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Abdominal Assessment — Transcript

by Gina Kemper · 6,449 words · 1,153 segments · language en · Watch on YouTube

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0:01Welcome back to
0:05abdominal assessment. All right, so now
0:07we're getting into the abdomen.
0:12And here's what we're learning about
0:14today.
0:17So, as we move into the abdominal
0:19assessment, it's going to be really
0:21important that you start building a
0:23mental picture of where these organs are
0:25located in the body. And understanding
0:28anatomy is what's going to help us
0:30connect assessment findings, pain, and
0:32symptoms to what might actually be
0:34happening with the patient. So on the
0:36left side of the slide are the major GI
0:39organs. And you can see the digestive
0:41tract starts at the mouth, moves through
0:43the fairings and esophagus into the
0:46stomach, small intestine and large
0:48intestine, and then ends at the rectum
0:50and anus. And you also see the accessory
0:53organs like the liver, gallbladder,
0:55pancreas, salivary glands, which all
0:59help with digestion even though food
1:01doesn't physically pass through them or
1:03it shouldn't at least. So as nurses,
1:06knowing where these organs are helps us
1:09interpret findings during assessment.
1:12For example, if a patient tells you they
1:15have right upper quadrant pain, you
1:17should immediately start thinking about
1:19those organs that are located there like
1:20the liver or gallbladder. If someone has
1:23right lower quadrant pain, maybe you're
1:26thinking about appendicitis,
1:28epigastric pain may point more towards
1:30the stomach or the pancreas. So this is
1:33where anatomy starts connecting directly
1:35to clinical judgment.
1:38Now on the right side of the slide are
1:40the GU organs um the general ur urinary
1:45um including the kidneys, urtors,
1:47bladder and urethra. And one thing I
1:50want you to remember is that the kidneys
1:51are retroparitinal meaning they sit
1:53farther back behind the abdominal
1:56cavity. And because of that kidney pain
1:58is often felt more in the flank or back
2:01area instead of the front abdomen.
2:04You'll also notice how closely these
2:06organs relate to major blood vessels
2:08like the aorta and inferior vennea and
2:11that becomes important later when we
2:13talk about things like abdominal aortic
2:15aneurysms or assessing circulation to
2:18organs.
2:19Um, so as we go through abdominal
2:21assessment,
2:23this anatomy helps guide everything that
2:25we do. Where we oscultate bowel sounds,
2:28where we palpate for tenderness or
2:30masses, how we identify distension, how
2:32we document findings accurately, and how
2:34we recognize when something may be
2:36abnormal or urgent. So, I encourage you
2:39to start kind of visualizing these
2:40organs underneath the surface of the
2:42abdomen because that's what helps
2:44assessments become more meaningful
2:46instead of just kind of memorizing
2:48steps.
2:52The slide shows the reference lines we
2:54use to divide the abdomen into sections
2:56and these sections help us communicate
2:58findings clearly and consistently with
3:00other healthcare providers. So instead
3:03of saying the patient has pain somewhere
3:04on the right side, we can be much more
3:07specific about exactly where the finding
3:09is located. So the image on the left
3:12shows the four abdominal quadrants,
3:15which is the system you'll probably use
3:17most often in clinical practice. The
3:19abdomen is divided into right upper
3:22quadrant, right lower quadrant, left
3:24upper quadrant, left lower quadrant. And
3:27you'll use these quadrants con
3:29constantly when you're documenting pain,
3:32tenderness, bowel sounds, dissension or
3:34masses in your abdominal assessment. So
3:37for example, if a patient reports right
3:39upper quadrant pain, we start thinking
3:42about those organs that are located
3:43there like the liver or gallbladder.
3:46Whereas right lower quadrant pain may
3:48make us more think about appendicitis.
3:51So again, we're connecting the anatomy
3:53from the previous slide to these
3:55quadrants.
3:59The image on the right shows the nine
4:01region system, which is more detailed.
4:04The system is often used when describing
4:07more specific findings or locations. And
4:09you'll see regions such as epigastric,
4:12umbilical, hypogastric, or super pubic,
4:16right, and left inguinal regions. So
4:20epigastric pain may be associated with
4:23gastric reflux ulcers or pancreatitis
4:27whereas super pubic pain may more point
4:29towards bladder issues and pain in the
4:32right angle region could relate to
4:34appendicitis or a hernia.
4:37So the reference lines are really there
4:39to help us communicate accurately with
4:41providers. They're also there to trend
4:43changes in our patients symptoms,
4:45document our findings clearly, and
4:48prioritize possible complications based
4:50on the location of pain or tenderness.
4:56So, this slide gives us an overview of
4:57the major structures we assess when we
4:59perform an abdominal assessment. Even
5:02though we often think of the abdomen as
5:04mainly the digestive system, there are
5:06actually multiple body systems and
5:08structures located here that can
5:10contribute to symptoms or abnormal
5:12findings. So first we have the
5:15gastrointestinal organs. These include
5:18the stomach, small intestine and colon.
5:21These organs are responsible for
5:23digestion, absorption of nutrients and
5:26elimination of waste. So when patients
5:28complain about symptoms like nausea,
5:30vomiting, diarrhea, constipation,
5:32bloating, or abdominal pain, these are
5:34often the organs we're thinking about
5:36first.
