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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
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
26
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 
27
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
28
As far as reduction what Are our three main focuses involving the G.I. system
Colorectal cancer Foodborne illnesses Hepatitis
29
What are important patient teachings for the prevention of foodborne illnesses
(1) Cook food thoroughly (2) Refrigerate leftovers (3) have sanitary conditions
30
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
31
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
32
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
33
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   
34
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
35
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
36
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
37
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
38
Give the difference between dysphasia and odynophagia
Dysphasia: difficulty swallowing odynophagia: painful swallowing - odynophagia feels like food stuck in your throat/esophagus
39
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
40
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 
41
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
42
What kind of pain is kidney/flank pain
Kidney/flank pain is pelvic pain
43
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
44
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
45
What Cultural considerations are common among your Jewish
Jewish are likely to suffer from ulcerative colitis and Crohn’s disease
46
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
47
What is the most common among your native Americans
Alcoholism leading to malnutrition is most common among Native Americans
48
Amung cultural considerations what is the most common among Asians
Gastric (stomach) cancer more common amung asians
49
Give the order in which you would conduct an objective exam On a patient with abDominal issue Why is palpation last
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
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
51
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
52
Where do you listen to vascular sounds upon auscultation
Vascular sounds heard at the - aorta - Renal - iliac - Femoral
53
 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
54
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 
55
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
56
What will bowel sounds of an obstruction sound like
And obstruction will have hyper active bowel sounds BEFORE obstruction absent AFTER
57
Describe borborygmi and what it means if Auscultated
Borborygmi is it loud rushing sound indicative of gastroenteritis
58
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
59
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
60
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
61
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 ``` 2. Shifting dullness: percussion of abdomen supine then right then left 
62
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
63
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 
64
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
65
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 
66
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
67
What are two ways you can locate the liver
1. Palpate right mid clavicular with one hand behind the patient’s back 2. Hooking technique over right costal margin
68
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 
69
Diagnostic tests EGD: esophagogastroduodenoscopy Assesses what Rules out what
EGD= endoscopy EGD assesses: mucosa of -esophagus -duodenum -stomach ``` Rules out: -cancer lesions ulcers  ```
70
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
71
What does a CT scan identify
CT identifies soft tissue problems - enlarged organs - Tumors - aneurysms +
72
What does an MRI identify
Evaluate condition of organs, ducts, blood vessels 🚫 do MRI if pacemaker
73
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
74
What is the gray Turner sign
Gray Turner sign is red/brown tinge around flanks
75
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
76
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
77
Give nursing diagnosis related to the abdomen
``` Impaired nutrition Diarrhea constipation incontinence fluid volume deficit ```
78
Give nursing outcomes related to the admin
Patient will defecate formed stool every one or three days Patient reports decreased incontinence episodes
79
Give nursing interventions related to the abdomen
Teach patient to pace fluids, limit bedtime intake  Admin bulk laxatives per physician order

Health Assessment (20 decks)

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