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Questions and Answers
What is the correct order for conducting abdominal assessments?
Which symptom would you assess during an oral examination?
When assessing a patient’s abdomen, what indicates the presence of excess air?
Which statement is true regarding the palpation technique during abdominal assessment?
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What should you look for during an anal examination?
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What is a common early symptom of rapid influx of stomach contents into the jejunum?
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What late symptom is specifically associated with hypoglycemia?
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Which medication is recommended for managing severe cases of hyperglycemia following rapid stomach content influx?
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What dietary intervention is suggested for managing symptoms related to hyperglycemia?
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What physical sign might indicate the presence of pernicious anemia?
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What is the primary cause of vitamin B12 deficiency in patients with pernicious anemia?
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What is an important nursing intervention for a patient diagnosed with pernicious anemia?
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Which of the following symptoms is not typically associated with the rapid influx of stomach contents?
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Which medication is typically used for acute upper GI bleeding?
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What is the initial bolus dose of intravenous PPI for treating GI bleeding?
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What is the primary use of the Sengstaken-Blakemore tube?
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How long is the Sengstaken-Blakemore tube typically left in place?
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What is the first lumen of the Sengstaken-Blakemore tube used for?
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Which of the following is NOT a part of nursing management for bleeding?
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What function does the second lumen of the Sengstaken-Blakemore tube serve?
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In endoscopic clipping for bleeding, where is the bleeding vessel usually identified?
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What is the recommended post-operative position for a patient who has undergone surgery?
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Which procedure involves the removal of the entire stomach?
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What is a key characteristic of gastric ulcers compared to duodenal ulcers?
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What is the first diet step for a patient after surgery as per post-operative management?
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What is a potential complication that should be monitored for after gastric surgery?
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What enzyme's normal range is 10 - 40 units per liter?
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Elevated liver enzymes may indicate what regarding liver damage?
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What hormone is responsible for relaxing the sphincter of Oddi?
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What is the primary cause of ascites?
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Hepatocellular jaundice is primarily a result of what?
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At what serum bilirubin level does jaundice typically become clinically evident?
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Which of the following is a common cause of fulminant hepatic failure?
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What is the first symptom of fulminant hepatic failure?
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Obstructive jaundice can result from which of the following?
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Which of the following medications is known to be hepatotoxic?
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What condition results from increased destruction of red blood cells?
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Study Notes
Gastrointestinal Assessment
- Mouth: Examine for dryness, gingivitis, tonsil inflammation, number of teeth, presence of dentures, gag reflex, swallowing ability, and taste and odor sensitivity.
- Esophagus: Evaluate for difficulties swallowing and gag reflex.
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Abdomen:
- Inspection: Observe the abdomen's appearance.
- Auscultation: Listen to bowel sounds, starting in the right lower quadrant and following the colon's anatomy.
- Percussion: Tap the abdomen to detect any abnormalities, particularly tympany indicating excess air.
- Palpation: Feel the abdomen, starting with areas of least pain and palpating the painful area last to minimize discomfort.
- Anus: Inspect for bleeding, hemorrhoids, fissures, cracks, and abscesses.
Rapid Influx of Stomach Contents
- Symptoms: Nausea and vomiting, abdominal fullness, cramping, palpitations, and diaphoresis.
- Hypertonic food bolus draws fluid from blood vessels to dilute high concentrations of carbohydrates and electrolytes.
- This leads to hyperglycemia, stimulating insulin secretion.
- Subsequently, hypoglycemia occurs.
- Later symptoms: Drowsiness, weakness, and dizziness.
Management of Rapid Influx of Stomach Contents
- Octreotide (Sandostatin) for severe cases: Slows stomach emptying and blocks insulin release.
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Nursing interventions:
- Low-carbohydrate diet.
- Small, frequent meals with more dry items.
- Avoid fluids with meals.
- Lie down after meals.
- Administer anti-spasmodic medications to delay gastric emptying.
Pernicious Anemia
- Condition resulting from stomach damage or dysfunction leading to vitamin B12 deficiency.
- Causes:
- Autoimmune destruction of parietal cells.
- Lack of intrinsic factor.
- Total destruction or removal of the stomach.
Assessment of Pernicious Anemia
- Severe pallor.
- Fatigue.
- Weight loss.
- Smooth, beefy-red tongue.
- Mild jaundice.
- Paresthesia of extremities.
- Balance disturbances.
Nursing Interventions for Pernicious Anemia
- Lifetime vitamin B12 injections: Initially 12 times weekly, then monthly.
Acid Suppression
- For acute upper GI bleeding, proton pump inhibitors (PPIs) or H2 blockers are typically administered.
- IV PPI is usually given every 12 hours or as a continuous infusion.
- Common dosage: 80mg IV PPI bolus followed by a continuous infusion of 8mg/hour for 72 hours.
Endoscopic Clipping or Sewing Techniques
- Used to oversew bleeding vessels in the stomach or duodenum (usually identified by endoscopy).
- Treatment for non-variceal upper GI bleeding.
- Clips are passed out with stools, some within 1-3 weeks.
Sengstaken-Blakemore Tube
- Inserted through the nose or mouth to control bleeding, particularly from esophageal varicosities.
- Remains in place for 24 hours.
- Three lumens:
- One lumen to inflate gastric balloon.
- Second lumen to inflate esophageal balloon.
- Third lumen to aspirate gastric contents.
- Gastric balloon inflated initially with 50 ml (followed by X-ray), adding 200 ml more air.
- Esophageal balloon inflated to 30 mmHg initially, increasing to 45 mmHg if bleeding persists.
- Gastric balloon inflated and placed on traction first.
- Esophageal balloon inflated only if bleeding is not controlled.
- Pressure in balloons released after 24-48 hours to prevent necrosis, deflated in reverse order of inflation.
Nursing Management for Bleeding
- Maintain NPO status.
- Administer intravenous fluids and medications.
- Monitor hydration status, hematocrit, and hemoglobin.
- Assist with saline lavage.
- Insert nasogastric tube for decompression and lavage.
- Prepare for blood transfusion.
- Prepare to administer vasopressin to induce vasoconstriction and reduce bleeding.
- Prepare the patient for surgery if warranted, including: total gastrectomy, vagotomy, gastric resection, Billroth I and II, pyloroplasty, and antrectomy.
Nursing Management After Surgery
- Monitor vital signs.
- Maintain Fowler's position.
- NPO until peristalsis returns.
- Monitor for bowel sounds.
- Monitor for complications.
- Monitor intake and output, intravenous fluids.
- Maintain nasogastric tube.
- Diet progression: clear liquid > full liquid > six bland meals.
- Manage dumping syndrome.
Gastric Ulcer vs. Duodenal Ulcer
- Gastric ulcer: Older patients, normal acidity, pain early after eating, worsens with food and relieved by vomiting, bleeding, weight loss, and vomiting, risk for cancer.
- Duodenal ulcer: Younger patients, increased acidity, pain late after eating (2-4 hours), relieved by food, less likely to bleed and vomit, no risk for cancer.
Liver Functions
- Liver produces bile, helps metabolize carbohydrates, proteins, and fats, synthesizes clotting factors, detoxifies harmful substances, and stores vitamins and minerals.
Common Manifestations of Liver Diseases
-
Elevated liver enzymes (LFTs):
- May be abnormal only after 70% of the liver parenchyma is damaged.
- Normal values:
- AST: 10-40 units.
- ALT: 5-35 units.
- GGT/GGTP: 10-40 IU/L.
- LDH: 100-200 units (for biliary cholestasis).
- Ascites: Usually results from portal hypertension, leading to increased capillary pressure and obstructed venous blood flow.
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Jaundice: Elevated blood bilirubin levels causing yellow or greenish-yellow discoloration of tissues.
- Clinically evident when serum bilirubin levels reach >2.5 mg/dL.
-
Types of jaundice:
- Hemolytic: Increased destruction of red blood cells overwhelms the liver's ability to excrete bilirubin.
- Hepatocellular: Damaged liver cells cannot clear normal amounts of bilirubin.
- Obstructive: Biliary obstruction from factors such as gallstones, inflammation, tumors, or pressure from enlarged organs.
Hepatotoxic Drugs
- Phenothiazines.
- Antithyroid drugs.
- Erythromycin.
- Amoxicillin.
- Androgens.
Fulminant Hepatic Failure
- Sudden and severe impairment of liver function in a previously healthy person.
- Develops within weeks.
- Common causes: Viral hepatitis, toxic medications and chemicals, metabolic disturbances.
- Initial symptom: Jaundice, progressing to encephalopathy.
Categories of Liver Failure
- Acute: Sudden onset and usually reversible.
- Chronic: Gradual progression and often irreversible.
- Fulminant: Rapid and life-threatening.
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Description
Test your knowledge on the proper techniques and considerations for conducting abdominal assessments. This quiz covers important procedures, symptoms to observe during examinations, and key techniques in palpation and inspection. Enhance your understanding of abdominal health evaluations.
