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Health Assessment > Week 7 GI > Flashcards

Week 7 GI Flashcards

1
Q

Which kidney will you be able to palpate, if palpable at all and why?

A

the right kidney because it sits lower than the left

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2
Q

Define peritoneum and retroperitoneal

A

peritoneum = membrane lining walls of abdominal and pelvic cavities

retroperitoneal = space near the posterior abdominal wall and the peritoneum

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3
Q

Which organ is of most importance when referring to the right lower quadrant

A

the appendix

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4
Q

list the organs in the right upper quadrant

A
  • ascending colon
  • duodenum
  • gallbladder
  • right kidney
  • liver
  • pancreas
  • transverse colon
  • ureter (right)
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5
Q

list the organs in the left upper quadrant

A
  • descending colon
  • left kidney
  • pancreas (body and tail)
  • spleen
  • stomach
  • transverse colon
  • ureter (left)
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6
Q

list the organs in the right lower quadrant

A
  • appendix (most important)
  • ascending colon
  • bladder
  • cecum
  • rectum
  • ovary, uterus and fallopian tube (female)
  • prostate and spermatic cord (male)
  • small intestine
  • ureter (right)
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7
Q

list the organs in the left lower quadrant

A
  • bladder
  • descending colon
  • ovary, uterus, fallopian tube
  • prostate and spermatic cord (male)
  • small intestine
  • sigmoid colon
  • ureter (left)
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8
Q

What are the introductory questions that you can ask when performing the abdominal assessment

A
  • changes of appetite, diet
  • food intolerances, food allergies
  • 24 hour dietary recall
  • weight changes
  • difficulty swallowing (dysphagia)
  • exposures
  • travel to and from US (parasites, diarrhea, etc.)
  • stressors
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9
Q

What are the OLD CART questions to ask for vomiting

A
  1. Onset: when did it start?
  2. Location: can only come from one place, so not very helpful
  3. Duration: timing of system
  4. Characteristics: what color? digested or no? projectile or not?
  5. Associated factors: any headaches, abdominal pain, etc.
  6. Relieving or aggravating factors
  7. treatments tried
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10
Q

What are the medications we want to know about when gathering a history for abdominal assessment

A
  • NSAIDs
  • antiemetics
  • antibiotics
  • iron tables
  • anticoagulants
  • antidiarrheals
  • laxatives
  • antacids
  • intolerances
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11
Q

What is normal frequency for bowel habits

A

2-3 times a day to 3x a week

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12
Q

What do tarry stools (melena) and bright red stools (hematochezia) mean

A

Melena: GI bleed up high, mixing with acid and being digested

Hematochezia: RBCs are fresh, bleed is coming from lower GI tract; need to know quality and quantity

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13
Q

What would blood when wiping but no where else indicate

A

possible fissure, but not a GI bleed

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14
Q

Explain gastroenteritis. What are the causes? What are the common symptoms?

A

Defined: inflammation of the GI tract (mouth, esophagus, stomach, and intestines)

Causes: virus, bacteria, parasite, medications, food intolerances

Symptoms:

  • nausea and or vomiting
  • diarrhea (this is good because your system is trying to get rid of bad stuff)
  • abdominal cramping
  • fever
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15
Q

How do you gather a pain history for the abdominal assessment

A
  1. Identify possible causes: food, stress, fatigue, menses, infection
  2. obtain pt description: cramping, sharp, dull, knifelike, burning, gnawing with pain scale
  3. ask what relieves the pain: meds (analgesics or antacids), or position
  4. location and radiation of pain: site characteristics, referred pain (location not always at site of affected organ)
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16
Q

What subjective data do we want to know about when gathering an abdominal assessment

A
  • GERD
  • visceral dysfunction
  • surgery (disruption of peritoneum leads to scar tissue)
  • tests and results (colonoscopy or endoscopy)
  • GI cancer
  • substance abuse (alcohol, opiates, tobacco)
  • family hx (GI cancer, colitis, IBS)
  • vaccination (hep A and B)
17
Q

What is meant by solid viscera? What structures are classified as solid viscera

A

organs that maintain a characteristic shape

  • liver
  • pancreas
  • kidney
  • adrenal glands
  • spleen
18
Q

What is meant by hollow viscera? What organs are classified as hollow viscera

A

organs whose shape depends on their contents

  • stomach
  • gallbladder
  • colon (makes room for stool, gas, etc.)
  • small intestine
  • bladder
19
Q

What symptoms do we want to know about when discussing the urinary tract during an abdominal assessment

A
  • suprapubic pain
  • dysuria? urgency? frequency?
  • polyuria or nocturia (more than 3-4 times a night)
  • urinary incontinence
  • hematuria (gross vs. microscopic)
  • kidney or flank pain (especially unilateral)
20
Q

