NR 325 Adult Health Final Exam Concept Reviews

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Focused Gastrointestinal Physical Assessment Techniques

In conducting a focused gastrointestinal (GI) physical assessment, ensure the patient is in a supine position with knees slightly flexed and the head of the bed raised slightly. The patient should also empty their bladder before the assessment. The evaluation sequence is as follows:

Inspection: Observe the abdomen for any skin changes, umbilicus positioning, symmetry, contour, concavity, or protuberance. Check for hernias, masses, and any observable movements.
Auscultation: Auscultate before percussion and palpation. Use the stethoscope diaphragm for high-pitched sounds and the bell for lower pitches. Listen to all four quadrants, starting in the right lower quadrant (RLQ), for at least two minutes to determine if bowel sounds are normal, hypoactive, or hyperactive.

NR 325 Adult Health Final Exam Concept Reviews

Percussion: This technique helps estimate liver size and detect fluid, distention, or masses. Start below the umbilicus at the right midclavicular line and percuss upwards to detect dullness. Move to the nipple line, percuss downwards, and listen for changes indicating the liver’s upper border.
Palpation: Start with light palpation to assess tenderness, sensitivity, muscular resistance, masses, and swelling. Follow with deeper palpation for organ assessment and mass detection. Keep fingers together, use fingertip pads, depress the abdominal wall approximately 1 cm, and palpate all four quadrants, starting with the RLQ. Monitor for both verbal and non-verbal indications of discomfort.

NR 325 Adult Health Final Exam Concept Reviews

Endoscopic and Biopsy Procedures

Procedure	Purpose	Nursing Responsibility
ERCP	Uses an endoscope inserted through the mouth to examine the biliary ducts, gallbladder, liver, and pancreas with contrast X-rays	Pre-op: NPO 8 hours, consent, sedation, antibiotics if ordered; Post-op: Monitor for perforation, infection, pancreatitis, and gag reflex return
Colonoscopy	Allows visualization of the rectum, sigmoid, and transverse colon	Pre-op: Bowel prep, clear liquids 24 hr prior, NPO after midnight; Post-op: Monitor for bleeding and severe pain, increase fluids
Liver Biopsy	Needle biopsy of hepatic tissue	Pre-op: Check coagulation status, cross-match blood, and provide instructions; Post-op: Monitor for bleeding and maintain a flat position for 12-14 hours

Gastrointestinal Blood Studies

Amylase (Pancreas and Small Intestine): 40-140 U/L
Lipase (Pancreas): 0-160 U/L
Total Bilirubin (Liver, Gallbladder): 0.3-1.0 mg/dl
AST (Liver): 0-35 U/L
ALT (Liver): 4-36 U/L
PT (Warfarin-related clotting): 11-13.5 seconds
aPTT (Heparin-related clotting): 22-35 seconds
Cholesterol (Blood Vessels): Total cholesterol – less than 200 mg/dL; LDL – less than 100 mg/dL; HDL – 40 mg/dL or higher
Serum Ammonia (Production: Intestines, Kidneys; Consumption: Liver, Muscles): 6-47 mmol/L (10-80 mcg/dL)

NR 325 Adult Health Final Exam Concept Reviews

References

American Nurses Association. (2020). Nursing: Scope and Standards of Practice. 4th ed. Nursing Publishers.