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Health Assessment > Gastrointestinal and Urinary Assessment > Flashcards

Gastrointestinal and Urinary Assessment Flashcards

1
Q

Review of Systems: Esophageal

A

Esophageal
Epigastric pain/distress:9 quadrants, use middle: Epigastric, umbilical, hypogastric or suprapubic
Listed under GI
Reflux after eating-Chest pain up higher, but if you have an ulcer it’s lower. stomach acid
Reflux when bending over-increase abdominal pressure
Reflux when lying down-educate pt. to stay upright 2 hours after eating. don’t eat acidic foods, put bed at angle when lying down. Smoking and drinking dec. lower esophageal reflux. don’t eat right before bed.
Frequent heartburn
Swallowing problems
Dysphagia-(swallowing problemscancers or other problems, long term reflux can cause this, can get barritis esophagitis a cancer of the esophagus.
Hematemesis
Frank blood

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2
Q

Abdomen

A 
Abdomen
Abdominal pain-cramping
Abdominal pain-sharp-Peritineum; around entire cavity-inflammation of this get pin-point pain sharp.
Cramping in intestines: IBS
Nausea- 
Vomiting-green? bile
Emesis characteristics
Hematemesis
Coffee ground-indicitive of blood that goes into the stomach changes it and makes it that consistency.(GI bleed)
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3
Q

Intestinal

A

Occasional diarrhea
Frequent diarrhea
Explosive diarrhea-food intolerance, infectious cause
Diarrhea & Constipation: IBS & inflammatory bowel: Crohns & ulcerative colitus(bloody diarrhea)
Occasional constipation
Frequent constipation
Bloating
Frequent belching-peptic ulcer, gall bladder-food intolerance
Frequent flatulence-celiac disease-food intolerance
Hematochezia -bright red blood
Black tarry stools (Melena)-do you take iron or pepto bismal(bismuth) What other medication are they on?
Alcoholics will end up w/ulcers

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4
Q

Rectum

A

Irritation
Rectal itching-hemroids, parasites
Rectal trauma
Frank blood-hemroids, tears
Rectal Screening-occult blood means you can’t see it w/your eyes. when screening it it turns blue, means the presence of blood.
-always work up blood whether it is frank blood, or brown, or hematachazia, or occult

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5
Q

Past medical history

A 
Past Medical History
Pregnancy status
Medications
Abdominal surgery or trauma
GI/Rectal problems
GI bleed, hepatitis, Crohn’s disease, ulcerative colitis, colon cancer, rectal cancer, appendicitis, diverticulitis, liver disease, pancreatitis, GERD, hiatal hernia, PUD
Family History:
Colorectal cancer, alcoholism, polyps, chronic inflammatory bowel disease
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6
Q

NSAIDS

A

Cause GI problems IBprophin, motrin, advil, asprin, bear, medform, causes peptic ulcers and GI bleeds

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7
Q

Appendicitis

A

feces stuck, bacteria brewing, appendix inflammed. Inflammation of peritonieum can rupture= bacteria and feces in body cavity.

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8
Q

diverticulitis

A

little pouches, something lodged (feces, nuts) in there & infectious process going on

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9
Q

Hiatel hernia

A

Stomach is located below the diaphragm, get reflux, hernia has moved up through the diaphragm, this is the hernia.

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10
Q

Signs of Distress

A

Signs of Distress
Body Position-slumped over, gaurding, in a ball position dec. abdominal pressure. Kidney stones(gall stones):collicky pain, can’t get comfortable walk around or rock.
Severe pain- peritonitis pt. stays still doesn’t move(phone triage ask pt to jump, sign of peritonitis if they can’t jump)
Etc.

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11
Q

Gastrointestinal: identify/inspet

A

Date of last bowel movement
Continence of bowel
Continent(hold and control), incontinent, occasionally incontinent
Presence of ostomy(bringing the intestine to the level of the skin)
Characteristics of stool(take sample if there is abnormality)
Firm, loose, watery, hard, brown, black, green, gray, yellow, tarry, tan, rusty, blood-streaked, frank blood, foul odor

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12
Q

Stool Characteristics

A 
Bright red blood in stool (Hematochezia)
On surface- Rectal bleeding
Mixed in feces-Possible blood from colon
Occult blood
Could suggest carcinoma, GI bleed, diverticulitis, colitis
Black tarry stool (Melena)
GI bleed
Non-tarry black stool with Iron or bismuth preparations
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13
Q

stool characteristics

A

Jelly-like mucus mixed in stool
Inflammation
Gray, tan stool
Absent bile pigment (e.g. obstructive jaundice)
Pale yellow, greasy stool
Increased fat content (steatorrhea), gas, or malabsorption syndrome.

