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Health Assessment > Ch 20: Abdominal Assessment > Flashcards

Ch 20: Abdominal Assessment Flashcards

1
Q

What are the functions of the G.I. system

A
  • Ingest
  • digest
  • nutrient absorption
  • solid waste Elimination
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2
Q

What are abdominal assessment components

systems in the abdominal assessment

A 
G.I. 
cardiovascular 
reproductive 
neuromuscular
 GU
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3
Q

What are the major G.I. organs

what are the accessory organs

A

Major:

  • stomach
  • small intestine
  • Large intestine (colon)

Accessory:

  • Liver
  • pancreas
  • gallbladder
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4
Q

Give the major GU genitourinary organs 

A 
Kidneys 
ureters 
bladder 
urethra 
reproductive organs
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5
Q

What is the function of the kidneys

A

The kidneys:

  • Control blood pressure through production of the renin
  • simulating RBC by secreting erythropoietin
  • filter/ remove waste from body
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6
Q

Where does the abdomen span from

what is it bordered in the back by

what is it bordered on the sides by

A

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

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7
Q

What connects the four large abdominal muscles

A

The linea alba joins the four large abdominal muscles

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8
Q

What are the major blood vessels in the abdomen

What is the peritoneum

A

Aorta
arteries
veins

The peritoneum is a serous membrane that covers and holds the organs in place

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9
Q

What are the functions of the muscles in the abdominal area

2

A

Protect and support digestive system as well as keep in place

Assist in digestion, mastication, swallowing, and poop

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10
Q

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

A

Right lower quadrant
Right upper quadrant
Left upper quadrant
Left lower quadrant

The four quadrants intersect at the umbilicus

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11
Q

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

A

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

  1. Right hypochondriac region
  2. Epigastric region
  3. Left hypochondriac region
  4. Left lumbar region
  5. Umbilical region
  6.  left lumbar region
  7. Right inguinal region
  8. Hypogastric/supra pubic region
  9. Left inguinal region
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12
Q

What is the lowest region of the nine regions

What is the best way to divide the nine regions

  • horizontal down
  • middle vertical down
A

The hypogastric/suprapubic is the lowest region

horizontal down:
Hypochondriac, lumbar, inguinal

vertical down:
Epigastric, umbilical, hypogastric/suprapubic



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13
Q

What is the mechanical process of digestion

What is the chemical process of digestion

A

Mechanical:
Chew and break down food, peristalsis, churning

Chemical:
Break down food through metabolic reactions

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14
Q

Where does absorption of nutrients take place and what is absorbed

A

Obsorption of nutrients takes place in the small and large (colon) intestines,
Absorbed is

  •  water
  • electrolytes
  • vitamins
  • excrete waste Products
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15
Q

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

A

Food that is not absorbed is eliminated within 48 hours

With decreased liver function monitor:

  • AST/ALT
  • alkaline phosphate
  • Billirubin 
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16
Q

What are common Lifespan considerations for your older adults in relation to the abdomen
(2 things)
Production
Mvement

A

decreased saliva production and stomach acid production

Slowed gastric motility/peristalsis
-causing constipation difficulty swallowing chewing absorbing/digesting

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17
Q

What are common lifesman considerations for your pregnant women in relation to the abdomen

Activity
Other
Skin
Baby oushing on causing 
Liftiing
Other 
Other
A
  • decreased ball activity: constipation
  • Linea alba = Linea Negra “pregnancy line” due to hormones 
  • striae
  • stress incontinence (coughing/sneezing)
  • umbilical hernia
  • Pica
  •  heartburn
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18
Q

What kind of assessment is severe dehydration

What signs and symptoms does it cause

Who is dehydration very significant in

A

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

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19
Q 
Give life-threatening situation that need emergency assessments
#1 where is pain
A
  1. Appendicitis
    - stabbing pain RLQ!!!
  2. Peritonitis
  3. Ectopic pregnancy
  4. Strangulated hernia
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20
Q

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 ?

A

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

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21
Q

When asking subjective data for personal history what are general topics you are going to ask about

A

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


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22
Q

What is relevant personal history you need to check for when assessing subjective data

Diseases/issues

A

Any history of Gerd/PUD
IBS/IBD
Ulcerative colitis/Crohn’s
Anemia/thalassemia 

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23
Q

What are relevant family history Risk factors for abdominal assessment

A
  • Colon/gastric CA
  • ulcers?
  • DM
  • alcohol abuse
  • Gerd/IBD
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24
Q

What are our health promotion goals for the abdomen

A

Colo rectal cancer screening

Reduce new cases of ESRD+ HTN
-end stage renal disease

Reduce cirrhosis deaths

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25
Q

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
A

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
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26
Q

What is a primary cause of cirrhosis that we work to reduce cirrhosis deaths in?

