week 2 : Seminar ( Nursing assesments ) Flashcards
alteration in digestive function
a. difficulty swallowing
b. accumulation of fluid in the peritoneal cavity
c.loss of appetite
d. vomiting blood
e. dark, tarry stools
f. frank bleeding from the rectum
match the description with the term
dysphagia
ascites
anorexia
hematemesis
melena
hematochezia
The digestive system breaks down _____ prepares it for uptake by the body’s ____ absorbs _____ and eliminates _____
ingested
cells
fluids
waste
Subjective assessment –> general health history
what kind of questions are we asking ?
past medical history
- any current or past diagnoses ?
medications ?
- any current meds for gi system ?
-any current meds with s/e that can affect the GI system
obstetrical history ?
surgical history ? ( ex: colectomy, hemicolectomy, appendectomy, cholecystomy, gastrectomy, splenectomy )
significant fam history
Subjective assessment –> general health history
smoking/etoch
activity level/lifestyle
- active or sedentary ? nutritional status ?
toxin exposure ( occupational )
recent travel ?
Subjective Assessment→GENERAL HEALTH HISTORY
HPI ( history of presenting illness ) : OPQRSTUV
- pain
- n and v
- changes in BMS ( diarrhea or constipation )
- change in appetite
-weight loss
- flatulence
- distension
- gi bleeding
-allergies/food intolerances
-time of last food/drink
- date of last bm
health history : abdominal pain
what do you have to ask ?
abdominal pain ( don’t forget to use the OPQRSTUV questions )
desriptors : arching, cramping, burning, sharp, stabbing, constant, intermittent, waves, pulsation, surface, deep with movement, at rest, with touch, pressure ( light, deep ) with eating, between meals, time of day, lying down with meds, etc, associated symptoms
abdominal rigidity
objective –> assessment : ( Gi-system )
how to you do a comprehensive
comprehensive:
- on admission
- health history
- initial head to toe ( vital signs, serves as baseline )
goal : establish baseline Gi functioning
objective- assessment –>physical assessment (Gi system ) focused
PT has a GI complaint
pt has a symptom related gi functioning
goal : is to obtain information to guide treatment
just assessing the GI tract : reassessing a new change/ complaint
how do we assess GI functioning in an organized way ?
assess , think about
asess :
- mouth/teeth
- esophagus/swallowing
- stomach
- small intestine/ large intestine
- rectum
think about :
-1) ingestion / related symptoms. drugs (mouth/teeth/esophagus/swallowing )
2) digestion/absorption related symptoms/drugs ( stomach, small intestine)
3) absorption/elimination
related symptoms/ drugs ( large intestine/rectum )
name what undergoes assessment of upper GI objective assessment
gag/swallow intact
look at lips, teeth, gums, inside mouth, neck
mucous membranes ( this will be dry sometimes due to dehydration )
lesions
teeth intact
visible masses
Upper GI symptoms : esophageal
objective assessment
presence of gag reflex
is the patient able to swallow?
- fluids
-solid food
any observable masses to the neck ?
common complaints :
1) dysphagia
2) wide rage o cuases
- sturctural/neuromuscular dysfuncrion?
2)
what are the most common complaints for upper gi symptoms : esophageal
) Dysphagia
Wide rage of causes:
* Structural / neuromuscular dysfunction?
2) Dyspepsia / Pyrosis / “heartburn”
3) Odynophagia→painful swallowing
4) Belching
alternate nutrition: enteral feeding
parenteral feeding
pipe tube ( feeding tube can be surgical inserted, used for dysphagia ( a life long case )
Upper GI→Stomach & Sm. Intestines
objective assesments
Objective Assessment:
* Note abdomen size (distended?)
* Auscultate Bowel Sounds (hypo/hyperactive?)
* Palpate abdomen (soft/firm/tender/palpable
masses)
Upper GI→Stomach & Sm. Intestines
common complaints
( digestion/absorption )
1) Nausea
* Consider origin
* Describe (OPQRSTU)
* Alone or with vomiting/diarrhea/anorexia
* Related to meds/intake/activity
* Effective treatment
2) Vomiting
* OPQRSTU
* Alone or with nausea?
* Emesis appearance? (bile/food/medications/blood*)?
* Dry heave or retch?
* Projectile, no warning?
* Precipitating factors? Related to intake/meds/activity?
* Effective treatments?
3) Abdominal Pain
Lower GI→Lg. Intestines & Rectum
Subjective information:
* LBM?
* New medications?
* Laxatives (Oral Docusate, Senokot, Lactulose, PR suppositories & enemas) or Antidiarrheals (Bismuth, Lomotil, Imodium)
* S/e of other meds?
Objective Assessment:
* BMs & Stool Appearance
* Rectal bleeding
* Presence of hemorrhoids or anal fissures
are these the objective assessments under the lower gi–> intestine and rectum
( absorption/elimination )
yes this is true
lower gi–> large intestines and rectum
what are the common complaints : change in BM’s ( consistency/frequency/control/appearance )
diarrhea
constipation
flatulence
gi or rectal bleeding
- melena
-hematochezia
red flag findings ( for acute, potentially life threatening illness )
GI bleed
what are the additional assessment we could do ?
