A nursing health assessment of the gastrointestinal system involves the examination of the abdomen and abdominal contents. A gastrointestinal assessment is always included as part of a routine head-to-toe assessment. Show
And, as with any other system, knowing possible symptoms and how to focus the interview and physical assessment are important skills for nursing students to have. To begin the study of an assessment of the gastrointestinal system, review your anatomy and physiology of the system. Some helpful facts about the gastrointestinal system are included in the article 11 Facts About the Gastrointestinal System Every Nursing Student Should Know. During a gastrointestinal assessment, a nursing student will use the skills of inspection, auscultation, percussion, and palpation. This article contains 9 Tips for Performing a Nursing Health Assessment on the Gastrointestinal System. Tip #1 – Gather Information on Chief Complaints or Symptoms.There are a variety of upper and lower gastrointestinal complaints or symptoms. Gathering health information about the patient’s chief complaints and symptoms will help narrow the diagnosis of the gastrointestinal system. S ome chief complaints of the gastrointestinal system include nausea, vomiting, loss of appetite, change in bowel habit, diarrhea, and constipation. Nausea and vomitingNausea is a sensation that comes in waves in the back of the throat, the abdomen or epigastric region that causes the patient to have the urge to vomit. Vomiting is the forceful voluntary or involuntary emptying of the stomach. This is a means of the gastrointestinal tract getting rid of an irritation. Sensory fibers stimulate the vomiting center. The abdominal muscles contract, the lower esophageal sphincter opens and the contents of the stomach are regurgitated out. Ask the patient the following questions about nausea.
Ask the patient the following questions about vomiting.
AnorexiaAnorexia is not the disorder Anorexia Nervosa most people think about. That disorder is the refusal to eat. Anorexia is also a symptom of abdominal problems. It is the lack or loss of appetite or intolerance to certain foods due to a gastrointestinal problem. Ask the patient the following questions about loss of appetite or anorexia.
Change in bowel habitQuestions about bowel habits provide information about how the bowel is functioning. Assess elimination patterns and any changes in the characteristics of the stool. Ask the patient the following questions about bowel habit.
DiarrheaDiarrhea is the passage of loose, watery stools frequently. This occurs when the water contents of the small intestine go through the large intestine too fast. There is not enough time for the water or electrolytes to be absorbed. This can cause problems if the diarrhea is prolonged. Ask the patient the following questions about diarrhea.
ConstipationConstipation is difficulty passing stools or the infrequent passage of hard stools. Sometimes the contents of the intestine move through the large intestine too slow. Too much water is reabsorbed which makes it hard for the feces to continue to move through the system. And, the longer the feces stay in the larger intestine the more water is reabsorbed. This can become a vicious circle. Ask the patient the following question about constipation.
Tip #2 – Gather Information About Abdomen PainAbdominal pain is a chief complaint or symptom of the gastrointestinal system. Abdominal pain can be a benign condition or it can be life-threatening. There are several types of abdominal pain. These types of pain include visceral pain, parietal pain, and referred pain. Visceral painVisceral pain is a burning, aching, cramping, and gnawing pain. It can have additional symptoms such as nausea, vomiting, and restlessness. Visceral pain originates from the intestine or another hollow organ. Also, the pain can arise from the biliary tree. Whenever these organs are stretched beyond capacity the patient will experience visceral pain. Parietal painParietal pain is usually more severe than visceral pain. This type of pain is a constant aching pain. It is usually localized over the organs causing the pain. If a patient moves or coughs, the pain becomes worst. These patients like to remain very still. Referred painReferred pain is pain that is not felt at the site of origination. This type of pain can be felt in the back, over the chest or other sites. As abdominal pain becomes greater, the pain appears to radiate or travel to another site. This type of pain can be deep or superficial. Ask the following questions to gather more information about the abdominal pain.
Tip #3 – Know the Landmarks of the AbdomenThe Four QuadrantsFor the purpose of assessment, the abdomen is usually divided into four quadrants. Also, the fours quadrants can be used for assessing abdominal contents. However, dividing the abdomen into the nine regions is helpful. This method divides the middle of the abdomen into the epigastric, umbilical and suprapubic regions. These regions are very useful for descriptive purposes. The four quadrants include the right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant. Dividing the abdomen into four quadrants are used to assess bowel sounds during an abdominal assessment. The stomach is divided into the four quadrants using one horizontal plane and one vertical plane. The horizontal plane is the transumbilical. This plane crosses through the umbilicus. And, the vertical plane is the medial plane. It extends from the xiphoid process to the symphysis pubis. Below are the organs contained in the four quadrants. Tip #4 – Inspection the Abdomen
To inspect the abdomen:
A flat abdomen is commonly seen in a person of normal weight. There is a straight line from the costal margin to the symphysis pubis. A rounded abdomen has a convex shape. This usually indicates additional fat around the abdominal area. A rounded abdomen is normal in pregnant women and toddlers. A scaphoid abdomen has a concave shape. From the side, the abdomen looks sunken. This shape is usually seen in patients who are extremely thin. A protuberant abdomen is seen in patients who are obese or have ascites. The abdomen is extremely rounded. This shape is seen in women who are pregnant but is also seen in men with ascites. Tips #5 – Auscultate the AbdomenBowel sounds are auscultated to check for bowel motility.
