HEALTH ASSESSMENT EXAM 3

solid viscera

- maintain characteristic shape.

- some palpable (liver/right kidney)

- liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus

hollow viscera

- shape depends on contents

- usually not palpable

- stomach, gallbladder, small intestine, colon, and bladder.

position of kidneys

- retroperitoneal (behind abdominal contents) and pancreas (behind stomach).

abdominal anatomy

- 4 quadrants = RUQ, RLQ, LLQ, LUQ (midpoint is belly button).

- 9 quadrants = right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right iliac, hypogastric, left iliac

right upper quadrant (RUQ)

liver, gallbladder, duodenum, head of pancreas, right kidney, adrenal gland, part of ascending colon.

left upper quadrant (LUQ)

stomach, spleen, left lobe of liver, body of pancreas, left kidney, adrenal gland, and part of transverse and descending colon.

right lower quadrant (RLQ)

cecum, appendix, right ovary+tube, right ureter, and right spermatic cord

left lower quadrant (LLQ)

part of descending colon, sigmoid colon, left ovary+tube, left ureter, and left spermatic cord

midline structures abdominal

aorta, uterus, bladder

GI tract order

mouth, esophagus, stomach, small intestine (duodenum, jejunum, ileum), large intestine (cecum, colon, rectum), anus

subjective adbonial with eating

appetite, dysphagia (solids/liquids), food intolerance, lactose intolerace (Sx), abdominal pain (PQRSTU)

subjective nausea/vomiting

frequency, hematemesis (bloody), timing, associated symptoms, reflux?

subjective bowel habits

- COCA = color, odor, consistency, amount.

- changes in BM, laxative use, bleeding

- melena (bloody), black-tarry (old blood/occult) = upper GI

- red, frank blood = lower GI

bristol stool chart

medical aid to classify stool

past history abdominal

surgeries, other GI problems, gallbladder disease, uclers, appendicitis, and hepatisis

family history abdominal

cancer, polyps, IBD, IBS

medication history abdominal

antiacids, NSAIDS (aspirin), iron supplements (stain black/green)

nutritional assessments abdominal

24 hour diet recall useful, tobacco, ETOH (alcohol), caffeine

developmental abdominal for infants/children

breast/formula, whole milk 1yr, intro of solids, constipation, # stools/day + liquid in diet, overweight, pain.

developmental abdominal for teens

eating patterns, exercise patterns, weight loss/gain, body image (anorexia/bulimia).

developmental abdominal for aging adults

how do they get their food, who grocery shops, eat alone, weight changes, bowel preoccupations.

apple/android shape

- excess fat on abdomen

- common in men

- has significant correlation with metabolic syndrome

pear/gynoid shape

- excess fat on the things and buttocks

- common in women

- not signifciant correlation with metabolic syndrome

low fat diets

- polysaturated/monsaturated fats +

- trans fats low/eliminated

- cholesterol in diet ONLY comes form animal products (reduced)

low sodium

- DASH diet = dietary approach to stop hypertension by department of health.

renal diet

- lower protein and Na, K, phosophate, and calcium

BRAT diet

- bananas, rice, applesauce, toast

- for nausea, vomiting, and diarrhea

low residue diet

- intended to put less stress on GI system and bowel

- low fiber

- avoid seeds, nuts, berries, popcorn, caffeine, and tough meats.

lactose intolerant diet

- no dairy

- lactaid pills and products can be helpful for these patients

carb control diet

- ADA diet = reduced simple sugars, reduced carbohydrates

- for people with diabetes and glucose control concerns.

gluten free diet

- for those with celiac disease (CD)

- avoid wheat, rye, breads, cereals, crackers, cookies, flour tortillas, gravy, ice cream cones, and pancakes.

marasmus

protein-calorie malnutrition caused by starvation, cancer, anorexia, or bowel obstructions.

failure to thrive

- lower than expected weight and growth (kids).

- profound weight loss (elderly).

kwashiorkor

- protien malnutrition

- high calories and low protein.

objective abdominal assessments

lighting, empty bladder (specimen), warm room+stethoscope+hands, supine w/ knees flexed.

order of GI assessment

inspect, auscultation, percuss, palpate

inspection for abdominal cavity

- demeanor relaxed or agitated

- contour of abdomen = scaphoid, flat, rounded, protuberant, distended.

- symmetry

- pulsation = aortic pulsation

- visible masses

- umbilicus

- skin

- JP drain or ostomies

scaphoid

concave or sunken

rounded

slightly rounded

protuberant

bulging or stretched

distended

fat, air, gas, ascites, pathology (cysts/tumor), stool

umbilicus

- midline, inverted, no discolroation

- inflammmation or hernia (typically harmless).

umbilical hernia

part of gthe intestine protrudes through an opening or weak spot in the abdominal muscles

skin

lesions, rashes, scars, ostomies, tubes, drains.

JP drain

- jackson-pratt drain

- suction drain w/ tubing inside the body and pulls fluid out of the body for after abdominal surgery

ostomies

operations to remove part of the small or large intestine resulting in the need to create an artificial opening in the body for the elimination of bodily wastes

ostomy assessment

- stoma should be pink/red and moist

- stoma should not be black or purple.

- assess ostomy bag for COCA.

- consider placement and output (small intestine has more liquid than colon)

auscultate abdominal

- press lightly with diaphragm

- all 4 quadrants

- begin in RLQ (ileocecal valve) and go clockwise = RLQ, RUQ, LUQ, LLQ

bowel sounds

- air/fluid moving thorugh small intestine.

- high pitched, irregular, gurgling, or cascading sounds from 5-40 times/minute.

- you judge if they are normal, absent, hypoactive or hyperactive.

- listen for 5 minutes

-

borborygmus

stomach growls sounds

causes of absent/hypoactive bowel sounds

- peritonitis, or infection/inflammation of peritoneum

- surgery/manipulation of bowel/meds used during surgery/late bowel obstruction.

causes of hyperactive bowel sounds

diarrhea, laxative use, early bowel obstruction, gastroenteritis.

characteristics and frequency of abdomen

- normal = 5-30X/min

- absent = 0X5'

- hyperactive

- hypoactive

auscultating vascular sounds or bruits on abdomen

use bell

- vascular sounds not normal.

percuss

- all 4 quadrants

- typmany predominates (air rises to surface when patient lays down)

- dull = solid organ

- use a smooth, systemic pattern; be sure to get all 4 quadrants

liver span

- going down chest's MCL = resonance to dull (ICS 5th).

- going up from abdomen = tympany to dull.

spleen

not typically palpable and is small unless enlarged due to disease.

percussing costovertebral angle tenderness (CVAT)

direct or indirect

- hit back with fist for kidney pain.

fluid wave

- done when there is suspicion of ascites and differentiate from gas.

- stand of right side and place ulnar edge of someone elses hand in middle of abdomen.

- place your hands on either flank and press left flank and wait for tap

- gas/adipose tissue = no tap.

- ascites = tap on your other hand

- reason = HF, cancers, pacreatitis.

palpation for on abdomen

size, location, shae, consistency, surface, mobility, pulsatility, tenderness

how to palpate with abdomen?

- light then deep 1 cm then 5-8 cm(2-3inches).

- use first 4 fingers make a gently rotary motion.

- lift fingers clockwise around the abdomen.

- use palmar surface fingers.

palpation hints

- palpate known tender area last.

- knees bent.

- voluntary guarding (cold/tense/ticklish) vs. involuntary rigiduty (hardness of muscles).

bimanual technique

- large abdomen

- retroperitoneal organs = duck bills.

hooking method/technique

- face the patient's feet = hooking fingers over costal margin from above

- ask person to take deep breath = feel bump agaist fingertips or not

- palpate lower margin of liver.

gallbladder murphy's sign

- take deep breath inspiration depresses liver/GB for palpation under costal margins

- (+) inspiratory arrest = descending liver pushes inflamed GB onto hand, sharp pain and midway inspiration stops

- normal. = no pain

cholecystitis

GB inflammed causing pain.

palpation spleen

- bimanual

- palpable when 3X normal size

- spleen enlarges with mononucleosis, trauma, leukemia, and lymphomas.

- friable and can rupture easy with over palpatation.

palpation of kidneys/adrenal glands

- bimanual "duck bill" technique

- at right/left flank

- may palpate R lower pole as round/smooth sliding mass (can be normal)

- no changes felt with deep inspiration

- palpating the R lower pole or palpating nothing are both normal findings.

blumberg sign

rebound tenderness in RLQ when pressure is apllied to LLQ indicating appendicitis.

iliopsoas sign

patient supine, lifts right lef straight up, flexing at hip, then pushing down over lower part of right thigh as person holds leg up.

- abnormal = pain felt in RLQ

- normal = no pain with the test.

developmental changes with infants/children

- large liver and most organs palpable

- abdomen protuberant > 4 years.

- BS only, no vascular sounds on auscultation.

developmental changes with geriatric

- increased fatty deposits in abdomen and hips.

- muscle atrophy = organ easily palpable.

- abdominal muscles atrophy so the abdominal wall thinner/softer, so organs more easily felt.

referred pain

pain is not be directly over injured organ; may be referred to where organ was located in fetal development.

function of MS system

support to stand erect, movement, encase and protect inner vital organs, produce RBCs in bone marrow (hematopoiesis), and reservoir to store essential minerals. (calcium+phosphorus).

musculoskeletal system

skeleton, joints, muscles

skeleton/bones

the framework of the body

joints

functional structure needed for mobility

nonsynovial joints

bones united by fibrous tissue or cartilage can be immovable (skull) or slightly moveable (vertebrae)

synovial joints

move freely because bones separate and enclose in joint cavity (knees). the cavity is filled with lubricant or synovial fluid which allows sliding to permit movement

muscles

account for 40-50% of the body weight and made of 3 types skeletal, cardiac, and smooth.

when muscles contract they produce _______.

movement

skeletal muscles

muscle attached to bone by tendons and are under conscious control.

cardiac muscles

under unconscious control.

flexion

bending limb at joint.

extension

straightening limb at joint

abduction

moving limb away from midline of body

adduction

moving limb toward midline of body

pronation

turning forearm palm down

supination

turning forearm so palm is up

circumduction

moving arm in circle around shoulder

inversion

moving sole of foot inward at ankle

eversion

moving sole of foot outward at ankle

rotation

moving head around central axis

elevation

raising a body part

depression

lowering a body part

plantar flexion

pointing toe downward

dorsiflexion

oppoite of plantar flexion, pulling foot upwards.

temporomandibular joint (TMJ)

articulation of mandible and temporal bone; permits jaw function of speaking and chewing; assess for crepitus or pain with TMJ motion or palpation; allow for hinge (open/close), gliding (side/side), and gliding (retraction).

infants musculoskeletal

3 months gestation the fetus has formed skeleton of cartilage; bone growth continues rapidly during infancy.

children musculoskeletal

steady growth and lengthening at epiphyses/growth plates; any trauma can risk bone deformities.