5:38You'll also see the accessory organs
5:40listed here. So the liver, pancreas, and
5:42gallbladder. So again, even though food
5:44doesn't pass directly through these
5:46organs, they do play a major role in
5:49digestion. So the liver helps with
5:51metabolism, detoxification,
5:54bile production, so much more. um we'll
5:57get into when we talk about adult health
6:00into adult health too. Um the
6:03gallbladder stores and releases bile.
6:05The pancreas produces digestive enzymes
6:08and also helps regulate blood glucose.
6:12So when these organs become inflamed or
6:14diseased, patients can present with very
6:16different symptoms. For example,
6:19gallbladder issues may cause right upper
6:21quadrant pain after eating fatty foods.
6:24Pancreatitis often causes severe
6:27epigastric pain that radiates to the
6:29back. Liver disease may lead to
6:32jaundice, acites or enlarged abdominal
6:35veins.
6:38Next are the uh GU organs including the
6:41kidneys, uriters and bladder. And
6:43sometimes patients will come in with
6:44abdominal pain that is act actually
6:46urinary in origin rather than GI related
6:50things like kidney stones, urinary
6:52retention, UTI or bladder distension.
6:55These can all present with abdominal or
6:57flank discomfort.
6:59And we also can't forget about the blood
7:01vessels, paritonyium, and muscles of the
7:03abdomen. The abdominal aorta, it's a
7:06major vessel that we assess especially
7:08in older adults or patients with
7:10cardiovascular risk factors. So an
7:12enlarged or widened aorta can indicate
7:15an abdominal aortic aneurysm and that
7:18can become life-threatening.
7:20The paritinium is another important
7:23structure and when the paritinium
7:25becomes inflamed patients may develop
7:27guarding, rigidity, rebound tenderness
7:30or severe pain and these findings um
7:34should be immediately um or should
7:36immediately raise concern.
7:39So, as we go through abdominal
7:41assessment, I want you to remember that
7:42not all abdominal pain comes from the
7:44same system. And part of your job as a
7:46nurse is using assessment findings,
7:49anatomy, and patient symptoms together
7:51to think critically about what could be
7:53causing the problem.
8:00Now, let's talk about what's actually
8:02happening during ingestion and
8:03digestion. because understanding normal
8:06physiology helps you recognize when
8:08something is going wrong. Um, digestion
8:12is really a combination of both
8:13mechanical and chemical processes.
8:16Mechanical digestion is the physical
8:19breakdown of food. This includes
8:20chewing, swallowing, paristalsis, and
8:23the churning movement that occurs in the
8:24stomach and intestines. Paristalsis is
8:27especially important to understand
8:29because it's those wavelike muscular
8:32contractions that move food into the GI
8:35tract. And when paristalsis slows down
8:38or stops, patients can develop
8:40constipation, bowel obstruction, or
8:43decreased bowel sounds. When it speeds
8:46up too much, patients may experience
8:48diarrhea or cramping.
8:51Chemical digestion is the breakdown of
8:53food substances
8:55um like hydrochloric acid, enzymes and
8:57hormones. And these chemical reactions
9:00help convert food into nutrients that
9:02the body can absorb and use for energy.
9:05The digestive process actually begins in
9:07the mouth. And as food is chewed or
9:10masticated, it mixes with saliva. Saliva
9:13starts the digestive process early by
9:17helping break down those carbohydrates.
9:19And the food then forms into a bolus
9:21which is basically a soft mass of chewed
9:23food ready to be swallowed. The bolus
9:26moves through the oro fernx and
9:28esophagus. It's pushed towards the
9:30stomach through slow parastolic
9:32movements. Once it reaches the stomach
9:35and mixes with th those digestive juices
9:37and hydrochloric acid. The stomach turns
9:40and breaks the food down even further
9:42until it becomes a semi-liquid substance
9:44called kim.
9:46And I want you to think about how all
9:49this connects to symptoms patients might
9:50report. For example, difficulty
9:52swallowing may point to esophageal uh
9:55esophageal issues. Heartburn or reflux
9:58that can occur when stomach acid moves
10:00upward. Nausea and vomiting. It may
10:03indicate irritation or slowed gastric
10:05emptying. Hyperactive bowel sounds may
10:08suggest increased GI mo motility. while
10:11absent bowel sounds could indicate a
10:13serious obstruction or an ilas.
10:17So, as nurses, understanding the normal
10:19uh digestive process helps us interpret
10:21what we're hearing, seeing, and
10:23palpating during assessment. So, when
10:25you know how the system is supposed to
10:27work, it becomes so much easier to
10:29recognize abnormal findings and then
10:31connect them to possible causes.
10:37Now that we've talked about digestion,
10:38let's look at what happens next.
10:40absorption of nutrients. This is really
10:42the whole purpose of digestion. The body
10:44is trying to break down uh into forms
10:48that we can actually use to absorb um
10:51for energy, growth, and normal body
10:54function. Most nutrient absorption
10:56occurs in the small intestine. Even
10:58though the stomach gets a lot of
10:59attention, its primary role is more
11:02about mixing and breaking food down. The
11:04small intestine is where the majority of
11:07absorption actually takes place.
11:10So the first section of the small
11:11intestine is a dadnum. This is where
11:13pancreatic juices and bile enter and mix
11:16with the kim coming from the stomach.
11:18Pancreatic enzymes help break down
11:20proteins, fats and carbohydrates. Bile
11:23which is produced by the liver and
11:25stored in the gallbladder helps emulsify
11:28flat um flats emulsify fats so that um
11:32they can be absorbed more easily. This
11:34is why problems of the pancreas, liver
11:37or gallbladder can significantly affect
11:39digestion and nutrition. Patients with
11:42gallbladder disease or pancreatitis may
11:44have trouble digesting fatty foods and
11:46they can develop nausea, bloating or
11:48malabsorption issues.