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14
Q

Inspection of abdomen

A 
Contour
Flat
Scaphoid/Concave
Rounded
Protuberant/Distended
Distention causes:
Obesity, air/gas, ascites, ovarian cyst, uterine fibroids, pregnancy, feces, tumor
 -look at contours from 2 angles
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15
Q

Auscultation

A

Inspect first, Auscultate, percuss, then palpate
Auscultate all 4 quadrants
Listen to bowel sounds using diaphragm of stethoscope (high pitch).
Warm stethoscope
Begin in right lower quadrant(illeocecal valve is noisy) and move clockwise to all 4 quadrants. Wait long enough to determine if bowel sounds are hyper or hypo active. They are high pitched sounds (tinkers) (bowel sounds resonate really well) listen with diaphragm,
Temporarily turn off GI tubes connected to suction

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16
Q

Auscultation of bowel sounds: Normal, Hypoactive, and Hyperactive, mechanical

A

Normal/Active x 4 quads
high pitched gurgling noise. Approx 5-35 sounds per minute, or at least 1 every 5-15 seconds.
Hypoactive/sluggish
Often soft and widespread. Less than 5 BS per minute.
Post operatively following general anesthesia, pain medications, immobility.
Hyperactive
Loud, gurgling, frequent sounds. Greater than 35 BS a minute.
Inflammation of bowel, anxiety, diarrhea, bleeding, excessive ingestion of laxatives, rxn of intestines to certain foods, early bowel obstruction
Mechanical bowel obstruction: absent bowel sounds if there is an obstruction downstream, but upstream is hyperactive

17
Q

Auscultation of Bowel sounds: Absent, Borborygmi

A

Absent/Not heard
No bowel sounds heard. Must listen for 1 minute in each quad(4 min total) before concluding that bowel sounds are absent
Late stage bowel obstruction, paralytic ileus, peritonitis
Other (describe in notes) not mechanical is a paralytic illeus after surgery pain issues, “have you been able to pass gass, have a bowel movt.?” gas distention.
Borborygmi – Loud stomach growling, rumbling sound produced by movement of gas in stomach and intestines. Heard with or without stethoscope, has to do with paraystalsis, does not mean that you are hungry.

18
Q

Light Palpation Techniques

A

Palpation techniques:
Have patient:
Lie in supine position with arms to the side or laying across chest
Bend knees(dec. inter abdominal pressure) if not soft or need to perform deep palpation
Warm hands
Palpate painful areas last
Distract patient if necessary
Begin palpation with patient’s hand under yours if patient is ticklish, then slip your hand underneath directly

19
Q

Light Palpation x4 quadrants

A

Light Palpation x 4 quadrants
Press fingertips gently into abdominal wall, approx ½ inch
Use one hand approach’
Watch patient’s face for signs of pain

20
Q

Palpation Light: Normal, Abnormal

A 
Normal
Soft to palpation
Non-tender to palpation
Abnormal
Firm to palpation
Tender to light palpation
RUQ, LUQ, RLQ, LLQ
Documentation:Epigastric, periumbilical, generalized
Guarding to palpation-pain
Rigid to palpation-Peritonitus
 -soft to firm is still normal
make sure pt is relaxed
21
Q

Abdominal Inspection, symmetry, umbilicus, abdominal movt.

A

Symmetry
Bulges(gas,fluid,abdominal hernia=bowel pushes through when inc. inter abdominal pressure), masses, asymmetric shape
Umbilicus-have the pt. sit up to inc. abdominal pressure look for belly button to pop
Color, placement, inflammation
Everted- Ascites, pregnancy, mass, hernia
Sunken- Obesity
Bluish- Cullin’s sign indicator of
intraabdominal bleeding
Abdominal movement
Pulsations or movement
-tissues should be pink and soft, if it becomes cyanotic or necrotic you have clamping down on tissues–>ischemia–>tissue death–>see in kids(blue around belly button inter abdominal bleeding)

22
Q

auscultation for bruits

A

Auscultate with bell of stethoscope
Aorta

23
Q

Percussion: Percuss 4 quadrants

A

Performed to detect fluid, gaseous distention, and masses, and to assess position and size of liver and spleen.
Percuss in all 4 quads for tympany and dullness
Dull in areas with mass, enlarged organ, bowel content, fluid

