Sample Answer for NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System Included After Question
On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?
Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.
This week, you will explore how to assess the abdomen and gastrointestinal system.
Learning Objectives
Students will:
- Evaluate abnormal abdomen and gastrointestinal findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system
Photo Credit: Hill Creek Pictures/UpperCut Images/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 4, “Vital Signs and Pain Assessment” (pp. 50-63)
This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.
- Chapter 17, “Abdomen” (pp. 370-415)
In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment on the abdomen.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 3, “Abdominal Pain” (pp. 11-32)
This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.
- Chapter 10, “Constipation” (pp. 110-117)
The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.
- Chapter 12, “Diarrhea” (pp. 133-147)
In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.
- Chapter 29, “Rectal Pain, Itching, and Bleeding” (pp. 344-356)
This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 10, “Admitting a Patient to the Hospital” (pp. 217-238)
Note: Download this Adult Examination Checklist and Abdomen Physical Exam Summary to use during your practice abdominal examination.
Required Media
Online media for Seidel’s Guide to Physical Examination
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.
- Chapter 10, “The Urinary System” (pp. 528–540)
In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system.
Assesment 1: Assessing the Abdomen
A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
Abdominal Assessment
SUBJECTIVE:
- CC: “My stomach hurts, I have diarrhea and nothing seems to help.”
- HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
- PMH: HTN, Diabetes, hx of GI bleed 4 years ago
- Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
- Allergies: NKDA
- FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
- Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
OBJECTIVE:
- VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
- Heart: RRR, no murmurs
- Lungs: CTA, chest wall symmetrical
- Skin: Intact without lesions, no urticaria
- Abd: soft, hyperctive bowel sounds, pos pain in the LLQ
- Diagnostics: None
ASSESSMENT:
- Left lower quadrant pain
- Gastroenteritis
- PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
To prepare:
With regard to the SOAP note case study provided:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
To complete:
- Analyze the subjective portion of the note. List additional information that should be included in the documentation.
- Analyze the objective portion of the note. List additional information that should be included in the documentation.
- Is the assessment supported by the subjective and objective information? Why or Why not?
- What diagnostic tests would be appropriate for this case and how would the results be used to make a diagnosis?
- Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.
By Day 7
This assignment is due.
Submission and Grading Information
Grading Criteria
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 6 Assignment draft and review the originality report.
Submit Your Assignment by Day 7
Week 6 Midterm Exam
This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
This exam will be on topics covered in weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of two hours for completion. When time is up, your exam will automatically submit.
Submission and Grading Information
Submit Your Midterm Exam by Day 7
Assignment 2 (Optional) Practice Assessment: Abdominal Examination
The causes of abdominal pain can be extremely varied due to the sheer number of structures, organs, and functions within the abdomen. If abdominal pain is caused by a life-threatening condition, then swift and accurate assessment is essential.
In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice performing an abdominal examination this week.
Note: This is an optional practice physical assessment. You do not have to capture a video of this assessment, as no submission is required.
To prepare:
- Arrange an appropriate time and setting with your volunteer “patient” to perform an abdominal examination.
- Download and review Adult Examination Checklist: Guide for Abdominal Assessment provided in this week’s Learning Resources.
- To perform the examination, ensure that you have a stethoscope, a centimeter ruler, measuring tape, and marking pens to mark the areas of measurement for consistency in measuring.
To complete:
- Perform the abdominal examination. Be sure to cover all of the areas listed in the checklist and to use the equipment appropriately.
Week in Review
This week, you properly applied assessment techniques and diagnoses for the abdomen and gastrointestinal system. In addition, you evaluated abnormal abdomen and gastrointestinal findings, listing five different possible conditions for the patient’s differential diagnosis with justifications as to why.
Next week, you will explore how to assess the musculoskeletal system.
A Sample Answer For the Assignment: NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System
Title: NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System
Initials: JR Age: 47 Sex: Male Race: Caucasian
S:
I’ve had a stomach ache for 3 days, and some diarrhea. I can eat but I get some nausea afterwards.
HPI:
This is a 47 year-old male presenting with generalized abdominal pain with onset 3 days ago. He said he also has diarrhea, he can eat but with some nausea following his meals.
PMHx: Diabetes, hypertension, obesity. He had a GI bleed 4 years ago.
Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs. Patient denies taking any medications for current illness.
Allergies: NKDA
FMHx: Father: Type II Diabetes, Hypertension; Mother: hypertension, hyperlipidemia, GERD. Denies any history of colon cancer in family.
Social: non-smoker, states moderate alcohol use, married, and 3 children.
O:
Vital signs: Temp 99.8, BP 160/86, RR 16, Pulse 92, Height 5’10”, weight 248 lbs.
Heart: RRR, no murmurs
Lungs: Clear to auscultation, chest wall symmetrical
Skin: intact, no lesions or uticaria
Abdomen: soft, hyperactive bowel sounds, positive for pain in LLQ on palpitation
Diagnostics: none
Assessment: Left lower quadrant pain, rule out gastroenteritis vs. diverticulosis, IBS, bowel obstruction,
Additional Subjective Information.