11:51So as kim continues through the jigunum
11:54and illiam nutrients continue to be
11:56absorbed into the bloodstream. This
11:58includes things like glucose, amino
12:01acids, vitamins, minerals, water, and
12:03electrolytes. I want you to think about
12:06how this connects to our assessment
12:08findings. So, if nutrient absorption is
12:11going to be impaired, patients may
12:13present with weight loss, malnutrition,
12:16weakness or fatigue, vitamin
12:18deficiencies, diarrhea or fatty stools,
12:22even electrolyte imbalances. That can
12:24all manifest in different ways. For
12:27example, patients with inflammatory
12:28bowel disease like Crohn's disease, they
12:31may have impaired absorption because
12:34their intestinal lining becomes damaged
12:36and inflamed. And as nurses,
12:39understanding where absorption occurs
12:41helps us connect those GI disorders to
12:43the symptoms that we're seeing
12:44clinically. It also helps explain why
12:46some patients become dehydrated or
12:48malnourished even when they appear to be
12:51eating normally.
12:55Now let's talk about elimination which
12:57is the final step in the digestive
12:59digestive process and after nutrients
13:02have been absorbed in the small
13:03intestine any remaining material moves
13:06into the large intestine and the large
13:08intestine's main job is not digestion
13:11it's mainly responsible for absorbing
13:13some remaining water and electrolytes
13:15and then preparing waste for
13:17elimination. This is really important
13:19because the body is constantly trying to
13:21maintain that fluid and electrolyte
13:23balance and as waste moves through the
13:26colon more water ab is absorbed. If too
13:29much water is absorbed stool becomes
13:32hard and dry leading to constipation. If
13:35not enough water as is absorbed, stool
13:37becomes loose or watery which results in
13:39diarrhea
13:41and eventually the remaining waste
13:43products are excreted as feces and under
13:46normal conditions waste products from in
13:49um ingested food are typically
13:51eliminated within about 48 hours.
13:53Although this can vary from person to
13:55person depending on their diet,
13:57hydration, activity level, medications,
14:01and you know kind of their overall
14:03health. So start thinking about the
14:06elimination process as an important
14:09assessment area, not just a routine
14:11bodily function because changes in bowel
14:14habits can tell us a lot about what's
14:15happening physiologically.
14:17For example, constipation may occur with
14:19dehydration, opioid use, decreased
14:22mobility or bowel obstruction.
14:26Diarrhea, this we know can lead to
14:28dehydration and electrolyte imbalances
14:31very quickly. black tar stools. This can
14:34indicate an upper GI bleed, whereas
14:37bright red stool um could could suggest
14:41lower GI bleeding or even hemorrhoids.
14:44Pencil thin stools could raise concern
14:47for an obstruction or even colurectal
14:49cancer. So bowel assessment is a major
14:52part of our patients care and you'll
14:54frequently assess bowel patterns, stool
14:57appearance, presence of blood, abdominal
15:00distension, bowel sounds, patients
15:02comfort and pain. It's also important to
15:05remember that many patients are
15:06uncomfortable talking about bowel
15:08habits. So creating a professional and
15:10non-judgmental environment, it's going
15:13to be really important during your
15:14assessment. And understanding normal
15:16elimination helps you recognize when
15:18findings become abnormal or potentially
15:20life-threatening.
15:24So when we assess older adults, it's
15:26important to remember that again normal
15:29aging causes changes throughout the GI
15:31system in every system um that we've
15:33talked about. Um and those can affect
15:37nutrition, digestion, elimination, and
15:39even how symptoms present. So one of the
15:42first changes we see is reduced
15:44production of saliva and stomach acid.
15:46Saliva is important remember for
15:49lubrication and the beginning stages of
15:51digestion. So decreased saliva can make
15:54chewing and swallowing more difficult.
15:56Um reduction uh of stomach acid. It can
15:59also affect digestion and the absorption
16:02of certain nutrients like vitamin B12,
16:04calcium and iron.
16:07Older adults may also experience more
16:09difficulty with swallowing, digestion,
16:11and absorption overall. And this can
16:14increase the risk for malnutrition,
16:16dehydration, and unintended weight loss,
16:19especially if the patient already has
16:20chronic illness or mobility limitations.
16:24And then motility and paristalsis. This
16:26also slows down with age. And remember,
16:29paristalsis is that movement that pushes
16:31food through the GI tract. So when this
16:34slows, constipation becomes more common.
16:37This is why constipation is such a major
16:39issue in older adults, especially when
16:41combined with decreased mobility, lower
16:43fluid intake, or medications like
16:45opioids.
16:48Changes in dentition, that's another
16:50important consideration. Older adults
16:52may have missing teeth, dentures, gum
16:54disease, or chewing difficulties. And
16:56these issues can affect food choices and
16:58nutritional intake. Sometimes patients
17:01avoid healthier foods simply because
17:03they're really difficult to chew.
17:05One really important point on the slide
17:07is that older adults may be like uh less
17:09likely to feel pain with abdominal
17:11conditions. They can have serious
17:13infections or abdominal emergencies with
17:16really subtle symptoms. For example, an
17:19older adult with appendicitis, bowel
17:21obstruction, or peritonitis
17:23may not present with the classic severe
17:25abdominal pain we would expect in a
17:27younger patient.