24
Q

Specialized Testing: Shifting dullness(ascites test)

A

Testing for shifting dullness
Map borders between tympany and dullness. Ask patient to roll to side. Percuss and mark borders again. In ascites dullness shifts to more dependant side

25
Q

Deep palpation

A

Deep Palpation
Use two hand approach & press approx 1-3 inches.
Assess masses, tenderness, and organ enlargement.
Masses: Note location, size, shape, consistency, tenderness, pulsation.
Never over surgical incision, extremely tender organs, or pulsatile mass

26
Q

chirotic liver

A

bumpy and nodular

27
Q

Specialized Test: Murphy’s Sign

A

Ask patient to take deep breath while palpating RUQ under costal margin
Positive- When patient winces in pain or stops inspiring
Presence of Cholycytitis-inflammation of gallbladder
-liver comes down when they breathe

28
Q

Specialized Test Rebound Tenderness & Rovsing’s

A

Rebound Tenderness (Blumberg sign)-apendicitis or peritinitis
Positive-Pain in RLQ after removing hand pressure quickly in RLQ
-both you are going to get a vibriation of the peritneum
Rovsing’s Sign
Positive- Pain in RLQ after removing hand pressure quickly in LLQ

29
Q

Specialized Test:Psoas & Obturator

A

Psoas sign- Pain with flexion of the right leg at the hip-Appendicitis
Obturator sign: Pain with rotation of the right leg internally at the hip-RLQ appendicitis

30
Q

Rectum/Anus Inspection
Rectal prolapse
Lesions

A

Rectal Prolapse
Lesions
Redness/rashes
Hemorrhoids-external and internal hemroids
Anal fissures-will channel, chemotherapy is a common time people develop this, opening of the skin or another cavity.
Anal fistula-tears, impaired immune system becomes a problem
Abscess-pocket of infection
Other:
Excoriation- people scratch b/c or hemroids
STIs-in rectal area
Pilonidal cyst or sinus-source of infection, sinus tract source

31
Q

Review of Systems
Urine retention , No urinary incontinence
Occasional incontinence,Frequent incontinence, Bladder distention, Other, Hematuria, Suprapubic pain, Flank pain
Pain on urination, Burning on urination,Urgency,Frequency, Night wetting, Hesitancy, Dysuria, Oligura, Nocturia, Pyuria

A

dysuria-painful urination-

  • all of these are symptoms of UTI
  • could be considered frank blood or occult blood
  • hesitancy & lack of flow( benign prostate hypertrophy BPH difficult to start a stream) weak stream.
  • Pyuria-pus in urine (WBC’s)
  • Kidney infection will have flank pain and blood in urine
  • Bladder infection subrapubic pain
32
Q

Assess Urination mode

A 
Voiding
Foley catheter to gravity drain
Straight catheter by self/family
Straight catheter by nursing staff
Urinary diversion-bringing bladder to skin
Anuric-absence of urine
33
Q 
Urine Color
Yellow, straw-colored
Pale yellow
Dark yellow
Amber 
Dark  brown
Green-brown
Orange-red
Orange-brown
Red-brown
Frank blood
A
  • dark brown-kidney problems
  • orange-peridium
  • redness-blood
  • dark yellow-more concentrated
34
Q

Clarity or urine

A 
Clear
Cloudy-infection
Precipitates, sediment visible-protiens(kidney disease)infection
Clots visible
Milky
35
Q

Urine odor

A 
No odor
Unusual odor
Foul odor
Ammonia odor-incontinent
Sweet odor-diabetic DKA(diabetic ketone acidosis) those on adkines diet.
36
Q

Additional assessments: Dialysis

A 
Dialysis
Peritoneal dialysis
Day of last treatment
Day of next treatment
Renal dialysis
Day of last treatment
Day of next treatment
37
Q

Additional assessments: Percussion of Flank for the Kidney

A

Assessing for costovertebral angle tenderness (CVA)suggestive of kidney infection
Normal= non-tender
Tenderness occurs in acute infection (pylonephritis)

38
Q

Additional Assessments: routinely check the bladder for distention if:

A 
Unable to void
Incontinent
Indwelling catheter is not draining well
Bladder non-palpable without 
tenderness

Health Assessment (4 decks)

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