Assessment of Digestive and Gastrointestinal Function

GI

Assessment of Digestive and Gastrointestinal Function

Health History and Clinical Manifestations
• The nurse begins by taking a complete history, focusing on symptoms common to GI dysfunction.
• These symptoms include:
– Pain
– Indigestion
– Intestinal gas
– Nausea and Vomiting
– Changes in bowel habits and stool characteristics.

Pain
• Pain can be a major symptom of GI disease. The character, duration, pattern, frequency, location, distribution of referred pain, and time of the pain vary greatly depending on the underlying cause. Other factors, such as meals, rest, defecation, and vascular disorders, may directly affect this pain.

Assessing Pain
• Characteristics
– Can you describe the pain (sharp, dull, superficial, or deep)?
– Is the pain intermittent or continuous?
– Was the onset sudden or gradual?
– Can you point to where the pain is located?
– What makes the pain better, worse?
• Associated factors
– Are there other symptoms associated with the pain fever, nausea, vomiting, diarrhea, constipation, anorexia, weight loss, dyspepsia?
• History
– Any family history of GI cancer, ulcer disease, inflammatory bowel disease?
– Any previous history of tumors, malignancy, or ulcers?

Indigestion
• Upper abdominal discomfort or distress associated with eating.
• The basis for this abdominal distress may be the patient’s own gastric peristaltic movements.
• Indigestion can result from disturbed nervous system control of the stomach or from a disorder in the GI tract or elsewhere in the body.

Intestinal Gas
• The accumulation of gas in the GI tract may result in belching or flatulence.
• It is through belching that swallowed air is expelled quickly when it reaches the stomach.
• Usually, gases in the small intestine pass into the colon and are released as flatus.

Assessing Indigestion and Intestinal Gas
• Characteristics
– Have you experienced any of the following symptoms:
• feeling of fullness
• heartburn
• excessive belching
• flatus
• nausea
• a bad taste
• mild or severe pain

• Associated factors
– Is there nausea, vomiting, blood in bowel movements, or diarrhea?
– Is there a history of alcohol, nonsteroidal anti-inflammatory drug (NSAID), or aspirin use?
– History
– Any family history of cancer, inflammatory bowel disease?
– Any history of bowel obstruction?
– Any previous abdominal surgeries?

Nausea and Vomiting
• Vomiting is another major symptom of GI disease.
• Vomiting is usually preceded by nausea, which can be triggered by odors, activity, or food intake.
• The emesis, or vomitus, may vary in color and content. It may contain undigested food particles or blood (hematemesis).

Nature of Vomitus
1. Yellowish or greenish – May contain bile
2. Bright red (arterial) – Hemorrhage, peptic ulcer
3. Dark red (venous) – Hemorrhage, esophageal or gastric varices
4. Coffee grounds – Digested blood from slowly bleeding gastric or duodenal ulcer
5. Undigested food – Gastric tumor, Ulcer, Obstruction
6. Bitter taste – Bile
7. Sour or acid – Gastric contents
8. Fecal components – Intestinal obstruction

Change in Bowel Habits and Stool Characteristics
• Changes in bowel habits may signal colon disease.

Diarrhea
– An abnormal increase in the frequency and liquidity of the stool or in daily stool weight or volume.
– Commonly occurs when the contents move so rapidly through the intestine and colon that there is inadequate time for the GI secretions to be absorbed.

Assessing Diarrhea
• Characteristics
– How long has the diarrhea been present?
– Determine the frequency, consistency, color, quantity, and odor of stools.
– Is there blood, mucus, pus, or food particles in the stools?
• Associated factors
– Any fever, nausea, vomiting, abdominal pain, abdominal distention, flatus, cramping, urgency with straining?
– Is the patient taking antibiotics?
– Has there been any recent travel to foreign countries?
– Is the patient experiencing emotional stress or anxiety?

