NR 325 Adult Health Final Exam Concept Reviews

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Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

NR 325 Adult Health Final Exam Concept Reviews

Focused Gastrointestinal Physical Assessment Techniques

A focused gastrointestinal (GI) physical assessment requires a structured and systematic approach to obtain accurate clinical findings. The patient should be positioned in a supine posture with the knees slightly flexed and the head of the bed elevated slightly for comfort and relaxation of the abdominal muscles. It is essential that the bladder be emptied before the examination to prevent misinterpretation of findings caused by bladder distention. The evaluation is performed in the following sequence: inspection, auscultation, percussion, and palpation.

Inspection

During inspection, the abdomen is observed for skin integrity, color changes, lesions, and striae. The contour is carefully assessed for flatness, concavity, or distention. Attention should also be directed toward the umbilicus, checking for displacement or abnormalities. The presence of visible peristaltic movements, hernias, scars, or masses should also be documented. This initial step provides baseline data and may guide further examination.

Auscultation

Auscultation is performed before percussion or palpation because physical manipulation can alter bowel sound characteristics. Using the diaphragm of the stethoscope, high-pitched bowel sounds are assessed, while the bell may be applied to detect lower-pitched vascular sounds. The examiner should listen in all four quadrants, beginning in the right lower quadrant (RLQ), for at least two minutes. Findings should classify bowel activity as normal, hypoactive, hyperactive, or absent.

Percussion

Percussion is a valuable tool for assessing organ size, abdominal fluid, or gaseous distention. The liver borders are evaluated by percussing upwards from below the umbilicus along the right midclavicular line until dullness is noted. Then, percussion continues downward from the nipple line to identify the superior margin. Shifts in sound from tympanic to dull help confirm liver size and the presence of abnormal fluid or masses.

Palpation

Palpation begins lightly to detect surface tenderness, guarding, or muscular resistance. This is followed by deep palpation to evaluate organ size, masses, or abnormal structures. The examiner should keep the fingers together, using the fingertip pads to depress the abdominal wall approximately 1 cm during light palpation and more deeply for organ assessment. All four quadrants are examined, beginning with the RLQ, while carefully observing the patient for both verbal and non-verbal cues of discomfort or pain.

Endoscopic and Biopsy Procedures

Several diagnostic procedures support the evaluation of gastrointestinal health. Each requires specific preparation and post-procedure nursing care.

Procedure	Purpose	Nursing Responsibilities
ERCP (Endoscopic Retrograde Cholangiopancreatography)	Involves insertion of an endoscope through the mouth to evaluate the biliary ducts, gallbladder, liver, and pancreas using contrast X-rays.	Pre-op: NPO for 8 hours, obtain consent, administer sedation, and antibiotics if prescribed. Post-op: Monitor for perforation, infection, pancreatitis, and return of gag reflex.
Colonoscopy	Allows visualization of the rectum, sigmoid, and transverse colon.	Pre-op: Complete bowel preparation, clear liquid diet for 24 hours, and NPO after midnight. Post-op: Observe for bleeding, abdominal pain, and encourage increased fluid intake.
Liver Biopsy	A needle biopsy is performed to obtain a tissue sample from the liver.	Pre-op: Assess coagulation profile, cross-match blood, and provide clear instructions. Post-op: Monitor closely for bleeding and maintain a flat supine position for 12–14 hours to reduce the risk of hemorrhage.

Gastrointestinal Blood Studies

Blood studies provide critical diagnostic information about gastrointestinal and hepatic function. Normal laboratory values and their clinical significance are outlined below:

Test	Organ/Function Assessed	Normal Range
Amylase	Pancreas and small intestine	40–140 U/L
Lipase	Pancreas	0–160 U/L
Total Bilirubin	Liver and gallbladder	0.3–1.0 mg/dL
AST (Aspartate Aminotransferase)	Liver enzyme function	0–35 U/L
ALT (Alanine Aminotransferase)	Liver enzyme function	4–36 U/L
PT (Prothrombin Time)	Warfarin-related clotting	11–13.5 seconds
aPTT (Activated Partial Thromboplastin Time)	Heparin-related clotting	22–35 seconds
Cholesterol	Blood vessels (lipid metabolism)	Total: <200 mg/dL; LDL: <100 mg/dL; HDL: ≥40 mg/dL
Serum Ammonia	Production: intestines, kidneys; Utilization: liver, muscles	6–47 mmol/L (10–80 mcg/dL)

These studies guide diagnosis and management of hepatic, pancreatic, and metabolic disorders. Abnormal values often indicate the need for further diagnostic testing or therapeutic intervention.

References

American Nurses Association. (2020). Nursing: Scope and standards of practice (4th ed.). ANA Publishing.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2020). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.