Week 4: Gastrointestinal/Genitourinary/Reproductive Assessment & Medication Reconciliation

Question 1

Abdominal mapping: Structures of the right upper quadrant (RUQ) (8)

Answer 1

1. Duodenum
2. Gallbladder
3. Liver
4. Head of pancreas
5. Right kidney
6. Right adrenal gland
7. Hepatic flexure of the colon
8. Part of ascending and transverse colon

Question 2

Abdominal mapping: Structures of the left upper quadrant (LUQ) (8)

Answer 2

1. Left lobe of the liver
2. Stomach
3. Spleen
4. Body of pancreas
5. Left kidney
6. Left adrenal gland
7. Splenic flexure of the colon
8. Part of the transverse and descending colon

Question 3

Abdominal mapping: Structures of the right lower quadrant (RLQ) (6)

Answer 3

1. Cecum
2. Appendix
3. Part of the ascending colon
4. Right ovary and tube
5. Right ureter
6. Right spermatic cord

Question 4

Abdominal mapping: Structures of the left lower quadrant (LLQ) (5)

Answer 4

1. Part of the descending colon
2. Sigmoid colon
3. Left ovary and tube
4. Left ureter
5. Left spermatic cord

Question 5

Abdominal mapping: Structures of the midline (3)

Answer 5

1. Aorta
2. Uterus
3. Bladder

Question 6

Liver: Roles

Answer 6

The liver plays a key role in metabolizing carbohydrates, proteins, fats, and drugs, producing bile, detoxifying harmful chemicals, and producing clotting factors.

Question 7

Gallbladder: Roles

Answer 7

The gallbladder and biliary system collect, store, concentrate, and transport bile to the intestines to aid in digestion.

Question 8

Pancreas: Roles

Answer 8

This organ has two primary functions. It has an endocrine function that secretes insulin and an exocrine function to release pancreatic juices.

Question 9

Spleen: Roles

Answer 9

It is the largest lymph organ in the body with a major function in our immune system.

As part of the reticuloendothelial system, the spleen filters blood; manufactures lymphocytes, monocytes, macrophages; stores erythrocytes and platelets; and produces erythrocytes during bone marrow depression

Question 10

Small intestine: Roles

Answer 10

The primary functions are completion of digestion and absorption of nutrients.

Question 11

Large intestine: Roles

Answer 11

The primary function of the large intestine is the reabsorption of water. The large intestine forms and temporarily stores fecal matter.

Question 12

Kidneys: Roles

Answer 12

The kidneys are powerful chemical factories that perform the following functions:
-Remove waste products from the body
-Remove drugs from the body
- Balance the body’s fluids
-Release hormones that regulate blood pressure
-Produce an active form of vitamin D that promotes strong, healthy bones
-Control the production of red blood cells

Question 13

The patient states that he has pain in his RUQ after eating a fatty meal for the past month. He denies nausea and vomiting. What organ do you suspect is the source of this pain?
A) Liver
B) Stomach
C) Gallbladder
D) Pancreas

Answer 13

C. The gallbladder is located in the right upper quadrant (RUQ). This organ contracts and releases bile into the common bile duct and the bile helps to digest fats.

Question 14

What is one unique element of health history important to GI/GU?

Answer 14

History of out of country travel
- Risk for hepatitis A, B, C

Question 15

4 preliminary steps for an abdominal assessment

Answer 15

1. Instruct patient to empty the bladder.
2. Position patient in the supine position, with head on a pillow and arms by their side. If the patient is unable to flex knees, place a pillow under the knees.
3. Expose the abdomen, place a drape over the patient’s symphysis pubis and chest area for women.
4. If the patient states that he or she has abdominal pain, say that you will assess the painful abdominal area last.

Question 16

Sequence of assessment for an abdominal assessment

Answer 16

1. Inspection
2. Auscultation
3. Indirect percussion
4. Palpation (light and deep)

Question 17

Why is the order of abdominal assessment different from other assessments?

Answer 17

So that peristalsis is not stimulated by percussing and palpating

Question 18

Inspecting the abdomen: 4 groups of assessment characteristics

Answer 18

1. Contours, size, symmetry
2. Size and position of umbilicus
3. Condition of skin: Color, lesions, veins, hernias
4. Movements, pulsations, peristalsis

Question 19

Ascites

Answer 19

Abnormal accumulation of fluid in the peritoneal cavity

Question 20

Diastasis recti

Answer 20

A bulging area in the abdomen occurring with the separation of the two halves of the rectus abdominis muscles in the midline at the linea alba

Question 21

Cullen’s sign

Answer 21

Superficial bleeding under the skin (ecchymosis) around the umbilicus and may indicate intra-abdominal bleeding

Question 22

Auscultating bowel sounds: Abnormal findings (3)

Answer 22

1. Hyperactive: Loud, high-pitched sounds. Heard in patients with diarrhea, laxative use, gastroenteritis, early intestinal obstruction
2. Hypoactive: Slow, decreased sounds. Heard in patients with constipation, obstruction, side effects of medications
3. Absent: No sounds heard. May indicate a paralytic ileus after surgery, bowel obstruction, peritonitis

Question 23

Broborygmus

Answer 23

Normal bowel sounds. Loud gurgling or rumbling sounds made by the movement of gas through the intestines

Question 24

Auscultating vascular sounds: Abnormal findings (3)

Answer 24

1. Bruits: Turbulent, blowing sounds heard over a partially or totally obstructed artery. Bruits are most commonly caused by a buildup of plaque in the artery.
2. Venous hum: A continuous medium-pitched, roaring sound caused by turbulent blood flow in a large vascular organ.
   3.Friction rub: A grating sound heard over inflamed organs with serous surfaces; most commonly heard in the RUQ (liver) or LUQ (spleen).

Question 25

Percussing the abdomen: Normal findings (2)

Answer 25

1. Tympany in all 4 abdominal quadrants
2. Dullness over organs

Question 26

Percussing the abdomen: Abnormal findings (3)

Answer 26

1.Excessive, high-pitched tympanic sounds may indicate distention.
2.Dullness may indicate increased tissue density such as organ enlargement or an underlying mass.
3.Pain during percussion may indicate peritoneal inflammation.

Question 27

The patient is complaining that he has been constipated for the past 6 days but has very small bouts of diarrhea. You auscultate for bowel sounds and do not hear any sounds. What should you do?
A) Call the doctor immediately.
B) Listen for at least 3 to 5 minutes.
C) Palpate the abdomen to stimulate peristalsis.
D) Document hypoactive bowel sounds.

Answer 27

B. Listen for 3 to 5 minutes before documenting that there are no bowel sounds.

Question 28

Recommendations relating to colon cancer screening

Answer 28

Men and women at average risk for colon cancer should begin screening at 45 until 75