-Can produce constipation or overflow incontinence

76
Q

Causes of fecal impaction

A

-Decreased bowel mobility (ex. hospitalized patients and spinal cord injury patients)
-Low-fibre diets

77
Q

Symptoms of fecal impaction?

A

-Severe bloating
-Pain
-Anorexia
-Urgency to go to the bathroom with the inability to go (sphincter is constantly signaled but can’t go)
-Stains in underwear
-If able to pass gas maybe some stool comes through as well usually liquid
-Constipation
-Swelling

78
Q

Which patient would you want to assess first during your morning rounds and why?

  1. Patient who has had diarrhea for 2 days
  2. Patient who states their hemorrhoids are bothering them (causing pain)
  3. Patient who has not passed stool in 2 days
  4. Patient who has melena while on iron supplements
A

Patient who has had diarrhea for 2 days - because you would suspect electrolyte and fluid loss if severe enough can cause confusion (from being dehydrated)

79
Q

Decreases in male genitourinary system with age

A

-No end to fertility
-Sperm production decreases around 40
-Decrease in pubic hair and colour changes to grey/white
-Decrease in penis and testes size
-Decrease tone of dartos muscle = scrotum hanging lower
-Decreased rugae = hanging look to scrotum

80
Q

Testosterone in males and age

A

-Gradual decrease in testosterone production starting around 55
-Decrease in testosterone = slower and less intense sexual response (may become demoralized from changes in sexual activity)

81
Q

Male genitourinary Hx

A

-Frequency, urgency, nocturia (Polyuria, oliguria, infection)
-Dysuria (Acute cystitis, prostatitis, urethritis)
-Hesitancy & straining (Prostate enlargement, acute cystitis)
-Urine color (Dehydration, UTI, hematuria, cancer)
-Past GU Hx (Incontinence, kidney disease, prostate disease)
-Penis (Infection)
-Scrotum/testes (hernia, cancer, hydrocele)
-Sexual activity & contraceptive use (risky sexual activity, STI’s, erectile dysfunction ED)

82
Q

Dysuria

A

Pain or burning sensation upon urination

83
Q

Hydrocele

A

Type of scrotal swelling that occurs when fluid collects in the main sheath that surrounds the testicles

84
Q

Oliguria

A

Your body produces less urine than normal

85
Q

Polyuria

A

Your body makes more urine than normal
-More than 1500 mL/day

86
Q

Nocturia

A

Frequent urination at night

87
Q

Cystitis

A

Infection of the bladder secondary to bacterial infections in the urine

88
Q

Hypospadias

A

A birth defect in boys in which the opening of the urethra is not located at the tip of the penis. The abnormal opening can form anywhere from just below the end of the penis to the scrotum

89
Q

Epispadias

A

A rare birth defect located at the opening of the urethra. In this condition, the urethra does not develop into a full tube, and the urine exits the body from an abnormal location. The causes of epispadias are unknown

90
Q

Inspection and palpation of the penis

A

-Glans: Easy retraction and sliding back when uncircumcised
-Palpate shaft between thumb and first 2 fingers
-No discharge

91
Q

Scrotum inspection and palpation

A

-Size dependent on room temperature
-Left scrotal sac typically lower than the right
-Slide easily, freely ovable, rubbery, smooth, firm, oval
-Patient to hold penis out of the way (if not use back of your gloved other hand)

92
Q

Is the rugae more constricted when cold or hot?

A

Rugae is more constricted when cold, opposite when hot - survival instinct for semen

93
Q

Hernia

A

Bulging of internal organ or fatty tissue through an opening in the muscle anterior to it
-Favour side of the hernia

94
Q

Inguinal and femoral hernias

A

-Most common indirect inguinal hernia
-Visually see bulge when patient stands
-Palpate the bump/mass

95
Q

Female genitourinary decreases that occur with age

A

-Decrease in vaginal secretions
-Decrease in mons pubis from decrease fat pads
-Decrease in labial and clitoral size
-Decrease in the amount of pubic hair and colour change to grey/white
-Uterus shrinks and may droop (prolapsed uterus)
-Vagina atrophies to 1/3 length and width