17:30You may also notice there is changes in
17:32body composition such as increased fat
17:34accumulation in the lower abdomen.
17:37In addition, overall organ function
17:39declines with age, including liver and
17:41kidney function, which can affect
17:43metabolism, medication clearance, and
17:46healing. So, this means we need to be
17:49especially thorough when we're assessing
17:50older adults. Sometimes their symptoms
17:52are going to be really vague or
17:55atypical.
17:56So instead of those dramatic findings,
17:59you may notice things like fatigue,
18:02decreased appetite, confusion, weakness,
18:05functional decline,
18:08mild abdominal discomfort instead of
18:10severe pain.
18:12So this is why our older adults are
18:14going to require really strong clinical
18:16judgment. We can't rely on those
18:18textbook symptoms. We really have to
18:20look at the whole patient and recognize
18:22subtle changes that may indicate
18:23something more serious.
18:28So this slide is going to highlight
18:29important um culture variations and
18:32health disparities. So as nurses we need
18:34to recognize that certain health
18:35conditions may occur more frequently in
18:38specific populations. But we also have
18:40to be careful not to stereotype or make
18:42assumptions about patients. So every
18:44patient is an individual and culturally
18:47culturally competent care means that
18:50we're approaching each person
18:51respectfully and without bias.
18:54So some conditions have known genetic or
18:57population-based prevalence patterns.
18:59For example, cickle cell anemia. This is
19:02more commonly seen in individuals with
19:04African ancestry. Also could be
19:06European. G6PD deficiency may occur more
19:10frequently in individuals of Africa,
19:12Mediterranean or Asian descent.
19:15Lactose intolerance. This is more common
19:17in many Asian, African, Hispanic and
19:20indigenous populations.
19:22So understanding these patterns can help
19:24guide our assessment and clinical
19:26reasoning, but it shouldn't really
19:28replace individualized patient care.
19:32The sled also highlights conditions like
19:34chronic liver disease, liver and bowel
19:36cancer, obesity, diabetes, and endstage
19:39renal disease. These are conditions that
19:42are influenced by many factors including
19:44access to care, socioeconomic status,
19:47nutrition and food access, environmental
19:50exposures, education, insurance
19:53coverage, and experiences with health
19:56care systems. Health disparities,
19:59they're not simply about genetics.
20:01They're often connected to broader
20:03social determinance of health. So you'll
20:06see things like uh uh helilcobactor
20:10pylori h pylori
20:13wow I can't ever say it infection.
20:16This bacteria is associated with
20:18gastritis and peptic ulcer disease and
20:20it occurs more commonly in some
20:22populations and areas with limited
20:25healthcare access or crowded living
20:27conditions. So we need to think beyond
20:30the diagnosis. We should ask ourselves,
20:32does this patient have access to healthy
20:34food? Can they afford medications? Do
20:36they have transportation to
20:38appointments? Are there language
20:40barriers affecting communication? Are
20:42cultural beliefs influencing healthcare
20:45decisions? Um, because we want to be
20:48culturally competent nurses. We want to
20:51avoid assumptions, respect their beliefs
20:53and practices, and really listen to our
20:56patients.
21:00This slide focuses on priority or urgent
21:02abdominal assessment findings. So in
21:04other words, symptoms that may indicate
21:06something serious or potentially
21:08life-threatening and require our
21:09immediate attention. So one of our
21:11biggest responsibilities is recognizing
21:13when a patient is unstable or when
21:15symptoms could indicate an emergency. So
21:18abdominal complaints can sometimes seem
21:20vague at first, but certain findings
21:22should really immediately raise your
21:24concern. So one of those is severe
21:25dehydration especially when patients are
21:28experiencing persistent nausea, vomiting
21:30or diarrhea. These symptoms can quickly
21:33lead to fluid volume deficits and
21:35electrolyte imbalances. So patients may
21:38present with tacocardia, hypotension,
21:41dry mucous membranes, decreased urine
21:43output, weakness or dizziness. And in
21:46severe cases cases, dehydration can
21:49progress to shock especially in our
21:51older adults or even young children.
21:55Fever is going to be another important
21:57finding because it may indicate
21:59infection or inflammation. So when fever
22:01is combined with abdominal pain, we
22:03start thinking about possibilities like
22:05appendicitis, choleiccyitis,
22:07diverticulitis, pancreatitis or
22:10peritonitis, all the itises.
22:13Um acute abdominal pain. This is
22:16something we take very seriously.
22:18Anything sudden severe pain can indicate
22:21conditions like bowel obstruction,
22:23perforation, eskeeia,
22:26uh ectopic pregnancy or appendicitis.
22:30One thing I want you to remember is that
22:31the severity, location, onset, and
22:33associated symptoms are going to all
22:35help guide our clinical judgment.
22:38One of the most concerning findings on
22:40this slide is a board-like abdomen. So
22:42this refers to extreme abdominal
22:44rigidity where the abdomen feels very
22:46hard and tense during our assessment.
22:49This can indicate peritineal irritation
22:52or peritonitis which is a medical
22:54emergency. So patients with peritonitis
22:56may also have rebound tenderness,
22:58guarding, fever, nausea and severe pain
23:01with movement. So this is where our
23:03assessment skills become really
23:04critical. We are often the first people
23:06to recognize when a patient's condition
23:08is deteriorating. So, when we're
23:11assessing a patient with urgent
23:12abdominal findings, you should also pay
23:14attention to their vital signs, mental
23:17status changes, skin color, and
23:19profusion, any signs of shock, changes
23:22in bowel sounds, and the degree of
23:25abdominal distension or rigidity.
23:28Again, I also want you to remember that
23:30not every patient presents textbook. Um
23:33we have those older adults
23:35uh immuno compromised patients or
23:37patients with chronic illness. They
23:39could present with subtle findings even
23:41when something is really serious.
23:48So now we're moving into subjective uh
23:50data collection which is a huge part of
23:53the abdominal assessment. Before we ever
23:55touch the patient, we're going to gather
23:56a thorough health history. And a lot of
23:59times the patients answers will will
24:01already start pointing you toward what
24:03may be going on. So the first thing we
24:05assess is risk factors and past medical
24:07history. So previous GI or GU conditions
24:11that um these can significantly affect
24:13our assessment findings. For example, a
24:16patient may um present with a history of
24:19GIRD um acid reflux, Crohn's disease,
24:22gall stones, liver disease, kidney
24:25stones, or abdominal surgeries. They may
24:27already be at higher risk for certain
24:29complications or reoccurrent symptoms
24:31with that kind of history.
24:34Hold on, I need a drink.
24:39Okay.
24:41Lifestyle and personal habits are also
24:44really important to assess. We want to
24:45ask about things like chewing or
24:47swallowing difficulties, appetite
24:49changes, weight gain or weight loss,
24:52bowel and bladder habits, any alcohol
24:54use, substance use, and their dietary
24:56habits. These questions are going to
24:58feel very personal to patients
25:00sometimes, but it's important to ask
25:01them in again a professional, non
25:04non-judgmental way. You'll also notice
25:07this slide connects abdominal assessment
25:09to other body systems. GI and GU
25:12problems can affect multiple areas of
25:14the body. For example, liver disease,
25:17may cause skin changes like jaundice.
25:20GI bleeding can affect the hematologic
25:22system and lead to anemia.
25:26Kidney dysfunction. This can affect
25:28fluid balance and neurological status.
25:32Um, we also want to ask about
25:34occupations which can provide important
25:36clues. Patients who work around
25:38chemicals, toxins, or infectious
25:41exposures may have increased risk for
25:43certain GI or liver conditions.
25:46Any foreign travel, that's another
25:48important question because it can expose
25:49our patients to different types of
25:52infections, parasites, contaminated
25:54food, or waterbornne illness,
25:57um, like hepatitis. We also assess for
26:00high-risisk behaviors. This may include
26:03things like unprotected sex, IV drug
26:05use, excessive alcohol use because these
26:08behaviors can increase the risk for
26:10conditions like liver disease, certain
26:12infections, and again hepatitis.
26:15So, medication histories going to be
26:17next. Um, it's going to be extremely
26:19important in our abdominal assessment
26:20because many medications can affect the
26:23GI system. Um, for example, NSAIDs,
26:26these can contribute to ulcers or GI
26:28bleeding. opioids. These can cause
26:31constipation. Antibiotics could lead to
26:34diarrhea or ced difficil infection.
26:38And finally, family history matters
26:41because many GI and GU disorders have
26:43genetic components. So a family history
26:45of colon cancer, inflammatory bowel
26:47disease, liver disease or kidney disease
26:50may increase a patient's risk.
26:53So again, subjective data collection.
26:55This is going to be where we begin
26:57building our clinical picture. Um, the
26:59questions are going to help guide what
27:02you focus on during your physical
27:03assessment and what findings may require
27:05further investigation.
27:09This slide continues our discussion of
27:12that subjective data collection and it's
27:15going to focus on patient teaching,
27:16health promotion and common symptoms
27:18related to GI system. So assessment is
27:21not just about identifying problems,
27:23it's also about prevention and
27:25education. So a big part of our nursing
27:26care is helping patients reduce their
27:28risk factors and recognize symptoms
27:30early and one important area of health
27:33promotion is colurectal cancer
27:35screening. Colorectile cancer is one of
27:38the most preventable cancers when
27:39screening is done regularly and patients
27:42may need education about colonoscopies,
27:45stool testing, diet and recognizing
27:47warning signs such as changes in bowel
27:49habits or blood in the stool.
27:53Food born illness. This is another
27:54important teaching topic. Patients can
27:56develop GI infections from contaminated
27:59food or water. Uh undercooked food. So
28:02teaching often includes proper hand
28:04hygiene, food preparation, cooking
28:06temperatures, and then fa safe food
28:09storage, which many people actually
28:10don't know about. So that's where you
28:13come in.
28:15We also educate patients about hepatitis
28:17A, B, and C. These infections affect the
28:20liver and are transmitted transmitted in
28:22different ways.
28:24A is often spread through contaminated
28:26food or water. If it's a vowel, it comes
28:29from the bowel. Um whereas hepatitis B
28:32and C, these are spread through blood
28:34and body uh body fluids.
28:37So teaching may include vaccination,
28:40safe food handling, avoiding needle
28:42sharing, and safe sexual practices.
28:46So the second slide uh half of this
28:49slide focuses on common GI symptoms
28:51where you'll assess frequently in
28:53practice things like indigestion or
28:56dispsia. These can include symptoms like
28:58bloating, discomfort, reflux or a
29:01feeling of fullness. Sometimes this may
29:03be relatively minor but persistent
29:06ingestion indigestion
29:08can also indicate ulcers, acid reflux,
29:12sometimes even cardiac issues in some
29:14patients like um heart attack.