This nurse has several questions for the patient. What are his stools like? Has he traveled to a
foreign country (Barr and Smith, 2014) or relate his symptoms to anything he ate? Does eating
decrease the pain, increase it, or not affect his abdominal discomfort? Is there any abnormal urination such as frequency, pain, or retention? When he had the GI bleed, what was done? (Such as upper endoscopy, colonoscopy, flex sigmoidoscopy) Is he adherent with his medication regimen? How long has he been diagnosed with diabetes? Is it type I or II? Does he take his blood glucose levels at home? If so, how do they run? Does he see a health care provider regularly? He admits “moderate drinking.” A provider might see such symptoms with very heavy drinking, so this writer would screen for alcohol use disorder, perhaps with the CAGE screening tool. Does he have back pain, or take any pain medications such as ibuprofen, acetaminophen, or any opioid-based medication.
The patient is alert, awake and oriented x4. The patient is obese.
General: The patient is alert, awake and oriented x 4. He considered to be obese.
HEENT:
Neck: Normal range of motion
Breasts: Denies any pain and discomfort in the pectoralis area
Respiratory: Normal and effortless, no signs of respiratory distress
Cardiovascular/Peripheral Vascular: denies any pain in the chest,
Gastrointestinal: abdominal pain with nausea, and vomiting, loose stool, hyper-active bowel sounds
Genitourinary: increase in urinary frequency and urgency
Musculoskeletal: Normal range of motion
Psychiatric: Speech is normal, and behaviors normal, denies any memory deficits. Mood and affect anxious.
Neurological: He is alert, awake and oriented to person, place time and day. No signs of cranial nerve deficits
Skin: Skin is slight hot, and moist
Hematologic: denies any bruising, and bleeding problems
BP 140/72/ Pulse 82/ Temp 37.5 C (oral)/ Resp 20/ Ht 167.5 cm/ Wt. 102 kg / BMI 30.82 kg/m2/ SpO2 100%
Additional Subjective Data
The patient reports acute pain for 3 days in the left lower quadrant (LLQ). He has low-grade fever, elevated blood pressure (160/86) in patient with hypertension, on medications. (Barr and Smith, 2014) in a discussion of differential diagnosis for abdominal pain, shows five areas, the four quadrants plus medial superior and inferior regions. In the LLQ, the writers only cite female-specific conditions. Therefore, the nurse considers diagnoses specific to the adjoining areas, which are bowel conditions: irritable bowel syndrome (IBS), diverticulitis, obstruction or ischemia, or appendicitis (Gulacti, Borta, Lok, Aydin, Cebe, and Arslan, 2017)note that left side appendicitis is very rare); abdominal aortic aneurysm (AAA). (Linett, 2014) writes that it is very important to rule out AAA and that it is often seen in middle-aged, hypertensive males); Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) or diabetic ketoacidosis (DKA) or gastroenteritis are all sometimes found in persons with left and inferior abdominal pain (Linett, 2014) and note that acute abdominal pain sufferers may have “acute pancreatitis, acute appendicitis, or acute cholecystitis.” In alcohol-Induced pancreatitis, the authors note that the disorder is common in alcohol users, so this is relevant if the man turns out to be a heavy drinker.
Diagnostic Tests
A provider might order routine labs (complete blood count, complete metabolic panel) as well as hemoglobin A1C. The nurse could do a rectal exam and hemoccult to rule out GI bleed, especially given his past history of same. She can do a groin exam to rule out incarcerated hernia. Clinicians look for elevated white cell count (WBC) especially with the man’s fever, however if elevated, this is non-specific as to diagnosis. Given the diarrhea, the clinician assesses possible fluid volume depletion, looking at labs and patient’s physical exam and subjective account. Decreased hemoglobin and hematocrit are seen in persons with severe GI bleeding. Liver function studies and serum lipase tests help rule out pancreatic, liver, or gallbladder disease. Finally, providers use abdominal ultrasound studies to look for aneurysms, appendicitis, diverticulitis, and bowel obstruction. (Gulacti, et al., 2017).
Acceptance or Rejection of Current Diagnoses
In this assessment, the writer diagnoses the patient with gastroenteritis. This writer believes the assessment is not complete and the provider needs to consider other diagnosis including immediately life-threatening conditions. Mayumi, Yoshida, Tazuma, Furukawa, Nishii, Shigematsu (2015), writing about “acute abdomen” state: …cholelithiasis, small intestinal obstruction, ureteral stone, peptic ulcer perforation are possible causes of abdominal pain.” “Furthermore, acute abdomen should be differentiated from myocardial infarction, torsion of the spermatic cord. As far as gastroenteritis, (Townes, 2014) notes that most cases …in the USA are viral-based, and the writer discusses the diagnostic and treatment issues. According to Townes (2014) common symptoms of gastroenteritis, consists of loose stool with blood, stomach cramps, nauseousness, pain the stomach among other (Townes, 2014).
Thus, this patient needs a full assessment including serum glucose, routine labs, and a discussion of his medication adherence and alcohol use on this visit. If there are no further complications, he could be referred for follow-up at a later time. It is well to assess people for their adherence to visits as well, to see if he is likely to go to his appointments. Obviously, there could be more serious issues than benign gastroenteritis, which should itself be self-limiting. In case of more serious conditions are seen, aneurysm, hernia, appendicitis, bowel obstruction, or complications of alcohol use are seen, and the provider will arrange appropriate immediate treatment or referrals.
There are several medical conditions that can cause abdominal pain and discomfort in the gastrointestinal system. This could be the case with the patient that was discussed in the case study, therefore careful assessment must be done to rule out certain disorder to make an accurate and diagnose and formulate an appropriate treatment plan.
Differential diagnosis
Inflammatory Bowel Disease
There are various types of inflammatory disorders. There is ulcerative colitis and Crohn disorder and irritable bowel syndrome (IBS). These two disorders differ because of where they tend to occur in the gastrointestinal system. Crohn’s disorder mostly impacts the small intestines and initial portion of the colon. The disorder is not only limited to the small intestinal area, but it can also affect any area in the GI tract system and walls of the colon. While ulcerative colitis mainly in observed in the large intestine and deep within the colon walls. These disorders tend to occur due to inflammation in the GI system. Some symptoms that might occur in these disorders are pain the abdomen, among others (Huether & McCance, 2017). Irritable bowel syndrome (IBS) happens whenever there are multiple symptoms concurrently taking place. These symptoms in includes diarrhea and constipation which can takes place separately or together. According to the Crohn’s & Colitis Foundation of America (CCFA, 2014), normally, the muscles lining the intestines intermittently contract and relax to move food along the digestive tract. In IBS, this pattern is disturbed, resulting in uncomfortable symptoms.
Laboratory and test: Special blood and stool test are done to rule out other diagnoses and to confirm inflammatory bowel disease.
Peptic Ulcers
It believed that peptic ulcers are related to when holes occur in the stomach lining, which is referred to as gastric ulcer and duodenal ulcers when the erosion happens in beginning of the duodenum (Vakil, 2018). The bacteria that contributed to the stomach erosion is Helicobacter pylori and the usage of certain medication that inters with the stomach (Vakil, 2018). Aftertimes symptoms tend to present themselves based on the ulcer location and the patient’s age. There can be nausea and vomiting, and pain which taking place due to blockage and scaring in the GI tract system (Vakil, 2018). These were some of the symptoms in the case was complaining of.
Laboratory and testing: Blood tests, urea breathe test, stool test, upper GI series, computerized tomography (CT) scan.
- Gastroparesis: This disorder in attributed to the stomach in ability to contact, which inhibits the propelling of food into the small intestines. This in turn impact digestion. One of the main common cause of this disorder is diabetes. Nausea and vomiting can be signs and symptom of the disorder (Fox and Foxx-Orenstein, 2012)
Laboratory and testing: upper endoscopy, gastric emptying study, scintigraphic, gastric accommodation, a small intestinal x-ray, among others, (Fox and Foxx-Orenstein, 2012)
References
Barr, W., & Smith, A. (2014). Acute diarrhea in adults. Retrieved from
https://www.aafp.org/afp/2014/0201/p180.html
Crohn’s & Colitis Foundation of America (CCFA, 2014). Inflammatory bowel disease and
irritable bowel syndrome similarities and differences. Retrieved from http://www.crohnscolitisfoundation.org/assets/pdfs/ibd-and-irritable-bowel.pdf
Fox, J., and Foxx- Orenstein, A. (2012). Gastroparesis. Retrieved from
http://patients.gi.org/topics/gastroparesis/
Gulacti, U., Borta, T., Lok, U., Aydin, I., Cebe, I. H., & Arslan, E. (2017). Male with left lower quadrant pain. Annals of Emergency Medicine, 70(6). doi:10.1016/j.annemergmed.2017.06.011
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Linett, L. M. (2014). Dissecting abdominal aortic aneurysm in a young man: An uncommon presentation of abdominal pain. The American Journal of Emergency Medicine, 23(3), 383-385. doi:10.1016/j.ajem.2005.02.007
Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Shigematsu, K. (2015). The practice guidelines for primary care of acute abdomen. Japanese Journal of Radiology. 34 (1) 80-115. doi: 10.1007/s11604-015-0489-z
National Institute of Diabetes and Digestive and Kidney Diseases (2014). Diagnosis of peptic
ulcers (stomach ulcers) how do doctors diagnose a peptic ulcer. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/diagnosis
Townes, M. J. (2014).Acute infectious gastroenteritis in adults; seven steps to management and
prevention, Retrieved from https://www.mayoclinic.org/diseases-conditions/viral-gastroenteritis/symptoms-causes/syc-20378847
Vakil, N. (2018). Peptic ulcer disease. Retrieved from
https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease