Week 9 - Abdomen, Violence/Mental, Genitals, Nutrition Flashcards
Where do we expect to hear DULLNESS on percussion in abdominal assessment
liver, spleen, adipose tissue, over feces
Hyperresonance in abdomen can indicate:
gaseous distension
Costovertebral angle tenderness in abdomen can indicate:
kidney inflammation
What does the person’s abodomen look like if they have distention from ASCITES
o Inspection-Single curve & everted umbilicus; bulging flanks; taut skin; increased abdominal girth
o Auscultation-Normoactive, diminished over fluid
o Percussion-Tympany over bowels but dull over fluid
o Palpation-Taut skin and increased pressure
What is the greatest risk factor for cervical cancer?
human papilloma virus (HPV)
79 million have HPV in US
what is a priapism
a long and painful erection (not from sexual excitation). This can occur in PTs w/ leukemia or hemoglobinopathies (e.g. sickle cell)
What qualifies as binge drinking
Binge drinking= 4 drinks in 2 hours for women, 5 drinks in 2 hours for men
How much alcohol is safe for a pregnant woman to drink?
NONE!
What are 4 general steps for alcohol screening and brief intervention?
■ Step 1: Ask about alcohol use
■ Step 2: Assess for alcohol use disorders
■ Step 3: Advise and assist
■ Step 4: Follow-up and continued support
What are the signs of UNCOMPLICATED alcohol withdrawal?
peaks at 2nd day, improves by 4th/5th day. Most s/s are GI or neuro
o Tremors of hands, tongue, eyes
o Anorexia, malaise, nausea, vomiting
o Autonomic hyperactivity – tachycardia, sweating, elevated BP
o Headache, insomnia, anxiety/depression, irritability, hallucinations
What are the signs of severe alcohol withdrawal?
Withdrawal delirium = delirium tremors - occurs within 1 week of cessation
■ Coarse, irregular tremor
■ Extreme autonomic hyperactivity (tachycardia, sweating)
■ Vivid hallucinations and elusions, agitated behavior
■ Fever
What scale can be used to assess alcohol withdrawal?
○ CIWA scale (Clinical Institute Withdrawal Assessment) for Alcohol
Max score: 67
● Mild withdrawal
What scale can be used to assess opiate withdrawal?
Clinical Opiate Withdrawal Scale (COWS)
Max score: 48
○ Mild withdrawal 36
Hypoactive bowel sounds are common in patients with what conditions?
constipation and paralytic ileus (paralysis of the intestinal muscles)
Hyperactive bowel sounds are common in patients with what conditions?
gastroenteritis (An intestinal infection marked by diarrhea, cramps, nausea, vomiting, and fever) and diarrhea
What are venous hums found during abdominal assessment?
continuous sounds found in the epigastric region and around the umbilicus and caused by portal hypertension.
What % of GI diseases can be diagnoses by obtaining a thorough health history?
80-90%
What is the 2nd leading cause of US cancer deaths
colorectal cancer
What is the most common blood-borne U.S. viral infection?
Hepatitis C
The RUQ includes:
liver galbladder head of pancreas right adrenal gland hepatic fixture of colon duodenum part of ascending and transverse colon
LUQ includes
body of pancreas stomach spleen left lobe of liver left adrenal gland splenic fixture of colon left kidney left adrenal part of transverse and descending colon
RLQ includes
cecum appendix right ureter right ovary right spermatic cord
LLQ includes
sigmoid colon part of descending colon left ovary and tube left ureter left spermatic cord
after middle age, where does fat accumulate in females?
in the suprapubic area due to decreased estrogen levels
what are age related changes in abdomen?