29:18Anorexia means loss of appetite. This
29:21can occur with infection, cancer,
29:23depression, GI disorders or chronic
29:26illness. In older adults especially,
29:28decreased appetite can quickly
29:29contribute to malnutrition and weakness.
29:33Nausea and vomiting very common
29:35symptoms, but they can have many
29:37different causes. So when assessing
29:39vomiting, we want to ask questions like
29:41how long has it been occurring? What
29:43does the vomit look like? Is there blood
29:45present? Are there associated symptoms
29:46like pain or fever?
29:49Hematmesis meaning vomiting blood and uh
29:54so this is always concerning. Patients
29:56may describe bright red blood or vomit
29:59that looks like coffee grounds which can
30:00indicate upper GI bleeding.
30:05Abdominal pain. This is another major
30:06symptom we assess. One thing I really
30:08want you to focus on is asking that
30:10detailed follow-up question. Uh we want
30:13to know location, severity, onset,
30:16duration, what makes it better, what
30:17makes it worse, any associated symptoms.
30:20Um remember that the patient's history
30:23is often going to give us some of the
30:25biggest clues about what may be
30:26happening. So the more thorough your
30:28subjective assessment is, the stronger
30:30your clinical judgment will become.
30:36This slide continues some of the common
30:38symptoms you'll assess during abdominal
30:40and GI history collection. Many of this
30:42these um symptoms may seem really simple
30:46at first but they can point to
30:48significant underlying conditions. So
30:51always asking good follow-up questions
30:53is really important. First we have
30:55dysphasia
30:56um which means difficulty swallowing. Uh
31:00odinopasia which means painful
31:02swallowing. Patients may describe food
31:05as getting stuck, coughing when eating
31:07or pain with swallowing. So these
31:09symptoms can occur with gird so that
31:12acid reflux, esophageal strictctures,
31:15neurologic disorders like stroke or even
31:18esophageal cancer. Dysphasia is
31:20especially important because it
31:22increases aspiration risk which can lead
31:25to pneumonia which is something we don't
31:26want because people die from pneumonia.
31:29Um next are changes in bowel function
31:32including constipation and diarrhea.
31:36So one thing I want you to remember is
31:37that we always want to compare bowel
31:39habits to what is normal for that
31:41specific patient. Um constipation may be
31:44related to decreased mobility, low fiber
31:46intake, dehydration, opioid use, bowel
31:49obstruction.
31:50And then diarrhea can result from
31:52infection, food intolerance,
31:54inflammatory bowel disease, medications
31:58or malabsorption disorders. Persistent
32:01diarrhea is going to be concerning
32:02because again it can quickly lead to
32:04dehydration and electrolyte imbalances.
32:07Jaundice also called erus refers to
32:11yellowing of the skin or scaraa caused
32:13by elevated bilarubin levels. So this
32:16finding often points towards liver
32:18dysfunction bile duct obstruction or
32:21hemolyis.
32:23So destruction of red blood cells. When
32:26we're assessing jaundice, you'll want to
32:28think about associated symptoms like are
32:30they having any dark urine, pale stools,
32:33itching or fatigue.
32:36We also talk about in this slide urinary
32:38and renal symptoms because abdominal
32:40assessment overlaps closely with the GU
32:42system. So patients may report urinary
32:45incontinence, flank pain, difficulty
32:48urinate, urinating, uh renal collic,
32:51which is severe pain often associated
32:53with kidney stones, flank pain. This is
32:56especially important because patients
32:57often mistake kidney pain for back pain.
33:01And finally, remember that older adults
33:03are going to present differently than
33:04younger patients. Again, those vague
33:07symptoms, delayed symptom reporting,
33:09minimal pain even when it's serious.
33:12So we could see things like confusion,
33:14weakness, decreased appetite, functional
33:17decline instead of those classic GI
33:19symptoms.
33:23So now we're moving into the actual
33:25physical assessment techniques for the
33:26abdomen. There are four techniques you
33:29already know from other assessments.
33:31Inspection, oscultation, percussion, and
33:34palpation. But the abdomen is unique
33:36because the order is different than what
33:39you've probably learned. Well, I know
33:41that you you've learned in the past. Um,
33:44so for most assessments, we usually
33:46inspect, palpate, percuss, and then
33:49oscultate. But for the abdomen, the
33:51correct order is inspection,
33:53oscultation, percussion, and palpation.
33:57And the reason for this is that
33:58palpation and percussion can actually
34:00change bell sounds. So if we touch or
34:03stimulate the abdomen first, we may
34:06alter what we hear during oscultation
34:08and we may get inaccurate findings. So
34:10first we inspect before touching the
34:12patient at all. We look at the abdomen
34:14for the contour symmetry any distension,
34:18skin changes or scars, any visible
34:20masses or pulsations and movement with
34:23respiration.
34:25Inspection starts the moment you walk
34:26into the room. Remember with your eyes,
34:29you're already observing how the patient
34:30moves, if they're guarding, breathing,
34:33or responding to discomfort. So next is
34:35going to come oscultation. We listen for
34:37bowel sounds in all four quadrants.
34:39Before touching the abdomen, we're
34:41assessing presence or absence of bowel
34:44sounds, frequency, and then the
34:46character of the sounds. You may hear
34:49normal active bowel sounds. You might
34:51hear hyperactive bowel sounds or
34:53hypoactive bowel sounds, even nothing.
