GI Assessment Notes

GI Assessment

A&P of the Digestive Tract

  • The digestive system consists of various structures involved in the processing of food, absorption of nutrients, and elimination of waste. The main components include:
      - Mouth
      - Pharynx
      - Esophagus
      - Stomach
      - Small Intestine
      - Large Intestine
      - Anus

  • Accessory organs play a critical role in digestion and include:
      - Liver
      - Spleen
      - Gallbladder (GB)
      - Pancreas

Age Related Changes

  • As individuals age, various changes occur in the digestive system, including:
      - Mouth
        - Changes in teeth and gingival health
        - Decreased number of taste buds
        - Reduced saliva production
      - Esophagus
        - Alterations in lower esophageal sphincter (LES) function
      - Stomach
        - Diminished production of digestive enzymes
        - Slower motor activity
      - Large Intestine
        - Changes in anal sphincter function
      - Absorption
        - Altered ability to absorb vitamins and minerals

GI Assessment – Subjective

  • When conducting a GI assessment, gather subjective data on the following:
      - History of Present Illness (HPI)
        - Identify what issues the patient is experiencing:
          - Problems such as dyspepsia (indigestion)
          - Nausea/Vomiting (N/V)
          - Abdominal pain
          - Alterations in bowel elimination
          - Changes in weight

Onset, Location, Duration, Character, Aggravating, Relieving, Timing (OLD CART)

  • Utilize the OLD CART acronym to obtain detailed information:
      - Onset: When did the symptoms begin?
      - Location: Where is the symptom located? Does it radiate?
      - Duration: How long have the symptoms persisted?
      - Character: How bothersome is the problem? Does it affect ADLs (activities of daily living)?
      - Aggravating: Is the condition worsening, improving, or unchanged? What worsens the symptoms?
      - Relieving: What alleviates the symptoms? What interventions have been attempted?
      - Timing: What induced the patient to seek treatment today?

GI Assessment – Subjective - Medical History

  • Collect information on the patient’s past medical history related to the GI system, including:
      - Past medical history (PMH):
        - Ulcers
        - Colitis
        - Hepatitis
        - Cancer of the GI tract
      - Surgical history (Surg Hx):
      - Family history (Fam Hx):
        - Any familial GI disorders

GI Assessment Subjective - Additional Considerations

  • Inquire about:
      - Difficulty swallowing (dysphagia) or chewing
      - Altered taste sensations
      - Oral health including breath odors: halitosis (bad breath)
      - Appetite or dietary changes

GI Assessment - Pain Assessment

  • Assess abdominal pain using the following elements:
      - Palliation/Provocation: What makes the pain better or worse?
      - Quality: Characterize the pain (sharp, dull, etc.)
      - Region/Radiation: Where is the pain situated? Does it radiate?
      - Severity: Rate the pain on a scale (e.g., 0-10)
      - Timing: When does the pain occur?

GI Assessment – Subjective & Objective Data

  • Pay attention to objective signs such as changes in bowel habits or stool appearance:
      - Type of stool:
        - Formed
        - Hard
        - Presence of blood
        - Clay-colored
        - Foamy
        - Liquid

GI Assessment – Objective Findings

  • Inspection of Abdomen
      - Assess skin for any abnormalities
      - Look for:
        - Distention
        - Tautness
        - Visible pulsations
        - Visible peristalsis
        - Presence of hernias
        - Scarring from previous surgeries

  • Auscultation
      - Listen for abnormal sounds:
        - High-pitched or tinkling sounds
        - Bruits
        - Friction rubs
      - Reminder: Absent bowel sounds for a full 5 minutes necessitate further investigation

GI Assessment – Objective Findings in the Mouth

  • Examine oral conditions:
      - Signs of gingivitis or stomatitis (inflammation of the mouth)
      - Look under the tongue for abnormalities
      - COCA: Consider the characteristics of vomit and stool:
        - Hematemesis (vomiting of blood)
        - Melena (black, tarry stools)

  • Address alternative feedings and diverting mechanisms:
      - G-tube (gastrostomy) or J-tube (jejunostomy) placement
      - Document location and characteristics of stool from these devices

GI Assessment - Objective Findings Related to Medications

  • Review current medications that may impact GI health:
      - Use of laxatives
      - Steroids
      - Non-steroidal anti-inflammatory drugs (NSAIDs)
      - Acknowledge their relevance to conditions such as ulcers and infections

Conclusion

  • Humorous Note: "I HAVE A SURPRISE FOR YOU… IT'S POOP."

  • This light-hearted remark emphasizes the importance of gastrointestinal health and the often-taboo nature of discussing such vital bodily functions.

  1. A nurse is assessing a patient with a suspected gastrointestinal bleed. Which of the following findings would the nurse expect?
       - A. Bright red blood in the stool
       - B. Coffee-ground-like vomitus
       - C. Pale skin and shortness of breath
       - D. All of the above
    Correct Answer: D. All of the above

  2. When educating a patient about dietary changes to manage gastroesophageal reflux disease (GERD), which statement by the patient indicates a need for further teaching?
       - A. "I should eat smaller meals throughout the day."
       - B. "I can eat spicy foods as long as I limit my portion sizes."
       - C. "I need to avoid lying down after eating."
       - D. "I will avoid fatty foods and caffeine."
    Correct Answer: B. "I can eat spicy foods as long as I limit my portion sizes."

  3. The nurse is caring for a patient with a history of hepatitis. Which lab result would be of priority to assess?
       - A. Elevated bilirubin levels
       - B. Elevated white blood cell count
       - C. Decreased hemoglobin levels
       - D. Elevated potassium levels
    Correct Answer: A. Elevated bilirubin levels

  4. Which assessment finding would indicate a potential issue with the lower esophageal sphincter (LES) function?
       - A. Dysphagia
       - B. Heartburn or acid reflux
       - C. Abdominal pain after meals
       - D. Nausea
    Correct Answer: B. Heartburn or acid reflux

  5. During an abdominal assessment, the nurse notes that the patient has visibly distended abdomen. What is the most appropriate nursing action?
       - A. Document the finding and reassess later
       - B. Palpate the abdomen immediately to assess for tenderness
       - C. Notify the healthcare provider of the finding
       - D. Ask the patient about their recent fluid intake
    Correct Answer: C. Notify the healthcare provider of the finding

  6. A nurse is providing instructions to a patient regarding the use of NSAIDs for pain management. Which statement indicates that the patient understands the instructions?
       - A. "I will take these medications with food to reduce the risk of gastrointestinal upset."
       - B. "I can take them on an empty stomach for faster relief."
       - C. "I should increase my intake of alcohol while on these medications."
       - D. "I can safely take them for any length of time without consulting my doctor."
    Correct Answer: A. "I will take these medications with food to reduce the risk of gastrointestinal upset."