Question

 

Mr. Jones, a 50 year old man, has been admitted to your hospital unit with a diagnosis of gastrointestinal bleeding. He drove himself to the emergency department after vomiting bright red blood twice within 6 hours. The emergency department staff reported that he arrived on the unit oriented times three but is anxious, slurring his words, and smells of alcohol. He was not able to provide a full history upon admission, but admits to drinking a "few" drinks that day and believes he may have ingested “cleaning fluid or something” by accident. He also states that he is "supposed to stop drinking" and takes "something for his stomach," but could not recall the name of the medication. Once the patient is admitted and brought to your unit, he is able to give more history information. He reports intermittent dizziness and fatigue that has been worsening over the past 2 days. His skin is dry and pale. His abdomen is very distended. Capillary refill is greater than 3 seconds, blood pressure is 140/90mm Hg, pulse rate is 110 beats/min, respiratory rate is 24 breaths/min, and temperature 99 degrees F. He reports that he has been passing black, sticky, foul smelling stools x 3 days. He further complains of epigastric burning that has also been worsening over the past 2 days. He reports that he smokes two packs of cigarettes per day and occasionally smokes cigars. He has been treated for hypertension in the past, but denies taking hypertension medications now.

Questions: 

1. You note that the Emergency Department staff did not assess Mr. Jones’s abdomen. What are the steps for assessing the abdomen?

2. What is the order for assessing the abdomen? What is the rationale for the order?

3. What are some important questions to ask during the abdominal assessment and why?

4. Mr. Jones’s abdomen is distended-Discuss the significance of this finding.

5. Describe how you will discuss Mr. Jones’s alcohol consumption with him.

6. What patient teaching will you perform while Mr. Jones is on your hospital unit? What health promotion topics are a high priority for you to review with him?

3 resources

Answer 1

1. Steps for assessing the abdomen
2. Subjective data, Objective data , abdominal assessment
3. Order for assessing the abdomen and its rationale
4. Inspection,Auscultation, Percussion, Palpation. Auscultation should be performed before percussion and palpation which can increase peristalsis
5. Questions to ask during abdominal assessment
6. Inspection- Inspection helps to determine contour and symmetry for bulging and mass. To check skin surface and umbilicus ( Midline or inverted). Inspection determines peristaltic waves and pulsation from the aorta.
7. Auscultation- To determine bowel sounds, gurgling sounds. To compare normal / hypoactive or hyperactive abdomen. To know vascular sounds or bruits by checking at aorta, renal arteries, iliac arteries and femoral arteries.
8. Percussion- Tympany over abdomen and dullness over liver and spleen. Percuss kidney to determine the pain.
9. Palpation- It helps to understand the presence of aneurysm by palpating aorta. Normal pulsation should be forward direction.
10. The assessor can ask for dysphagia, radiating pain (To rule out pancreatitis), Obstruction ( Intestinal Obstruction), burning pain after eating ( peptic ulcer), Nausea or vomiting,any abdominal surgery, bowel habits to determine the distension of the abdomen. It is better for the client to empty the bladder. ask the exact location of pain to determine ,where it is affected.
11. Abdomen distention and its finding
12. Bleeding ulcer can cause black stools
13. Burning, bloating , bleeding indiactes peptic ulcer. The three types of peptic ulcer are gastric ulcer, Esophageal and duodenum. As presented , vomiting, bleeding are signs of peptic ulcer.
14. Discussion of alcohol consumption
15. Firstly, assess the knowledge of the patient
16. Determine whether patient is ready for discussion
17. Maintain eye to eye contact
18. Discuss the current scenario and adverse effects of alcoholism, especially it worsens the disease
19. Alcoholism also triggers hypertension as the patient is already hypertensive
20. Discuss the situations which make the patient to take alcohol
21. Arrange for therapy to prevent alcoholism
22. Never judge the patient. Seek help from a social worker, if necessary
23. Always acknowkedge the patient
24. Patient teaching
25. Laxatives should be discouraged
26. Spicy food should be prevented
27. Check for the foods which trigger gastric irritation. They should be avoided
28. Obesity and overweight should be prevented
29. Maintain stress and emotional health
30. Proper sleeping and regular physical examinations
31. Consume balanced diet
32. Consult physician for gastro intestinal disturbances as soon as possible
33. The priority topics are related to sedentary life styles and positive outlook towards life.