Week 12: Chp 55: Assessment of Gastrointestinal Function Flashcards
(138 cards)
1
Q
What is the gastrointestinal system responsible for?
A
intake, digestion, and elimination of foods and fluids, and proper functioning is key to adequate nutrition
- known as the alimentary tract, begins with the esophagus and ends with the anus
- responsible for the digestion and absorption of nutrients and expelling of metabolic wastes
2
Q
What are the two divisions of the GI system?
A
- Alimentary Tract
- Accessory Organs
3
Q
If normal intake can not be through the mouth, how else is nutrition delivered?
A
nutrition may be delivered directly to the stomach or small intestine
4
Q
Where does digestion begin?
A
begins in the mouth and continues in the stomach and small intestine
-the large intestine is responsible for reabsorption of fluids and electrolytes and elimination of waste products
5
Q
What is the large intestine responsible for?
A
the reabsorption of fluids and electrolytes and elimination of waste products
6
Q
What are the accessory organs?
A
teeth, tongue, salivary glands, liver, gallbladder, and pancreas
7
Q
The GI tract consists of what?
A
the mouth, pharynx, esophagus, stomach, small intestine, and large intestine
8
Q
The Mouth
A
where digestion begins, where the mechanical (mastication) and chemical breakdown of food occurs
9
Q
The mechanical breakdown of ingested food occurs through the process of what?
A
mastication (chewing)
10
Q
Mastication
A
- chewing
- the mechanical breakdown of ingested food
- saliva, which contains amylase, lipase, and lysozyme, is excreted from a group of glands: parotid, sublingual, and submandibular glands
- amylase is responsible for the chemical breakdown of carbohydrates, whereas lipase chemically digests fat; digestion of proteins actually occurs in the stomach
- lysozyme has antimicrobial properties that destroy the cell wall of bacteria in the mouth
11
Q
Chemical breakdown
A
Saliva, which contains amylase, lipase, and lysozyme, is excreted from a group of glands: parotid, sublingual, and submandibular glands
- amylase is responsible for the chemical breakdown of carbohydrates, where a lipase chemically digests fat
- lysozyme has antimicrobial properties that destroy the cell wall of bacteria in the mouth
12
Q
Deglutition
A
“swallowing”
consists of two phases and involves the pharynx, esophageal muscles, and the following cranial nerves CN V (trigeminal), CN VII (facial), CN IX (glossopharyngeal), and CN XII (hypoglossal)
-the buccal (mouth) phase involves the tongue and the pharyngeal muscles, and the esophageal phase involves the palate and esophageal muscles
-peristaltic movement of the esophagus moves the bolus of food into the stomach
13
Q
2 phases of deglutition
A
“Swallowing”
- Buccal (mouth) phase: involves the tongue and the pharyngeal muscles
- Esophageal phase: involves the palate and esophageal muscles
14
Q
The Esophagus: What is it and the location
A
is a hollow muscular tube that extends from approximately the vertebral levels of C6 to T7
-it is positioned inferior (below) to the pharynx and posterior (behind) to the trachea and passes through the diaphragm via a space known as the esophageal hiatus and then connects to the stomach
15
Q
The Esophagus and what it does
A
the peristaltic movements push the food bolus downward as the esophagus constricts above the bolus and dilates below the bolus
-in normal digestion, the lower esophageal sphincter protects the esophageal mucosa from regurgitation of partially digested food and the acid produced in the stomach
16
Q
What happens in the stomach?
A
digestion of protein -specialized cells secrete chemicals essential to the digestive functions of the stomach >Mucous Cells >Parietal Cells >Chief Cells >Enteroendocrine Cells
17
Q
Stomach Cells: Mucous cells
A
secrete mucus that protects the stomach lining
18
Q
Stomach Cells: Parietal Cells
A
secrete hydrochloric acid that aids in the conversion of food to chyme (partly digestive semiliquid food), as well as convert gastric lipase and pepsinogen to active forms
-also secrete intrinsic factor, a chemical needed for the absorption of vitamin B12, an important component of hemoglobin synthesis
19
Q
Stomach Cells: Chief Cells
A
secrete the enzymes gastric lipase, which digests approximately 15% of dietary fat, and pepsinogen, which is responsible for protein digestion
20
Q
Stomach Cells: Enteroendocrine cells
A
secrete hormones needed for digestion:
>Gastrin: stimulates secretion of hydrochloric acid and enzymes, and intestinal motility
>Serotonin: stimulates gastric motility
>Histamine: stimulates secretion of hydrochloric acid
>Somatostatin: inhibitory hormone that delays emptying of the stomach, reduces absorption in the small intestine, and inhibits secretions from the gallbladder and pancreas
21
Q
Gastric Motility is influenced by?
A
smooth muscle regulated by the sympathetic and parasympathetic nervous systems
22
Q
Before meals the stomach has a volume of what?
A
has a volume of 50 mL, but can hold up to 4 L at its fullest
-swallowing stimulates the swallowing center in the medulla oblongata to signal the stomach to stretch to receive food
23
Q
What does the peristaltic contraction controlled by the pacemaker cells of the smooth muscle do in the stomach?
A
churn the food and mix it with gastric secretions
24
Q
The stomach has 4 landmark areas
A
- the cardiac area (small segment below the gastroesophageal sphincter)
- fundic area (uppermost segment)
- corpus (body, and largest segment)
- pyloric area (lowermost segment and consists of the antrum, a narrow funnel that leads to the pyloric canal)
25
The small area right beyond the pyloric canal of the stomach is called the what?
the pylorus, and it connects to the duodenum
26
The passage of chyme into the duodenum is controlled by what?
the pyloric sphincter, which is a ring of smooth muscle surrounding the pylorus
27
Rugae
the lining the of stomach has folds known as rugae that allow for stretching of the lining in order to facilitate absorption
28
Through hormonal and neurological feedback systems, gastric secretion activity occurs in three phases:
- Cephalic phase
- Gastric Phase
- Intestinal Phase
29
Gastric Secretion Activity: Cephalic Phase
First phase
| -mental and sensory stimuli activate the vagus nerve (CN X) to stimulate gastric secretion
30
Gastric Secretion Activity: Gastric Phase
Second Phase
-the presence of carbohydrates, fat, and partially digested protein stimulates the release of acetylcholine, histamine, and the hormone gastrin
>these chemicals stimulate the parietal cells to secrete hydrochloric acid and intrinsic factor, whereas the stimulation of the chief cells results in the secretion of pepsinogen
>Hydrochloric acid converts pepsinogen to pepsin, the enzyme responsible for the digestion of proteins
31
Gastric Secretion Activity: Intestinal Phase
the presence of chyme stretches the duodenum
-initially, the duodenal stretch leads to the release of intestinal gastrin and the stimulation of the vagus nerve, which stimulates the stomach; however, the presence of acid and semi digested food in the duodenum also begins the inhibitory phase; signals from the medulla stimulate the sympathetic and parasympathetic nervous systems, which inhibit gastric activity; the secretion of secretin and cholecystokinin also inhibits gastric motility and enzyme secretions
32
The Liver
second largest organ of the body (skin is first)
- attached beneath the diaphragm, and positioned largely across the right upper quadrant and extends into the left upper quadrant
- segmented into 4 lobes separated by ligaments that suspend the liver under the rib cage and diaphragm in the abdominal cavity
- the inferior view has two grooved areas where the inferior vena cava, hepatic vein and artery, common hepatic duct, and gallbladder are positioned
- 25% of the cardiac output flows through the dual blood supply system, an oxygen-rich supply from the hepatic artery and a nutrient-rich supply from the portal vein
- 20% of the bodys total oxygen consumption is utilized by the liver
- the blood supply from the portal vein receives nutrients from the stomach, intestines, spleen, and pancreas
33
Major functions of the liver
-absorption and metabolism of nutrients
-degradation of toxins, hormones, and medications
-synthesis of proteins (clotting factors, albumin, several clotting factors, fibrinogen, and prothrombin)
>Kupffer cells are responsible for detoxifying the blood of bacteria
-liver aids in digestion of fat by producing bile acids and lecithin
34
List of Functions of the liver
- Digestion
- Vitamin and mineral metabolism
- Protein metabolism
- Carbohydrate Metabolism
- Lipid Metabolism
- Plasma protein synthesis
- Detoxification
- Phagocytosis
35
Liver Functions: Digestion
- emulsification of fat
| - absorption of dietary fat
36
Liver Functions: Vitamin and mineral metabolism
- storage of vitamins A, B12, D, Ferritin
| - Excretes excess calcium
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Liver Functions: Protein Metabolism
- deamination and transamination of amino acids
| - converts ammonia to urea
38
Liver Functions: Carbohydrate Metabolism
- conversion of dietary fructose and galactose to glucose
- conversion of lactic acid to pyruvic acid or glucose-6-phosphate
- storage and release of glycogen
- synthesizes glucose from fat and amino acids when glycogen stores are low
39
Liver Functions: Lipid metabolism
- synthesis of fat, cholesterol, and phospholipids
| - produces ketone bodies, VLDL, and HDL
40
Liver Functions: Plasma Protein Synthesis
synthesizes blood plasma proteins: albumin, fibrinogen, prothrombin
41
Liver Functions: Detoxification
detoxifies alcohol and medications that are metabolized in the liver; deactivates thyroxine and metabolizes bilirubin and excretes it as bile pigment
42
Liver Function: Phagocytosis
aids in the elimination of bacteria in the blood
| -Kupffer cells detoxify the blood of bacteria
43
Kupffer Cells
cells in the liver that are responsible for detoxifying the blood of bacteria
44
What constitute the majority of hepatic cells and are responsible for many of the functions of the liver?
hepatocytes
45
The Gallbladder
located in the right upper quadrant, the gallbladder, a pear-shaped sac, is attached to the inferior portion of the liver and is responsible for bile storage and concentration
-bile is needed for the emulsification of fat
46
Bile
need for the emulsification of fat
- contains phospholipids (lecithin), bile pigments (bilirubin), and bile salts
- about 500 to 1000 mL of bile is excreted from the liver and stored in the gallbladder; Bile leaves the liver and passes through a ductal system: Hepatic ducts-->common hepatic ducts-->cystic duct and into gallbladder
47
What happens to bile after ingestion of a meal?
after ingestion of a meal, bile exits the gallbladder via the cystic duct that communicates with the bile duct
- the terminal end of the bile duct connects with the terminal end of the pancreatic duct to form the hepatopancreatic ampulla in the pancreas; this ampulla connects with the duodenal papilla, which contains the hepatopancreatic sphincter (sphincter of Oddi) that opens during digestion and releases bile to the small intestine to emulsify the dietary fat
- bile is released from the gallbladder to the duodenum of the small intestine
48
The pancreas position and location
a gland that is positioned inferior (below) to the stomach in the right upper quadrant
- it has 3 landmarks: the head, which is surrounded by the duodenum; the body, and the tail
- the pancreatic duct is in the middle of the pancreas and extends from the tail to the head, where it joins the bile duct
49
Endocrine Functions of the pancreas
-produces insulin and glucagon
50
Exocrine Functions of the Pancreas
as an exocrine gland, it secretes 1200 to 1500 mL daily of liquid known as pancreatic juice that contains water, sodium bicarbonate, proenzymes needed for protein digestion, and the pancreatic enzymes needed for carbohydrate (amylase), fat (lipase, phospholipase A, and cholesterol esterase), and DNA and RNA (deoxyribonucleases, ribonucleases) digestion
- the digestion of these nutrients is essential for cellular metabolism
- the release of these enzymes is secreted through the acinar cells of the pancreas and is regulated by neural and hormonal feedback systems
51
What does pancreatic juice contain?
-water
-sodium bicarbonate
-proenzymes needed for protein digestion
-pancreatic enzymes needed for carbohydrate, fat, and DNA and RNA digestion
>carbohydrate (amylase)
>fat (lipase, phospholipase A, cholesterol esterase)
>DNA and RNA (deoxyribonucleases, ribonucleases)
52
What stimulates the release of pancreatic enzymes during the cephalic phase?
Acetylcholine
53
How Pancreatic enzymes are released
pancreatic enzymes are stored in the duodenum and released as chyme arrives
- cholecystokinin is released from the jejunum and duodenum when gastric acid, long fatty chains, and certain amino acids are present
- the release of cholecystokinin stimulates the release of pancreatic enzymes that contract the gallbladder and relax the hepatopancreatic sphincter for the release of bile into the duodenum
- secretin is released from the small intestine in response to the presence of the acidic chyme in the small intestine; the release of secretin stimulates the liver and pancreas to release sodium bicarbonate, which neutralizes the acidic chyme and protects the intestinal lining
54
Role of Cholecystokinin
is released from the jejunum and duodenum when gastric acid, long fatty chains, and certain amino acids are present
-the release of Cholecystokinin stimulates the release of pancreatic enzymes that contract the gallbladder and relax the hepatopancreatic sphincter for the release of bile into the duodenum
55
The role of Secretin
is released from the small intestine in response to the presence of the acidic chyme in the small intestine
-release of secretin stimulates the liver and pancreas to release sodium bicarbonate, which neutralizes the acidic chyme and protects the intestinal lining
56
What Happens in the small Intestine?
protein, carbohydrate, and fat digestion
57
Anatomy of the small intestine
diameter of 2.5 com, beginning at the end of the pyloric sphincter and ending at the ileocecal junction and filling most of the abdominal cavity
-divided into 3 components; the duodenum, jejunum, and ileum
58
Duodenum
first and shortest segment of the small intestine (2.5 cm)
| -chyme leaves the stomach via the pyloric canal and connects with the duodenum
59
Jejunum
where digestion and absorption occur (8 ft)
| -the rich blood supply and muscular intestinal wall make it the thickest portion of the small intestine
60
ileum
longest portion of the small intestine (12 ft)
| -occupies the lower portion of the abdominal cavity and connects to the large intestine at the ileocecal valve
61
What is the process that results in only ingestible fibers entering the large intestine
pancreatic enzymes and bile pass through the bile duct and the pancreatic accessory duct and are released into the duodenum
-pancreatic amylase and intestinal enzymes break down carbohydrates into monosaccharides
-the lining of the small intestine has villi, fingerlike projections that increase the absorption of nutrients; each villus has goblet cells that secrete mucus and enterocytes, which aid in absorption
>this process results in only ingestible fibers entering the large intestine
62
Villa
lines the small intestine
- finger-like projections that increase the absorption of nutrients
- each villus has goblet cells that secrete mucus and enterocytes which aid in absorption
63
The large intestine
last segment of the digestive tract
- function is fluid and electrolyte reabsorption and elimination
- includes the cecum, colon, and anal canal
64
How does semiliquid chyme leave the small intestine to get to the large intestine?
semiliquid chyme leaves the small intestine through the ileocecal valve and enters the last segment of the digestive tract, the large intestine
65
Large Intestine: Cecum
is pouchlike and receives the semiliquid chyme from the small intestine
- vitamin A,D,E, and K; sodium, and water are reabsorbed, creating semi formed stool
- the appendix is attached to the end of the cecum, the exact role is unknown but is filled with lymphocytes
66
Large Intestine: Colon
the transformation of waste from a semiliquid state to formed stool occurs in the colon
-colon is divided into 4 sections: ascending, transverse, descending, and sigmoid
67
Large Intestine: Colon: Ascending colon
begins in the right lower quadrant at the ileocecal valve and extends to the hepatic flexure in the RUQ
-the stool is in a semiliquid state
68
Large Intestine: Colon: Transverse colon
following the ascending colon, which extends from the right hepatic flexure in the RUQ to the left splenic flexure in the LUQ
69
Large Intestine: Colon: Descending colon
extends from the left splenic flexure in the LUQ to the sigmoid colon in the LLQ
70
Large Intestine: Colon: Sigmoid colon
last portion of the colon; connects the descending colon and rectum
71
Large intestine: rectum
sits in the pelvic cavity
72
Large Intestine: Anal Canal
last 3 cm of the digestive tract
- it includes internal and external anal sphincters to regulate the passage of stool, which consists of bacteria, bilirubin, and indigestible fiber
- the presence of bacteria is the cause for flatus and represents 30% of fecal content
73
Health History of GI system
- dietary practices
- nutrition
- oral health
- preventative health
- weight changes
- appetite changes
- stool changes
- pain
74
GI Assessment: it is important for the nurse to assess what?
- level of understanding and ability to communicate to ensure a reliable health history account
- must conduct a culturally sensitive and relevant interview while avoiding stereotyping
- asking questions about cultural practices may provide insight into eating habits as well as general healthcare practices
- collect a thorough medical, surgical, family, and social history (cardiac, psychiatric, neurological, and endocrine disorders can impact the function of the GI system)
- determine patients medication regimen is necessary to ascertain the effects, as well as side effects, of medications on the gastrointestinal system
75
A nutritional assessment aids in what?
understanding the patients behaviors and practices specific to food intake and impact on the GI system and includes a thorough history, physical assessment, and serum studies
76
A nutritional assessment focuses on what?
questions focus on weight or appetite changes, loss of appetite (anorexia), or binging or purging practices
- amounts and types of foods eaten, accessibility to health foods, known nutritional deficiencies, and changes in bowel patterns
- characteristics of stool: color, frequency, consistency
- presence of blood in stool can be described as bright blood in the stool (hematochezia) or black, tarry stool (melena)
77
What tools are used for a nutritional assessment?
The Malnutrition Universal Screening Tool (MUST)
| -a referral to a nutritionist for a complete nutritional assessment is indicated for a MUST score of 2 or higher
78
hematochezia
bright blood in the stool
79
Melena
black, tarry stool
80
The physical assessment includes
a head-to-toe assessment and anthropometric measurements, including height, weight, BMI, waist circumference, body composition, skinfold measurements, and circumference measurements
>actual height and weight measurements should be taken rather than stated values by the patient because the calculations of BMI is based on height and weight
81
Why is waist circumference an important nutritional measurement?
because excess adipose fat along the waist increases the risk for type 2 diabetes mellitus, elevated blood lipids, hypertension, and cardiovascular disease
82
What does body composition provide?
data about fat mass, muscle mass, and body fat percentage
- skin calipers, biometrical impedance, and dual-energy x-ray absorptiometry (DEXA) scans are examples of techniques to measure body composition
- body composition is usually trended over time
83
Why are skinfold measurements taken?
used to estimate subcutaneous body fat
84
Why are circumference measurements taken?
circumference measurements of the calf and midarm may be used as another approach to body composition analysis
85
Specific Diagnostic Studies that are helpful in determining nutritional status
- Serum albumin
- prealbumin
- transferrin
86
Diagnostic Studies: Serum Albumin
Normal: 3.4-5.1 g/dL
-levels less than 3.5 g/dL are indicative of altered nutritional status and are associated with increased morbidity and mortality in older adults
87
Diagnostic Studies: Prealbumin
Normal: 12-42 mg/dL
- considered a more accurate indicator of plasma proteins when compared with albumin
- decreased levels are associated with increased morbidity and mortality in older adults
88
Diagnostic Studies: Transferrin
Normal: 215-365 mg/dL males, 250-350 mg/dL females
- due to transferrin's role in iron binding and transport, transferrin levels are important in a nutritional assessment
- decreased levels of transferrin are associated with infection, kidney disease, and hepatic damage, and indicative of insufficient protein in the diet in patients with malnourishment
89
The physical examination includes a direct assessment of what?
- the oral cavity
- direct assessment of the skin
- an indirect assessment of the underlying structures; the intestinal tract, liver, kidney, spleen, and abdominal arteries
90
Before Proceeding with the actual physical examination what is important to consider?
information collected during the health history
- individual preferences, religious, cultural, or geriatric considerations, may require the nurse to alter the approach
- some, based on religious or cultural reasons, are uncomfortable with exposing the abdominal area or are sensitive to touch, which can lead to contraction of the underlying musculature in the abdomen, giving the false appearance of abdominal rigidity
91
What lab results may appear with hepatomegaly (enlarged liver)?
may reveal elevated liver function tests (LFTs)
92
Age-related changes to the GI system
with changes in the esophagus, patient often complains of eructation (belching), heart-burn, and early satiety
93
Position for a physical assessment of the abdomen
positioned supine with arms relaxed at the sides and the knees bent in order to promote relaxation of the abdomen
-assessment order: inspection, auscultation, percussion, and palpation
94
Inspection of the oral cavity
offers insight to gastrointestinal and oral health
-with a bright light, assess oral mucosa, gums, tongue, general repair of dentition, jaw strength, and the ability to swallow
95
Inspection of the skin over the abdomen
using indirect lighting and tangential views, inspect skin for color, striae, lesions, presence of superficial vessels, and scarring
- the contour and shape of the abdomen are noted; should be slightly concave to round
- in thin patients it is normal to note a midline pulse
- moving to the exterior portion of the anus, note the color, which should be darker than the surrounding skin
- documentation should include a full description of findings, and position should be recorded according to the anatomical locations
96
Bleeding or lesions on the underside of the mouth may indicate what?
oral cancer
97
Lesions on the tongue can contribute to what?
can impair taste and appetite or impair the ability to swallow and may contribute to decreased nutritional status
98
Missing teeth or dental pain can lead to what?
malnutrition
99
Bugling masses on the abdomen may indicate what?
tumors or hernias (displacement or protrusion of a part of the intestine)
100
Hernia
displacement or protrusion of a part of the intestine
101
Pulsatile masses may indicate what?
aneurysms (enlargement or bulging of an artery usually associated with weakening of the vascular wall)
102
What physical indication on a patients skin may indicate a rapid change in weight?
striae (stretch marks)
103
What indicates the presence of liver disease?
yellow coloring (jaundice) of the skin, and perhaps the sclera of the eyes, or superficial vessels
104
What physical assessment is associated with intra-abdominal bleeding?
blue or purple coloring (Cullen's Sign) around the periumbilical area
105
Visible swollen, protruding veins underlying the skin of the anus are indicative of what?
hemorrhoids
106
Inspection of an Ostomy: The Three "Ss"
- Skin: the surrounding skin color of the stoma should be consistent with the rest of the abdomen; any lesions or excoriations should be described and documented
- Stoma: assess the stoma for color and consistency; the stoma should be pink and moist
- Stool: consistency of stool is dependent on the location of the stoma. For instance, am ostomy located in the ileum will pass semiliquid stool, whereas the stool from the sigmoid colostomy will be formed
107
Purpose of auscultation
indirectly assess bowel sounds and the vascular integrity of the arteries
-diaphragm of the stethoscope is best for high-pitched sounds such as bowel sounds
108
Where are bowel sounds normally present?
in the RLQ at the ileocecal valve and are the starting point for auscultation
-moving in a counterclockwise position, the nurse listens in each quadrant, paying close attention to the quality and pitch of sound made by the intestines
109
Normal bowel sounds
can range from low to high pitched gurgling, and the frequency occurs at a rate of 5 to 30 times per minute
110
How to determine absence of bowel sounds
auscultate each quadrant for a minimum of 5 minutes
111
What can hypoactive bowel sounds be caused by?
anesthetics, opioids, anticholinergic medications, constipation, or ileus (absence of normal GI motility)
112
What can hyperactive bowel sounds be caused by?
secondary to the actions of cholinergic medications, or infectious and inflammatory bowel disorders
113
The abdominal arteries such as the abdominal aorta, renal, iliac, and femoral arteries can be directly assessed by using what?
the bell of the stethoscope, which is best for hearing low-pithed sounds like bruits (abnormal sounds heard upon auscultation of blood vessels)
114
The Whooshing Sound of A bruit May indicate what?
partial obstruction of the vessel, and it is never considered a normal variant to hear a bruit in the abdomen
- an arterial obstruction
- avoid palpation of the abdomen if a bruit is heard and report finding to healthcare provider
115
Hypoactive bowel sounds may indicate what?
can be a later indicator of obstruction
116
Hyperactive bowel sounds may indicate what?
an early indication of obstruction, diarrhea, or inflammatory bowel disorders
117
Absent bowel sounds may indicate what?
paralytic ileus caused by mechanical or neurological dysfunction
118
Reason for percussion of the abdomen
the size of the organs is ascertained through percussion and palpation
-requires quiet environment, fingernail length to be short, and patient should be supine with legs slightly bent allowing for abdominal muscles to be relaxed
119
What should you hear when percussing/ normal finding
percussion over the intestinal area should elicit a drum-like sound known as tympany
ex: similar to the sound heard when percussing a balloon filled with air
120
What should be heard when percussing the liver or stomach?
should elicit dullness, a flat sound
| -ex: similar to the sound produced when tapping a balloon filled with water
121
When can dullness be heard?