GI BLEED:
rectal bleeding : melena stools
frank blood per rectum
hematemesis :
frank red vs. coffee ground
priority- vital signs
hgb
clotting factors ( PTT/INR)
fecal occult blood test ( FOBT )?
prep for endoscopy
red flag findings ( for acute, potentially life threatening illness ) :
Peritonitis or Gi perforation
what are the additional assessment we could do ?
rigid, bpard like abd ( classic symptoms )
dominished or absent bowel sounds
absensce of flatus
difficulty breathing d/t increased pressure on the diagrapgh
hypovolemic shock
fever
additional assesment:
-vital signs
diagnostic imaging + prep for surgery
RED FLAG FINDINGS:for acute, potentially life threatening illness: bowel obstruction
what are the additional assessment we should utilize?
small bowel :
frequent vomitting, might be projectile
vomitting without warning
large bowel :
abdominal distention
absolute contipation
additonal assesment :
diagnostic imaging+ prep for surgery
need for gastric comprehension?
SATA : REd flag findings for gi bleed
a. melena stools –> blood is partially digested ( UPPER GI ) - pUD
b. Frank red blood per rectum –> blood is undgested and from the lower GI
- hemorrhoids
-anal fissures
c.hematemesis ( frank red and coffee ground)`
all the above are red flag findings
describe what frank red and coffee ground mean
coffee ground is partially digested and coagulated for ex: pud
frank red blood may have come from above the stomach
- mallory weis tear
-esophageal varices
red flag findings ( underlying causes ): peritonitis or gi perforation
what undergoes this category
pud
ruptured g.b
ruptured spleen
hemorrhage
perforated appendix
ibd
intestinal obstruction
red flag findings ( underlying causes ): bowel obstruction
what undergoes this category:
Mechanical / Structural→physical obstruction in the intestine.
* Adhesions from surgery
* Tumor/mass
* Fecalith
* Hernia
* Volvulus
* Intussusception
Functional→occurs from a neurological impairment or failure of propulsion of the intestine. Often called paralytic ileus.
* Peritonitis
* Spinal cord injuries
* Severe electrolyte imbalances
Gi system : diagnostics
lab work : what undergoes this section when diagnosing a gi system
what about diagnostic imaging?
lab work :
blood work
stool sampling
diagnostic imaging :
ultrasound
xray
ct scan
mri
endoscopy
surgery
laboratory diagnostic investigations
what should we take a look at when doing stool samples ?
fecal analysis
fecal occult blood ( FOB, OB)
stool for culture and sensitivity
stool for O&P ( ova and parasites0
laboratory diagnostic investigations
what should we take a look at when doing blood work:
H pylori testing ( also breathe testing is an option )
amylase, lipase, gastrin
laboratory diagnostic investigations
what should we take a look at when doing the liver function tests:
serum billirubin ( bile formation and excretion )
albumin and ammonia ( protein metabolism )
PT, aPTT, INR, and Vit K ( hemostatic function )
ALP, AST, ALT, GGT ( liver enzymes )
total cholesterol, LDL, HDL , triglycerides ( lipid profile )
SATA: laboratory diagnostic investigations
what should we take a look at when doing the liver function tests:
PT, aPTT, INR, and Vit K ( hemostatic function )
ALP, AST, ALT, GGT ( liver enzymes )
total cholesterol, LDL, HDL , triglycerides ( lipid profile )
all applies
Gi - common diagnostic tests
abdominal x-ray ( with or without contrast )
upper GI series
upper gi series: ( barrium swallow ) pt drinks contrat ( barium ) which coats upper GI tract allowing better detail. Contrast is passed in stool ( white constipating ). Able to examine esophagus, stomach and start of duod. MUST BE NPO PRIOR
Gi - common diagnostic tests
abdominal x-ray ( with or without contrast ):
small bowel series : define what we do
uses barium, pictures q30 as barrium passses into and through the small bowel. MUST BE NPO PRIOR
Gi - common diagnostic tests
abdominal x-ray ( with or without contrast ):
lower GI series : define what we do
( barium/enam/air contrast barium enema) . MUST be clear with purgatives ( e.g golytely) NPO prior
Common GI diagnostics: define what undergoes this
Abdominal ultra sound ( abd U/S)
Abdominal CT scan
Abdominal MRI
1) massess ( tumor, cysts),biliary and liver disease, gallstones
minimal prep–> the pt may need to be NPO
Common GI diagnostics: define what undergoes this :
Abdominal CT scan
*radiological exposure; *may be done with or without contrast dye
detects biliary tract, liver, and pancreatic disorders
Prep: Helpful for patients to be NPO ~4 hours prior.
If contrast dye required: ?renal function (serum Cr)
Common GI diagnostics: define what undergoes this : Abdominal MRI:
radiofrequency waves and a magnetic field
can detect hepatobiliary disease, hepatic lesion, sources of GI bleeding, stage colorectal ca
Prep: identifying safety concerns→*contraindicated in patients with metal implants or pregnancy
