Exam 3 Flashcards
Abdomen
- Bordered superiorly by the costal margins
- Bordered inferiorly by the symphysis pubis and inguinal canals
- Bordered laterally by the flanks
4 Abdominal Quadrants
- Right upper Quadrant
- Right Lower Quadrant
- Left upper Quadrant
- Left lower Quadrant
Right Upper Quadrant
- Right lobe of the liver
- Gallbladder
- Pylorus
- Duodenum
- Head of the pancreas
- Hepatic flexture of the colon
- Portions of the transverse and ascending colon
Right Lower Quadrant
- Cecum and appendix
- Portion of the ascending colon
Left Upper Quadrant
- Left lobe of the liver
- Spleen
- Stomach
- Body and tail of the pancreas
- Splenic flexture of the colon
- Portions of the transverse and descending colon
Left Lower Quadrant
- Sigmoid colon
- Portion of the descending colon
Abdominal Wall Muscles
- Three muscle layers from back, around flanks, to front:
- External abdominus oblique: Outermost layer
- Internal abdominus oblique: Middle Layer
- Transverse abdominus: Innermost Layer
- Abdominal wall muscles protect internal organs and allow normal compression during functional activities such as coughing, sneezing, urination, defacation, and childbirth.
Internal Anatomy of the Abdomen
-Parietal peritoneum: Lines the abdominal cavity
-Visceral peritoneum: Covers the external surfaces of most abdominal organs
-Different body systems:
Gastrointestinal
Reproductive (female)
Lymphatic
-Urinary
Internal Anatomy: Solid Viscera
- Viscera: Organs that don’t expand, solid
- Liver
- Pancreas
- Spleen
- Adrenal Glands
- Kidneys
- Ovaries
- Uterus
Liver
- Largest solid organ in the body.
- In right costal margin, palpated with both hands, can only feel it if enlarged, assists with GI system, storage of glucose, formation of blood, plasma proteins, and clotting factors, urea synthesis, cholesterol production, bile formation, destruction of rbc, stores iron and vitamins, helps with detoxification of body and blood
Pancreas
- Normally not palpable
- Up and behind stomach, extends from RUQ to LUQ, endocrine gland, assessory organ to help with digestion
Spleen
-only palpate if enlarged, below 9th and 11th ribs, 7cm wide, functions to filter blood of cellular debris, assists with digestion of microorganisms, returns breakdown products to liver, nonpalpable organ, only if enlarged
Kidneys
-10x5cm, located in posterior side of T12-L3, primary functions is filtration and eliminations, sometimes assist with electrolyte control, help with BP, function as endocrine glands by secreting hormones
Uterus and Ovaries
- Uterus: May be palpated above the level of the symphysis pubis in the midline
- Ovaries: Located in RLQ and LLQ.
Internal Anatomy: Hollow Viscera
- stomach
- gallbladder
- small intestine
- colon
- bladder
Stomach
Not usually palpable, located on LUQ, function is to store, churn and digest food
Gallbladder
Not normally palpable, located posterior to liver, 10cm long, functions is to concentrate and store bile that is need to digest fat
Small Intestine
Not normally palpable, 2.5cm wide, 7meters long, function is digesting and absorbing nutrients
Colon
1.4m long, 6cm wide, ascending, transverse, descending, functions is to secrete large amounts of alkaline mucous to lubricate intestines and to neutralize acids that form by intestinal bacteria and absorption of water and waste of products for elimination
Bladder
Located behind pubic bone, functions as temporary receptacle for urine.
May be palpated if it is filled with urine.
Viscera Normally not palpable
Pancreas, spleen, stomach, gallbladder, small intestine
Vascular Structures
Abdominal organs are supplied with arterial blood by abdominal aorta
Aorta branches into right and left iliac arteries
Peptic Ulcers
- Ulcers or open sores
- Located in the lining of the esophagus, stomach, and small intestine when acid eats away the protective mucous covering and erodes the underlying lining of these organs.
- Gastric ulcer if located in the stomach
- Often caused by Helicobacter Pylori (H. pylori)
- Symptoms: burning, worsening pain when stomach is empty, feeling full, nausea, vomiting, chest pain, fatigue, weight loss, black or tarry stools.
Risk Factors for Peptic Ulcer Disease
-Presence of Helicobacter pylori in gastrointestinal tract(Can be controlled)
-Excessive alcohol intake
-Regular use of nonsteroidal anti-inflammatory medications (NSAIDs), as well as bisphosphonates (Can be controlled)
-Smoking cigarettes or chewing tobacco (Can be controlled)
-Serious illness (especially if on respirator)
-Radiation treatments (Can’t be controlled)
-Zollinger–Ellison syndrome (rare condition of a tumor in the pancreas releasing a high level of an acid-producing hormone) (Can’t be controlled)
-Uncontrolled stress (Can’t be controlled)
Client educations for Peptic Ulcer Disease
- Hand hygiene
- Cook food completely
- Use all recommended cautions when taking pain relievers, Taking as low a dose over as short a length of time as possible, take with food.
- Avoid excessive alcohol intake
- Avoid smoking
- Avoid chewing tobacco
- Follow healthcare provider’s instructions and report if their are continuing symptoms, worsening symptoms, or more serious symptoms occur.
Gastroesophageal Reflux Disease (gerd)
- Stomach acid flow back to esophagus
- It irritate the lining of the esophagus
- Esophageal strictures: The ulcers will swell and obstruct causing narrowing of the esophagus.
- Esophageal ulcers
- Symptoms: laryngitis, chronic dry cough, hoarseness, asthma, feeling as if there is a lump in the throat, sudden increase in saliva, bad breath, earahces, and/or chest pain.
Risk Assessment for Gastroesophageal Reflux Disease
- Factors that increase the chances of developing GERD:
- Obesity
- Hiatal hernia
- Pregnancy
- Smoking (weakens esophageal sphincter)
- Dry mouth
- Asthma
- Diabetes
- Delayed stomach emptying
- Connective tissue disorders, such as scleroderma
- Alcohol consumption (weakens esophageal sphincter)
Abdomen Assessment: Current Symptoms
- Abdominal pain
- Factors that precipitate pain or make it worse
- Description and location of pain
- Other symptoms such as nausea, vomiting, diarrhea, constipation, gas, fever, weight loss.
- Recent weight gain or loss
Abdomen Assessment: History
-Past:
-Abdominal surgery, trauma, injury, medications
-Abdominal pain and treatment
-Lab work or gastrointestinal studies
-Family:
Stomach, colon, liver cancer
Abdominal pain, appendicitis, colitis, bleeding, hemorrhoids
Nutritional habits in family
Abdomen Assessment: Lifestyle and Health Problems
- Smoking: Do you smoke, how much?
- Alcohol use: Do you drink, how much and how often?
- Diet: What types of food and how much do you consume daily?
- Antacid
- Medications
- Fluid intake
- Exercise: Do you exercise?
- Stress: What kind of stress do you have in your life?
Abdomen Assessment: Preparing the client
- Empty the bladder.
- Remove clothes and put on a gown.
- Lie supine with the arms folded across the chest or resting by the sides.
- Drape the client.
- Breathe through the mouth; take slow, deep breaths.
Abdoment Assessment: Inspection
- Coloration of the skin: Abdominal skin may be paler.
- Aortic pulsations.
- Peristaltic waves: Normally not seen, may be visible in very thin people.
- Vascularity of abdominal skin: Scattered fine veins may be visible.
- Striae: New striae are pink or bluish, old striae are silvery, white, linear, and uneven stretch marks.
- Scars: Pale, smooth, minimally raised.
- Umbilicus
- abdominal contour,
- abdominal movements when client breathes
- Lesions and rashes.
- Abdominal symmetry.
Assess Abdominal Countour
- Flat
- Rounded
- Scaphoid (may be abnormal)
- Distended/Protuberant (Usually abnormal)
Abdomen Assessment: Ausculation
- Auscultate for Bowel Sounds
- Start in RLQ
- Auscultate clockwise for one minute in each quadrant
- Bowel sounds occur every 5-15 seconds, gargling or clicks
- If you do not hear any sounds you must listen for 5 minutes before you document (or ask someone else to listen)
- Hyperactive bowel sounds referred to as “borborygmus” may also be heard. These are the loud, prolonged gurgles characteristic of one’s “stomach growling.”
Abdominal Assessment: Percussion
- Percussing for tone over the abdomen allows the examiner to hear different sounds over hollow vs solid organs.
- Tympany is heard over most of the abdomen due to the air in the stomach and intestines.
- Dullness is heard over the liver and spleen.
- Do it during a focus assessment
- Tympany- where there is air in inner structure
- Dullness- full organ with no air inside
Abdomen Assessment: Palpation
- Perform light palpation.
- Deeply palpate all quadrants to delineate abdominal organs and detect subtle masses.
- Palpate for masses.
- Palpate the umbilicus and surrounding area for swellings, bulges, or masses.
- Light: 1cm or less
- Deep: 5-6cm
Organ Palpation
- Aorta
- Liver
- Spleen
- Kidneys
- Urinary bladder
- aorta- two fingers, thumb and first finger
- Umbilical- see if you feel masses
- Liver- not palpated usually, on right side below 11th or 12th rib palpate deep and up to patients head (will fell if enlarged)
- Spleen- not usually palpated, have patient lay on right side and palpate with both hands
- Urinary bladder- wont palpate if its empty
Tests for Appendicitis: Rebound Tenderness
- Rebound Tenderness (Blumberg Sign)
- Used to diagnose appendicitis
- Deeply palpate at 90 degrees into abdomen, LLQ, one half way between umbilicus and inferior iliac crest and quickly release pressure.
- Patient will feel pain when you let it go (Sharp, stabbing)
Test for Appendicitis: Psoas sign
- Have patient laying on left side and hyper extend leg -patient will have pain in RLQ when leg is hyperextended
Test for Cholecystitis
-RUQ pain or tenderness
-Murphy sign
-Deeply palpate on RUQ and pain will be when pressure is applied
Pain elicited when pressure is applied under the liver boarder at the right costal margin and client inhales deeply.