34:56So, absent bowel sounds. And remember,
34:58absent bowel sounds can indicate
35:00something serious. Um, so that's not
35:02something we really want to hear is
35:04nothing.
35:06Um, so definitely going to, you know,
35:09dive deeper into that. So after
35:12oscultation comes percussion. Percussion
35:14helps us assess what's underneath the
35:16abdominal surface. We're listening for
35:18timony, which is a drumlike sound over
35:22air fil structures, any dullness, which
35:25may indicate solid organs, masses, or
35:27fluid. Percussion can help identify
35:30things like enlarged organs, ascites, or
35:32abnormal masses. And finally, we
35:35palpate. And palpation allows us to
35:37assess tenderness, masses, muscle
35:40guarding, organ enlargement,
35:43temperature, and texture. We also start
35:45with light palpation before moving to
35:48deep palpation. And we save any painful
35:51area for last so we don't increase
35:54guarding or patient discomfort early in
35:55the exam.
35:59And then always thinking about patient
36:01comfort. So, warm hands, clear
36:03communication, watching the patients
36:05facial expressions as we're palpating.
36:09Um, patients will often tense their
36:12abdomen when they're anxious or
36:13uncomfortable, which can affect your
36:15findings.
36:20So, this slide covers the basic
36:21equipment we'll need for our abdominal
36:23assessment. Most of this equipment you
36:25already use regularly, but each item has
36:28a specific purpose. Um, the most
36:30important piece of equipment is going to
36:32be your stethoscope for the oscultation.
36:35Remember, oscultation comes before
36:37percussion and palpation.
36:41And we'll use the diaphragm of the
36:43stethoscope to assess bowel sounds and
36:46sometimes vascular sounds like brewies
36:48over the aorta or renal arteries. A
36:52measuring tape may be used if you need
36:53to assess abdominal girth. This is
36:55important for patients with acites or
36:57abdominal distension, fluid retention,
37:00pregnancy, post-operative swelling, um,
37:04or measuring the abdominal circumference
37:06over time to help us monitor for any
37:08changes. A pen or marker. This can be
37:11used to mark landmarks or measurement
37:13areas during certain assessments. Maybe
37:16we're doing abdominal girth daily. Want
37:18to measure in the exact same location
37:20each time for accuracy. And finally,
37:23don't underestimate the importance of a
37:24pillow. Patients positioning and comfort
37:27really matter a lot during abdominal
37:30assessment. So, placing a pillow under
37:31the patient's knees uh can help relax
37:34the abdominal muscles and make palpation
37:36easier and more accurate.
37:41So, before you begin the abdominal
37:43assessment, preparation is going to be
37:44really important. So, good preparation
37:46helps us improve our patients comfort
37:48and the accuracy of our assessment
37:50findings. So, we want to make sure that
37:52the environment is warm, it's private,
37:55it's well lit. Patients are more likely
37:58to relax when they feel comfortable and
38:00respected. Um, a cold room can cause
38:03muscle tension. Poor lighting may make
38:05it harder to observe things like skin
38:07changes, scars, distension, or
38:10pulsations. We also want the client to
38:13empty their bladder before the
38:15assessment because a full bladder can
38:17cause discomfort and may interfere with
38:19palpation findings especially in the
38:21lower abdomen.
38:23Proper drapen is draping of the body is
38:26another really important part of the
38:27assessment. We want adequate exposure of
38:29the abdomen while still maintaining the
38:31patients dignity and privacy. And
38:33remember how we make patients feel
38:35during an assessment really matters just
38:37as much as the technical skill itself.
38:40So before starting, we're explaining the
38:42process. Let them know what you'll be
38:44doing and why. This helps reduce
38:47anxiety.
38:49Um, and as you assess, we're
38:51continuously observing the client for
38:53signs of discomfort or pain.
38:57Sometimes patients don't tell you
38:59verbally that they're uncomfortable, but
39:01you'll notice things like guarding,
39:03facial grimacing, mus muscle tension,
39:06holding their breath, pulling away
39:08during palpation. So these observations
39:10are part of your assessment, too. So
39:13make sure you're paying attention. And
39:15finally, always examine painful areas
39:17last. Um, we want to if we start with
39:20the painful area first, the patient's
39:22going to be tense and their abdominal
39:24muscles guarding throughout the rest of
39:26the assessment, which makes your
39:28findings less accurate.
39:33So, this slide gives an overview of the
39:35full abdominal physical assessment and
39:37how each assessment technique helps us
39:38gather different types of information.
39:40And remember the abdominal assessment
39:42follows a specific order with
39:44inspection, oscultation, percussion, and
39:47palpation.
39:52Again, we're when we're observing the
39:55abdomen, we're looking at the contour
39:56and symmetry, skin color and integrity,
40:00scars or lesions, distension, visible
40:02masses or pulsation.
40:04Inspection also includes observing
40:07output like urine, emmesis and stool
40:10which can provide huge clues about
40:12what's happening.
40:15Um next comes oscultation. We listen to
40:18the bowel sounds in all four quadrants
40:20before touching the abdomen.
40:23We are assessing presence or absence of
40:25bowel sounds, the frequency and
40:27character. Um
40:31then percussion to assess for areas
40:35filled with fluid, air or solid tissue.
40:39Um we may percuss organs such as the
40:42liver, spleen, bladder, kidneys.
40:45Um
40:47and finally, we palpate. We always begin
40:49with light and then move to deeper.
