which is indicative of rebound tenderness in the abdomen? a. appendicitis b. gastric ulcer c. pancreatitis d. gastroesophageal reflux disease (GERD)Awhich problem would the nurse expect to find in a patient with dysphagia?difficulty in swallowingIn what order does the nurse assess the abdomen?inspect ascultate percuss palpatewhich finding is consistent with sudden onset of severe colicky pain in the lower abdomen? a. appendicitis b. cholecystitis c. kidney stones d. gastroenteritisC. (colicky = severe pain in abdomen due to gas or intestinal blockage) A - dull, perumbilical to RLQ pain b - sudden RUQ pain that radiates to the scapula on either side D - diffuse, general pain with nausea and diarrheawhich is the nurse performing when placing the stethoscope over the xiphoid process while lightly stroking the skin with one finger up the midclavicular line from the RLQ? a. scratch test b. splenic dullness screeningA done to detect the lower border of the liverwhich abdominal assessment would the nurse use to confirm rebound tenderness? a. murphy sign b. blumberg sign c. obturator test d. iliopsoas muscle testB positive sign is pain on release of pressure - choose site away from the painful areawhich feature is specific to the right kidney? a. lies at the costovertebral angle b. may be palpableB due to different position caused by liverwhich is the cause of a marked visible peristalsis? a. ascites b. hypertension c. enlarged liver d. intestinal obstructionDwhich term would the nurse use to document the palpation of a small fatty nodule through the linea alba on the abdomen when the patient is standing? a. epigastric hernia b. umbilical herniaAWhich intervention is used to determine murohy sign?ask the patient to take a deep breath while holding the fingers under the liver border - inspiratory arrest is seen with cholecystitiswhich is the possible cause of a scaphoid- shaped abdomen in a 4- year old patient? a. tumor b. feces c. ascites d. dehydrationDwhich assessment should the nurse use to confirm the placement of a feeding tube?x-raywhich conditions would the nurse monitor to evaluate gastrointestinal motility for the post-abdominal surgery patient? select all that apply a. flatus b. incisional pain c. urinary output d. urinary frequency e. bowel movementsA, EThe appendix is in which abdominal quadrant?RLQThe liver is primarily in what abdominal quadrant?RUQThe stomach is located in which abdominal quadrant?LUQThe spleen is located in which abdominal quadrant?LLQHow are the four abdominal quadrants split up?vertically and horizontally from the umbilicusThe peritoneum is a continuous membrane that lines the ________________ and covers most of the abdominal organs.abdominalThe kidneys are retroperitoneal meaning.....?located in the back of the abdomen behind the peritoneum (sit behind the lining)where is the bladder located?midline between RLQ and LLQthe ovaries are located where?in the RLQ and LLQwhich area of the abdomen is considered the epigastrum?between the costal margins (Where the ribs meet the sternum)which area of the abdomen is considered the umbilical region?around the belly buttonwhich area of the abdomen is considered the suprapubic area? what is another name for this area?above the pubic bone where the bladder and urethra is also called the hypogastriumwhich are of the abdomen is considered the flank?sides of the abdomen right flank and left flankT or F: meds can cause common side effects such as nausea and constipationtrueThe following questions should be asked during a health history. Label which one is screening for Hep B/C and which is screening for Hep A. What patient would we especially screen with these questions? A. IV drug use or blood transfusion or tattoos in the past year? B. Ingestion of raw shellfish such as oysterA. Hep B/C B. Hep A A patient who presents with jaundice (also ask about vaccination status)Why should new foods be introduced one at a time to infants?to identify potential food allergiesT or F: Irregular eating patterns are common in children and should not be a concern as long as they are growing appropriately.trueWhat is PICA?when a child eats nonedible foods (child should be able to recognize edible foods by the age of 2 years old)Adolescents are at risk for eating disorders, so eating habits should be screened. Amenorrhea is one S/S of anorexia. What is amenorrhea?absence of periodwhat are some reasons that nutritional deficits are more common in older adults?