Ch 20: Abdominal Assessment Flashcards
What are the functions of the G.I. system
- Ingest
- digest
- nutrient absorption
- solid waste Elimination
What are abdominal assessment components
systems in the abdominal assessment
G.I. cardiovascular reproductive neuromuscular GU
What are the major G.I. organs
what are the accessory organs
Major:
- stomach
- small intestine
- Large intestine (colon)
Accessory:
- Liver
- pancreas
- gallbladder
Give the major GU genitourinary organs 
Kidneys ureters bladder urethra reproductive organs
What is the function of the kidneys
The kidneys:
- Control blood pressure through production of the renin
- simulating RBC by secreting erythropoietin
- filter/ remove waste from body
Where does the abdomen span from
what is it bordered in the back by
what is it bordered on the sides by
They have them in spans from the diaphragm to the brim of the pelvis
Abdomen bordered in the back by rotible column
I have them in bordered on the sides in front by lower rib cage and abdominal muscles
What connects the four large abdominal muscles
The linea alba joins the four large abdominal muscles
What are the major blood vessels in the abdomen
What is the peritoneum
Aorta
arteries
veins
The peritoneum is a serous membrane that covers and holds the organs in place
What are the functions of the muscles in the abdominal area
2
Protect and support digestive system as well as keep in place
Assist in digestion, mastication, swallowing, and poop
What is the most common reference lines used
Give the four quadrants that are used as reference lines
what do they cross and intersect intersect
Right lower quadrant
Right upper quadrant
Left upper quadrant
Left lower quadrant
The four quadrants intersect at the umbilicus
What is the most specific/precise reference lines to use when addressing the abdomen
- where does the first horizontal line begin at
- where does the second horizontal line lie
Give the nine regions from right top row middle row and bottom row
The nine regions are the most specific reference lines to use in the abdomen
1st: at the lower edge of costal margin
2nd: at the anterior/iliac spine of iliac bone
- Right hypochondriac region
- Epigastric region
- Left hypochondriac region
- Left lumbar region
- Umbilical region
-  left lumbar region
- Right inguinal region
- Hypogastric/supra pubic region
- Left inguinal region
What is the lowest region of the nine regions
What is the best way to divide the nine regions
- horizontal down
- middle vertical down
The hypogastric/suprapubic is the lowest region
horizontal down:
Hypochondriac, lumbar, inguinal
vertical down:
Epigastric, umbilical, hypogastric/suprapubic

What is the mechanical process of digestion
What is the chemical process of digestion
Mechanical:
Chew and break down food, peristalsis, churning
Chemical:
Break down food through metabolic reactions
Where does absorption of nutrients take place and what is absorbed
Obsorption of nutrients takes place in the small and large (colon) intestines,
Absorbed is
-  water
- electrolytes
- vitamins
- excrete waste Products
How long does it take food that is not absorbed to leave the body
With the Decreased liver function what lab test must you monitor
Food that is not absorbed is eliminated within 48 hours
With decreased liver function monitor:
- AST/ALT
- alkaline phosphate
- Billirubin 
What are common Lifespan considerations for your older adults in relation to the abdomen
(2 things)
Production
Mvement
decreased saliva production and stomach acid production
Slowed gastric motility/peristalsis
-causing constipation difficulty swallowing chewing absorbing/digesting
What are common lifesman considerations for your pregnant women in relation to the abdomen
Activity Other Skin Baby oushing on causing Liftiing Other Other
- decreased ball activity: constipation
- Linea alba = Linea Negra “pregnancy line” due to hormones 
- striae
- stress incontinence (coughing/sneezing)
- umbilical hernia
- Pica
-  heartburn
What kind of assessment is severe dehydration
What signs and symptoms does it cause
Who is dehydration very significant in
Severe dehydration = emergency assessment
S&s:
- N/V
- ⬇️BP ⬆️HR
- dark urine
- fluid volume deficit
- tenting
- dry oral mucosa
Dehydration is very significant in infants and the elderly
Give life-threatening situation that need emergency assessments #1 where is pain
- Appendicitis
- stabbing pain RLQ!!! - Peritonitis
- Ectopic pregnancy
- Strangulated hernia
If a patient comes in with unexplainable pain and you cannot find a reason as to why they’re in pain what do you want to assess for
What are adhesions ?
If patient has unexplainable abdominal pain assess for previous abdominal surgeries to identify the presence of any adhesions
Adhesions are fibrous bands connecting tissue and orgs not meant to be connected
When asking subjective data for personal history what are general topics you are going to ask about
Personal history: General questions
- chewing and swallowing
- breathing any weight gain
-neurological system/metabolism
CVA, dysphagia? Cant swallow?
DM, thryoid issues?
-hematological systems
any anemia?
-substance abuse/occupation
alcohol= malnutrition// risk of ulcers
Lifestyle factors
Sex life: hep B, hep C any IV drugs

