quiz 7 Flashcards
notes from 11.1-11.4
how to calculate an ankle brachial index
higher ankle pressure on the side youre testing, divided by the higher arm pressure
ABI ranges
normal: 1.00 to 1.29
borderline: 0.91 to 0.99
mid to moderate: 0.41 to 0.90
severe: less than 0.40
procedure for ABI
- patient lies supine for five minutes to prepare
- BP cuff on right and left arms and an ankle
- use doppler to measure SBP in right and left arms, and right DP and PT
- then repeat on the other side
ideal position for inspection of abdomen
supine with knees slightly flexed
when assessing dressings
do not displace
- CDI or OTA
visially inspect abdomen for…
skin color, contour, distention, dressings, dehiscence or evisceration
borborygmi
loud, prolonged, gurgles sometimes associated with bowel infection
high pitched tinkling sounds can indicate …
bowel obstruction
paralytic ileus
- no peristalsis
- absent bowel sounds
- happens post surgery or anesthesia
listen for ? minutes if reporting no bowel sounds
five minutes
percussion over stomach or intestines should be
tympany
percussion tells you…
organ position or massess
patient had abd surgery : do you still palpate?
yes
where is an enlarged liver palpated
below right rib margin
abnormal findings
tenderness
masses
hernia
fluid wave
spasms of muscle wall
hematoma
what to ask after surgery or with ileus /bowel obstruction
- are you passing flatus
- do you feel like eating or have hunger pains
components of GI surgery specific assessment
location and size of incision
flatus? (expected to be none 24-48 hours post-op)
N/V?
abd pain or distension
NG tube to suction for decompression
- low intermittent wall suction (LIWS)
- check for low blood Na+ and K+
IV fluids
- TPN after 2-5 days NPO
PEG tube stands for
percutaneous endoscopic gastrostomy tube
if PEG tube is in jejunum…
less volume but continuous flow
(as opposed to bolus feedings)
salum sump
used for suction
deefing tube (dobhoff)
- used for tube feeding
- ND or NJ
check residuals…
only if ordered
hold TF if…
residual is 250mL
colostomy/ ileostomy
- surgery to remove part of the intestine and bring “cuffed” end out through abd wall
- creates stoma
- difference in stool based on location
paralytic ileus results from…
surgery
ruptured appendicitis
S&S of mechanical obstruction
- high pitched tinkling sound over bowels
- hyperactive BS/visible peristalsis THEN absent bowel sounds
- N/V increasingly more projectile
- possible emesis w feces
- abd pain, cramping, and distention
if emesis w feces…
- pt will need surgery
- make pt NPO
GERD
gastro esophageal reflux disease
- reflux of gastric secretions up into esophagus
- d/t weak lower esophageal sphincter (LES)
S&S of GERD
- heartburn
- acidic sour taste
- hoarseness and chronic cough
most classic symptom of GERD
dry, unproductive chronic cough
tx: PPI and H2 blockers
hiatal hernia
part of the stomach passed through the hiatus in the diaph. up into the chest
S&S of hiatal hernia
epigastric pain relieved by sitting upright
- dysphagia– difficulty swallowing
- may be asymptomatic
GI bleeding indicated by …
bright red blood in stool or emesis
hematochezia
recent bleeding in the stool
sometimes called currant jelly stools by lay people
hematemesis
recent bleeding in vomit
coffee ground emesis
old blood
melena
black, tarry stool from old blood
occult blood
not visible
- guaiac test
kehr sign
referred shoulder pain if blood in peritoneal cavity irritates diaphragm
lab sign for anemia
decreasing H&H
severe GI bleeding…
hypovolemia
- BP plummets
- dizzy and weak
- diaphoresis and tachycardia
lower GI bleed often d/t
colon cancer
signs of appendicitis
pain
low grade fever
mcburney sign
pain moves from periumbilical to RLQ
guarding
anorexia
rupture
rebound tenderness (if the rupture causes peritonitis)
mcburney sign
intense pain in RLQ
1/3 the distance from right iliac spine toward the belly button
rebound tenderness is caused by…
peritonitis caused by a ruptured appendix
peritonitis
life threatening infection of membrane lining abdomen caused by rupture of bowel or other organs
