Question

2. List ten items to assess for the client's health history r/t Gl and renal systems: 3. Describe physical examination techniques for Gl system, including techniques, equipment, order of assessment, normal findings: 4. List one health promotion/counseling measures related to each listed disorder: Health promotion/counseling measure Disorder Alcohol abuse hepatitis Colorectal cancer Urinary incontinence

Answer 1

2) 10 items for assessing client history related to GI and renal system .

* GI system _upset stomach( like gas,bloating ,constipation ,diarrhoea,heart burn) ,unintentional weight changes,dietary pattern ,food intolerance ,bowel movement,chronic or unusual abdominal pain,difficulty and pain when swallowing ,persistent vomiting or nausea ,episodes of checking .

* Renal system_chronic or unusual abdominal pain,persistent nausea or vomiting ,changes in urination habbit (urinating less frequently or not urinating at all) ,high blood pressure ,changes in colour of urine ,swelling or edema ,fluid intake .

3) techniques of GI assessment

*The main techniques include _inspection,auscultation ,percussion ,palpation .

*Equipments required_examining light,measure tape,water soluble skin marking pencil,stethoscope.

INSPECTION:

* Inspect the abdomen for skin integrity : normal finding include unblemished skin,uniform colour,silver White striae or surgical scar .

* Inspect for contour and symmetry :

Observe the abdominal contour ( profile line from rib margin to public bone )by standing at the client side when client is supine : normal finding include flat ,rounded abdomen .

Ask to take deep breath and to hold it to make an enlarged spleen or liver more obvious :normal finding include no evidence of enlarged spleen or liver

Measure the abdominal girth by measuring tape placing around the abdomen at the level of umbilicus normal finding seen without any distention .

Observe the vascular pattern to rule out liver disease ,ascites,dilated veins : normal finding include no visible vascular pattern

AUSCULTATION:

*Warm the hands and stethoscope and observe for bowel sounds (coldness may contract the abdominal muscle and be heard that sound during auscultation).normal finding include audible bowel sounds,absence of arterial bruits ,absence of friction rub.

To ascultate place the bell of stethoscope in each four quadrant of abdomen over all of the auscultatory place and listen for active or irregular noises about every 5 to 20 seconds.

For vascular sounds place the bell over the aorta ,renal arteries ,iliac arteries ,femoral arteries and listen for bruits.

PERCUSSION

*Perform percussion in each area of the 4 quadrant to determine the presence of gas in stomach and intestine .begin in lower right quadrant and proceed to upper right quadrant ,upper left quadrant ,and lower left quadrant .normal findings include :tympany over the stomach and gas filled bowels and dullness especially over the liver and spleen or a full bladder.

* Percuss the liver for liver size begin In the midclavicular line below the level of umbilicus then percuss upward over the tympanic area untill a dull percussion sound indicates the lower liver border mark the site with a skin marking pencil.then percuss downward at the right midclavicular line begining from the lung resonance area and progress upward untill a dull percussion sound indicate upper liver boarder mark with skin marking pencil .measure the 2 marks

Normal finding include 6 to 12 cm in the mid clavicular line and 4 to 8 cmat the mid sternal line.

PALPATION

*Pepprform light palpation to determine the area of tenderness and muscle guarding .

Hold the palm of your hand slightly above the client abdomen ,with the fingers parell to the abdomen then depress the abdominal wall lightly 1 cm with finger pads .move the finger pads in a slight circular motion .

Normal finding include -no tenderness,relaxed abdomen with smooth consistent tension .

* Perform deep palpation over all 4 quadrant .palpate the sensitive area last .

Normal finding include tenderness may present near xiphoid process ,over cecum,over sigmoid colon .

*Palpation of liver by placing one hand along the anterior rib cage and other on posterior rib cage

Normal finding -may not be palpable or borders feel smooth

*Palpation of bladder by palpating over the area above the symphysis pubic.

Normal finding include not palpable bladder .

4)alcohol abuse - Provide counselling sections or educate regarding alcohol cessation clubs working to support people to quit alcoholism .

Hepatitis -- educate regarding available vaccine to prevent hepatitis .educate not to share needles or syringes,avoid personal items of infected person ,use condons during sex .

Colorectal cancer_educate to avoid the risk factor such as smoking ,alcoholism ,not doing exercises .advice for colorectal screening if risk present .

Urinary incontinence _educate to cut down alcohol and caffeine intake and to quit smoking,avoid lifting weight and loss excess body weight ,teach pelvic floor exercises.