How do you prepare for an abdominal physical exam

A
  • warm environment, hands, and stethoscope
  • short fingernails
  • client in supine position, knees flexed (fully supine engages rectus abdominus and makes it difficult to palpate)
  • client with empty bladder and bowel
  • watch facial expressions for discomfort
  • examine painful area last
21
Q

What is the order of exam for abdominal assessment

A
  • inspect
  • auscultate
  • percuss
  • palpate
22
Q

What are you looking for when inspecting the abdomen

A
  • skin lesions or rashes, scars, striae (stretchmarks), color
  • umbilicus (herniation)
  • abdominal contour
  • distension, symmetry, masses
  • motion of internal organs on surface (peristalsis)
  • venous patterns, pulsations (aorta)
23
Q

Name and explain the different contours of abdomen

A

flat = normal
scaphoid = seeing every bone
rounded
protuberant = belly is protruding

24
Q

What are the 6 F’s of protuberant abdomen

A
  • fat
  • fluid (collecting and shifting in peritoneal space)
  • flatus
  • fetus
  • feces
  • fatal growths (tumors)
25
Q

What are the sounds you may hear if a patient has ascites. What can do to evaluate if there are air bubbles, or ascites

A

you can hear tympany (tightdrum) or dullness

umbilicus may be protuberant

roll them on their side to see if the air bubble moves when you turn them

26
Q

What are the steps to remember when auscultating for bowel sounds. What is abnormal?

A
  • use diaphragm in all 4 quadrants
  • normal: 5-34 times per minute (need at least 60 sec to know what those sounds are)

Abnormal:

  • absent (obstruction) = listen for 5 minutes
  • hypoactive (decreased motility) = quiet gurgling <4 in 1 min
  • hyperactive (increased motility) = high pitched, loud, >35
27
Q

How do you auscultate for vascular bruits

A
  • use bell
  • listen for aorta, renal arteries, iliac, and femoral arteries
  • abnormal: bruits (turbulent blood flow which should never be in abdomen)
28
Q

What arteries are you listening for

A
  • aortic pulsations
  • renal arteries
  • iliac artery (both sides)
  • femoral artery (both sides)
29
Q

What organs do you percuss

A
  • quadrants first
  • stomach
  • liver
  • kidneys
  • bladder
30
Q

What is the normal liver span? How do you percuss the liver? Explain the liver scratch test

A

Normal span: 6-12 cm

Percussion technique:
- start with lung resonance and work down. work up from abdominal sounds until dull; measure distance between

Liver scratch test:

  • place stethoscope on the liver
  • begin scratching fingernail lightly just below where you expect the liver
  • scratch sound will intensify over liver; mark it
  • then scratch above expected liver border and measure the distance
31
Q

How do you percuss kidneys

A

blunt technique at the costovertebral angle using the hand and fist. This will elicit vibrations that may cause pain due to inflammation, infection, or irritation

32
Q

Where do you measure the liver

A

at the MCL

33
Q

What are the steps for light palpation

A
  • one hand, firm palpation while rolling hand
  • over all 4 quadrants
  • tone, tenderness, surface characteristics
  • masses, enlarged organs
  • pulsations: aorta, femoral
  • inguinal nodes
34
Q

Explain deep palpation

A
  • bimanual (one hand on top of the other to get deeper)
  • over all 4 quadrants
  • spleen (avoid if enlarge or if concern for injury)
  • kidneys; sandwich technique (L shouldn’t feel, right is 1-2 cm lower; only feel lower pole)
  • liver hook technique
35
Q

When palpating the abdomen, take note of any what?

A
  • rigidity
  • guarding
  • tenderness
  • rebound tenderness (does it hurt more when I press down or let go?)
36
Q

What are additional maneuvers you can do for an abdominal assessment

A
  • palpate in other positions besides supine
  • palpate inguinal area for hernia
  • can localize most painful area by having patient breathe in deep and contract abdomen (coughing motion which increases pressure) and let patient point to most tender spot
  • ticklish patients? use patient’s hand when palpating
37
Q

What are classic findings when discussing health promotion

A
  • hepatosplenomegaly (big liver and spleen caused by cirrhosis)
  • ascites
  • caput medusa (super distended belly with distended veins)
  • spider angiomas
  • peripheral edema
  • palmar erythema
  • erythematic or bulbous nose (purple red bulb end of nose)
38
Q

What are the preventions of urinary incontinence

A
  • pelvic muscle training
  • pelvic muscle exercises
  • incontinence is not normal
39
Q

A bulging pulsation in abdomen can indicate what?

A

abdominal aortic aneurysm

Health Assessment (11 decks)

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