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Pt.2 PHRM/PHYS/NS > week 2 : Seminar ( Nursing assesments ) > Flashcards

week 2 : Seminar ( Nursing assesments ) Flashcards

1
Q

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

A

dysphagia
ascites
anorexia
hematemesis
melena
hematochezia

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2
Q

The digestive system breaks down _____ prepares it for uptake by the body’s ____ absorbs _____ and eliminates _____

A

ingested
cells
fluids
waste

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3
Q

Subjective assessment –> general health history

what kind of questions are we asking ?

A

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

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4
Q

Subjective assessment –> general health history

A

smoking/etoch

activity level/lifestyle
- active or sedentary ? nutritional status ?

toxin exposure ( occupational )

recent travel ?

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5
Q

Subjective Assessment→GENERAL HEALTH HISTORY

A

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

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6
Q

health history : abdominal pain
what do you have to ask ?

A

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

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7
Q

objective –> assessment : ( Gi-system )
how to you do a comprehensive

A

comprehensive:
- on admission
- health history
- initial head to toe ( vital signs, serves as baseline )
goal : establish baseline Gi functioning

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8
Q

objective- assessment –>physical assessment (Gi system ) focused

A

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

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9
Q

how do we assess GI functioning in an organized way ?

assess , think about

A

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 )

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10
Q

name what undergoes assessment of upper GI objective assessment

A

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

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11
Q

Upper GI symptoms : esophageal
objective assessment

A

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)

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12
Q

what are the most common complaints for upper gi symptoms : esophageal

A

) Dysphagia
Wide rage of causes:
* Structural / neuromuscular dysfunction?
2) Dyspepsia / Pyrosis / “heartburn”
3) Odynophagia→painful swallowing
4) Belching

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13
Q

alternate nutrition: enteral feeding

A

parenteral feeding
pipe tube ( feeding tube can be surgical inserted, used for dysphagia ( a life long case )

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14
Q

Upper GI→Stomach & Sm. Intestines

objective assesments

A

Objective Assessment:
* Note abdomen size (distended?)
* Auscultate Bowel Sounds (hypo/hyperactive?)
* Palpate abdomen (soft/firm/tender/palpable
masses)

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15
Q

Upper GI→Stomach & Sm. Intestines

common complaints

( digestion/absorption )

A

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

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16
Q

Lower GI→Lg. Intestines & Rectum

A

Subjective information:
* LBM?
* New medications?
* Laxatives (Oral Docusate, Senokot, Lactulose, PR suppositories & enemas) or Antidiarrheals (Bismuth, Lomotil, Imodium)
* S/e of other meds?

17
Q

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 )

A

yes this is true

18
Q

lower gi–> large intestines and rectum

what are the common complaints : change in BM’s ( consistency/frequency/control/appearance )

A

diarrhea
constipation
flatulence
gi or rectal bleeding
- melena
-hematochezia

19
Q

red flag findings ( for acute, potentially life threatening illness )
GI bleed
what are the additional assessment we could do ?

A

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

20
Q

red flag findings ( for acute, potentially life threatening illness ) :
Peritonitis or Gi perforation

what are the additional assessment we could do ?

A

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

21
Q

RED FLAG FINDINGS:for acute, potentially life threatening illness: bowel obstruction
what are the additional assessment we should utilize?

A

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?

22
Q

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)`

A

all the above are red flag findings

23
Q

describe what frank red and coffee ground mean

A

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

24
Q

red flag findings ( underlying causes ): peritonitis or gi perforation
what undergoes this category

A

pud
ruptured g.b
ruptured spleen
hemorrhage
perforated appendix
ibd
intestinal obstruction

25
Q

red flag findings ( underlying causes ): bowel obstruction
what undergoes this category:

A

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

26
Q

Gi system : diagnostics

lab work : what undergoes this section when diagnosing a gi system

what about diagnostic imaging?

A

lab work :
blood work
stool sampling

diagnostic imaging :
ultrasound
xray
ct scan
mri

endoscopy
surgery

27
Q

laboratory diagnostic investigations
what should we take a look at when doing stool samples ?

A

fecal analysis
fecal occult blood ( FOB, OB)
stool for culture and sensitivity
stool for O&P ( ova and parasites0

28
Q

laboratory diagnostic investigations
what should we take a look at when doing blood work:

A

H pylori testing ( also breathe testing is an option )
amylase, lipase, gastrin

29
Q

laboratory diagnostic investigations
what should we take a look at when doing the liver function tests:

A

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 )

30
Q

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 )

A

all applies

31
Q

Gi - common diagnostic tests
abdominal x-ray ( with or without contrast )

upper GI series

A

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

32
Q

Gi - common diagnostic tests
abdominal x-ray ( with or without contrast ):

small bowel series : define what we do

A

uses barium, pictures q30 as barrium passses into and through the small bowel. MUST BE NPO PRIOR

33
Q

Gi - common diagnostic tests
abdominal x-ray ( with or without contrast ):

lower GI series : define what we do

A

( barium/enam/air contrast barium enema) . MUST be clear with purgatives ( e.g golytely) NPO prior

34
Q

Common GI diagnostics: define what undergoes this

Abdominal ultra sound ( abd U/S)

Abdominal CT scan

Abdominal MRI

A

1) massess ( tumor, cysts),biliary and liver disease, gallstones

minimal prep–> the pt may need to be NPO

35
Q

Common GI diagnostics: define what undergoes this :
Abdominal CT scan

A

*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)

36
Q

Common GI diagnostics: define what undergoes this : Abdominal MRI:

A

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

Pt.2 PHRM/PHYS/NS (14 decks)

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