40:52Remember,
40:54we're watching the patients body
40:55language, their face, how they are um
41:01tolerating the assessment.
41:06This slide just covers some additional
41:08abdominal assessment techniques that you
41:10may see in practice or perform when
41:13certain conditions are suspected. These
41:14are more focused or advanced assessment
41:16maneuvers that help us gather more
41:18information about possible underlying
41:20problems. First is the bladder scan. A
41:23bladder scan um this is a non-invasive
41:26ultrasound tool used to estimate how
41:28much urine is in the bladder. This is
41:30especially useful when we suspect
41:32urinary retention. Patients may complain
41:34of lower abdominal discomfort,
41:36difficulty urinating or frequent small
41:39voids. And a bladder scan can help us
41:41determine whether the bladder is
41:43actually empty emptying properly.
41:46Next is the abdominal reflux. This uh
41:49neurological reflex is assessed by
41:51lightly stroking the abdomen and
41:53observing for contraction of the
41:55abdominal muscles and changes in the
41:57reflex can sometimes indicate
41:59neurological dysfunction. You'll also
42:02see assessment techniques for ascites
42:04which is fluid accumulation in the
42:05abdominal cavity uh mainly from liver
42:09disease. Two common tests are shifting
42:12dullness and fluid wave. These tests
42:14help identify excess fluid in the
42:16abdomen which is often associated with
42:18liver disease, cerosis, heart failure or
42:20cancer. Um, patients with a sites may
42:24also have abdominal distension,
42:25discomfort, shortness of breath or
42:27weight gain.
42:30The Bloomberg sign refers to rebound
42:34tenderness and this is used to assess
42:36for peritineal irritation. This is done
42:39by pressing slowly into the abdomen and
42:41then quickly releasing pressure. Pain
42:44upon release is considered a positive
42:46finding and a positive Bloomberg sign
42:50may indicate peritonitis or significant
42:52inflammation within the abdomen. It
42:54should always raise concern.
42:58Murphy sign. This is something uh used
43:00when we suspect gallbladder inflammation
43:02or choleiccyitis. So during palpation of
43:05the right upper quadrant, the patient is
43:07asked to take a deep breath. If they
43:09suddenly stop inhaling because of pain,
43:11this is called inspatory arrest and it's
43:14considered a positive Murphy sign. The
43:17iliooso muscle test is associated with
43:20appendicitis.
43:22This test stretches the ilosoz muscle.
43:26Um, and pain with the maneuver may
43:28indicate irritation from an inflamed
43:30appendix, especially if the appendix is
43:33positioned behind the seeum. One thing I
43:36want you to remember is that these
43:37special tests are not usually routinely
43:39done on every patient. They're more
43:41focused assessments that are performed
43:43when your history and initial findings
43:45suggest a specific problem.
43:51And then this slide is going to bring
43:53everything together and focus on
43:55clinical decisionmaking. So we know that
43:57assessment is not just about collecting
43:59information. It's about analyzing our
44:01findings, recognizing patterns, and
44:04deciding what actions need to happen
44:06next. So we use our assessment findings
44:08to help guide lab and diagnostic
44:10testing. Depending on the patients
44:12symptoms and assessment findings,
44:14providers may order um testing such as
44:17um blood tests to assess electrolytes,
44:20kidney function, liver function,
44:24um maybe H. pylori breath test to check
44:27for bacterial infection that's
44:29associated with ulcers and gastritis.
44:32You might also see diagnostic procedures
44:35like an EGD
44:37um which helps us visualize part of the
44:40upper GI tract. Colonoscopy we know to
44:43examine the colon. Um ERCP, this is to
44:47assess and treat problems involving the
44:49bile ducts and pancreas. CT scans or
44:53MRIs, those are more detailed imaging.
44:58So as nurses, part of our role is
44:59understanding why these tests are being
45:01ordered, preparing patients
45:03appropriately, monitoring for
45:05complications afterwards, and
45:07recognizing abnormal results um may
45:10require followup.
45:12So the next thing um is our clinical
45:15judgment. So after gathering our
45:17subjective and objective data, we are
45:19starting to ask ourselves what is the
45:21most concerning finding? What could be
45:23causing these symptoms? Is this patient
45:25stable or unstable? What needs immediate
45:29intervention?
45:31We also continuously analyze changing
45:33findings. Um because abdominal
45:36conditions can really change quickly. So
45:38our reassessments are extremely
45:40important and we're documenting any
45:43changes in pain, abdominal distension,
45:46bowel sounds, nausea, vomiting, their
45:48intake and output and their response to
45:50our interventions.
45:52And interprofessional collaborations is
45:54another major part of abdominal care.
45:57We're going to work closely with
45:58providers, radiology, surgery, maybe
46:01nutrition, and other healthcare team
46:03members. So, good communication with
46:06them and reporting any changes or
46:08concerning findings.
46:11And after we have identified the the
46:13problem, we plan care and implement
46:15interventions.
46:17Maybe pain management, fluid
46:19replacement, NPO status, monitoring
46:21labs, and patient education. Maybe we're
46:24preparing for procedures or surgery. And
46:26then lastly, we're going to evaluate our
46:28outcomes. We reassess the patient to
46:31determine whether our interventions were
46:33effective and whether the patient is
46:35improving, worsening, or staying the
46:37same.
46:41And that was it for today. Thank you so
46:43much for joining me um on another
46:46beautiful journey through assessment um
46:51GI assessment. I will see you in class.
46:54Can't wait.

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