Abdominal/Gastrointestinal Assessment Flashcards
Name the 4 layers of muscle that protect the abdominal content.
1: Inguinal ligament
2: Transverse
3: Internal oblique
4: External oblique
What is the linea alba?
A tendinous seam that joins the abdominal muscles of the ventral wall.
What are the 4 major quadrants of the stomach?
Right Upper (RUQ) Right Lower (RLQ) Left Lower (LLQ) Left Upper (LUQ)
What are the differences of an abdominal assessment for infants and children?
- Prominent umbilical cord in newborns
- Liver takes up more space in abdomen and may be palpated below the right costal margin
- Bladder lies between symphysis and umbilicus (higher then in an adult)
- Abdominal wall less muscular, organs are easier to palpate
What are the differences of an abdominal assessment for a pregnant women?
- Acid Reflux
- Decreased gastric motility-prolongs transit time in gut, therefore more water absorbed, leads to constipation
- Constipation and increased venous pressure in lower pelvis can lead to hemorrhoids
- Intestines displaced upward and posteriorly by enlarging uterus
- Bowel sounds diminished
- Appendix displaced upward and to the right
- Striae and linea nigra
What are the differences of an abdominal assessment for an aging adult?
- May have fat accumulation also know as the “spare tire”
- Decreased salivation, dry mouth
- Esophageal emptying delayed (be careful feeding in supine position)
- Gastric acid secretion decreases-interferes with vitamin B12 absorption leading to anemia, and lowered incidence of gallstones
- Decreased liver size (normal function but decreased drug metabolism
- Constipation
What is the RNAO BPG for treating constipation?
- Drink lots of fluids
- Reduce caffeine
- Eat dietary fibres
- Implement routine toiletting
- Exercise
What things should be noted when doing a GI history on an adult?
- Meal/snack patterns
- Types of food consumed
- Exercise patterns
- Weight less then body requirement (fatigue, hunger, body image, activity pattern, family/social feedback)
- Body more then body requirement (timelines, eating habits, exercise pattern, Hormonal irregularities)
What things should be noted when doing a GI history on an aging adult?
- What is their access to food
- Alone or shared meals
- 24 hour intake history
- Swallowing, digestive difficulties
- Activity pattern post meal
- Bowel history
What food chain and cultural issues need to be considered in gi health?
- 70% of the world population is lactose intolerant
- There is recent rise in celiac disease (gluten intolerance)
- 10-20% of Canadians suffer from heartburn
- High incident of gastric ulcers (alcohol, smoking, helicobacter pylori, 8-10 million Canadians have H. pylori and 75% are first nations)
- One of the highest rates of inflammatory bowel disease
How can the nurse support relaxed abdominal muscles during abdominal exam?
- Ask patient to empty their bladder
- Warm room, warm equipment, warm hands
- Supine, head on pillow, arms at side, knees raised on pillow
- Examine painful, tender areas last
- Distraction-emotive imagery, soft voice, story, breathing
What is an aortic aneurysm? How might a nurse observe possible aortic aneurysms during abdominal assessment?
•An aortic aneurysm is a bulge in the artery.
Why is it important to watch patient behavior when examining the abdomen?
,
What are the four contour shapes of the abdomen?
- Flat
- Scaphoid
- Round
- Protuberant
What are striae?
Stretch marks
Why does auscultation take place before palpation?
Palpation and percussion may stir up the bowel sounds
How long does the nurse listen when auscultating for bowel sounds?
Normally have to listen for 5 minutes before you can say you have a silent abdomen.
What is a bruit? Where are listening locations for bruit? Diaphragm or bell?
A bruit is blood flowing through major vessels.
Where are listening locations for bruit? Diaphragm or bell?
Listening locations include the aorta, left renal artery, iliac artery and the femoral artery.
The bell is used.
What are the two primary sounds that can be heard in the abdomen?
Tympany: thick drum sound
Dullness:
What is the technique used for percussing the liver span?
- Landmark the right MCL
- Percuss over the 3-4 ICS (resonance)
- Continue to percuss down each ICS until sound changes to dull (usually around 5th ICS)
- Mark this spot.
- Percuss the abdomen for tympany, percuss up the MCL until the sound changes to dull
- Mark this spot
- Measure the distance between the marks
- Normal adult liver span is 5-12 cm
How does deep palpation differ from light palpation?
- Deep palpation: 5-8 cm deep
* Light palpation: 1cm depression, gentle rotary motion, lift from spot to spot (do not drag)
Can a registered nurse perform deep palpation?
•A registered nurse can not perform deep palpation, only NP’s and MD’s
How do you asses for Blumbergs sign?
- Assesses for rebound tenderness
- Choose a site away from the area of discomfort
- Hold hand at 90 degree to the abdomen
- Push slowly, and deeply
- Then lift of quickly
- Normal response is no pain with release of pressure.
How does assessment differ for infants?
- Protuberant
- May have venous pigmentation
- Umbilical cord: fresh, ready to fall off- dark, shriveled 10-14 days old
- Umbilical Hernia: appears at 2-3 weeks, more prominent with crying, maximum size of 2.5cm at 1 month, disappears at age 1
- Diastasis recti: separation of rectus muscle along midline, more common in African descent, disappear by early childhood
How does auscultation differ for infants?
No vascular sounds should be heard
How does percussion differ for infants?
- Tympany over stomach, dullness over liver
- Spleen not percussed
- Bladder normally dull
How do you palpate on an infant?
- Flex knees with one hand, palpate with other
- Normal to feel liver edge at the costal margin or 1-2cm below
- Also may palpate spleen tip, kidneys, bladder
- Cecum and sigmoid colon (like a sausage)
Identify epigastric, umbilical and suprapubic regions
Epigastric:
Umbilical:
Suprapubic:
