Week 6 - Assessment & Study Questions Flashcards
what should you assess regarding the mouth
- anything that interferes with ingestion
- abnormal tissue/growths
what should you assess regarding the esophagua
signs of GERD and cancer:
- dysphagia
- dyspepsia
- bleeding (frank)
list the symptoms for a small bowel obstruction
- NV
- crampy abdominal pain
- feces (short time)
list the symptoms for a large bowel obstruction
- distension
- obstipation
- crampy abdominal pain
what should you inspect regarding the stomach
- comfort
- symmetry
- contour
- movement
- tender
- rigid?
what two types of stomach contour correlate with distension
- rounded
- protuberant
what possible inspection findings could be found during abdominal assessment
- striae
- scars
- petechiae
- angiomas
- moles
- pulsations or peristalsis
what are peteachiae
- pinpoint, round red or purple spots on the skin as a sign of bleeding
what does petechiae in the face indicate
- excessive vomiting
what is cullen’s sign? what does it indicate
- bruising around the umbilicus
- indicates intrabdominal bleeding
what is grey turner’s sign? what does it indicate?
- bruising around the flanks
- indicates intra-abdominal or retroperitoneal bleeding
what should you assess during auscultation of the stomach?
- BS
- vascular sounds
what should you assess regarding BS
- location
- character
- frequency
- changes
what should you assess regarding vascular signs
- bruit? (not normal)
what should you assess during percussion
- abdominal contents
- location & size of organs (such as the liver)
- screen for abnormalities
what should you assess during palpation
- tenderness
- firmness
- rebound tenderness
- guarding
- involuntary rigidity
- grimacing
what does involuntary rigidity indicate
- peritonitis
what does rebound tenderness indicate
- peritonitis
- appendicitis (if the peritoneum is involbed)
list reasons why we may do a rectal exam
- screening (such as for prostate health)
- impaction
what is a common position for pt to be in during rectal exam
- left lateral decubitus (laying on L side with top leg bent)
what should the prostate feel like during a rectal exam
- smooth
what are common GI diagnostics
- radiology
- abdominal US
- abdominal CT scan
- abdominal MRI
- endoscopy
what radiology test is used for upper GI tract
- barium swallow
describe how barium swallow works
- pt drinks contrast (barium) which coats the upper GI tract allowing better detail
- contrast is then passed in stool
what does the stool look like following barium swallow
- white
- constipating
what does barium swallow of the upper GI tract allow
can examine:
- esophagus
- stomach
- start of duodenom
what must a pt be prior to an upper GI series
- pt must be NPO
what radiology test is used for the small intestine
- barium
describe the use of barium for the small intestine
- pictures q30 min as it passes into and thru the small bowel
what is a nursing priority prior to using barium in the small intstine
- must be NPO prior
what radiology test is used for lower GI series
- barium enema + purgatives
what type of barium is used for lower GI
- enema
- air contrast barium enema
what are purgatives
- type of laxative that helps clear the lower GI tract
what is an example of a purgative
GoLytelyy
should pts be NPO prior to lower GI series?
- yes
who are abdominal MRIs contraindicated in?
- pregnant pts
- pts with metal
what is a MRI
- imaging technique that uses radiofrequency waves & magnetic field
what is a CT scan
- imaging technique that uses radiological exposure
what is one thing to note regarding CT scan
- can be nephrotoxic
- so assess u/o
what is a gastroscopy
- EGD
- can see esophagus, stomach, and duodenom
what is the prep for gastrscopy
- NPO
what is a colonoscopy
- endoscopy that allows you to visualize the colon up to the ileocecal valve with flexible scope
what is prep for a colonscopy
- NPO & purgative
what is a sigmoidscopy
- endoscopy that allows you to visualize the rectum & sigmoid colon
what is prep for a sigmoidoscopy
- NPO & purgative
what is a capsule endoscopy
- pt swallows a disposable video camera
- as cam passes thru the intestine images are transmitted via radiofrequency
what is a capsule endoscopy useful for
- visualizing sections of the small bowel that is difficult to reach w endoscopy
what is a laparoscopy
- surgery that uses a thin, lighted tube put thru a cut in the belly to look at the abdominal organs or female pelvic organs
what can a laparoscopy be used for
- taking tissue samples
- performing procedures
- or inspection
what can a laparoscopy detect
- cysts
- adhesions
- fibroids
- infection
what is a laparotomy
- open procedure where the stomach is opened up to look at things you cannot see with a laproscopy
what is a colectomy
- partial or complete removal of the colon
describe what a normal stoma looks like
- pink
- rose to brick red (indicates good blood flow)
- raised
describe what an abnormal stoma looks like
- pale pink
- blanching, dark red to purple
- edema
- bleeding
- prolapse or concave
what does pale pink stoma indicate
- possible anemia
what does a blanching, dark red to purple stoma indicate
- inadequate blood supply
what amount of edema is normal vs not
- mild may be normal
- change may be due to trauma or abstruction
what amount of bleeding is normal vs not
- small amount normal
- moderate to large may indicate trauma, coagulation problem, lower GI bleeding
during your physical assessment of a pt with crohn’s disease you notice red, painful nodules on their legs & the skin on their abdomen is inflamed. You recognize these findings as
- a systemic complication associated with active inflammation
what percentage of pts with an exacerbation of UC go into remission with conservative therapy (meds) and nursing management
80%
what is the significance of cullen’s and grey turner’s sign
- sign of pancreatitis
- result from seepage of blood-stained exudate from the pancreas
what type of bowel sounds would you expect to hear in diarrhea? constipation?
- diarrhea = hyperactive
- constipation = decreased
why are immunosuppressant and immunomodulatory drugs used for IBD
- for severe cases
- if pt has failed to respond to other drugs
- before surgery is considered
