GIT Intro + Module Overview PDF

Contextual Health & Nursing Care I Module overview and GIT intro Photo by Stefan Els Division | Centre | Unit Name SEMESTER 2 OVERVIEW GASTROINTESTINAL SYSTEM Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskap...

Contextual Health & Nursing Care I Module overview and GIT intro Photo by Stefan Els Division | Centre | Unit Name SEMESTER 2 OVERVIEW GASTROINTESTINAL SYSTEM Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe MUSCULOSKELETAL SYSTEM Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Semester 2 assessments Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe FEEDBACK!! Semester 1 Assessments Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe How to formulate a nursing diagnosis Three components 1. Problem statement – patient’s current health problem and needed nursing interventions 2. Aetiology (cause) of the problem / related factors –probable causes of the health problem and /or conditions involved in the development of the problem 3. Defining characteristics (signs and symptoms of the health problem) / risk factors of the problem – groups of signs and symptoms indicating the presence of a particular diagnostic E.g.: Impaired physical mobility (problem statement) related to decreased muscle control (related factors/aetiology) as evidenced by inability to control lower extremities (defining characteristics / patient signs and symptoms A medical diagnosis can be referenced as part of interdisciplinary assessment of care but CANNOT be included in the writing of the nursing diagnosis Division | Centre | Unit Name Types of nursing diagnoses 1. Problem focused diagnoses patient’s problem present at time of nursing assessment, based on signs and symptoms present in the assessment ) e.g: Impaired physical mobility (problem focused diagnosis) related to decreased muscle control (related factors) as evidenced by inability to control lower extremities 2. Risk diagnosis Identifies interventions needed to decrease the risk related to a person’s problem e.g: Risk for infection as evidenced by suppressed inflammatory response (Risk factors) Division | Centre | Unit Name Quadrants and Regions of the Abdomen Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Examination of the Abdomen Equipment needed: - Stethoscope Quite examination or consultation room Patient considerations: - Empty bladder - lying in supine position - Not over exposed / properly draped Nursing consideration - Watch patient’s face for signs and symptoms of discomfort Division | Centre | Unit Name Abdominal quadrants and organs Division | Centre | Unit Name  GASTRO –INTESTINAL TRACT: The Person with ABDOMINAL PAIN Photo by Stefan Els Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 1. Inspection Inspect skin for: - Scars - Striae - Hernias - Vascular changes - Lesions or rashes Look for movement associated with peristalsis or pulsations Note abdominal contour: flat, scaphoid or protuberant Division | Centre | Unit Name 2. Auscultate Place the stethoscope diaphragm lightly on the abdomen Listen for bowel sounds - Are they normal, increased, decreased or absent Bruits (sound of blood flowing through a narrowed portion of an artery)over renal arteries, iliac arteries or aorta Division | Centre | Unit Name Percussion Percuss in all four quadrants Categorise what you hear as tympanic (present over most of abdomen) or dull - Unusual dull = fluid/ascites/ underlying abdominal mass https://youtu.be/lEJXQ-JmEr4 Division | Centre | Unit Name Palpation Looking for areas of tenderness ( watch for patient’s facial expression ) Start with light to deep - Identify abdominal masses or areas of deep tenderness - Palpate liver ( normal liver should not be tender) Division | Centre | Unit Name The Process: Ask & Assess Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Process (ask & assess) Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  2. First impressions Gait & Posture: ? Leaning forward due to pain General Appearance: ………….. Mood: ? Anxious Abnormal Sounds: ……………… Abnormal Odours: ……………… Hearing Problems: ……………… Visual Problems: ………………… Overall Condition: ………………. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  3. Umbrella Questions Pain Questions: Site, Onset, Character, Radiation, Associated Symptoms, Timing, Exacerbating & relieving factors, Severity (SOCRATES) General Health: Headache, Chest Pain, Dyspnoea, TB Contact, Appetite/Weight Changes, Abdominal Pain, Indigestion, Bowel Habits, Abnormal Urinary symptoms, Normal Menstruation, Last Menstrual Period, Family planning, Abnormal Bleeding, Change in Sleeping Habits, Seasonal Flu Vaccine Allergies: to medication, food or allergens (ask what the exact reaction was!) Own History: Medical Hx, Surgical Hx, Chronic Conditions, Chronic Medications Family History: Record the age & current health or the cause of or the ages at death of the patient’s parents, siblings and children Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Process continued…… (ask & assess) Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  4. Person’s context Social Determinants of Health: Occupation, marital status, sexual history, smoking, alcohol, illicit drug use, exercise, diet Family & Community: any support & involvement of family & community Physical Environment: Living circumstances; type of housing and with whom Literacy & Education: can he/she read & write, highest education Economic Stability: pensioner, grant etc. Food & Water: Availability of fresh food & water Healthcare Access: Nearby access to comprehensive healthcare facility Mobility: frail or disabled Travel History: e.g. travelled to area where there might be Malaria HIV Status Mental State: Appearance, behaviour, speech, mood Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  5. System Questions GI – Subjective data Does your client present with any of these symptoms? Dyspepsia? Hiccups? Abdominal Pain? Changes in Eating pattern/Appetite? Nausea or Vomiting? Diarrhoea? Changes in Weight? Bowel Habits? Stool characteristics? Bleeding? Haemorrhoids? Flatulence? Helminthiasis (worms)? Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  5. System Questions GI – Subjective Data Does your client present with any of these symptoms? Dyspepsia? Hiccups? Abdominal Pain? Changes in Eating pattern/Appetite? Nausea or Vomiting? Diarrhoea? Changes in Weight? Bowel Habits? Stool characteristics? Bleeding? Haemorrhoids? Flatulence? Helminthiasis (worms)? Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe 6. Basic Physical Data Temperature Pulse & Respiration BP Weight & Height MUAC HB & Hgt Urine & Beta HcG Head Circumference (children) Peak Flow Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Process continued…. Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  7. Physical Assessment: Chapter 38 Inspection of the abdomen: skin, respiratory movements, distension, asymmetry, pulsations, peristalsis, hernias Percussion of the abdomen: identifying the liver, establish the presence of fluid, air or masses Palpation of the abdomen: Light palpation – used to detect tenderness, skin sensitivity, masses & swelling; Deep palpation – to locate liver, spleen, kidneys or any masses *keep watching your client’s facial expression Auscultation: with your stethoscope you listen for bowel sounds (present, absent, increased or decreased) *Client’s bladder must be emptied before the abdominal examination and the examiner must warm their hands!!! Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe In Practice: Demo https://www.youtube.com/watch?v=44N8NL8SNx4 Please watch this video on YouTube in your own time. Pay attention to the fact that we would like you to auscultate before palpation and percussion. Why do you think we prefer this? Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Process: Ask & Agree Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe The Process: Ask- Agree – Assist - Arrange Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Photo by Stefan Els Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe