Unit 8 - Abdominal and NG Flashcards
What are the boarders of the abdominal cavity?
Diaphragm to pelvis (top to down)
Lower rib cage, abdominal muscles and vertebral column (front to back)
What muscles make up the abdomen?
External oblique, internal oblique, rectus abdominus, transversus
Collagen tissue separating the right and left abdomen is called?
Linea Alba - visible in pregnant woman.
Inside the abdominal cavity, all the internal organs are called _________ ?
Viscera
The Liver, pancreas, spleen, and kidneys are an example of what type of viscera?
Solid viscera as they maintain consistent shape.
The stomach, gallbladder, small intestine are examples of what type of viscera?
Hollow viscera as the shape depends on its contents.
What organs will you find in the right upper quadrant?
Liver, Gallbladder, Duodenum, Head of pancreas, right kidney and adrenal gland, hepatic flexure of colon, parts of ascending and transverse colon.
What organs will you find in the right lower quadrant?
Cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord
What organs will you find in the left upper quadrant?
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, parts of transverse and descending colon
What organs will you find in the left lower quadrant?
part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord.
What is considered a normal BMI ?
18.5 - 24.9 Normal weight
What is the purpose of a waist to hip ratio?
Reflects body fat distribution as an indicator of health risk.
A waist circumference exceeding ______ in women and ______ in men increases risk of cardiovascular disease,
88cm women
102cm men
What is some subjective history collected when assessing the abdomen?
Appetite, food intolerance, abdominal pain
dysphagia, nausea/vomiting, bowel habits
Past abdominal hx, medications, diseases
Pregnancy, surgery, gallbladder attacks, appendix
24 hour Nutritional assessment, alcohol and tobacco use
What is some considerations that should be made when preparing the patient for the abdominal assessment?
Comfort - laying flat, pillow under legs, pillow under head, warm up hands, assess ticklish
Proper lighting, proper draping and exposure.
In inspection of the abdomen, what are we looking at?
Contour - normally flat or rounded Symmetry Umbilicus - midline? Skin - striae, scars Pulsation or movement (aortic aneurism?) Hair distribution - triangle/diamond? Demeanour - skill, restless?
To assess symmetry and contour, where would you place yourself to inspect the abdomen?
You want to be standing at their feet to ensure that they look the same on both sides.
Contour you would be looking on the side (eyes level with abdomen) to assess what it looks like (normally flat or slightly rounded)
Where do you start to listen to bowel sounds and why?
RLQ, at the ileocecal valve because sounds are normally always present here
True or False
If a patient is experiencing pain, you are to assess all other quadrants and assess the one with pain last.
True
What are you listening for during auscultation of bowel sounds?
High pitched gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per min. Do not bother counting them, use your judgement.
Absent bowel sounds only have none heard for 5 mins.
What sites are you listening to for vascular sounds?
Aorta, Left renal artery, iliac artery, femoral artery.
You do not want to hear anything, listening for bruits.
What would you be hearing during percussion of the abdomen and why?
Tympany should be dominate because air in the intestines rises to the surface when the patient is supine.
You may hear dullness due to the liver in the RUQ
If you identify a mass, what should you be noting?
Location, size, shape, consistency, surface, mobility, pulsatility, tenderness
What are normally palpable structures due to deep palpation?
Liver, Spleen, Kidney’s, Aorta
What is the 6 F’s of abdominal distension?
Fat Flatus Fluid Feces Fetus Fibroid
What hepatitis is transmitted via the fecal-oral route?
Hepatitis A & E
What hepatitis is transmitted via the blood or body fluids?
Hepatitis B (blood and body fluid), C (Blood), D (Blood serum)
What is an abnormal fluid build up in the abdominal cavity?
Ascites
What is cholecystitis?
Inflammation of the gallbladder
What is cholelithiasis?
Gallstones
What are 3 reasons as to why a nasogastric tube would be needed?
Decompression (attached to suction)
Feeding
Lavage or irrigation
What is the purpose of decompression via NG tube?
Remove fluid and gas from the GI tract
Obtain a specimen of gastric contents
Treat gastric immobility and bowel obstruction
What is the purpose of feeding via NG tube?
Patient can digest but not ingest food
What is the purpose of lavage or irrigation via NG tube?
Stomach pumping
Remove ingested drug overdose or poisoning
Flush if active bleeding
What are some contraindications to placement of NG tube?
If pt has or is suspected to have a basal skill fracture or cribriform plate fracture
There is danger of perforation (esophageal surgery, gastric surgery)
Facial fractures or recent surgery to ear, nose and throat, jaw surgery/fractures
Severe coagulopathies (check INR/PTT, HGB and platelets prior to procedure)
What supplies do you need prior to placing an NG tube?
Gloves, mask, kidney basin, tube, lube, tape, pin, elastic, marker, pen, glass of water with straw
What is the order of events to ensure you can to insert an NG tube?
