Chapter 20— Abdominal Assessment

1. Chapter 20—Abdominal Assessment

2. Structure and Function • Function • Ingestion, digestion of food • Nutrient absorption; solid waste elimination • Anatomical landmarks • Reference lines • Quadrant method; nine regions • Abdominal organs • GI organs; GU organs • Blood vessels, peritoneum, and muscles

3. Structure and Function—(cont.)‏ • Ingestion and digestion • Absorption of nutrients • Elimination • Lifespan considerations: older adults • Reduced: saliva production; stomach acid production • Slowed: gastric motility; peristalsis • Cultural considerations

4. Urgent Assessment • Potentially life-threatening symptoms that require prompt attention • Severe dehydration: nausea, vomiting • Fever • Acute abdominal pain

5. Subjective Data • Assessment of risk factors • Personal history • General GI questions; chewing and swallowing • Breathing; weight gain; GU issues; joint pain • Neurological system; metabolism; skin • Lymphatic, hematological systems • Substance abuse; occupation; foreign travel • Lifestyle • Medications • Family history

6. Risk Reduction and Health Promotion • Health promotion and goals • Colorectal cancer screening • Reduce new cases of ESRD • Reduce cirrhosis deaths • Risk reduction • Colorectal cancer; food-borne illness • Hepatitis: A, B, C • Hepatitis A, B immunizations • Screening, patient teaching

7. Question • What is one topic pertinent to abdominal health promotion? A. Early pregnancy care B. Food-borne illness C. Respiratory disease D. Esophageal cancer

8. Answer • B. Food-borne illness • Rationale: Three areas of focus involving the GI system include colorectal cancer, food-borne illness, and hepatitis.

9. Common Symptoms • Abdominal symptoms • Indigestion; anorexia • Nausea, vomiting, hematemesis; abdominal pain • Dysphagia, odynophagia • Change in bowel function • Constipation; diarrhea • Jaundice/icterus • Urinary/renal symptoms • Incontinence; kidney/flank pain; ureteral colic

10. Lifespan Considerations: Older Adult • Additional questions • Risks for nutritional deficit • Bowel function • Daily medications • Cultural considerations • African; Asian; Jewish; Mediterranean • Native Americans

11. Objective Data • Common and Specialty/Advanced Techniques • Equipment; preparation • Comprehensive physical assessment • Inspection; auscultation; percussion; palpation • Eliciting abdominal reflex • Assessing for ascites; peritoneal irritation • Gallbladder inflammation • Appendicitis

12. Lifespan Considerations: Older Adults‏ • Potential alterations • Poor dentition • Decreased muscle mass, tone • Decreased motility, peristalsis  bloating, distention, constipation • Liver shrinkage  decreased medication metabolism • Decreased renal function  decreased medication efficacy • Cultural considerations

13. Critical Thinking • Common laboratory and diagnostic testing • Labs: CBC; BMP • Esophagogastroduodenoscopy (EGD) • Barium enema • Colonoscopy • Endoscopic retrograde cholangiopancreatography (ERCP) • Computed tomography scan (CT) • Magnetic resonance imaging (MRI)

14. Critical Thinking—(cont.)‏ • Diagnostic reasoning: nursing diagnoses, outcomes, interventions • Outcomes (partial list) • Patient will defecate formed stool every 1 to 3 days. • Patient will report decrease in incontinent episodes. • Interventions (partial list) • Teach patient to pace fluids, limit bedtime intake. • Administer bulk laxatives per physician order.

15. Question • Mrs. Jones presents at the emergency department complaining of severe pain in her abdomen. She has a history of a liver transplant. What would the nurse know NOT to do? A. Auscultate the abdomen B. Inspect the abdomen C. Palpate the abdomen D. Percuss the abdomen

16. Answer • C. Palpate the abdomen • Rationale: Do not palpate the abdomen of patients who have had an organ transplant or of a child with suspected Wilms tumor. Transplanted organs are often located in the anterior portion of the abdomen and not as well protected as the original organ.