Nursing Procedures: Abdominal Assessment & ABG Analysis

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Questions and Answers

What is the recommended sequence of abdominal assessment techniques?

Inspection, Percussion, Auscultation, Palpation

Inspection, Auscultation, Percussion, Palpation (correct)

Auscultation, Inspection, Palpation, Percussion

Palpation, Inspection, Auscultation, Percussion

Which condition should you avoid palpating in a patient?

Appendicitis

Inflammatory bowel disease

Wilm's tumor (correct)

Cholecystitis

What should be done for a patient prior to arterial blood gas analysis?

Place specimen in room temperature

Assess for bleeding at the puncture site (correct)

Apply firm pressure for 1-2 minutes

Perform suctioning

What dietary preparation is necessary for a barium enema procedure?

Liquid diet Signup and view all the answers

What should be advised to a patient after a barium swallow to prevent constipation?

Increase fluid intake and fiber-rich foods Signup and view all the answers

What is the purpose of performing cardiac catheterization?

To measure oxygen levels in blood vessels Signup and view all the answers

What should be confirmed regarding medication prior to the barium swallow procedure?

Withhold narcotics for 24 hours Signup and view all the answers

What is the primary reason for obtaining arterial blood gas analysis?

To monitor oxygen therapy response Signup and view all the answers

What is the recommended positioning for a patient after catheterization for urinary drainage?

Flat with lower extremities hyperextended Signup and view all the answers

What must be done if bleeding occurs at the arterial puncture site after a procedure?

Apply pressure and monitor closely Signup and view all the answers

What is the purpose of conducting a Cystoscopy?

To assess the bladder and urethra Signup and view all the answers

Which of the following actions is crucial before a CT scan involving contrast medium?

Check for allergies to iodine Signup and view all the answers

What is the correct action regarding the catheter drainage bag during a procedure?

It should hang below the level of the bladder Signup and view all the answers

What should be done during Central Venous Pressure (CVP) monitoring for accuracy?

Anchor the manometer at the right atrium level Signup and view all the answers

What is the recommended duration for a patient to be NPO before a CT scan?

4 hours Signup and view all the answers

What is the recommended position for a patient during a liver biopsy?

Left side or supine Signup and view all the answers

What should a patient avoid doing before a mammogram?

Using deodorant or lotion Signup and view all the answers

When is the ideal time for a self-breast examination?

7 days after menstruation Signup and view all the answers

What position should a patient be in after undergoing a lumbar puncture?

Flat for 6-12 hours Signup and view all the answers

What is the purpose of a Mantoux test?

To determine exposure to TB Signup and view all the answers

What induration size is considered positive for foreign-born children under 4 years in the Mantoux test?

10 mm Signup and view all the answers

Which of the following is checked before performing a lumbar puncture?

Consent Signup and view all the answers

What is the primary purpose of an MRI?

To provide detailed images of brain tissues Signup and view all the answers

What is the normal blood sugar level range for a healthy individual?

80-120 mg/dl Signup and view all the answers

What should a patient refrain from consuming before an EEG procedure?

Caffeine and stimulants Signup and view all the answers

What is a key nursing instruction for a patient preparing for an ECG?

Refrain from talking during the test Signup and view all the answers

What indicates that a patient may have a myocardial infarction based on an ECG?

Both A and C Signup and view all the answers

Which preparation is necessary before undergoing an IVP?

Be NPO for 8-10 hours Signup and view all the answers

What should be done if a patient has HCl levels in a duodenal ulcer?

HCl levels are elevated Signup and view all the answers

What type of sample should be refrigerated if not tested within 4 hours during gastric analysis?

Gastric samples Signup and view all the answers

What is the purpose of a Doppler ultrasound?

To assess the patency of veins and arteries Signup and view all the answers

What is the primary purpose of tonometry?

Measures intraocular pressure Signup and view all the answers

What should be the position of a patient during thoracentesis?

Leaning over a bedside table Signup and view all the answers

What is the normal range for PAP systolic and diastolic pressure?

20 to 30 mm Hg Signup and view all the answers

Which condition is indicated by a specific gravity that is increased in a urinalysis?

Dehydration Signup and view all the answers

During the Weber test, where is the tuning fork typically placed for a reliable assessment?

On the patient's forehead or teeth Signup and view all the answers

What is the expected normal reading range for tonometry?

12-21 mm Hg Signup and view all the answers

What immediate action should be performed after a patient undergoes thoracentesis?

Position the patient on the unaffected side Signup and view all the answers

What is the maximum suction duration permitted when suctioning a patient?

15 seconds Signup and view all the answers

Study Notes

Abdominal Assessment

Used to check for masses, abnormal bowel sounds, lesions, and other abnormalities in the abdomen.
Position: Dorsal Recumbent
Sequence of Assessment: Inspection, Auscultation, Percussion, Palpation
Palpation: Start from RLQ to RUQ to LUQ, to LLQ.
Do not palpate patients with Wilm's tumor and abdominal aortic aneurysm.

