Gastrointestinal and Urinary Assessment Flashcards
Review of Systems: Esophageal
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
Abdomen
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)
Intestinal
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
Rectum
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
Past medical history
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
NSAIDS
Cause GI problems IBprophin, motrin, advil, asprin, bear, medform, causes peptic ulcers and GI bleeds
Appendicitis
feces stuck, bacteria brewing, appendix inflammed. Inflammation of peritonieum can rupture= bacteria and feces in body cavity.
diverticulitis
little pouches, something lodged (feces, nuts) in there & infectious process going on
Hiatel hernia
Stomach is located below the diaphragm, get reflux, hernia has moved up through the diaphragm, this is the hernia.
Signs of Distress
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.
Gastrointestinal: identify/inspet
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
Stool Characteristics
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
stool characteristics
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.
Inspection of abdomen
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
Auscultation
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
Auscultation of bowel sounds: Normal, Hypoactive, and Hyperactive, mechanical
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
Auscultation of Bowel sounds: Absent, Borborygmi
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.
Light Palpation Techniques
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
Light Palpation x4 quadrants
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
Palpation Light: Normal, Abnormal
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
Abdominal Inspection, symmetry, umbilicus, abdominal movt.
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)
auscultation for bruits
Auscultate with bell of stethoscope
Aorta
Percussion: Percuss 4 quadrants
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
Specialized Testing: Shifting dullness(ascites test)
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