Causes of Diarrhea
– Infectious agents (Escherichia coli, Salmonella, Shigella, Campylobacter)
– Food poisoning
– Drugs (antibiotics, magnesium)
– Fecal impaction
– Bowel disease (ulcerative colitis)
– Malabsorption syndromes (lactose intolerance, celiac sprue, fat malabsorption)
– Short bowel syndrome
– Malignant syndromes (Zollinger-Ellison syndrome)

Constipation
– A decrease in the frequency of stool, or stools that are hard, dry, and of smaller volume than normal.
– May be associated with anal discomfort and rectal bleeding.

Assessing Constipation
• Characteristics
– What is the frequency, consistency, color of the stools?
– Have there been dietary changes?
– Is there blood or mucus in the stools?
– Any laxative use?

• Associated factors
– Are there periods of diarrhea?
– Is there abdominal pain or distention?
– Is the patient experiencing stress?
– Is there a change in activity level?
– Does the patient have a regular time for defecation?
– Does the patient use antacids containing calcium or an anticholinergic?
• Causes of Constipation
– Inadequate fluid intake
– Psychological factors
– Electrolyte imbalances
– Hormonal abnormalities
– Mechanical bowel obstruction, ileus
– Drugs (laxative abuse, anticholinergic agents, opiates)
– Loss of innervation (Hirschsprung’s disease)
– Neuromuscular (paralysis, spinal cord injury or sacral lesion, multiple sclerosis)
– Anorectal disorders (hemorrhoids, fecal impaction, cancer, abscess, fissures)

Characteristics of Stool
• The appearance of blood in stool may be characteristic of its source.
– Upper GI bleeding, tarry black (melena)
– Lower GI bleeding, bright red blood (hematochezia)
– Lower rectal or anal bleeding blood streaking on surface of stool or on toilet paper
• Other characteristics of stool may indicate a particular GI problem.
– Bulky, greasy, foamy, foul smelling, gray with silvery sheen steatorrhea (fatty stool)
– Light gray clay-colored (due to absence of bile pigments, acholic) biliary obstruction
– Mucus or pus visible (chronic ulcerative colitis, shigellosis)
– Small, dry, rocky-hard masses (constipation, obstruction)

Physical Assessment
• The physical examination includes assessment of the mouth, abdomen, and rectum.
• The mouth, tongue, buccal mucosa, teeth, and gums are inspected
• Ulcers, nodules, swelling, discoloration, and inflammation are noted.

Assessment of the Abdomen
• The patient lies supine with knees flexed slightly for inspection, auscultation, palpation, and percussion of the abdomen.

Inspection
– The nurse performs inspection first
– noting skin changes and scars from previous surgery.
– It also is important to note the contour and symmetry of the abdomen, to identify any localized bulging, distention, or peristaltic waves.

Auscultation
• The nurse performs auscultation before percussion and palpation (which can increase intestinal motility and thereby change bowel sounds) and notes the bowel sounds:
– character
– location
– frequency

• The nurse assesses bowel sounds in all four quadrants using the diaphragm of the stethoscope; the high-pitched and gurgling sounds can be heard best in this manner.
• It is important to document the frequency of the sounds, using the terms:
– Normal
• sounds heard about every 5 to 20 seconds
– Hypoactive
• one or two sounds in 2 minutes
– Hyperactive
• 5 to 6 sounds heard in less than 30 seconds
– Absent
• no sounds in 3 to 5 minutes

Percussion
– The nurse notes tympany or dullness during percussion.

Palpation
– Use of light palpation is appropriate for identifying areas of tenderness or swelling;
– The nurse may use deep palpation to identify masses in any of the four quadrants.
– If the patient identifies any area of discomfort, the nurse can assess for rebound tenderness.
• To elicit rebound tenderness, the nurse exerts pressure over the area and then releases it quickly.
• It is important to note any pain experienced on withdrawal of the pressure.

CREDITS TO MR. RELIE CASTRO