Arterial Blood Gas Analysis

Used to monitor patient response to oxygen therapy and detect acid-base imbalance.
Do not suction prior to obtaining a blood specimen.
Assess for bleeding and hematoma at the puncture site.
Apply firm pressure at the puncture site for 5-10 minutes.
Place specimen in iced container.
Assess for metabolic alkalosis in patients with vomiting, and metabolic acidosis in patients with diarrhea.

Barium Enema

Used to assess the large intestines.
Provide a liquid diet before the procedure.
Administer a laxative before the procedure for better visualization, and after to prevent constipation.
Report to the doctor if a bowel movement does not occur within 2 days.
Instruct the patient to increase fluids and consume fiber-rich foods.

Barium Swallow

Used to assess the esophagus, stomach, and some portions of the small intestines.
NPO for 6-8 hours before the procedure.
Withhold anticholinergic and narcotics for 24 hours before the test.
Administer a laxative after the procedure to counteract the constipating effects of the barium.
Instruct the patient to increase fluids and consume fiber-rich foods.

Cardiac Catheterization

Used to measure oxygen concentration, saturation, tension, and pressure in various chambers of the heart. Helps determine the need for cardiac surgery.
Check for informed consent.
Assess for allergy to iodine.
NPO for 6-8 hours before the procedure.
Check for distal pulses after the procedure.
Check for bleeding at the arterial puncture site and apply pressure.
Keep a 20 lbs. sandbag at the bedside as a pressure instrument if bleeding occurs.
Keep the patient flat on the bed with lower extremities hyperextended for 4-6 hours.
Perform neurovascular assessment distal to the catheter insertion site and report any abnormalities.

Catheterization, Urinary

Used to determine residual urine and obtain a sterile specimen.
Maintain a sterile environment.
The drainage bag must always be below the bladder to prevent backflow of urine.
Do not allow the drainage bag to touch the floor.
Do not allow the drainage spout to touch the collection receptacle or the toilet bowl when draining it.
Provide urine acidification.

Chest X-Ray

Used to detect abnormalities of the organs in the thoracic area.
Remove any metallic objects before the procedure.
Use a lead shield for women of childbearing age.

CT Scan

Provides photographs of tissue densities using radiation.
If contrast medium is used, assess for any allergy to iodine and instruct the patient to be NPO for 4 hours prior to the procedure.
Assess for any fear of close spaces (claustrophobia).
Contraindicated in pregnant patients and those obese (>300 lbs.).
Instruct the patient to lie still during the whole procedure.

CVP (Central Venous Pressure) Monitoring

Measures the pressure of the Right Atrium.
Place the zero level of the manometer at the level of the right atrium at the 4th intercostal space for accurate reading.
Instruct the client to avoid coughing and straining as it alters readings.
Normal CVP reading is 2-12 mmHg (when the tube is at the superior vena cava).

Cystoscopy

Used to assess the bladder and urethra
Check for informed consent. If general anesthesia is used, have the client on NPO; liquid diet if local anesthesia is used.
Monitor intake and output.
After the procedure:
- Force fluids as prescribed.
- Administer sitz bath for abdominal pain.
- Pink-tinged or tea-colored urine is expected within 24-48 hours.
- Notify the doctor if bright red urine or clots appear.

Doppler Ultrasound

Evaluates patency of veins and arteries in the lower extremities.
Inform the patient that it is painless.

ECG (Electrocardiogram)

Records electrical waves of the heart.
Instruct the patient to lie still, breathe normally during the procedure.
Instruct the patient to refrain from talking during the test.
ST segment elevation or T wave inversion indicates MI.

EEG (Electroencephalogram)

Records the electrical activity of the brain.
Detects intracranial hemorrhage and tumors.
Advise the client to shampoo hair before and after the procedure.
If electrode gel is not removed by shampooing, the patient may use acetone.
Withhold stimulants, antidepressants, tranquilizers, and anticonvulsants for 24-48 hours prior to the test.

Fasting Blood Sugar Level

Used to detect diabetes mellitus.
Normal blood sugar level is 80-120 mg./dl.
A blood sugar level of more than 140 mg./dl confirms diabetes.

Gastric Analysis

Used to detect ulcers, rule out pernicious anemia, and analyze acidity, appearance and volume of gastric secretions.
In gastric ulcer, HCl is normal.
In duodenal ulcer, HCl is elevated.
Refrigerate gastric samples if not tested within 4 hours.