Mechanism and Sources of Abdominal Pain
- Types of pain:
- Visceral- hollow organs become distended or contract. (Dull, aching, burning, cramping, or colicky.)
- Parietal-peritoneum is inflamed (appendicitis, peritonitis)
- Referred- distant to places innervated at the same levels. this pain travels from the primary site and becomes highly localized at the distant site.
Abdominal Distention
- Pregnancy (normal)
- Fat: Obesity accounts for most uniformly protuberant abdomens. The abdominal wall is thick, and tympany is the percussion tone elicited. The umbilicus usually appears sunken.
- Feces: Hard stools in the colon appear as a localized distention. Percussion over the area discloses dullness.
- Fibroids and other masses: A large ovarian cyst or fibroid tumor appears as generalized distention in the lower abdomen. The mass displaces bowel, thus the percussion tone over the distended area is dullness, with tympany at the periphery. The umbilicus may be everted.
- Flatus: The abdomen distended with gas may appear as a generalized protuberance (as shown), or it may appear more localized. Tympany is the percussion tone over the area.
- Ascitic fluid: Fluid in the abdomen causes generalized protuberance, bulging flanks, and an everted umbilicus. Percussion reveals dullness over fluid (bottom of abdomen and flanks) and tympany over intestines (top of abdomen).
Abdominal Bulges
- Umbilical Hernia: An umbilical hernia results from the bowel protruding through a weakness in the umbilical ring. This condition occurs more frequently in infants, but also occurs in adults.
- Epigastric Hernia: An epigastric hernia occurs when the bowel protrudes through a weakness in the linea alba. The small bulge appears midline between the xiphoid process and the umbilicus. It may be discovered only on palpation.
- Diastasis Recti: Diastasis recti occurs when the bowel protrudes through a separation between the two rectus abdominis muscles. It appears as a midline ridge. The bulge may appear only when the client raises the head or coughs. The condition is of little significance.
- Incisional Hernia: An incisional hernia occurs when the bowel protrudes through a defect or weakness resulting from a surgical incision. It appears as a bulge near a surgical scar on the abdomen.
Enlarged Abdominal Organs
- Enlarged liver: An enlarged liver (hepatomegaly) is defined as a span greater than 12 cm at the midclavicular line (MCL) and greater than 8 cm at the midsternal line (MSL). An enlarged nontender liver suggests cirrhosis. An enlarged tender liver suggests congestive heart failure, acute hepatitis, or abscess.
- Enlarged nodular liver: An enlarged firm, hard, nodular liver suggests cancer. Other causes may be late cirrhosis or syphilis.
- Liver higher than normal: A liver that is in a higher position than normal span may be caused by an abdominal mass, ascites, or a paralyzed diaphragm.
- Enlarged spleen: An enlarged spleen (splenomegaly) is defined by an area of dullness exceeding 7 cm. When enlarged, the spleen progresses downward and toward the midline.
- Aortic aneurysm: A prominent, laterally pulsating mass above the umbilicus strongly suggests an aortic aneurysm. It is accompanied by a bruit and a wide, bounding pulse.
- Enlarged kidney: An enlarged kidney may be due to a cyst, tumor, or hydronephrosis. It may be differentiated from an enlarged spleen by its smooth rather than sharp edge, the absence of a notch, and tympany on percussion.
- Enlarged gallbladder: An extremely tender, enlarged gallbladder suggests acute cholecystitis. A positive finding is Murphy sign (sharp pain that causes the client to hold the breath).
Older Client: Abdomen
- Have dilated superficial capillaries without a pattern may be seen.
- Move visible to sunlight
- Have acute abdominal conditions as sensitivity of pain decreases
- GI tract problems- take a lot of medications
- Appetite may decrease
- Have dentures or have problems chewing (assess gums)
- Complications with diarrhea, such as fluid volume deficit, dehydration, and electrolyte and acid-base imblances because of a higher fat-to-lean muscle ratio.
- Prone to UTIS because protective bacteria in the urinary tract declines with date.
Structure and Function of the heart
- The size of a clenched fist
- Hollow, muscular organ
- Located in mediastinum
- Four chambers: left atrium and ventricle, right atrium and ventricle
- Two atrioventricular valves
- Two semilunar valves
- Three layers:
- Epicardium: membrane covering the outer surface of the heart.
- Myocardium: The middle layer of the heart, made of cardiac cells
- Endocardium: The inner layer of the heart.
- Surrounded by a sac called the pericardium.
- Precordium: The anterior chest area that overlies the heart and great vessels.
How is blood transported through the heart?
Very Important: The right atrium receives the blood from the body, the atrium sends it to the right ventricle, the ventricle sends it to the lungs by the pulmonary artery to be oxygenated, the oxygenated blood from the lungs returns to the left atrium by the left pulmonary vein, blood comes to the left ventricle and is pumped to the rest of the body.
- The right side of the heart pumps blood to the lungs for gas exchange (Pulmonary circulation)
- The left side of the heart pumps blood to all other parts of the body (Systemic circulation)
