Unit 3: Chp 55: Assessment of Gastrointestinal Function Flashcards
Health History: Questions regarding dietary practices
- Who prepares the food in your home?
- Do you fast for cultural or religious reasons?
- Do you have any dietary restrictions d/t religious or cultural practices?
- How often do you eat?
- What do you consider to be healthy or unhealthy foods?
- Do you use food to treat illnesses?
- Any food intolerances?
- Any food allergies?
Health History: Questions regarding Nutrition
- Do you take vitamins?
- Any hx of vitamin deficiencies?
- Completion of a food frequency questionnaire
- Completion of nutritional screening tool (MUST)
Health History: Questions regarding Oral Health
- Do you see a dentist?; How often per year?
- Do you have a hx of dental caries or cavities?
- Do you wear dentures?
- Do you have gum disease?
- Have you been treated for oral candidiasis or oral cancer?
- Do you have difficulty swallowing or suffer w/ chronic hoarseness?
Health History: Questions regarding Preventative health
- what are your exercise habits?
- have you had Hepatitis vaccines?
- have you had a colonoscopy or sigmoidoscopy?
- what were the results?
Health History: Questions regarding weight changes?
- have you had any unexplained weight loss or weight gain?
- do you diet frequently?
- any binging or purging?
- do you ever make yourself vomit?
- any hematemesis (blood in emesis)/ Hemoptysis (blood in sputum)
- calculate BMI
Health History: Questions regarding Appetite changes
- have you had increased hunger or thirst?
- any early feeling of fullness?
Health History: Questions regarding Stool changes
- how often do you have a bowel movement?
- when was your last bowel movement?
- have you noticed any changes in color, consistency, or odor?
- have you noticed any bright red blood?
- have you noticed undigested food?
- any laxative use?
- frequent flatus?
Health history: Questions regarding Pain
- where is the pain?
- how often do you have pain?
- when do you have pain?
- what have you done to relieve the pain?
- what are the characteristics of your pain?
- do you experience pain before or after eating meals?
- do you experience pain w/ defecation?
anorexia
loss of appetite
Hematochezia
bright blood in the stool
Melena
black, tarry stool
What does the physical assessment include?
>head-to-toe assessment >anthropometric measurements: -height -weight -BMI -waist circumference -body composition -skinfold measurements -circumference measurements
Specific Diagnostic Studies
- Serum albumin
- Prealbumin
- Transferrin
Serum Albumin
- 4 to 5.1 g/dL
- levels less than 3.5 = altered nutritional status; increases morbidity and mortality
Prealbumin
12 to 42 mg/dL
- more accurate indicator of plasma proteins when compared w/ albumin
- decreased levels associated w/ increased morbidity and mortality
Transferrin
215 to 365 mg/dL in males
250 to 350 mg/dL in females
-important in nutritional assessment b/c of transferrin’s role in iron binding and transport
-decreased levels associated w/ infection, kidney disease, hepatic damage, and indicative of insufficient protein in diet in patients w/ malnourishment
Social History Questions to ask Upon Assessment
- do you smoke?
- do you use street drugs?
- do you use OTC medications?
- do you use herbals?
- do you drink alcohol?
- recent antibiotic use?
- any recent international travel?
Medical History questions to assess the GI system
- do you have a hx of previous heart attacks, chest pain? Parkinson’s disease, sickle cell disease? Sjogren’s syndrome?
- do you have a hx of diabetes, multiple sclerosis? Crohn’s disease? Irritable bowel disorder? Gastroesophageal reflux disease (GERD)?
- do you have a hx of anorexia nervosa? bulimia? depression? familial adenomatous polyposis? celiac disease?
Surgical hx questions to assess the GI system
any hx of previous abdominal surgeries
Eructation
belching
Physical Examination Includes?
- direct assessment of oral cavity
- direct assessment of skin
- indirect assessment of the underlying structures: intestinal tract, liver, kidney, spleen, and abdominal arteries
What should you do before proceeding with the actual physical examination?
- consider information collected during the health hx
- individual preferences, along w/ religious, cultural, or geriatric considerations may require the nurse to alter the approach to the examination
- some people, base on cultural or religious reasons, are uncomfortable w/ exposing the abdominal area or are sensitive to touch, which can lead to contraction of the underlying musculature in the abdomen, giving the false appearance of abdominal rigidity
- in assessing the older adult, important to recognize age-related changes to GI system
- clearly explain all aspects of the examination and provide the patient a private and comfortable environment
Proper position for best results of a physical assessment of abdomen
- supine
- arms relaxed at the sides
- knees bent in order to promote relaxation of the abdomen
Correct Order of the Physical Assessment
- Inspection
- Auscultation
- Percussion
- Palpation