What is relevant personal history you need to check for when assessing subjective data
Diseases/issues
Any history of Gerd/PUD
IBS/IBD
Ulcerative colitis/Crohn’s
Anemia/thalassemia 
What are relevant family history Risk factors for abdominal assessment
- Colon/gastric CA
- ulcers?
- DM
- alcohol abuse
- Gerd/IBD
What are our health promotion goals for the abdomen
Colo rectal cancer screening
Reduce new cases of ESRD+ HTN
-end stage renal disease
Reduce cirrhosis deaths
As a health promotion goal when should people start getting coloresctal cancer screenings and how as well as how often
What exam is used for colorectal cancer screenings
- Family/personal history
- No history
People should start screening for colorectal cancer beginning at 50 with a colonoscopy
Get screened every 3 to 10 years
- 3: Family/personal history
- 10: no history
What is a primary cause of cirrhosis that we work to reduce cirrhosis deaths in?
Primary causes of cirrhosis are due to hepatitis especially alcoholism 
What does the Hemoccult testing assess for
Give another name for the Hemoccult testing
Hemoccult testing assess for blood in stool that’s not visibly seen
Hemoccult= guaiac testing
As far as reduction what Are our three main focuses involving the G.I. system
Colorectal cancer
Foodborne illnesses
Hepatitis
What are important patient teachings for the prevention of foodborne illnesses
(1) Cook food thoroughly
(2) Refrigerate leftovers
(3) have sanitary conditions
How is hep A transmitted and prevented
How is hep B transmitted
How is hep C transmitter
Hep A
Transmission: oral and fecal transmission
Prevent: proper handwashing
HEP B
Transmission: body fluids (sex), IV drug use, perinatal transmission (mom to baby) 
HEP C
-transfusion of blood in the 1980s and tattoos
What measures are taken to protect infants and those exposed to body fluids
In regards to HEP A& B
Hep A and hHp B immunizations have been created to protect infants and those exposed body fluids
What is used as a screening/assessment tool for alcoholics asking for treatment
CAGE
C-ut down drinking * patient realizes need  A-nnoyed by drinking criticism * “you’re drinking too much”
G-uilty about drinking
E-ye opener
* first drink of the day is alcoholic
Where is the pain of appendicitis located
Where is paint of diverticulitis located
Where is pain of cholecystitis located
Where is pain of cystitis located
Appendicitis= pain in RLQ
Diverticulitis= pain in LLQ
-inflamm of colon
Cholecystitis = pain in RUQ
-inflamm of gall bladder
Cystitis= pain in symphysis pubis
-inflamm if bladder / urinary system 


Give common abdominal symptoms
Indigestion/anorexia
N/V/ hematemesis /abdominal pain
Dysphasia, odynophagia
Change in bowel function
-constipation/diarrhea
Jaundice/ icterus
Urinary/renal symptoms
-incontinence, kidney/flank pain, ureteral colic
Within the symptom of anorexia
Give the difference between normal anorexia, anorexia nervosa, and bulimia
Why do these symptoms come about
Who is most likely to have the symptoms
Normal anorexia: loss of appetite
Anorexia nervosa: limiting food intake to none
Bulimia: deliberately vomiting after eating
-patient will commonly have index finger tearing because they have to stick their finger in their throat
Symptoms come about due to illness
Common in men and women
What is bulimia harder to distinguish than anorexia nervosa
In bulimia: it’s hard to distinguish because the person is at a normal weight
In anorexia: the patient is cachectic
What is hematemesis
What is hematemesis commonly known as
What causes hemaemesis
Hematemesis is vomiting blood
Hematemesis known as coffee ground emesis)
Due to NSAIDs
Give the difference between dysphasia and odynophagia
Dysphasia: difficulty swallowing
odynophagia: painful swallowing
- odynophagia feels like food stuck in your throat/esophagus
When it comes to changes in bowel function like constipation and diarrhea
what is considered constipation
what is considered diarrhea and what do you want to do with a patient who claims to have diarrhea
Constipation: is 3 days without a bowel movement
Diarrhea: liquidy, watery stool 5 to 6 times a day
-if a patient presents with diarrhea it’s important to assess what they mean
What do you want to do if a patient presents to you with incontinence
What types are there of incontinence
(3 types)
If patient has incontinence you want to ask what type of incontinence
Tyoes:
- Stres: Cough/sneeze
- urgency: sudden
- total: cannot hold urine 
With any renal symptoms what are characteristics of :
BPH
Polyuria
hematuria with pain
Hematuria without pain
BPH signs and symptoms:
- decreased urine strength
- Nocturia
- urgency
- frequency
Poly uria:
-DM
Hematuria with pain: UTI
Hematuria with out. Oain: bladder cancer
What kind of pain is kidney/flank pain
Kidney/flank pain is pelvic pain
What are characteristics ofureteral colic