- over the liver or stomach
- in an obese abdomen
- over the intestinal tract when filled with fecal matter
- over a full bladder
- in the presence of fluid accumulation in the abdomen (ascites)
122
Abnormal finding when percussing the abdomen
the presence of fluid can displace air, and dullness can be the dominant sound
-this can also indicate constipation
123
Purpose of palpation
evaluate the underlying structures, assess for abdominal tenderness, and abdominal tone
-the starting point is away from any areas of discomfort stated by the patient
124
Abnormal Findings upon palpation
a rigid abdomen can indicate pain, guarding, or peritonitis, which is inflammation of the peritoneal cavity
-a mass may indicate a tumor, aneurysm, or hernia
125
Light palpation
light palpation begins by slightly pressing the pads of the fingers into the abdomen and gliding them in small, incremental, circular movements clockwise around the abdomen
126
Deep Palpation
technique that allows the assessment of the size and consistency of the liver, kidney, and spleen
127
Palpation: Hooking technique
used to assess the edge of the liver
-practitioner stands to the left of the patient and places the fingers under the 12th rib; when patient inhales, the livers edge may come below the rib and be palpated by the pads of the fingers
128
Laboratory Studies: complete blood count (CBC)
provides important information about potential blood loss through assessment of the red blood cell count, hemoglobin, and hematocrit
-WBC count is indicated for evaluation of inflammatory and infectious processes
129
Laboratory Studies: A serum chemistry panel
obtained to assess for electrolyte imbalances associated with impaired absorption or excretion
-serum albumin, prealbumin, and transferrin levels provide data regarding nutritional status
130
Laboratory Studies: Prothrombin
with suspected liver disease, a prothrombin time is important to assess clotting because this test measures the time required for prothrombin to be converted to thrombin and may be prolonged because of the impaired synthesis of clotting factors in the liver
131
Laboratory Studies: Liver function Tests (LFTs)
are elevated with suspected hepatic dysfunction
132
Laboratory Studies: Urine analysis
indicated in patients with suspected pancreatitis because urine amylase is elevated in this disorder
133
Diagnostic Studies: Ultrasonography
can detect any size and structural abnormalities of the underlying abdominal cavity organs and vessels
- preferred method of visualization of abdominal structures in patients who cannot tolerate contrast dye
- abdominal cavity also evaluated for presence of ascites
- the liver and pancreas can be utilized to detect cysts, tumors, or masses
- the gallbladder and kidney can be visualized for stones
- can be utilized to place stents in obstructed areas
134
Diagnostic Studies: Barium Studies
consists of a series of x-rays and are ordered to examine the integrity and patency of the GI tract
- requires a specific diet the day before the test (clear liquids) and then NPO after midnight
- a laxative or enema may also be prescribed
- typically given a barium, a radiographic opaque to drink; if there is concern about possible perforations anywhere along the GI tract, a water-soluble liquid, gastrografin, is administered
- several studies: upper gastrointestinal series, a small bowel series, and the barium enema
135
Safety Alert: Postprocedural care for barium studies
increased fluid intake and/or enemas are necessary to prevent constipation and impaction in patients who undergo barium studies
136
Diagnostic Studies: Endoscopy
a fiberoptic scope is used to visualize the GI tract
- can be diagnostic, curative, or palliative
- patients are sedated with a narcotic or sedative
137
Safety Alert: Endoscopy Procedural Care
after an upper endoscopy, the nurse monitors for the return of swallow before providing oral intake to decrease the risk of aspiration
-after a lower endoscopy, anticoagulants and aspirin (acetylsalicylic acid, or ASA) are usually held temporarily due to the risk of bleeding
138
Age-related changes
- as smooth muscle tone decreases in the GI system, contractions responsible for propelling food along weaken, and the movement of food through the digestive system is slower; this usually presents as constipation and may be accompanied by hemorrhoids if the constipation is chronic and requires straining when having bowel movements
- if there is weakening of the cardiac sphincter related to aging, esophageal reflux may develop, and the patient may present with "heartburn"
- cancer rates, particularly stomach and colon, increase with age
- loss of bone mass and changes in calcium regulation may also be associated with tooth loss in older adults that impacts nutritional intake and digestion
