Abdominal/Gastrointestinal Assessment Module Assignment

1. Describe at least 2 typical physical examination findings from the 4 examination techniques
(inspection, auscultation, percussion, palpation) for these abdominal conditions. Contrast these
findings with normal expected findings & why these abnormal findings occur. Follow the
example. (3 points)

Condition Physical Exam Findings Rationale

Hepatomegaly e.g. Dullness to percussion
measuring 16 cm in mid-
clavicular line. Liver palpable 5
cm below costal margin.
Ascites Protuberant shape, positive
wave test, jaundice
Constipation (feces in colon) Dull percussion, distention,
sense of fullness.
Appendicitis Positive obturator and iliopsoas
test, RLQ pain
e.g. Normal liver span in MCL
is 6 – 12 cm upon percussion; an
enlarge liver is percussed &
measured larger.
Normal liver may only be
palpable 1-2 cm; enlarged liver
is more than 1-2 cm below
costal margin.
Normal is flat or rounded shape,
negative wave test. Peritoneal
fluid/3rd spacing causes fluid
buildup outside of organs,
causing distention. Live
impairment causes bilirubin
buildup and jaundice.
Normal sounds are tympanic
unless percussing solid organs.
Solid stool creates dull sounds,
impacted bowels create sense of
fullness by occupying physical
space
Normal has no associated pain
with moving hip joint. Pain
associated with inflammatory
symptoms at the site and with
muscles around the site.

Hint: Consider doing this synthesis activity for your own learning for other abdominal conditions listed
in the module learning objectives.

GI Case Study

Subjective Data
HPI
Mr. Jones is a 49-year-old man admitted for acute hepatitis. He reports that he went to visit his nephew
who noticed that he was “yellow all over” and brought him to the hospital for an evaluation. He has lost
10 pounds in the past month without trying. He complains of right upper quadrant abdominal pain 6/10,
“very dark urine,” nausea and vomiting for the past week or so. Loss of appetite. His stool has become
lighter in the past 2 weeks but it was not a concern for him. Reports occasionally he feels momentary
lightheadedness, like he might faint. States that he wants to know more about hepatitis. Asks appropriate
and thoughtful questions about current treatment regimen and possible cure.

PMH
Gallstones, osteoarthritis, and diabetes.

SH
Non-smoker, social alcohol drinker once or twice per week.
Has had unprotected sexual intercourse with a female partner in the past 2 months.

Objective Data
V/S T, 100.80F; P 110b/min; R 22; BP 100/54
Pt is sitting upright in bed. He has generalized jaundice, most evident in sclera, face, chest. Skin dry with
poor turgor. Breathing does not appear to be labored. Abdomen is mildly distended. Bowel sounds
normoactive in all 4 quadrants.

Questions

2. What additional physical assessments are important to include for this patient? Describe 4 very
important & pertinent physical exam assessments to be done as priority for this patient. (3 points)

Abdominal palpation and percussion to test for liver enlargement

Murphy’s to test for pain and cholecystitis, wave to test for fluid/ascites
Test for orthostatic hypotension due to low BP and elevated HR

2. Write and SBAR for the case study. (4 points)

S: My name is GJ, I am a nurse calling about a Mr. Jones, a 49 year old male patient admitted for
acute hepatitis.
B: Mr. Jones has a history of diabetes, gallstones, and osteoarthritis. He denies smoking but
admits to drinking socially 1-2x per week, and has had unprotected sexual intercourse within the
past 2 months. He has had dark urine, loss of appetite, and N/V for the past week and light stool
the past 2 weeks. He reports occasional lightheadedness.
A: His temperature is slightly elevated, his HR and RR are high at 110bpm and 22, with a low BP
of 100/54. He presents with generalized jaundice, dry skin, and poor turgor. He does not appear
to have labored breathing. Bowel sounds are normoactive but abdomen is mildly distended. I am
most concerned with his liver function
R: I would like to recommend additional cardiac and respiratory tests and a CMP.

Optional BONUS Question (worth maximum of 1 point)

Case Scenario above continues: The patient’s girlfriend visits the Mr. Jones in the hospital. She
says that she feels fine and does not have any symptoms. She asks you, the nurse, whether she might
also be infected with hepatitis or whether she could become infected with hepatitis.
What is ONE priority health promotion (wellness) nursing diagnosis for the Mr. Jone’s girlfriend?
Please write it as a complete nursing diagnosis statement. (Note: please do not use “risk for
infection” – a risk nursing diagnosis is not the same as a health promotion nursing diagnosis).

Readiness for enhanced knowledge of hepatitis AEB patient asking questions about her own health
status, expressing desire to enhance learning.