- salivation decreasess, there is decreased taste
- esophageal emptying is delayed
- gastric acid secretion decreases with aging, leading to pernicious anemia (decreased B12 absorption)
- Incidence of gallstones increases
- liver size decreases with age, although most liver function remains normal. prolonged drug metabolism leads to increased side effects.
common causes of constipation include:
decrease physical activity inadequate water intake low fiber diet side effects of meds IBS hypothyroidism
how do you avoid abdominal tensing?
don't place arms above head warm stethescope short nails examine painful areas LAST to avoid muscle guarding have PT bend at knees while supine
what is a scaphoid abdomen?
when it is sucked inwards
mainly seen in sever malnutritional status, marasmus, cachexia, acute diffusive peritonitis due to muscle rigidity.
the umbilicus may be everted with
pregnancy
ascites
underlying mass
umbilical hernia
bluish periumbilical color occurs with
intraabdominal bleeding (cullen sign)
Striae
linear stretch marks (recent striae are pink or blue, then they turn silvery white)
normally, veins shouldn’t be visible. they appear dilated and prominent with
portal hypertension, cirrhosis, ascites, malnutrition
poor turgor occurs with
dehydration
marked visible peristalsis, with a distended abdomen, indicate
intestinal obstruction
absolute stillness on the examination table occurs with
pain of peritonitis
restlessness and constant turning indicates
colicky pain of gastroenteritis or bowel obstruction
what endpiece of the stethescope do you use when auscultating the abdomen?
diaphragm because bowel sounds are high pitched
what quadrant do you begin in for ab assessment?
RLQ at the ileocecal valve area because bowel sounds are always present
what are causes of abdominal distention?
Fat Fetus Feces Flatus Fluid Fatal Tumor Fibroid
normal bowel sounds occur:
5-30 times per minute
they are high pitched, gurgling, cascading, occuring irregularly
hyperactive sounds are:
over 30 times per minute
they are loud, high pitched, rushing, tinkling sounds that signal increased motility
hypoactive sounds occur
less than 4 per minute. they follow abdominal surgery, or with inflammation of peritoneum
how long must you listen to decide that bowel sounds are absent?
5 minutes
what is a borborygmus?
a hyperactive bowel sound termed stomach growling
indicates diarrhea, hyperperistalsis, or an early indication of intestinal obstruction
where do you listen for bruits at the abdomen?
aorta
renal artery
iliac
femoral
do this especially in hypertensives. usually no sound is present.
a systolic bruit occurs with
stenosis or occlusion of an artery
when percussing over the abdomen, what should predominate?
tympany
when is hyperresonance present during abdominal percussion?
gaseous distention
emphysema
pneumothorax
when does dullness occur during abdominal percussion?
distended bladder
adipose tissue
fluid
mass (liver, spleen)
When would you suspect someone has ascites?
a distended abdomen, bulging flank, and a protruding umbilicus that is protruding
when does ascites occur?
HF, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer
what is the definitive tool for ascites?
ultrasound.
what do you do enhance muscle relaxation when palpating?
bend person’s kees
keep palpating hand low and parallel to abdomen
with a ticklish person: keep person’s hand under your own wiht your fingers curled over their fingers.
what is the objective of light palpation?
to form an overall impression of the skin surface and superficial musculature.
save the examination of any identified tender areas until last
how do you do light palpation?
with first FOUR fingers depress skin 1 cm and make gentle rotary motion, sliding fingers and skin together. LIFT fingers when moving to next location, and go clockwise.
what changes occur in the elderly that are evident during an abdominal assessment?
organs are easier to palpate because of the thinner abdominal wall.
- liver is easier to palpate
- liver is palpated lower, descending 1 to 2 cm below costal margin with inhalation
- kidneys are easier to palpate.
- abdominal rigidity with acute conditions is less common in the old.
- Fewer complaints with acute abdominal pain because of decrease nerve impulses.
an enlarged and TENDER liver occurs with
HF
acute hepatitis
hepatic abscess
what is the problem with 24 hour recall for food?
daily pattern may vary. attempt week long diary of intake.
what is cullen’s sign?
bluish periumbilical color that occurs with intraabdominal bleeding
Inadequate intake of ___________ during pregnancy is linked to neural tube defects in newborns.
folic acid
How is BMI calculated?
• BMI is calculated as weight in kilograms divided by height 2 in meters squared (m ). BMI of 18.5 to 24.9 is healthy, less than 18.5 is underweight, 25 to 29.9 is overweight, and 30 or greater represents obesity.
Lab values r/t nutrition include
serum albumin, pre-albumin, transferrin, total protein, creatinine, sodium, potassium, hemoglobin, hematocrit, total lymphocyte count, and hypersensitivity reaction.