Question

Please complete the Intervention Skill Based Experience

1. What order will you complete the 4 steps of the abdominal assessment?

2. This is a sample nursing documentation:

6/10/15 0945 c/o “gassy” pain lower right quadrant. No bowel movement x

48 hrs. Ate 75% regular diet yesterday. Abdomen flat. Active bowel

sounds all 4 quadrants. Tympany above umbilicus, dull below. No masses

felt on palpation. 30 mL Milk of Magnesia given.

3. What does the tympany and dullness tell you?

All the following patients are at risk for alteration in nutrition except? (choose the

appropriate answer and cite the rationale for the chosen answer)

a. Patient I., whose weight is 10% above his ideal body weight

b. Patient J., who is 86-years-old, lives alone and has poorly fitting dentures

c. Patient M., a 17-year-old girl who weighs 90 pounds and frequently complains

about her baby fat

d. Patient K., who has been allowed nothing by mouth (NPO) for 7 days after bowel

surgery and is receiving 3000 mL of 10% dextrose per day.

4. List at least 3 laboratory assessments that will help you determine a patient’s nutritional status?

5. Identify at least 4 possible complications of enteral tube feedings and the possible cause.

Answer 1

1. The order of abdominal assessment will be inspection, auscultation, percussion, and palpation. It is different from examination of other systems. Inspection involves assessment for scars or distended veins. Auscultation includes listening the bowel sounds. Percussion involves assessment of ascites and palpation involves assessment of all quadrants of abdomen by hand.