Abdominal & Male Genitourinary Assessment Flashcards
Abdominal pain is very common T or F
False
Aging speeds up the digestive system T or F
False
insulin is made in the…
pancreas
The GI system includes
- Stomach
- Small & Large intestine
- Liver
- Gallbladder
- Pancreas
- Spleen
The Urinary system includes
- Kidneys
- Ureters
- Bladder
- Urethra
Reproductive system includes
- male reproductive parts
- female reproductive parts
Stomach function
mixes and churns food with gastric juice that contains acid creating chyme
Liver function
makes bile which aids in digestion and absorption of fat
Pancreas function
releases bicarbonate to neutralize intestinal contents and produce enzymes that digest carbs
Gallbladder function
Stores bile and releases it into the small intestine
Small intestine function
Digest foods and absorbs nutrients into blood or lymph
Large intestine function
Absorbs water and vitamins/minerals also passes waste material
Anus function
opens to allow waste to leave the body
What are the quadrants of the abdomen
Right Lower Quadrant, Right Upper Quadrant, Left Upper Quadrant, and Left Lower Quadrant
What quadrant do you start with when assessing?
Right Lower Quadrant
What organs are in the Right Lower Quadrant(RLQ)
- Appendix
- Ascending colon
- Rt. kidney lower lobe
- Rt. Ovary
- Rt. Ureter
- Rt. spermatic cord
- part of the uterus
What organs are in the Right Upper Quadrant(RUQ)
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Rt. adrenal gland
- Rt upper lobe kidney
- Ascending and transverse colon
What organs are in the Left Upper Quadrant(LUQ)
- Stomach
- Spleen
- Lt Lobe of liver
- Pancreas
- Lt. Adrenal gland
- Lt upper lobe kidney
- Transverse and descending colon
What organs are in the Left Lower Quadrant(LLQ)
- Signoid and Descending colon
- Lt. Kidney
- Lt Ovary
- Lt. Uterer
- Lt Spermatic Cord
- Part of uterus
Focused History Questions
- Do you have any abdominal pain?
- Where is it located?
- How long have you had it?
- Rate pain scale 1-10
- What helps the pain go away?
- How often do you have a bowel movement?
- Have you noticed any change in BM’s?
- Any problems with constipation/ diarrhea/ excess gas?
- Any problems voiding/ urinating?
Before you begin abdominal assessment…
- Instruct client to empty bladder
- position client supine with knees slightly flexed
- Assess client for pain
Order for abdominal assessment skills
1.) Inspection
2.) Auscultation
3.) Percussion
4.) Palpitation
Why does one inspect first?
To obtain a baseline before stirring abdomen
What is the order of Auscultation?
RLQ, RUQ, LUQ, LLQ
Inspection of abdomen
- Inspect shape of stomach: flat, raised, scaphoid, and protuberant
- Check for distention as it can be a hernia
- Assess size, symmetry, and contour of the abdomen
- Observe color, quality of skin, incision, drainage, rashes/red
- note abdominal movements
- note position, contour and color of umbilicus
Developmental variations: Inspection
- Infants and toddlers have protuberant stomach shapes
- Older adults abdomen may be more rounded because of decrease muscle tone
- infants and children peristaltic waves are often visible
- pregnancy
Expected findings: Inspection
- Thin clients, peristalsis and aortic pulsations may be visible
- men tend to use their abdominal muscles for breathing
- umbilicus is inverted and in midline, no discharge is present
Abnormal findings: Inspection
- Peristaltic wave may be seen if there is an intestinal obstruction
- Pulsation in clients who are not thin may indicate an aortic aneurysm
- Abnormal respiratory movements may be seen with respiratory distress
- Protrusion of the umbilicus may result from a hernia or an underlying mass
Auscultation Assessment
- use the diaphragm of the stethoscope using light pressure
- bowel sounds are loudest after eating or when meals are overdue
- Follow sequence: RLQ, RUQ, LUQ, LLQ
Expected Findings: Auscultation
- you should hear iiregualr gurgling, tinkling sound every 5-15 seconds or 30/ min
- Borborygmi
- no audible bruits are present
Borborygmi
the characteristic sounds of growling or rumbling that the stomach and intestines make as food, fluids, and gas pass through them
Abnormal Findings: Auscultation
- Hypoactive
- Hyperactive
- True absence
- bruit
Hypoactive
extremely soft, infrequent, indicates low mobility, possible obstruction
Hyperactive
overactive bowel sounds, high mobility, diarrhea, laxatives
Bruit
abnormal and may indicate an aneurysm or altered blood flow. Sounds like something rushing
Percussion Assessment
- use indirect percussion at multiple sites in all four quadrants
- same order as auscultation
- Assess for areas of tenderness, gas, fluid or masses
Expected findings: Percussion
- Tympany with dullness over organs or fluid if present
- no tenderness
Abnormal findings: Percussion
- Extremely high-pitched tympanic sounds are heard with distension
- extensive dullness indicates organ enlargement or underlying mass
Palpation assessment
- light palpation throughout the abdomen. Identify tenderness, muscular resistance, and turgor
- proceed in same sequence using a circular motion with both hands
- if patient is having pain in one area, assess that part last
- observe for grimacing, guarding, or verbal statements of pain
Expected Findings: Palpation
- Abdomen is soft and nontender, with no masses
- muscles are easily palpated, no guarding
Abnormal Findings: Palpation
- Guarding and rigidity may indicate peritonitis
- tenderness on light palpation needs further examination
Documentation of Abdominal Assessment
- Abdomen concave and symmetrical, no scars, skin intact, bowel sounds positive in all 4 quadrants. With light palpation, abdomen is soft, no distention and no areas of tenderness or masses noted
