Gastro-intesinal assessment

DR---NOHA ELSAYED 2015---2016

Gastro-intesinal assessment

Inspection(DCAP-BTLS)

Auscultation(not included)

Palpation

Percussion

Abdomen can be divided in four quadrantsPatient should be lying on supine position

INSPECTION

Inspect oral mucosa For example:1. Lips & mucous membranes should be moist & without lesions

(If dry …. Indicates dehydration)2. Large abdomen …. Indicates Ascitis (Abdominal veins may be

seen)3. Bruising …. Indicates trauma or bleeding in the abdominal

cavity4. Abdominal girth …. Used to document enlarging of organs or

swelling from internal bleeding5. Stools should be assessed for color, consistency & a foul odour

Dark melena stools(Upper GIT bleeding)

Bright red blood(Lower GIT bleeding)

Deformities & Discolorations D

Contusions C

Abrasions A

Penetrations & Punctures P

Burns B

Tenderness T

Lacerations L

Swelling & Symmetry S

DCAP-BTLS

+Visible peristalsis

Distension

Localised: mass,organomegaly

Generalized:

ascitis, weight gain or pregnancy.

Palpate the abdomen

Begin farthest away from the pain.

First superficial (for tenderness or rebound tenderness) rebound

tenderness means pain as pressure of palpation removed ……..suggest

peritoneal inflammation and then

deep palpation(for organs)

liver(palpate for nodules=malignancy)

Spleen not palpable

Kidney also not palpable only if there is a history of polycystic kidney

Assess for discomfort, rigidity, and masses.

If a pelvic fracture is suspected .the pelvis should not be assessed for

stability ………….that any hematoma that has formed to maintain

homeostasis may be disrupted causing internal hemorrhage.

Murphy’s sign severe right upper quadrant pain on deep palpation

exacerbated by deep inspiration this is associated with cholecysitis

Abdominal Palpation

Palpate lightly in all 4 quadrants. Press down around 1 cm. Remember to look at the patient’s face during palpation to see if any tenderness is elicited

Percuss the abdomen The abdomen should sound tympanic.

The upper left and upper right quadrants will sound duller.

Genito-urinal assessment:

Assessment of genitalia includes: Mammary, Testicular, Prostate glands

Limited to patients with specific needs, such as: Those with spinal cord injuries or trauma

Proper kidney function is vital because kidney excretes the majority of toxins from human body

The best indicator for kidney function …. Serum Creatinine (Normal: 0.6 – 1.2 mg/dl)

The more nephrons that have been destroyed, the higher the creatinine level

Take care: Blood urea nitrogen (BUN) is more indicator for hydration than

for renal function (Normal: 8 – 23 mg/dl) BUN/Creatinine ratio is the best method to determine whether

the patient has any type of renal failure (Normal: 10:1 to 20:1)

75% of nephrons can be destroyed before signs & symptoms of renal failure occur

Renal failure (RF) leads to

Monitored by: Arterial blood gases, Urine output Causes of RF: Burn, Crush, Injuries Release of large protein molecules from damaged tissue

destroys the nephrons End stage renal disease …. Requires Peritoneal dialysis (PD) or

Hemodialysis (HD)

•Metabolic acidosis•Congestive heart failure

•Electrolytes imbalance•Anemia

Peritoneal dialysis (PD) Hemodialysis (HD)

Catheter is placed in the peritoneum that serves as the filter to remove wastes from the peritoneal cavity using dialyzing solution

Will have arterio-venous (AV)shunt placed in the arm that is attached to machine acts as a mechanical kidney to remove wastes from the body.

This AV site should be assessed for a thrill (Palpate) & a bruit (Audible) which indicates patent & normally functioning shunt …. Absence of one or both of those indicates clotting of the shunt

• CCTP main concern is maintaining stability of joints by splints or soft and hard casts and assessing for neurovascular compromise of distal extremities.

• Assessment should be completed bilaterally and also assessment of distal skin color ,nail bed colour ,skin temperature ,mobility of distal joints ,pulses and pain sensation

Muscloskeletal assessment

Psychological & Emotional assessment

If a patient is hospitalized for more than 24 hours …. Complete psychological, emotional assessment should be transferred with the patient as it may be helpful to the staff at the receiving facility.

Previously diagnosed psychiatric disorders & Level of anxiety the patient is experiencing must be known.

Psychiatric disorders may be unsafe requiring physical & chemical restraint during transportation or administration of anxiolytics or benzodiazepines

Communication should be with the transferring hospital which is responsible for care of the patients until the arrival .

Changes, Orders & Response of patient should be called immediately to the staff at receiving hospital … To become aware of events occurring enroute so they are prepared to receive the patient.

Communication, Documentation

Documentation of assessment findings to provide continuity of care & patient safety & to protect themselves in case of legal issues.