GI/GU Assessment

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Author:
dllundgren
ID:
112786
Filename:
GI/GU Assessment
Updated:
2011-10-27 23:30:37
Tags:
NURS 1921 GI GU Assessment
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Description:
NURS 1921 Exam V
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  1. What makes up the GI system?
    • Mouth
    • Esophagus
    • Stomach
    • Liver
    • Gall bladder
    • Spleen
    • Small Intestine
    • Large Intestine
    • Rectum
    • Anus
  2. Function of the GI Tract
    • breakdown food into molecular form for digestion
    • absorption of nutrients by digestion
    • elimination of undigested food and other waste products
  3. What makes up the GU system?
    • kidneys
    • ureters
    • bladder
    • urethra
  4. Function of the GU system
    • maintain the body's state of homeostasis by regulating fluid and electrolytes
    • removing wastes
    • providing hormones that are involved in rbc production, bone metabolism and hypertension
  5. Peristalsis
    involuntary, progressive wave-like movement of the musculature of the GI tract
  6. Paralytic ileus
    Paralysis of intestinal peristalsis
  7. Peritonitis
    inflammation of the peritoneum
  8. Flatulence
    excessive formation of gases in the GI tract
  9. Flatus
    intestinal gas
  10. Epigastric Pain
    pain in the upper central region of the abdomen
  11. Rectum
    the final straight portion of the large intestine
  12. Anus
    opening at the end of the anal canal
  13. Sphincter
    circular muscle that constricts a passage or closes a natural orifice
  14. Striae
    irregular areas of skin that look like bands, stripes, or lines; stretch marks
  15. Health Promotion/Prevention for GI&GU systems
    • Routine physical exam
    • Nutritional status
    • Colon & Rectal Cancer Screening
    • Urinalysis test to detect diabetes, renal problems, infections
    • Pap smear
    • Testicular exam
    • PSA prostate spedific antigen
  16. Health History of GI/GU systems
    • Risk factors
    • Surgical history (abdominal surgery, trauma)
    • Medications, diet and alcohol
    • Family history
    • Bowel/bladder habits
    • Aids to elimination, either physical or chemical
    • Weight changes
    • Abdominal/ low back pain
    • Psychosocial history
  17. Chief Complaint
    (OPQRST system)
    • Onset
    • Palliating and provoking factors
    • Quality
    • Region or site of symptom
    • Severity
    • Timing of onset and duration of symptom
  18. Chief Complaint
    (Additional Infomation)
    • Statement of general health
    • Course since onset
    • Effects on activity
    • Associated S/S
    • What does the patient think is going on?
    • Is anyone else having similar symptoms?
  19. Regions of the Abdominal Area
    • Right hypochondriac region
    • Epigastric region
    • Left hypochondriac region
    • Right lumbar region
    • Umbilical region
    • Left lumbar region
    • Right iliac region
    • Hypogastric region
    • Left iliac region
  20. Steps of Assessment
    Standards:
    • Ensure that the patient has an empty bladder
    • Perform auscultation before palpation or percussion
    • Locate findings according to the abdominal quadrants
  21. Equipment for assessment
    • Stethoscope
    • Adequate lighting
    • Warm hands w/ short fingers
    • Small pillow
    • Tape measure
  22. Abdominal Assessment
    Patient Preparation
    • Room should be warm and patient's upper chest/legs should be draped
    • Expose the abdomen just above the xiphoid process down to the symphysis pubis
    • Patient should be supine with arms down to the sides and knees slightly bent
    • Use a small pillow for relaxation of abdominal muscles
    • Keep hands and stethoscope warm
  23. Abdomina Assessment
    Inspection
    • Color
    • Contour
    • Symmetry
    • Umbilicus
    • Pulsations
    • Peristalsis
  24. 7 F's of abdominal distention
    • Fat
    • Flatus
    • Fetus
    • Feces
    • Fluid
    • Fibroid
    • Fatal growth
  25. Contour of the Abdomen
    • Flat
    • Rounded (Convex)
    • Scaphoid (Concave)
    • Protuberant
    • Obese
    • Pendulous
  26. Abdominal Assessment
    Auscultation
    • Bowel sounds are high pitched, gurgling, cascading sounds occuring every 5 to 20 seconds
    • Use the diaphragm of the stethoscope
    • Assess all quadrants in a clockwise manner
  27. Abdominal Assessment
    Abnormal Bowel Sounds
    • Increased bowel sounds - diarrhea or early bowel obstruction
    • Decreased bowel sounds - abdominal surgery or late bowel obstruction (may need to re-awake the bowels)
    • Absent bowel sounds - peritonitis or paralytic ileus
  28. Abdominal Assessment
    Vascular sounds (Bruits)
    • Assess over the aorta, renal arteries, iliac and femoral arteries
    • Use the bell of the stethoscope

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