To auscultate the abdomen:
Types of Bowel SoundsHyperactive bowel sounds are high pitched, and loud. They are caused by increased gastric motility. Borborygmus is a type of hyperactive bowel sound. This usually occurs when your stomach growls. Hypoactive or absent bowel sounds are a sign of decreased gastric motility. Tip # 6 – Percussion of the AbdomenPercussion of the abdomen is used to assess for the amount of gas in the abdomen. Also, it can be used to identify organs and masses. Percussion can help estimate the size of the liver or spleen. As mentioned in other assessment articles, to be really good at percussion you have to see it demonstrated and you also have to practice the skill. This article will cover what you should look for when percussing the abdomen. When you percuss the abdomen you are checking for the density of the contents. Also, you want to locate the different organs and any masses that may be present. It is difficult to percuss the liver because most of it is covered by the ribcage. You have to percuss in the intercostal spaces between the ribs. Percussion of the liver is performed to distinguish the borders and the span of the liver. Dullness is heard when percussing the liver. You are able to percuss the spleen when it enlarges. It usually extends forward, downward and to the sides. The percussion sound is dullness where the stomach is usually located. When the spleen is enlarged it can be percussed below the costal margin. To percuss the abdomen:
Tip #7 – Palpation of the Abdomen
Palpation of the abdomen is used to evaluate the size and location of abdominal organs. Also, you can use palpation to assess for tenderness. When palpating the abdomen, begin with light palpation. Light palpation is helpful for assessing for tenderness. Perform deep palpation to check the abdominal masses. To lightly palpate the abdomen:
To deeply palpate the abdomen:
To palpate the liver:
Try the Hooking method:
To palpate the spleen:
Tip #8 – How to Assess for AscitesAscites is usually seen in patients with cirrhosis of the liver. The patient will have a protuberant abdomen. Ascites is caused by a increased hydrostatic pressure in patients with cirrhosis of the liver. Percussion is normally used for the assessment of ascites, however, there are other methods. An abdomen with ascites will have both tympanic and dull sounds. You will hear tympany at the top of the abdomen around the epigastric area. And dullness will be heard lower around the umbilicus or any dependent areas of the abdomen. Test for shifting dullness:
Test for a fluid wave:
Tip #9 – Assessing for AppendicitisWhen a patient has appendicitis the pain usually begins at the umbilicus and radiates to the right lower quadrant. Sometimes coughing increases the pain. Palpate for appendicitis:
Check for rebound tenderness: (Blumberg’s Sign)
Rovsing’s sign
Psoas sign
Obturator sign
Cutaneous hyperesthesia
Check for an inflamed gallbladderMurphy’s sign
In conclusion, the tips above will help you with a nursing health assessment of the gastrointestinal system. Practice auscultation to distinguish the different bowel sounds. The skills of percussion and palpation take time to master. At first, the abdomen feels all the same. Also, review your anatomy and physiology and the article on 9 Facts about the gastrointestinal system every nursing student should know. Reference Bickley LS., Szilagyi PG., (2017). Bates Guide to Physical Examination and History Taking. 12th ed. Philadelphia, PA. Wolters Kluwer/Lippincott Williams & Wilkins. Jarvis C., (2017). Physical Examination & Health Assessment. St Louis, MO. Elsevier Inc. Mosby’s Medical Dictionary (2017). 10th ed. St Louis, MO. Elsevier Inc. Disclaimer: The information contained on this site is not intended or implied to be a substitution for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained is provided for educational purposes only. You assume full responsibility for how you chose to use this information. Which question would the nurse ask first to obtain information about the patient's bowel habits?Ask the patient the following questions about bowel habit.
What is the consistency of the bowel movement? Do you have any diarrhea or constipation? Have you had any change in bowel habits? Do you have any problems having a bowel movement?
Which assessment technique for the abdomen is performed last to avoid a false finding?Auscultation is performed following inspection; the abdomen should be auscultated before percussion or palpation to prevent production of false bowel sounds. For accurate assessment of the abdomen, patient relaxation is essential.
What should the nurse suggest to a client to assist with regular bowel movements?Fluid and fibre
Increasing the amount of fibre in the diet improves propulsion times. The fibre helps speed up the passage of faeces through the colon. It also improves defecatory difficulty because the stools are softer and easier to pass. This improves bowel habit and reduces discomfort.
How would you assess his bowel elimination patterns?There are several common diagnostic tests related to bowel elimination, including stool-based tests, a colonoscopy, a barium enema, and an abdominal CT scan.
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