A

Primary causes of cirrhosis are due to hepatitis especially alcoholism 

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27
Q

What does the Hemoccult testing assess for

Give another name for the Hemoccult testing

A

Hemoccult testing assess for blood in stool that’s not visibly seen

Hemoccult= guaiac testing

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28
Q

As far as reduction what Are our three main focuses involving the G.I. system

A

Colorectal cancer

Foodborne illnesses

Hepatitis

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29
Q

What are important patient teachings for the prevention of foodborne illnesses

A

(1) Cook food thoroughly
(2) Refrigerate leftovers
(3) have sanitary conditions

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30
Q

How is hep A transmitted and prevented

How is hep B transmitted

How is hep C transmitter

A

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

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31
Q

What measures are taken to protect infants and those exposed to body fluids
In regards to HEP A& B

A

Hep A and hHp B immunizations have been created to protect infants and those exposed body fluids

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32
Q

What is used as a screening/assessment tool for alcoholics asking for treatment

A

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

33
Q

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

A

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 




34
Q

Give common abdominal symptoms

A

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

35
Q

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

A

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

36
Q

What is bulimia harder to distinguish than anorexia nervosa

A

In bulimia: it’s hard to distinguish because the person is at a normal weight

In anorexia: the patient is cachectic

37
Q

What is hematemesis

What is hematemesis commonly known as

What causes hemaemesis

A

Hematemesis is vomiting blood

Hematemesis known as coffee ground emesis)

Due to NSAIDs

38
Q

Give the difference between dysphasia and odynophagia

A

Dysphasia: difficulty swallowing

odynophagia: painful swallowing
- odynophagia feels like food stuck in your throat/esophagus

39
Q

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

A

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

40
Q

What do you want to do if a patient presents to you with incontinence

What types are there of incontinence
(3 types)

A

If patient has incontinence you want to ask what type of incontinence

Tyoes:

  • Stres: Cough/sneeze
  • urgency: sudden
  • total: cannot hold urine 
41
Q

With any renal symptoms what are characteristics of :

BPH
Polyuria
hematuria with pain
Hematuria without pain

A

BPH signs and symptoms:

  • decreased urine strength
  • Nocturia
  • urgency
  • frequency

Poly uria:
-DM

Hematuria with pain: UTI
Hematuria with out. Oain: bladder cancer

42
Q

What kind of pain is kidney/flank pain

A

Kidney/flank pain is pelvic pain

43
Q

What are characteristics ofureteral colic

What are ureteral colic also known as

Woth ureteral colic What do you want to assess for 

A

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

44
Q

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

A

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

45
Q

What Cultural considerations are common among your Jewish

A

Jewish are likely to suffer from ulcerative colitis and Crohn’s disease

46
Q

What cultural consideration is most common among those of Mediterranean decent

What is thalassemia?

A

Those of Mediterranean decent increased chance of Thalassemia

: thalassemia is inherited, Is when the body doesn’t make enough hemoglobin

47
Q

What is the most common among your native Americans

A

Alcoholism leading to malnutrition is most common among Native Americans

48
Q

Amung cultural considerations what is the most common among Asians

A

Gastric (stomach) cancer more common amung asians

49
Q

Give the order in which you would conduct an objective exam On a patient with abDominal issue

Why is palpation last

A

If abdominal issue:

  1. Inspect
  2. Auscultated
  3. Percuss
  4. Palpate

Palpation is last as it may interfere with normal abdominal sounds if done before auscultation and percussion

50
Q

Upon beginning auscultation where do you want to start.