IVP (Intravenous Pyelography)

Provides visualization of the urinary tract.
Check for consent.
NPO for 8-10 hours before the procedure.
Administer laxative to clear bowels before the procedure.
Check for allergy to iodine, seafoods or shellfish before the procedure since the procedure requires the use of iodine-based dye.
Keep epinephrine at the bedside to counteract possible allergic reaction.
IVP requires the use of a contrast medium while a KUB does not.
Inform the patient about the possible salty taste that may be experienced during the test.
Increase fluid intake after the procedure to facilitate excretion of the dye.

Liver Biopsy

Used to determine liver disorders.
Check for consent.
Obtain the result of blood tests before aspiration, as bleeding may occur.
Position the patient on the left side or in the supine position during the biopsy.
Instruct the patient to inhale, exhale, and hold their breath during the insertion of the needle to stabilize the position of the liver and prevent accidental puncture of the diaphragm.
Position the patient on the right side after the liver biopsy with pillows underneath to prevent bleeding.
Bedrest for 24 hours after the procedure.

Lumbar Puncture

Used to withdraw CSF to determine abnormalities.
Check for consent.
Before the procedure: empty bladder and bowel.
Position: C-position (fetal position).
During the procedure: the needle is inserted between L3-L4 or L4-L5 to prevent accidental puncture of the spinal cord, as the spinal cord ends at L2.
After the procedure: Position the patient flat for 6-12 hours to prevent spinal headache. Increase fluid intake.

Mammograph

Detects the presence of breast tumor.
Instruct the patient not to use deodorant, talcum powder, lotion, perfume, or any ointment on the day of the exam as these may give false-positive results.
Let the patient know that her breasts will be compressed between 2 x-ray plates.
Provide teachings related to Self-breast examination:
- Done 7 days after menstruation
- Position: Lying down with a pillow under the shoulder of the breast being examined, or sitting in front of a mirror while raising the hands to the side of the breast being examined.

Mantoux Test

A test to determine exposure to tuberculosis.
A positive test yields an induration of 10 mm or more for foreign-born children under 4 years old.
An induration of 5 mm or more is considered positive in patients with HIV, with treated TB, and if they have had direct exposure to TB patients.
BCG may cause a false-positive reaction.
Assess for previous history of PTB and report immediately to the doctor.
The result is read after 48-72 hours.

MRI (Magnetic Resonance Imaging)

Provides cross-sectional images of brain tissues, more detailed than a CT scan.

PAP (Pulmonary Artery Pressure) & PCWP (Pulmonary Capillary Wedge Pressure) Monitoring

If a fifth lumen exists, it is used for measuring oxygen saturation of the blood.
The normal adult PAP systolic and diastolic pressure is 20 to 30 mm Hg.
The normal PCWP is 8-13 mm Hg.
The only time the balloon should be inflated after it is in place is when obtaining PCWP readings.

Suctioning

Used to obtain sputum samples and clear the airway.
Hyperoxygenate the patient before and after the procedure.
Apply intermittent suction on withdrawal of the catheter.
Do not suction the patient for more than 15 seconds.

Thoracentesis

Aspiration of fluid and/or air from the pleural space.
Check consent.
Position: Sitting on the side of the bed with feet on a chair, leaning over a bedside table. If the patient cannot sit, they lie on their affected side with the hands of that side resting on the opposite shoulder.
Instruct the patient not to cough, breathe deeply, or move during the procedure.
After the procedure: Position the patient on the unaffected side/ puncture site up. Check for bleeding at the puncture site and monitor respiratory function.
Notify the physician if signs of pneumothorax, air embolism, and pulmonary edema occur.

Tonometry

Measures intraocular pressure.
Normal reading is 12-21 mm.Hg.
A reading of 25 mm./Hg. indicates glaucoma.

Urinalysis

Used to assess the characteristics of urine.
First voided morning sample preferred: 15 ml.
Use a clean container.
Decreased specific gravity: diabetes insipidus
Increased specific gravity: diabetes mellitus, dehydration, SIADH
(+) Protein: PIH, nephrotic syndrome.
(+) Glucose: Diabetes mellitus, infection.

Urine Collection, 24-Hour

Used to determine the excretion of substances from the kidneys, adrenal glands, and the stomach.
Required for ACTH test and Schilling's test.
Discard the first voided urine.

Weber Test

Used to detect the presence of unilateral hearing loss.
The tuning fork is set into vibration and placed on the patient's forehead or teeth. Placement on the teeth is generally more reliable, even when the patient has false teeth.

X-Ray

Provides radiological data for the assessment of certain organs and bones.
Assess the patient's exposure level to radiation.
Instruct the patient to remove all jewelry and other metallic objects before the procedure.

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Description

This quiz covers essential nursing procedures including abdominal assessments, arterial blood gas analysis, and the Barium enema procedure. Understand the techniques, positions, and precautions necessary for effective patient evaluation. Perfect for nursing students seeking to reinforce their clinical skills.