Doctors oder Ensure patency of nares bowel sounds gag/cough reflex intact Explain procedure (establish a signal) Gather all equipment
When aspirating gastric juices for placement of NG tube, you get a pH of 6. Would this be appropriate to provide that placement is correct?
NO. pH of 6 or over would indicate insertion in the respiratory tract has occurred. SHR says pH of 5.5 or below is confirmation of placement and fluid should bee green/brownish/orange.
What should you do to properly maintain and NG tube?
Anchoring tube Keep HOB elevate 30 degrees Pin to gown confirm placement q4h mouthcare - often NPA Nares care Bowel sounds
How do you remove an NG appropriately?
Disconnect from suctioning of feeding Remove fixation devices Pt breathe deeply, then hold Kink/clamp tubing and remove steadily and smoothly Mouth care verify tube is intact Document
What may be some complications that can happen due to NG tube?
Aspiration (choking) Displacement (intentional or not) Pneumonia Clogging Irritation of nares and nasal mucosa N&V, diarrhea (tolerance of feeds)
A bolus or gravity is what type of enteral nutrition?
Intermitten
A gravity or pump is what type of enteral nutrition?
Continuous
What are some types of formula that could be given for NG feedings?
Polymeric
Modular
Elemental
Speciality
What is hepatomegaly ?
Abnormal enlargement of liver
What does scaphoid contour mean?
Abnormally sunken abdominal wall, as with malnutrition or underweight.
What is pyrosis?
Heartburn; burning sensation in upper abdomen, due to reflux or gastric acid.
Select the sequence of techniques used during an examination of the abdomen.
A) percussion, inspection, palpation, auscultation
B) inspection palpation, percussion, auscultation
C) inspection, auscultation, percussion, palpation
D) auscultation, inspection, palpation, percussion
C) inspection, auscultation, percussion, palpation
Which of the following may be noted through inspection of the abdomen?
A) fluid waves and abdominal contour
B) umbilical eversion and Murphy’s sign
C) venous pattern, peristaltic waves, and abdominal contour
D) Peritoneal irritation, general tympany, peristaltic waves
C) venous pattern, peristaltic waves, and abdominal contour
Right upper quadrant tenderness may indicate pathology in the: A) liver, pancreas, or gallbladder B) liver and stomach C) sigmoid colon, spleen, or rectum D) appendix or ileocecal valve
A) liver, pancreas, or gallbladder
Hyperactive bowel sounds are: A) high-pitched B) rushing C) tinkling D) all of the above
D) all of the above
The absence of bowel sounds is established after listening for: A) 1 full minute B) 3 full minutes C) 5 full minutes D) none of the above
C) 5 full minutes
Auscultation of the abdomen may reveal bruits of which arteries?
A) aortic, renal, iliac, and femoral
B) jugular, aortic, carotid, and femoral
C) pulmonic, aortic, and portal
D) renal, iliac, internal jugular, and basilic
A) aortic, renal, iliac, and femoral
The range of normal liver span in the right midclavicular line in the adult is: A) 2 - 6 cm B) 4-8cm C) 8-14cm D) 6-12 cm
D) 6-12 cm
The left upper quadrant contains the: A) liver B) appendix C) left ovary D) spleen
D) spleen
Striae, which occur when the elastic fibres in the reticular lawyer of the skin are broken following rapid or prolonged stretching, have a distinct colour when of the long duration. The colour is: A) Pink B) blue C) purple-blue D) silvery white
D) silvery white
Auscultation of the abdomen is begun in the right lower quadrant because:
A) bowel sounds are always normally present here
B) peristalsis through the descending colon is usually active
C) this is the location of the pyloric sphincter
D) vascular sounds are best heard in the area.
A) bowel sounds are always normally present here
A dull percussion note forward of the left midaxillary line is:
A) normal, an expected finding during splenic percussion
B) expected between the eighth and twelfth ribs
C) found if the examination follows a large meal
D) indicative of splenic enlargement
D) indicative of splenic enlargement
Shifting dullness is a test for: A) Ascites B) splenic enlargement C) inflammation of the kidney D) hepatomegaly
A) Ascites
Tenderness during abdominal palpation is expected when palpating: A) the liver edge B) the spleen C) the sigmoid colour D) the kidneys
C) the sigmoid colour
Murphy’s sign is best described as:
A) the pain felt when the hand of the examiner is rapidly removed from an inflamed appendix
B) pain felt when taking a deep breath when the examiner’s fingers are on the approximate location of the inflamed gallbladder
C) a sharp pain felt by the patient when one hand of the examiner is used to thump the other at the costovertebral angle.
D) not a valid examination technique.
B) pain felt when taking a deep breath when the examiner’s fingers are on the approximate location of the inflamed gallbladder