(what is this region called, give its location and why) 

A

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

51
Q

What way do you proceed around the abdomen when using the 4 quadrants

A

When doing abdominal assessments proceed in clockwise directions starting from Illeosecal valve

52
Q

Where do you listen to vascular sounds upon auscultation

A

Vascular sounds heard at the

  • aorta
  • Renal
  • iliac
  • Femoral
53
Q

 among percussion what is the abdomens normal tone

What tone do you hear over organs like the liver

How do you assess CVA


A

Normal percussion tone: tympanic

Percussion tone over Organ (liver): dull

Use indirect percussion to assess CVA

54
Q

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

A

Normal bowel sounds:

  • 5–30 gurgles per minute
  • One sound every 5–15 seconds

Listen to each quadrant for 1minutes



55
Q

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

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

56
Q

What will bowel sounds of an obstruction sound like

A

And obstruction will have hyper active bowel sounds BEFORE obstruction absent AFTER

57
Q

Describe borborygmi and what it means if Auscultated

A

Borborygmi is it loud rushing sound indicative of gastroenteritis

58
Q

How deep is light palpation
How deep is deep palpation

When is it ABSOLUTELY CONTRAINDICATED to palpate a patient and why for each

A

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
59
Q

What is a thrill and where is it typically heard

What are signs and symptoms of an abdominal aortic aneurysm

A

A thrill is a Rushing vibration typically heard in the epigastric region

Enlarged aorta
pulsation +3 cm
Bruit

60
Q

How do you elicit the abdominal reflex
(technique)
(Normal finding)

A

Technique:
stroke the abdomen in all nine quadrants towards the umbilicus

Norm: umbilicus moves to the reflex

61
Q

When is third space fluid collection considered ascites

What are two ways to assess for ascites
Abnirmal findings

A

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
  1. Shifting dullness: percussion of abdomen supine then right then left
    
62
Q

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

Give technique



A 
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

63
Q

What tests observed for appendicitis

What does the rovsing sign test for

What is the technique for the rovsing sign 

What are abnormal findings

A
  • 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 

64
Q

How do patients describe the pain of appendicitis/peritonitis

A

Appendicitis/peritonitis pain often described as pain at the umbilicus that radiates to RLQ especially with cough

65
Q

What does the Murphy’s sign test for

What is the technique for the Murphy sign

Abnormal findings

A

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



66
Q

What does the Pasoas (Iliopsoas muscle test) test for

What is the technique for the iliopsoas muscle test

Abnormal findings

A

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

67
Q

What are two ways you can locate the liver

A
  1. Palpate right mid clavicular with one hand behind the patient’s back
  2. Hooking technique over right costal margin
68
Q

Lifespan considerations for older populations potential alterations

Muscle
Mobility
Liver
Renal

A

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


69
Q

Diagnostic tests

EGD: esophagogastroduodenoscopy

Assesses what

Rules out what

A

EGD= endoscopy

EGD assesses: mucosa of
-esophagus
-duodenum
-stomach

Rules out:
-cancer
 lesions
 ulcers

70
Q

ERCP: endoscopic retrograde cholangiopancreatogrophy

Assess what

Identifies what

A

ERCP assesses:
-ducts draining liver and pancreas

ERCP identifies:
-Identifies and removes gall stones and diagnosis pancreatic cancer

71
Q

What does a CT scan identify

A

CT identifies soft tissue problems

  • enlarged organs
  • Tumors
  • aneurysms +
72
Q

What does an MRI identify

A

Evaluate condition of organs, ducts, blood vessels

🚫 do MRI if pacemaker

73
Q

Why is a colonoscopy done and what does it identify

Recommend age to begin? How often

A

Colonoscopy done to look into colon and rectum to identify polyps, ulcerations, or tumors

Begin : 50 YOA q 3-10 years

74
Q

What is the gray Turner sign

A

Gray Turner sign is red/brown tinge around flanks

75
Q

What does a palpable bladder mean

What does a tender bladder mean

Bladder CA sign

A

Palpable bladder:
Either full or enlarged from underlying mass in bladder/pelvis

Tender bladder:
Tinder bladder= UTI

If you have hematuria without pain =CA

76
Q

What is the function of the oropharynx

What is the function of the esophagus

What is the function of the descending colon

A

Oropharynx: mastication 

Esophagus: propels food into stomach

Descending colon: Further absorption of electrolytes in water, excretion

77
Q

Give nursing diagnosis related to the abdomen

A 
Impaired nutrition
Diarrhea 
constipation 
incontinence 
fluid volume deficit
78
Q

Give nursing outcomes related to the admin

A

Patient will defecate formed stool every one or three days

Patient reports decreased incontinence episodes

79
Q

Give nursing interventions related to the abdomen

A

Teach patient to pace fluids, limit bedtime intake

Admin bulk laxatives per physician order

Health Assessment (20 decks)

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