abdomen and nutritinal assessment Flashcards
what are all the organs inside the abdominal cavity called?
the viscera
what are solid viscera?
organs in the abdomen that maintain a characteristic shape
ex, liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus
what is hollow viscera?
- shape depends on content inside the organs.
- usually not palpable
- ex, stomach, gallbladder, small intestine, colon, bladder
what takes up most of the space in the right upper quadrant?
the liver
how is it possible to palpate the liver?
-lower edge of it is normally palpable in deep palpation
2-4cm below rib
what is located in all 4 quadrants?
the small intestine
what is the spleen?
a soft mass of lymphatic tissue on the posterolateral wall of the abdominal cavity
- about 7cm long
- normally palpable
where is the gallbladder?
it rests under the posterior surface of the liver
what do the right and left iliac arteries become?
the femoral arteries in the groin
what is located behind the stomach in the left upper quadrant?
the pancreas- a soft, lobulated gland
functions of the pancreas?
- endocrine function is to regulate blood sugar
- exocrine function is to help with digestion by making enzymes
what are the kidneys protected by?
the posterior ribs and musculature
function of the kidneys?
-excrete wastes and regulates water and electrolytes
what is lactose?
its a digestive enzyme necessary for the absorption of lactose
what happens if an individual has a low level of lactose?
they are deemed lactose intolerant and have abdominal pain, bloating, and flatulence when they consume milk products
what is celiac disease?
an autoimmune condition in which intestinal tissue is damaged in response to eating gluten which results in conditions such as iron-deficiency anemia and osteoporosis
what is GERD?
symtoms of heartburn and regurgitation
what is some subjective data to ask a pt?
- appetite (changes? weight changes? intolerance?)
- dysphagia?
- food intolerance? (food u cant eat? heartburn? bloating? indigestion? use of antacids?)
- Abdominal pain? (worse before or after eating)
- constipation? (is this normal for you)
- nausea/vomiting
- bowel habits
- past abdominal history
- medications
- alcohol / tobacco
- nutritional assessment
what types of pts tend to have dysphagia?
- stroke patients
- spinal injuries
- cancers
- ALS
- pts with advanced dementia
what does acute abdominal pain necessitate?
- urgent diagnosis
- could be appendicitis, cholecystitis, bowel obstruction, perforation
what is the number 1 complaint that ppl present with in the emergency room?
abdominal pain
what are some subjective questions to ask about nausea and vomiting?
- how often?
- is is associated with clickly pain, diarrhea, fever, chills
- is it bloody?
what can cause hematemesis?
- occurs with stomach or duodenal ulcers
- esophageal varices (chronic alcohol use, swollen veins in lower esophagus that can rupture bleed)
- Mallory Weiss tear: tears that occur from retching and acid. self limiting
what are some subjective questions to ask about bowel habits?
- how often?
- what color?
- consistency?
- any diarrhea or constipation?
- stools may be black and tarry because of occult blood (melena) from GI bleeding
- bright red blood in stools occurs with GI bleeding or localized bleeding around anus
what are some significant abdominal history occurrences?
- ulcers
- hepatisis
- appendicitis
- hernia
questions to ask about medications related to abdominal history?
- what meds are u currently taking?
- use of any laxatives?
- opioids increase constipation
- use of laxatives?
- NSAIDS can cause bleeding and damage to the stomach
what included with inspecting the abdomen?
- assess the contour: is it flat? rounded, scaphoid (anorexia), or protuberant (distended)
- abdomen should be symmetrical
- bruises
- note any budging, visible masses or asymmetrical shapes (eg, hernia)
- if you see a scar, ask about it
- you may see pulsations from the aorta beneath the skin in the gastric area
what do bowel sounds originate from?
they are from movement of air and fluid through the small intestine (peristalsis)
what are hyperactive sounds (auscultation)
loud, high pitched rushing, tinkling sounds that signal increased motility (eg, bowel obstruction)
what are hypoactive sounds (auscultation)
can be heard after surgery or with inflammation of the peritoneum. more common
what are absent bowel sounds?
do not ever chart
-you would have to listen in each quadrant for 5 minutes (20 min total)
what is important to remember about the usual examination sequence when it comes to the abdomen?
normal sequence: inspection, palpation, percussion and auscultation
-auscultate right after inspection- this is because percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds
on percussion, what is a tympany notes?
it is heard predominant because air in the intestine rises when patient is supine
where is dullness heard on percussion?
is heard over distended bladder, adipose tissue, fluid or mass
what is the sequence of examination for the abdomen?
inspection, auscultation, percussion, palpation
what should a nurse begin with when palpating the abdomen?
begin with light palpation and DO NOT use deep palpation on someone with abdominal pain
-save examination of tender areas last
what is voluntary guarding?
Occurs when the patient is cold, tense, or ticklish
what is involuntary rigidity?
is a constant board like hardness of the muscles. it accompanies peritonitis- an acute inflammation of the peritoneum
what could right lower quadrant (RLQ) tenderness on palpation with acute abdominal pain migrating from the umbilicus possibly mean?
is can be indicative of appendicitis
- refer to a surgeon immediately required
- additional signs include nausea, vomiting, fever, and loss of appetite
what is ascites?
fluid in the peritoneal cavity
-the abdomen is distended, the flanks are budging and the umbilicus is protruding and displaced downward
what does ascites occur with?
heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer
what sound on percussion would ascites present with?
dullness to percussion
in what situations will the liver feel enlarged and smooth but is TENDER to palpation with?
occurs with heart failure, acute hepatitis, and hepatic abscess.
-more acute
in what situations will the liver feel enlarged, smooth, and nontender to palpation?
- fatty infiltration, portal obstruction or cirrhosis
what is a fatty liver?
Fatty liver disease is a condition in which fat builds up in your liver
1) Nonalcoholic fatty liver disease (NAFLD)
2) Alcoholic fatty liver disease,
where can the spleen extend to when extremely enlarged?
it can extend down to the left aspect of the pelvis
what does splenomegaly occur with?
- occurs with acute infections (mono) and is moderately enlarged and soft
- is usually nontender
- pts should refrain from contact sports- if the spleen ruptures it is highly vascular and will bleed a lot
what is nutritional status?
- is the degree of balance between nutrient intake and nutrient requirements
- this balance is affected by income, education, social environments, nutritional literacy and access to protective foods
when is optimal nutrition achieved?
- when nutrients are consumed in amounts that support daily requirements
what is undernutrition?
When nutrition reserves become depleted or when nutrient intake is inadequate to meet daily requirements or metabolic demands.
ex, eating disorders, depression, mania
what is overnutrition?
-results from the consumption of nutrients - most frequently calories, sodium, and fat in excess requirement. obesity, sedentary lifestyle, medication, metabolic syndromes, hypothyroidism
what happens with an infants weight in the first few days of life
infants lose weight during the first few days of life, birth weight is usually regained by day 7-10 after birth
what does the Canadian pediatric society recommend about breast feeding?
recommends all full term infants should be exclusively breast fed for the first 6 months of life
why should cows milk be avoided in the first year of life?
because It is associated with occult blood loss in stool
why is it essential that sufficient calories, protein, vitamins and minerals are consumed during pregnancy?
- they support the synthesis of maternal and fetal tissues during pregnancy
what can be done to reduce the risk of neural tube defects in infants?
400 mcg of folic acid should be taken daily
what is food security?
means that all ppl, at all times, have access to nutritious, safe, personally acceptable, and culturally appropriate foods, produced in ways that are environmentally sound and socially just
what percentage of indigenous ppl living in isolated communities experiance food insecurity?
40-83%
what is the first step in assessing nutritional status?
nutritional screening
what is an important question to ask patients regarding meals?
the 24-hour recall- asking patient or family members what was last consumed in the past 24 hours
- be aware pf gaps with this method
- pt may alter truth for various reasons
- snack items are usually underreported
what are some subjective questions to ask a pt about their food intake?
- eating patterns
- usual weight
- changes in appetite, taste, smell, chewing and swallowing
- recent surgery, trauma, burns, infections-need a lot of calories and protein
- nausea, vomiting, diarrhea, constipation
- food allergies or intolerances
- medications, nutritional supplements
- exercise and activity patterns
- psychological symptoms
- physical impairments
objective data for nutritional assessment?
- body mass index
- waist to hip ratio (reflects body fat distribution as an indicator of health risks)