96
Q

Menopause

A

-Cessation of menses
-Occurs around 48-51
-Preceding 1-2 years of irregular menses (lighter flow, further apart)
-Ovaries stop producing progesterone and estrogen
-Physical changes due to change in hormone levels

97
Q

Female genitourinary Hx

A

-Menstrual history (Amenorrhea, menorrhagia)
-Obstetrical Hx (GTPAL) (Difficulty conceiving)
-Menopause (Hormone replacement side effects - often linked to increased risk for breast cancer)
-Self-care behaviours (Irregular PAP test)
-Urinary symptoms (Dysuria, nocturia, hematuria, incontinence)
-Vaginal discharge (Vaginal infection)
-Gynecological Hx (Surgery on uterus, ovaries, vagina)
-Sexual activity & contraceptive use (Risky sexual activity, STI’s

98
Q

Menorrhagia

A

Menstruation that lasts more than 7 days, intense flow often with clots, intense loss of blood

99
Q

Inspection of external female genitalia

A

Labia minora: dark pink, moist, symmetrical
Labia majora: plump, well formed, symmetrical

100
Q

Perineum

A

-Area between anus and scrotum or vulva
-Should be smooth

101
Q

Urethritis

A

-Inflammation of the urethra due to infection
-Same bacteria can cause UTI’s and STI’s

102
Q

Subjective and objective data of urethritis

A

S: dysuria, pruritis, pain during sex
O: purulent discharge from meatus, fever (erythema - redness of the skin, tenderness and induration of urethra in anterior vaginal wall)

103
Q

Urine assessment

A

Normal urine output: 1200-1500 mL/day
-Clear, pale yellow/amber, very slight urine odour
-Note indwelling catheters (in situ - in place)

104
Q

Bladder capacity

A

-600-1000mL
-Moderate distention: more than 200 mL
-Discomfort: more than 400 mL

105
Q

Important urine assessment findings

A

-Oliguria, polyuria
-Change in urine color
-Suprapubic tenderness
-Costavertebral angle pain/tenderness
-Fever
-Discharge from meatus
-Change in mental status

106
Q

What can cause a green colour to urine?

A

Some medications

107
Q

What can cause a blue colour to urine?

A

-Some medication side effects
-Asparagus

108
Q

What can cause a cloudy colour to urine?

A

-Kidney stones
-UTI’s

109
Q

What can cause a dark red colour to urine?

A

-Liver disease
-Myoglobinuria
-Blood in the urine
-Some medications or food dyes

110
Q

What can cause a pink colour to urine?

A

-Beets, berries, food dyes
-Some laxatives
-Kidney stones
-UTI’s

111
Q

What can cause a red colour to urine?

A

-Blood
-Nephritis, cystitis
-Cancer
-Following prostate surgery

112
Q

What can cause orange urine?

A

-Some medication side effects (warfarin)
-Some foods and food dyes
-Some laxatives
-Dehydration
-Jaundice (bilirubinemia)

113
Q

What can cause dark grey urine?

A

-Contains melanin (melaninuria)

114
Q

What can cause amber coloured urine?

A

-Concentrated urine (dehydration)
-Some laxatives
-Food or supplements with B-complex vitamins

115
Q

Pale yellow urine color

A

-Clear, watery with excess liquids
-Acute viral hepatitis, cirrhosis

116
Q

Yellow urine

A

-Natural yellow is urochrome excretion, a pigment in blood
-Bright neon yellow with vitamin supplements

117
Q

Your patient has a foley catheter in situ for the last 3 days. Upon inspecting the draining bag, you notice a change in their urine color and appearance.
1. What subjective data would you collect?
2. What objective data would you collect?
3. Based on additional information gathered, what would your nursing diagnosis be?

A
  1. Ask any new pain-PQRSTU, any medications, ask if alert and oriented x3
  2. Describe color of urine, how much urine, take vital signs, urine odor, look at meatus for abnormalities, discharge
  3. UTI

Health Assessement NSG 2317 (3 decks)

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