Assessing Nutritional Status & Abdomen - Health Assessment Exam 2

Undernutrition

Inadequate nutrient intake or reserves being depleted

Overnutrition

Over supply of nutrients that can lead to obesity.

Risk factors for change in hydration status

Exposure to excessively high temps, inability to access adequate fluids, excess intake of alcohol or other diuretics, cognitive impairment/confusion, high fevers.

Optimal hydration reccomen

Eight glasses of 8 oz of water a day

Dehydration

When the body loses more fluid than it take in and does not have enough water to carry out normal functions.

Who is at increased risk for dehydration?

Especially dangerous in young children and older adults, chronically and seriously ill pts.

Who is at risk for fluid overload?

Pts with kidney, liver, or cardiac disease. The seriously and chronically ill.

Signs/symptoms of food-borne illness

Upset stomach, nausea, vomiting, diarrhea. Usually from norovirus or salmonella.

Mild food allergy reaction

Rash, redness, hives

Life-threating food allergy reaction

Anaphylactic reaction. Causes swelling and compromises airway. You may hear wheezing or stridor.

Food intolerace

Digestive system is irritated as it can’t properly digest a food. Ex. lactose intolerance, celiac disease.

Present health concern in nutrition assessment

24-hr food recall, height + weight, any unexplained weight loss or gain, any dieting, changes in taste/smell, difficulty chewing/swallowing, nausea, vomiting, diarrhea.

Personal heath history in nutrition assessment

Food allergies, chronic illness, medications, herbs, supplements.

Family history in nutrition assessment

Chronic illness, obesity

Lifestyle in nutrition assessment

Determine risk factors, religious/cultural beliefs, food safety, eating out, food budget, exercise.

Nutrition Screening Initiative (NSI)

Assesses for risk factors for poor nutrition in older adults.

Nutrition Screening Initiative (NSI) warning signs

Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medications, Involuntary weight loss/gain, Needs assistance in self-care, Elder years above 80.

Nutrition Screening Initiative (NSI) scores + interventions

0-2 (good) - recheck in 6 months

3-5 (moderate risk) - education + recheck in 3 months

6+ (high risk) - consult with HCP or dietician

Nasogastric vs gastric feeding tube

Nasogastric is in nose, gastric is in stomach

Duodenal vs jejunum feeding tube

Duodenal is in stomach/beginning of SI, jejunum is in SI

Things to note when pt has a feeding tube

Ask why pt has the tube, determine if it is just for supplementation or more, note and assess the length of the tube to see if it migrated.

General routine screening in nutritional assessment

Observe general nutrition status and appearance (A+O, development), observe body build

Ectomorph body build

Lean and long. Person has difficulty gaining muscle and has a fast metabolism.

Mesomorph body build

Muscular and well-built. Gain muscle easily.

Endomorph body build

High body fat. Gain muscle and fat easily, slower metabolism.

Ideal body weight (IBW) for woman

100 lbs for 5 ft + 5lbs for each inch over 5ft

Ideal body weight (IBW) for men

106 lbs for 5 ft + 6lbs for each inch over 5ft

How to calculate % IBW

(Actual weight /IBW) x 100 = %IBW

Lean %IBW

80-90%

Moderate malnutrition %IBW

70-80%

Severe malnutrition %IBW

Less than 70%

BMI calculation

Weight (kg) / height (meters)²

Why is BMI not used as a diagnostic indicator

It does not take in musculature into account.

Underweight BMI

<18.5

Normal weight BMI

18.5-24.9

Overweight BMI

25-29.9

Obesity BMI

30+

Why do we measure waist circumfrence?

Look for excessive visceral fat in abdomen that is surrounding the organs.

Normal female waist circumference

Less than or equal to 35 in

Normal male waist circumference

Less than or equal to 40 in

How to calculate I&O

Add up all intake. Add up all output. Find the difference. Always document +/-

What patients would require daily weight checks?

Malnourishment, eating disorders, fluid overload (heart failure, kidney disease, liver disease).

Skin turgor

Pinch skin. It should return to normal very quickly. If not, this indicates dehydration. This is not a reliable test in geriatrics as skin naturally loses its elasticity.

Inspecting tongue condition in hydration

Look for furrows (indentations) that indicate dryness

Observing eyes in hydration assessment

Sunken eyes/prominent dark circles indicate dehydration/malnutrition

Urine colors

Clear yellow = hydrated

Amber = dehydrated

Brown = severe dehydration requiring medical attention

What does high and low hemoglobin indicate?

High = dehydration

Low = overhydration, blood loss, low iron or protein, anemia

What does high and low hematocrit indicate?

Follows hemoglobin

What does high and low serum albumin indicate?

High = dehydration

Low = malnutrition, liver disease

What does high and low prealbumin indicate?

High = dehydration

Low = malnutrition, protein wasting

What does high and low transferrin indicate?

High = iron deficiency

Low = anemia

What does high and low blood urea nitrogen (BUN) indicate?

High = dehydration, high protein diet

Low = low protein diet, overhydration

What does high hemoglobin A₁C indicate?

High = uncontrolled diabetes

Special considerations for newborns/infants in nutrition assessment

Breast milk or iron-fortified formula is most desired food for first 6 months. (Formula every 3-4 hrs). Solids not recommended before 4 months. No honey for 1st year of life as their immune system can’t handle.

Special considerations for children & adolescents in nutrition assessment

Proper nutrition is essential for growth and development. Eating habits usually develop in preschooler age.

Special considerations for childbearing population in nutrition assessment

Need an additional 300-500 cal/day. Ask for normal daily intake of food to assess for lunchmeat, unpasteurized milk products, and vitamin supplements.

Special considerations for older adults in nutrition assessment

Any changes in appetite, describe typical day of food, ask about fluid intake, inquire about oral health, inquire about swallowing, get height and weight.

What quadrant is the duodenum in?

RUQ

What quadrant is the appendix in?

RLQ

What quadrant is the left kidney in?

LUQ

What quadrant is the pancreas in?

The head is in the RUQ and the body is in the LUQ

What quadrant is the liver in?

RUQ

What quadrant is the spleen in?

LUQ

What quadrant is the stomach in?

LUQ

What quadrant is the gallbladder in?

RUQ

What quadrant is the right ureter in?

RLQ

External abdominal oblique

Largest and most superficial of the abdominal wall muscles. Lies on the front and sides of abdomen.

Internal abdominal oblique

Lies deep. Is a broad, thin muscular sheet.

Transverse abdominis

Deepest of the abdominal wall muscles.

Is the liver solid or hollow viscera and can it be palpated.

Solid and palpable.

Is the pancreas solid or hollow viscera and can it be palpated.

Solid, can’t be palpated

Is the spleen solid or hollow viscera and can it be palpated.

Solid, can’t be palpated

Are the kidneys solid or hollow viscera and can it be palpated.

Solid, can’t be palpated

Are the ovaries and uterus solid or hollow viscera and can it be palpated.

Solid, palpable

What is hollow viscera and which abdominal organs are hollow?

Hollow viscera = organs that change in shape depending on their contents. Examples: stomach, gallbladder, small intestine, large intestine (colon), baldder.

Internal vs external iliac arteries

Internal = provides blood to pelvic organs

External = provides blood to legs (branches to femoral artery)

Visceral pain

Pain caused by damage or disruption to internal organs/tissues. Pain may be vague and not localized as many organs don’t have lots of nerve fibers. Described as dull, ache, burn, cramp.

Parietal pain

Pain caused by irritation of the peritoneal lining. Is easily localized as there are many nerve fibers. Described as sharp, constant, and severe. Pt is in guarded position.

Referred pain

Type of visceral pain but is felt in area not where the pain is coming from.

History of present concern of abdominal pain or indigestion

Use COLDSPA to work up/gather more info

History of present concern of nausea and vomiting

Ask about color and amount of vomit and when it started. Ask about any triggers like smells.

History of present concern of appetite

Note increase or decrease in appetite. Remember that older adults are prone to have lessened appetite as metabolism slows.

History of present concern of bowel elimiation

Describe stools (# per day, consistency, color). Constipation (no BM for 3+ days). Diarrhea.

Personal health history in abdominal assessment

GI disorders, UTIs, kidney disease/stones, recurrent UTIs, history of viral hepatitis, past abdominal surgery/trauma, any prescriptions or OTC meds

Lifestyle questions in abdominal assessment

Alcohol use (acute vs long term), exercise, stress, foods, caffeine, affects on ALDs

Sequence of abdominal exam

Inspect → auscultate → percuss → palpate

Preparing the pt for abdominal exam

Empty bladder if needed, have pt in supine with arms at side or across chest, inquire about any painful areas and assess those LAST, know that pt may be ticklish, warm your hands.

General inspection in abdominal assessment

Observe skin coloration, note vascularity, note any striae (stretch marks) (normal), scars (ask why), rashes, lesions

Grey Turner

Discoloration of left flank area. Associated with pancreatic issue.

Cullen’s sign

Bruise/discoloration right around umbilicus. Indicates internal bleeding.

Scaphoid abdominal contour

Indented abdominal contour when pt is lying down. Normal for thin pts but could indicate malnutrition.

Reasons for abdominal distension

6 F’s: Fat, Feces, Fetus, Fibroids, Flatulence, Fluid

Hernia

Protrusion of bowel though abdominal wall

Aortic puslation

NOT normal finding. Indicates presence of abdominal aortic aneurysm (AAA). Screening recommended for men between 65-75 yrs who have ever smoked.

Auscultation of bowel sounds

Use diaphragm. Begin in RLQ and move clockwise. Confirm bowel sounds in each quadrant. Listen for up to 5 mins (minimum 1 min per quadrant). Note intensity, pitch, and frequency.

Absent bowel sounds

Emergent! Indicants obstruction or necrosis.

Hypoactive bowel sounds

Indicate diminished bowel motility

Present bowel sounds

Normal finding

Hyperactive bowel sounds

Very rapid motility. Can be from hunger or an issue like diarrhea.

Special considerations in abdominal assessment in post-op clients

Stomach emptying takes 24-48 hrs to return. Colon requires 3-5 days to recover. Pt can’t have food until bowel sounds return. Begin with liquids and slowly introduce solids. Assess for distention and urine output.