- ADLs are limited due to living alone - functional deficits - CN deficits cause decreased taste and smellIt is important to ask older adults if they experience dysphagia. What is dysphagia?difficulty with swallowingwhat is chezia?stoolwhat is dyschezia?difficulty passing stoolWhat is the description of normal stool?brown, soft and formed (however, can vary from food)The patient presents with black, tarry stool. Answer the following: a. How would you document this finding? b. what is this a sign ofa. melena b. upper GI blood (stomach, small intestine)The patient presents with black, non-tarry stool. Answer the following: a. what supplement could cause this? b. why is this not melena?a. iron supplements b. this stool is non-tarry, melena is tarry and a sign of an upper GI bleedThe patient presents with bright red blood that looks like cherry pie filling in their stool. At times they only notice streaks of blood in the toilet. Answer the following: A. how would you document this finding? B. what could this be a sign of?A. hematochezie B. lower GI bleed (or localized rectal bleeding)The patient presents with oily, fatty stool. The stool floats on top of the water when the patient uses the restroom and you note oil droplets on the stool. Answer the following: A. how would we document this finding? B. what is this a sign of?A. steatorrhea B. malabsorption of fat (could be celiac disease, crohns, pancreatitis, Cystic Fibrosis (2nd to pancreatic dysfunction).A patient presents with yellow tinted stool that at times looks clay-like. What is this a sign of?Liver dysfunction, yellow due to excess billirubin. ( hepatitis, cirrhosis)During the palliative section of OPQRSTU of abdominal pain, why is it important to ask if they feel better or worse with eating (non empty stomach)?food can help or worsen pain for different types of ulcerswhat is the quality description pyrosis? What are some common causes?- burning feeling - common with ulcer, heart burn and gastritis (inflammation of the lining of the stomach(Cramping pain in the abdomen is commonly associated with what?spasm of the colonSharp abdominal pain that radiates to the upper back is commonly associated with what?gallbladder issueswhat is flatulencemedical term for passing gas; fartWhat is a very important question to ask patients who have a uterus when they come in for abdominal pain?- last menstural period any chance they are pregnantA patient presents with bloody vomit that looks like coffee grounds. Answer the following: A. how would we document this finding? B. What could this be an indication of?A. hematemesis B. upper GI bleedA patient presents with vomiting that began right after they ate dinner. What could be the cause of this?food poisoningIn what order do we perform IPPA for the abdominal assessment?Inspect Auscultate Percuss Palpate (Palpate last and palpate painful areas last so you can get through your assessment and not cause muscle guarding)T or F: Ensure the patient has a full bladder before you begin the abdominal exam.False. Ensure they have an empty bladder and do not have to go to the restroom.What is the normal finding regarding the umbilicus while inspecting the abdomen?- midline - inverted (no discoloration or hernias)The patient present with ecchymosis around the umbilicus and superficial edema. What is this?cullen's sign indicates internal hemorrhageThe patient presents with ecchymosis of the flank what is this sign called?turner's sign indicates internal hemorrhageThere are four contour types that can be used to describe the abdomen. What are they?- flat = normal - rounded = normal - concave / scaphoid = malnutrition - protuberant = abnormal unless pregnant, really sticking out, sign of distentionThe abdominal aortic pulsation may be visible in thin people at what region of the stomach?epigastricVisible waves of peristalsis is an early sign of _______________________. This may be normal to see on very thin people but only if the patient has NO pain!bowel obstruction the body recognizes it is about to obstruct and ramps up peristalsis to try to overcome, may not always be able to see.In which direction do we auscultate the abdomen, which quadrant do we start in?clockwise begin in RLQwe listen to bowel sounds with the _________ of the stethoscope and we listen to abdominal vascular sounds with the _________ of the stethoscope.diaphragm, bellWhat valve is located in the RLQ that produces the most active bowel sounds?ileocecal valve where the small and large intestine meetFor safe practice should you auscultate the abdomen to determine correct placement of a nasogastric (NG) tube?NO Xray should be used (can also use pH testing)borborygmibowel sounds that you can hear without a stethoscopeWhat is the term to describe bowel sounds that are high-pitched, gurgling, irregular pattern, 5-30 times per minute?normoactivewhat is the term to describe bowel sounds that are: Quieter or same as normative, but less frequent, <5 sounds/min? What could cause this?Hypoactive Decreased motility post abd surgery, peritonitis, opioids, obstructionbowel sounds are considered absent after auscultating for how many minutes and not noting any sounds? What could cause this?5 ileus ( lack of normal muscle contractions, could be due to surgery and can lead to obstruction) or obstruction___________ often occurs post-operative and can lead to an obstruction.Ileus (lack of movement in the intestine)what is the term for bowel sounds that are Loud, rushing, tinkling sounds, that occur more than normally? What could cause this?hyperactive sign of EARLY bowel movement borborygmus (hunger) diarrhea laxatives gastroenteritisHyperactive bowel sounds is an early stage of ________________, where hypoactive or absent or late signs.bowel obstruction tries to overcome the obstruction, hypo and absent means the obstruction has happenedWhat are we listening to in the abdomen when using the bell side of the stethoscope?vascular sounds (arteries)While listening to abdominal sounds with the bell of the stethoscope you note a low pitch whooshing sound. What is this and what does it indicate?Bruit Indicates stenosis, aneurysum or PAD + BRUITS ARE TURBULENT BLOOD FLOW. (Think of a wide river flowing smoothly and then the river has to go through a small canyon, the canyon is where we would see the bruits due to partial obstruction, most common cause is ARTHERLOSCLEROSIS).Are bruits a normal finding in an abdominal assessment?NO (for test purposes) (in real life if they have no cardiovascular risk factors may not be an issue)Venous hum in periumbilical region is rare and may indicate portal HTN or ________________.cirrhosisWhat would hearing a peritoneal friction rub indicate during auscultation?peritoneal surfaces rubbing from inflammation or tumorwhat areas do we listen to the vascular sounds over the abdomen?aorta, renal, iliac and femoral_________ predominates in the abdomen when percussed. What could caused dullness when percussed?tympany Dullness could be heard due to... - liver, fecal matter, ovarian cyst, adipose tissueWhat could dullness in the LLQ during percussion indicate?the patient may need to have a bowel movementT or F: You can percuss and palpate the suprapubic area to assess for urinary retention.yes (for testing purposes) (in real life use a bladder scanner)First percussion is done by placing the nondominant hand at the costovertebral angle and thumping it with the ulnar side of the dominant hand. What is this testing for? Where is the costovertebral angle (CVA)?- testing for pain, pain would indicate inflammation of the kidney (CVA tenderness) - where 12th rib meets the vertebral columnWhat is light vs deep palpation used for?light palpation is assessing for tenderness and surface characteristics (masses, hernias, lumps, distention) deep palpation (2"-3" or 5cm-8cm) is used to palpate organs or for large abdomensvoluntary guarding vs. involuntary guarding. What could involuntary guarding indicate?voluntary guarding: not that bad. (voluntary contracting their muscle, due to cold, ticklish, nerves, pain) but it can be over come by warmth, pain meds, distraction techniques. involuntary guarding: VERY BAD. (Muscles are always tense. This is a sign of PERITONITIS. (involuntary guarding = abdominal rigidity = board like abdomen)How do the following organs usually feel on palpation? A. liver B. gallbladder C. spleenA. normally smooth, firm and non-tender (need to push in under ribs to feel) B. normally not palpable C. normally not palpableThe liver should not extend __cm outside of the right costal margins. If it was extended more what would this indicate?2 enlargementWhat should you do if you palpate the spleen?Stop, notify a provider of enlargement. - Very vascular could rupture easily!T or F: If the gallbladder is palpable it is enlarged.TrueUmbilical hernias may be prominent when an infant cries due to increased inter-abdominal pressure. When should these go away?within the first year of lifeWhy do infants have protuberant abdomens?because their muscles are underdevelopedWhat could caused a midline bulge (diactesis recti) in an infants abdomen?underdeveloped musclesWhat is meconium? When do you want to see it?a babies first poop want them to pass within the first 2 days of life!Is it common for babies stool to very in color and consistency?yesWhere are you more likely to hear bowel sounds on a pregnant patient?pushed towards the flank (sides) - due to fetus pushing everything off to the side - harder to hearWhy is the development of hemorrhoids common in pregnancy?GI motility decreases > this causes constipation > which leads to straining causing hemorrhoidsWhy is diactesis recti common post-delivery in pregnant patients?the midline bulge is due to muscle weakness from muscles being separated during pregnancyPyrosis is common during pregnancy. What is pyrosis?heart burn due to pressure on the stomach and esophagus during pregnancyWhy are varicose veins common in pregnancy?fetus causes increased lower venous pressure, this leads to - varicose veins - hemorrhoids (varicose veins of the rectum)The aging adult has decreased gastric acid secretion, what can this lead to?Pernicious anemia decreased gastric acid secretion (has intrinsic factor in it that helps absorb vitamins and minerals) > altered vitamin B 12 absorption > can develop pernicious anemia. The body needs B12 to develop red blood cells. (Initially first symptom is a burning tongue (glossitis) and then turn into anemia (fatigue, etc...)T of F: Constipation is common NOT NORMAL for age.True (common due to medications, decreased activity, less water, less fiber). But it IS NOT NORMAL. (Much higher rates of fissures, hemorrhoids, rectal prolapses due to straining)why is abdominal rigidity not a reliable sign of peritonitis in older adults?Less abdominal musculature leads to a baseline rigidityT or F: HPI and Physical Exam helpful to form a hypothesis. Imaging (I.e. ultrasound, x-ray, CT) and labs (i.e. H&H low with bleed, WBC high with infection) often needed to confirm a diagnosis.True HPI = history of present illness H&H = hemoglobin and hematocritA patient presents with regurgitation, burning retrosternal chest pain after eating and reports the pain is worse when lying down. What could this be? What causes this?GERD Gastroesophageal reflux disease - flow of gastric secretions up into esophagus - caused by: weakened lower esophageal pressure or increased intra-abdominal pressure +Overtime backflow into esophagus can do tremendous damage and lead to cancerWhat are some things we could educate the patient with GERD to do to help ease their symptoms?- sit up after eating - drink less water during meals - limit spicy foods (tend to trigger)Where does peptic ulcer disease occur? What is the most common type of ulcer?esophagus, stomach and duodenum most common = duodenal ulcerPeptic Ulcer Disease usually results from infection with H. pylori. What are some other causes of a gastric ulcer?- stress - meds (steroids, aspirin, NSAIDS) (especially if not taken with food can tear up the stomach)Duodenal and Gastric ulcers both present a dull, aching, gnawing epigastric pain. But what is one thing that distinguishes one from the other?Duodenal is relieved by food intake. Gastric is worse pain with food intake. This is because the sm. intestine releases bicarbonate that counteracts the acid and relieves pain. So twill hurt if stomach is empty for duodenal. Gastric ulcer pain is worse with food intake because the stomach released acid when you eat food.A patient with history of ulcers presents with epigastric pain that radiates to the back. They have a fever and abdominal rigidity. What could be causing this?Perforation When the ulcer gets deep enough it can perforate the bowel and cause peritonitis.What are two possible findings you could come across if the ulcer is bleeding?- Hematemesis (blood in vomit) - Melena (black, tarry stool evident of upper GI bleed)A patient presents with protuberant abdominal contour, their flanks are bulging, the skit is taut and they are experiencing shortness of breath. A fluid wave test is performed with positive results and on percussion you note shifting dullness. What is this and what are some causes?Ascites Common causes: #1 is liver failure!, cirrhosis, heart failure, cancerWhat is the best method for early detection of ascites?routine measurement of abdominal girthWhy is the fluid wave test and shifting dullness not always a reliable sign of ascites?Must have a larger amount of fluid over 1 liter. Ultrasound is the definitive diagnostic tool.Explain the shifting dullness test, what is it used to assess?used to assess presence of fluid in the abdominal cavity (fluid collection in abdominal cavity = ascites) when on the side the patient will have dullness on the front of stomach near table, and tympany on theside of the pool thats opposite of the table. when on the back tympany on the top of the stomach and dullness to the sides and lower bottomWhat is the most sensitive test to overall body fluid retention, not just in the abdominal cavity?daily weights (if just the abdomen then measurement of abdominal girth)Explain the fluid wave testshould feel no wave by tapping, if there is fluid collection should feel wave tapping on the opposite hand of tapping. Patient places their hand at midline only good for 500mL of fluid and moreT or F: Masses will give dullness when percussed in the abdomen but they will not shift with gravity (when patient turns).trueFor a small amount of fluid in the abdominal cavity _____ can be used for treatment, but for larger amounts a procedure known as a paracentesis will be performed.diureticsWhat is blumberg's sign?also referred to as rebound tenderness, is a clinical sign that is elicited during physical examination of a patient's abdomen. It is indicative of peritonitis. (Appendicitis if at McBurney's point) It refers to pain upon removal of pressure rather than application of pressure to the abdomen.The patient presents to the ER with &V, fever and bloating. They note RLQ pain at McBurney's point with positive rebound tenderness. You perform a Iliopsoas muscle test and obtain a positive finding. What are these signs of? What is the iliopsoas muscle test?Appendicitis (inflammation of the appendix) Iliopsoas muscle test- pt raises right leg up, flexing at the hip (straight leg). Pain in the RLQ suggests appendicitis. Can also be tested with a flexed knee against resistance.What is McBurney's point?the area overlying the appendixWhat is rebound tenderness?patient experiences more pain when pressure is taken away.A proactive nursing intervention for appendicitis is to keep the patient NPO. What is NPO?nothing by mouthA patient presents with RUQ pain that radiates to the shoulder. They state that their pain is worse after meals. You test Murphy's sign and find a positive result. What is causing this in the patient and what is Murphy's sign?Cholecystitis (bile duct becomes obstructed by inflammation or gallstones) (gallbladder) MURPHY'S SIGN: patient supine, push deeply to RUQ, have patient breath in and push in deeper if they stop that is inspiratory arrest and very good sign of cholecystitis.what is cholelithiasis?gallstonesCholecystitis is very common in what type of patients?overweight femalesWhat type of diet is recommended for patients with non-severe cases of cholecystitis?low-fatA patient presents with crampy pain mostly in the LLQ, they are constipated, have a distended abdomen and have localized tenderness. What could be causing this?diverticulitis outpouching due to weakness in intestinal wall causes diverticula (often caused by chronic constipation)Diverticulitis is treated first with clear liquids and antibiotics then told to switch to high fiber diets after the flare up is over to reduce risk. Why must diverticulitis be treated, other than treating patient's pain?MUST BE TREATED because if pressure gets to high it will cause perforation, that bacteria will get into abdominal cavity and then you will get peritonitis.The following are symptoms of which inflammatory bowel disease: ulcerative colitis or crohn's disease? - affects the entire large intestine (colon) - profuse bloody, mucousy diarrhea - weight loss - abdominal painUlcerative Colitis Begins in the rectum and moves up Loss of hausrta (haustra help move food slowly and absorb water)The following are symptoms of which inflammatory bowel disease: ulcerative colitis or crohn's disease? - can affect any part of the digestive tract from mouth to anus - symptoms depend on location of fissures/fistula/ulcer - weight loss - abdominal painWhat is the big difference between ulcerative colitis and crohn's disease?ulcerative colitis only infects the colon: starts in rectum goes up and with flare ups get profuse bloody, mucous diarrhea. (sometimes have to get infected area removed and get colostomy) crohns can infect mouth to anus, can infect colon and have bloody stools but sometimes can have infected stomach or small intestine and that will give melenaIBS causes the patient to be gassy and bloated but these patients do not have __________.flare ups (it affects large intestine and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both)A patient presents with fever, bloating, abdominal pain and rigidity (involuntary guarding). What could this be and what are some causes?Peritonitis Happens when bacteria enters the abdominal cavity and causes peritoneal inflammation causes: perforated bowel, trauma, diverticulitis, perforated peptic ulcer, pancreatitis, ruptured appendix, peritoneal dialysis. Abdominal surgery.what is peritonitis?inflammation of the peritoneum — a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen — that is usually due to a bacterial or fungal infection.A patient presents to the ED with abdominal and lower back pain, you palpate a strong abdominal pulsation and note a bruit during auscultation over the abdominal aorta. What is this? If the patient were to have sudden, severe pain and hypotension what would that further indicate?Abdominal Aortic Aneurysm (AAA) - Dilation of the abdominal aorta caused by alteration in the integrity of its call, caused by arthlerosclerosis Sudden, severe pain and hypotension may indicate bursting (rupture) or seperation (dissection) and may lead to shock or deathIs an abdominal aortic aneurysm (AAA) a GI problem?No, it is a cardiovascular problemWhat is the biggest risk factor for developing an abdominal aortic aneurysm (AAA)?smokingwhat is an aneurysum?a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches. As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.

NUR 310: Chp. 22

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