What are ureteral colic also known as
Woth ureteral colic What do you want to assess for 
Ureteral colic
Is characterized as a sharp pain with hematuria and nausea and vomiting
A.k.a. kidney stones causing obstruction
you want to asses for CVA tenderness
What genetic disorders (cultural consideration) are more common in your African-Americans
In African-American patients with these issues what do you want to be careful with
Sickle cell anemia
 G6PD deficiency‘s: an enzyme in RBCs
lactose intolerance
Are all more common in African-Americans
In African-Americans with these issues be careful with aspirin continue medications
What Cultural considerations are common among your Jewish
Jewish are likely to suffer from ulcerative colitis and Crohn’s disease
What cultural consideration is most common among those of Mediterranean decent
What is thalassemia?
Those of Mediterranean decent increased chance of Thalassemia
: thalassemia is inherited, Is when the body doesn’t make enough hemoglobin
What is the most common among your native Americans
Alcoholism leading to malnutrition is most common among Native Americans
Amung cultural considerations what is the most common among Asians
Gastric (stomach) cancer more common amung asians
Give the order in which you would conduct an objective exam On a patient with abDominal issue
Why is palpation last
If abdominal issue:
- Inspect
- Auscultated
- Percuss
- Palpate
Palpation is last as it may interfere with normal abdominal sounds if done before auscultation and percussion
Upon beginning auscultation where do you want to start.
(what is this region called, give its location and why) 
Beginning auscultation, start at the point of ileocecal valve
Ileocecal valve located in RLQ displaced to the right under umbilicus
At the point of the ileocecal valve you have the most active sounds
What way do you proceed around the abdomen when using the 4 quadrants
When doing abdominal assessments proceed in clockwise directions starting from Illeosecal valve
Where do you listen to vascular sounds upon auscultation
Vascular sounds heard at the
- aorta
- Renal
- iliac
- Femoral
 among percussion what is the abdomens normal tone
What tone do you hear over organs like the liver
How do you assess CVA

Normal percussion tone: tympanic
Percussion tone over Organ (liver): dull
Use indirect percussion to assess CVA
How many times per minute are normal bowel sounds
How many sounds per second are normal bowel sounds
How long are you listening to each quadrant for
Normal bowel sounds:
- 5–30 gurgles per minute
- One sound every 5–15 seconds
Listen to each quadrant for 1minutes

If you do not hear any bowel sounds how long must you Auscultate for before saying No bowel sounds
And what does this indicate
A total of 5 minutes Must be auscultated for all four quadrants COMBINED to be considered no bowel sounds
If no bowel sounds for 5 minutes= emergency
What will bowel sounds of an obstruction sound like
And obstruction will have hyper active bowel sounds BEFORE obstruction absent AFTER
Describe borborygmi and what it means if Auscultated
Borborygmi is it loud rushing sound indicative of gastroenteritis
How deep is light palpation
How deep is deep palpation
When is it ABSOLUTELY CONTRAINDICATED to palpate a patient and why for each
Light:1cm
Deep: 4-6 cm
DO NOT PALPATE Any patient with an organ transplant or a child suspected of having Wilms tumor!!!
- transplant organs not well protected
- Wilms tumor aka NEPHROBLASTOMA is malignant tumor and if ruptured will spread
What is a thrill and where is it typically heard
What are signs and symptoms of an abdominal aortic aneurysm
A thrill is a Rushing vibration typically heard in the epigastric region
Enlarged aorta
pulsation +3 cm
Bruit
How do you elicit the abdominal reflex
(technique)
(Normal finding)
Technique:
stroke the abdomen in all nine quadrants towards the umbilicus
Norm: umbilicus moves to the reflex
When is third space fluid collection considered ascites
What are two ways to assess for ascites
Abnirmal findings
Ascites is considered over 500 mL in a third space
Assessing ascites: 1. Fluid wave: -have patient put hand as a barrier in middle of stomach tap one side and watch wave on the other •Abnormal: + if you can feel wave
- Shifting dullness: percussion of abdomen supine then right then left

What is the test done to observe peritoneal irritation
(give both names )
Give technique

Peritoneal irritation assessed using: Bloomberg sign (rebound tenderness)
Technique:
Press slowly on a tender area on abdomen and quickly withdrawing hands
Abnorm: positive pain when letting go= peritonitis
What tests observed for appendicitis
What does the rovsing sign test for
What is the technique for the rovsing sign 
What are abnormal findings
- Bloomberg (rebound tenderness)
- rovsing sign
- psoas (iliopasoas muscle test)
the rovsing sign tests for appendicitis
Technique:
-Press deeply and evenly in the LLQ and withdrawal
Abnormal: pain felt in RLQ = appendicitis 
How do patients describe the pain of appendicitis/peritonitis
Appendicitis/peritonitis pain often described as pain at the umbilicus that radiates to RLQ especially with cough
What does the Murphy’s sign test for

What is the technique for the Murphy sign
Abnormal findings
Murphy’s sign test for gallbladder inflammation
Technique:
- hold fingers down on liver border
- apply mild pressure
- ask patient to breathe deeply
Abnormal finding: + pain= Gallbladder inflammation

What does the Pasoas (Iliopsoas muscle test) test for
What is the technique for the iliopsoas muscle test
Abnormal findings
Iliopsoas muscle test done for appendicitis
Technique:
- patient supine right leg straight up knee straight
- push down on lower part of Rice thigh well patient pushes up
Abnormal finding: positive pain in RLQ = appendicitis
What are two ways you can locate the liver
- Palpate right mid clavicular with one hand behind the patient’s back
- Hooking technique over right costal margin
Lifespan considerations for older populations potential alterations
Muscle
Mobility
Liver
Renal
Poor dentition
⬇️ muscle mass/tone
⬇️ motility/peristalsis= bloating distention and constipation
* liver shrinks causing a decrease in medication metabolism
* decreased renal function decreasing medication efficacy

Diagnostic tests
EGD: esophagogastroduodenoscopy
Assesses what
Rules out what
EGD= endoscopy
EGD assesses: mucosa of
-esophagus
-duodenum
-stomach
Rules out: -cancer lesions ulcers 
ERCP: endoscopic retrograde cholangiopancreatogrophy
Assess what
Identifies what
ERCP assesses:
-ducts draining liver and pancreas
ERCP identifies:
-Identifies and removes gall stones and diagnosis pancreatic cancer
What does a CT scan identify
CT identifies soft tissue problems
- enlarged organs
- Tumors
- aneurysms +
What does an MRI identify
Evaluate condition of organs, ducts, blood vessels
🚫 do MRI if pacemaker
Why is a colonoscopy done and what does it identify
Recommend age to begin? How often
Colonoscopy done to look into colon and rectum to identify polyps, ulcerations, or tumors
Begin : 50 YOA q 3-10 years
What is the gray Turner sign
Gray Turner sign is red/brown tinge around flanks
What does a palpable bladder mean
What does a tender bladder mean
Bladder CA sign
Palpable bladder:
Either full or enlarged from underlying mass in bladder/pelvis
Tender bladder:
Tinder bladder= UTI
If you have hematuria without pain =CA
What is the function of the oropharynx
What is the function of the esophagus
What is the function of the descending colon
Oropharynx: mastication 
Esophagus: propels food into stomach
Descending colon: Further absorption of electrolytes in water, excretion
Give nursing diagnosis related to the abdomen
Impaired nutrition Diarrhea constipation incontinence fluid volume deficit
Give nursing outcomes related to the admin
Patient will defecate formed stool every one or three days
Patient reports decreased incontinence episodes
Give nursing interventions related to the abdomen
Teach patient to pace fluids, limit bedtime intake

Admin bulk laxatives per physician order
