Health Assess: Week 4: GI/GU/Reproductive & Medication Reconciliation

Abdomen: 2 Types of Peritoneum Lining

1. parietal

2. visceral peritoneum

Abdomen: 4 Pairs of Abdominal muscles

1. rectus abdominis

2. transverse abdominis

3. internal abdominal oblique

4. external abdominal oblique

Abdomen: 2 Types of Viscera

1. solid viscera: adrenal glands, kidneys, liver, pancreas, spleen, ovaries, uterus) (when percussed, should be DULL sound)

2. hollow viscera: gallbladder, SI, stomach, colon, bladder (when percussed, should be TYMPANIC)

Abdominal Assessment Order

1. inspection

2. auscultation

3. percussion

4. palpation
   (different than normal IPPA)
   (START ON RLQ and go clockwise)

Right Lower Quadrant Organs

• cecum, appendix, part of ascending colon, (right ovary/right spermatic cord, right ureter)

• hollow sound

Right Upper Quadrant Organs

• liver, gallbladder, duodenum (SI), head of pancreas, part of transverse & ascending colon (right adrenal gland)

• solid sound

Left Upper Quadrant Organs

• stomach, spleen (solid), body & tail of pancreas, part of transverse colon & descending colon, (left kidney, left adrenal gland)

• hollow sound

Left Lower Quadrant Organs

• sigmoid colon, part of descending colon (left ureter, left ovary/left spermatic cord)

• hollow sound

Liver

• heaviest & largest excretory organ; filter toxins/nutrients

• Diagnostic tests: AST, ALT, ammonia/bilirubin levels, liver biopsy

Gallbaldder

• store, concentrate, and transport bile to the intestines to aid in digestion (to digest fats)

• diagnostic tests: ultrasound, hepatobiliary iminodiacetic acid scan for cholecystitis inflammation

Pancreas

• secretes insulin & releases pancreatic juices

• diagnostic tests: amylase & lipase, glucose

Stomach

• temporary reservoir that stores food and breaks it down

• 3 parts: upper fundus, body, and lower pylorus

• diagnostic tests: esophagogastroduodenoscopy, capsule endoscopy

Spleen

• largest lymph organ (immune system)

• diagnostic tests: complete blood count (CBC)

Small Intestine

• digestion (& absorption of nutrients)

• 3 parts: duodenum, jejunum, ileum (more solid b/c absorbed further down GI)

Large Intestine

• absorption of water and electrolytes

• 4 segments: ascending, transverse, descending, sigmoid colon

Anus & Rectum

• rectum: store processed fecal material

• anus: endpoint of GI tract, internal & external sphincter

Kidneys

• remove waste/drugs, balance body fluids, release hormones

• lie in back part of upper abdomen

Bladder & Ureters

• bladder: reservoir for urine

• ureters: transport urine

Health History GI (OLDCARTS Questions)

weight, appetite, dysphagia, N/V, indigestion/heartburn, constipation/diarrhea, flatulence (gas)

• Onset

• Location

• Duration

• Characteristics

• Aggravating/Alleviating Factors

• Relieving Factors

• Treatment

• Severity

Health History Anus/Rectum

• change in size and diameter of stools

• Hematochezia: color of blood in stool gives you clues to where bleeding is occurring

  • Bright Red Blood: Often from the lower colon, rectum, or anus (e.g., hemorrhoids, anal fissures, colon polyps).

  • Dark Red/Maroon Blood: Can come from higher up in the colon or small intestine.

  • Black, Tarry Stools (Melena): Indicates bleeding from the stomach or upper small intestine

Health History GU

• urination (frequency, incontinence, back pain, dysuria, hematuria)

• if skin is jaundiced, indicates liver issue

• out of country travel

Steps for GI/GU Assessment Exam

1. Instruct patient to empty the bladder. (b/c they can pee themselves)

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. (only expose what we need to see to gain trust)

4. If the patient states that he or she has abdominal pain, say that you will assess the painful abdominal area last.

1. Inspecting the Abdomen

• at patient’s side & standing at patient’s feet

  • contour, size, symmetry, hair distribution → flat or round, symmetrical

• skin: color, lesions, veins, hernias → smooth

• movements, pulsations, peristalsis

ABNORMAL:

• sunken/scaphoid, protuberant/distended stomach

2. Auscultating Bowel Sounds of Abdomen

• starting in the RLQ then moving clockwise (RLQ→RUQ→LUQ→LLQ)

• hearing for peristalsis (movement):

  • normal: 5-34 clicks or gurgles/min (borborygmus sound)

  • hypoactive: <5 clicks/min (slow, dec. sounds)

  • hyperactive >34 clicks/min (loud, high-pitched sounds)

• if NO sounds for 3-5 min, then bowel obstruction/ileus (stoppage of peristalsis) = no BLOOD FLOW!!

3. Percussing the Abdomen

• use 2 fingers to tap on abdomen and hear sound and assess tenderness or inflammation

• normal sounds:

  • tympany: high-pitched drum-like sound in HOLLOW organs (ex: stomach, intestine, colon)

  • dullness: low sound in SOLID organs (ex: liver, spleen)

ABNORMAL:

• in distention, excessive high-pitched sounds → means trapped gas or fluid (ascites)

• dullness, pain

4. Palpating the Abdomen

• light, then deep palpation to assess tenderness

• nondominant hand over dominant hand, press down 1.2-2 iniches

ABNORMAL:

• Rovsing Syndrome: when palpation on LLQ causes pain in RLQ

• Blumberg Sign (Rebound Tenderness): press slowly on tender area and let go.. if extremely tender = peritoneal inflammation (infection)

Stool Inspection

• volume, color, odor, consistency, shape, constituents

Urine Inspection

• color, odor, turbidity (clear or cloudy), pH, specific gravity, constituents (abnormal: blood, pus, glucose, protein), amount

• urine output: 30 mL/hour

  • if urine output is TOO LITTLE, then blood loss (hypovolemia)

  • if urine output is TOO MUCH, then urinary retention (waste gets absorbed)

Healthy People 2030 for Cancer

• Goal: reduce the # of new cancers, disability, and death

• Colon Cancer Screening: screen for colon cancer depending on family hx, but begins at age 45 for both men and women

Medication Reconciliation

• creating an accurate list of a patient’s current medications and comparing it with physician’s admission, transfer, and discharge orders