- Stated last bowel movement and passes gas easily
Age-related changes: Stomach
Decreased gastric motility and reduction in gastric mucous. This makes the stomach more susceptible to peptic ulcer disease and gastriritis
Age-related changes: Intestines
Decrease in nutrient absorption- lipids, amino acids, glucose, calcium and iron. Peristalsis is slowed, and although constipation is not normal part of aging may be a common side effect of medications, life habits, inadequate fluid intake and lack of fiber indiet
Age-related changes: Accessory organs, Liver and Gallbladder
Decrease in blood flow to the liver which is associated with an increased half-life of fat soluble medications. Although the gallbladder function does not seem to change significantly, but gallstone changes increase to 50%
Structures in male genitalia
- Penis
- Scrotum
- Testes
- Bladder
- Urethra
- Seminal vesicles
- Vas deferens
- rectum
-anus
Penis
- The external reproductive organ of the male
- The penis is made up of two parts> the shaft and the glans
-glans: tip
-shaft: main part, contains the urethra
Scrotum
The bag of skin that holds and helps to protect the testicles
Testes
- Two small organs that are found inside the scrotum
- testes are responsible for making sperm and produce testosterone
Bladder
-hollow organ
- wall relax and expand to store urine and contract and flatten to empty
Urethra
- Tube that allows urine to pass outside the body
Seminal vesicles
Sac-like glands that lie behind the bladder and release a fluid that forms part of semen
Vas deferens
- Tube in which the sperm is stored and it carries the sperm out of the scrotal sac
- Located between the epididymis and the urethra
Rectum
The lower end of the large intestine leading to the anus
Anus
The opening at the end of the digestive tract where bowel contents leave the body
Prostate gland
- Sex gland in men
- made up of three lobes
secretes a slightly alkaline fluid that forms part of the seminal fluid - examined with a rectal exam
Focused history questions: Genitalia and Rectal
- Have you noticed any redness, swelling, discharge, or odor n your genital area?
- Any asymmetry, lumps, or masses?
- Any problems urinating/ bowel elimination?
- Are you sexually active?
- Do you have sex with men, women, or both?
- Describe sexual activity?
- Any history of STI/STD?
Gender-specific terms
- Transgender
- Transexual
- Cisgender
Inspection: Male genitalia and anus
- note hair distribution
- inspect condition of the skin of the penis, observe presence/absence of the foreskin
- observe size, position, and symmetry
- Inspect inguinal(groin) areas and note condition, look for swelling and bulges
- inspect anus, note condition of skin and the presence of any lesions
Palpation: Male genitalia and anus/rectum
- use gloves
- palpate shaft and retract the foreskin
- palpate the scotom, testes, and epididymis: note size, shape, and consistency
- Palpate lumps, masses, tenderness: shine light on as well
- palpate inguinal and femoral areas for hernias
- palpate lymph nodes in groin area
- palpate anus and rectum: have patient bend over and gently insert fingers, palpate wall for masses/ tenderness
Expected findings: Inspection
- hair is distributed triangular and normal for age
- no pediculosis present
- skin intact w/ no lesions or discharge
- Foreskin present or absent, if present covers glans and easily retractable
- scrotum free of lesions, nodules, and swelling
- left sac lower the right
- inguinal(groin) area free of swelling or bulges
- anal area intact with no inflammation or lesions
- anus is darker in color that surrounding tissue
Expected findings: Palpation
- penis is non-tender with no masses or nodules
- foreskin if present easily retracts
- no swelling or nodules are noted in the scrotom, testes, or epididymis
- no bulges or palpable masses are present in the inguinal areas or lymph nodes
- Anus: Good sphincter tone
- rectum is nontender
- no palpable masses or hard stool-
- stool is brown and negative for blood
inguinal area
groin area
explain the correct method for testicular self-examination
1.) Stand in front of mirror and check for scrotal swelling
2.) Use both hands to palpate testes, should be smooth and uniform
3.) With index and middle fingers under the testes and thumb on top, roll testes gently in a horizontal plane
4.) Feel for evidence of a small lump or abnormality
5.) Follow same procedure and palpate upward along the testes
6.) Locate the epididymis, a cord like structure on the top and back of the testicles that stores and transports sperm
7.) Repeat examination for the other teste, it is normal to have one larger
8.) If you find evidence of a lump consult your physican
Developmental Varations
- incontinent is a problem in older adults: muscles weaken= increase incontinence> medication and pregnancy can also increase
- BPH is common in men over 40, may cause incontinence, due to not being able to completely empty bladder
- prostate cancer
- ED: Erectile dysfunction increases with age
- Scrotum enlarges with age
Abnormal findings: penis
- Hypospadias: opening at the bottom of the penis
- Epispadias: opening at the top of the penis
- both common in newborns, heals its self
abnormal findings: anus/rectum
- External hemorrhoid
- perianal abcess
- anal fissure
- pilonidal cyst: blocked sebaceous gland base of spine
abnormal findings: prostate
- BPH: Benign prostate hypertrophy(enlarged prostate)
- Cancer of prostate
Testicular cancer most common at what ages
20-30
How many times should you self-examine self
At least once a month
