NURS 1660 Lecture Notes - Lecture 10: Bowel Resection, Coronary Artery Disease, Coeliac Disease
10 Jun 2018
School
Department
Course
Professor
11-63-166
Week Ten (November 20 - 24, 2017)
Health Assessment
Chapter Twenty-Two: Abdominal Assessment (Pgs. 602 - 644)
Anatomy and Physiology Overview
Reference Lines
- Abdominal quadrants (1-4) are used to map the location of findings.
- A more specific method is to divide the abdomen into nine regions.
Abdominal Organs
Gastrointestinal Organs
- Major organs of GI tract include: stomach, small intestines, and colon.
- Accessory organs of the GI tract include: liver, pancreas and gallbladder.
Genitourinary Organs
- The organs of the GU system include the kidneys, ureters, and bladder;
the spermatic cord and males; and the uterus and ovaries in females.
- The Kidneys control BP through production of renin, stimulate red
blood cell production by secreting erythropoietin and filter and
remove waste products from the blood.
- The ureters and bladder aid with removal of waste products in the
form of urine.
- The spermatic cord protects the vas deferens, blood vessels,
lymphatics and nerves that run from scrotum to penis.
- The ovaries produce ova and secrete estrogen and progesterone.
- The uterus allows fertilization of the ova with sperm, and an
environment for fetal development (if fertilization occurs).
Blood Vessels, Peritoneum, and Muscles
Blood Vessels
- The aorta and branching arteries and veins are found within the
abdominal cavity. They supply oxygenated blood to cells and
organs of the lower half of the body.
- The spleen also resides in the abdominal cavity and stores red
blood cells and platelets, produces new blood cells and
macrophages, and activates B and T lymphocytes.
Peritoneum
- The peritoneum is a serous membrane that covers and holds the
organs in place. It contains a parietal layer that lines the walls of
the abdomen and a visceral layer that coats the outer surface of
the organs.
- The mesentery supplies blood vessels and nerves to the intestinal
tract.
Muscles
find more resources at oneclass.com
find more resources at oneclass.com
11-63-166
Week Ten (November 20 - 24, 2017)
- The muscles that protect and support the digestive system assist
with ingestion, mastication (chewing), and swallowing of food and
with the voluntary defecation of its by-products.
Indigestion and Digestion
- The digestive process consists of mechanical and chemical digestion.
Absorption of Nutrients
- Takes place almost exclusively in the small intestine. In the first portion of the
small intestine (duodenum), pancreatic juices and bile are secreted into the
chyme, making it ready for absorption of nutrients by the villi that line the jejunum
and ileum.
Elimination
- Any food particles not absorbed by the small intestine pass into the large
intestine, where few electrolytes and water are further absorbed. Eventually, the
remaining waste products are excreted as feces.
- On average, waste products of are limited 48 hours after ingestion.
Acute Assessment
- If the patient presents an acute abdominal injury or illness, the history and physical
examination will be focused on that issue.
- Severe dehydration from nausea, vomiting, black, tarry stools, or frank blood in the stool,
emesis with fecal odour, yellowing of the skin, inability to void, pruritus, fever, and acute
abdominal pain are potentially life-threatening symptoms that require prompt attention.
Subjective Assessment
→ Make sure to introduce yourself and state your designation, provide privacy, clean
equipment, perform hand hygiene.
Demographic or Identifying Data:
- Name, age, address, phone number, occupation, marital status, number of
children
If you ask the date and time this will be part of general survey (behaviour A&Ox4)
Chief Concern - reason for seeking care:
- “Tell me why you came to the clinic today?” → What they tell you directs the
remainder of questions.
Past Health History of Patient (General)
- General past health - cancer, blood disorders, arthritis, HTN, diabetes, CAD,
PVD
Surgeries - Appendicitis, bowel resection, cholecystectomy, hysterectomy
Injuries - Trauma, work injury.
find more resources at oneclass.com
find more resources at oneclass.com
11-63-166
Week Ten (November 20 - 24, 2017)
Relevant Health History of Patient Pertaining to the Complaint (Abdomen)
- RUQ- liver disease (cirrhosis), hepatitis A,B,C- Gerd, cholecystitis,
gastric bypass.
- LUQ- Splenectomy, DM, Pancreatitis or Pancreatic CA, mononucleosis,
Renal colic, kidney disease.
- RLQ- appendicitis, Celiac Disease, sickle cell disease.
- LLQ Bowel cancer, bowel obstruction, IBD, Crohn’s, Colitis, polyps.
- GU- Bladder cancer, STD’s, ovarian or uterus problems, enlarged
prostate.
Family History
- Ask about illnesses that can be hereditary: Hypertension, coronary artery
disease, stroke, asthma, seizure disorders, mental illness, addictions
Relevant Family History
- Colorectal cancer (first degree relative), GERD, peptic ulcer disease, IBD,
anemia/thalassemia (splenomegaly), Celiac disease, DM, pancreatic
cancer, Crohn’s, sickle cell anemia, thyroid disease
Medications and Allergies
Medications: Prescription (Rx), Over the counter (OTC) (), vitamins and herbals
Relevant Medications: Narcotics - constipation. Antacids interfere with
medicines.
Allergies: Food, medications, environment
Relevant Allergies: Malabsorption - lactose intolerance, food allergies or
celiac.
Life behaviours - DADSPIES
-Diet: water - fiber (bowels), fat (gallbladder), spices (gastro). How is your diet 24-
hour recall? Special diet (vegetarian)?.
-Alcohol: liver (cirrhosis).
-Drugs: liver (hepatitis - sharing needles).
- Smoking/Second Hand Smoke.
-Physical Exam: Screening - colorectal at 50, colonoscopy.
-Immunizations: Hepatitis vaccines, shingles vaccine (on abdomen).
- Exercise.
-Stress: how do you deal with stress. What is your stress level like?
→ Changes in weight (eating disorder, cancer), # sex partners
Blood transfusion prior to 1980, problems with chewing/swallowing- Work (PPE)
hepatitis, travel- hepatitis A
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Abdominal quadrants (1-4) are used to map the location of findings. A more specific method is to divide the abdomen into nine regions. Major organs of gi tract include: stomach, small intestines, and colon. Accessory organs of the gi tract include: liver, pancreas and gallbladder. The organs of the gu system include the kidneys, ureters, and bladder; the spermatic cord and males; and the uterus and ovaries in females. The kidneys control bp through production of renin, stimulate red blood cell production by secreting erythropoietin and filter and remove waste products from the blood. The ureters and bladder aid with removal of waste products in the form of urine. The spermatic cord protects the vas deferens, blood vessels, lymphatics and nerves that run from scrotum to penis. The ovaries produce ova and secrete estrogen and progesterone. The uterus allows fertilization of the ova with sperm, and an environment for fetal development (if fertilization occurs).
