{"id":3715,"date":"2018-11-12T20:23:14","date_gmt":"2018-11-13T01:23:14","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&#038;p=3715"},"modified":"2019-12-31T13:06:52","modified_gmt":"2019-12-31T18:06:52","slug":"2-9-head-to-toe-assessment-abdominal-gastrointestinal-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-9-head-to-toe-assessment-abdominal-gastrointestinal-assessment\/","title":{"raw":"2.9 Head-to-Toe Assessment: Abdominal \/ Gastrointestinal Assessment","rendered":"2.9 Head-to-Toe Assessment: Abdominal \/ Gastrointestinal Assessment"},"content":{"raw":"Checklist 19 provides a guide for subjective and objective data collection in an abdominal \/\u00a0 gastrointestinal assessment.\r\n<table style=\"border-collapse: collapse;width: 99.9268%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist19\"><\/a>Checklist 19: Abdominal \/ Gastrointestinal Assessment<\/h3>\r\n[caption id=\"attachment_339\" align=\"aligncenter\" width=\"212\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1.png\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-212x300.png\" alt=\"\" width=\"212\" height=\"300\" class=\"wp-image-339 size-medium\" \/><\/a> Figure 2.18 GI system[\/caption]\r\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.<\/em><\/h5>\r\n<p style=\"text-align: center\"><strong>\u00a0<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse;width: 99.9268%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h3 style=\"text-align: center\">Objective Data<\/h3>\r\n<h5 style=\"text-align: center\"><span style=\"font-size: 16.8px;text-align: left\">Consider the following observations:<\/span><strong>\r\n<\/strong><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\r\n<h4 style=\"text-align: center\">Additional information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Overall Appearance:<\/strong> Observe for abdominal distension, stretch marks, contour, symmetry, presence and type of ostomy, overweight or underweight.\r\n\r\n[caption id=\"attachment_4171\" align=\"aligncenter\" width=\"200\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag.jpg\" alt=\"\" width=\"200\" class=\"wp-image-4171 size-full\" \/><\/a> Figure 2.20 Ileostomy bag[\/caption]\r\n\r\n[caption id=\"attachment_3680\" align=\"aligncenter\" width=\"200\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension.jpg\" alt=\"\" width=\"200\" class=\"wp-image-3680 size-full\" \/><\/a> Figure 2.19 Abdominal distension[\/caption]<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Abdominal distension may indicate ascites associated with conditions such as heart failure, cirrhosis, cancer, and pancreatitis.\r\n\r\nAn abdomen that appears thin with little adipose tissue might suggest nutrition issues.\r\n\r\nIt is important for the nurse to ask \"is this normal for your abdomen\" to help differentiate patient \"norm\" to signs and symptoms that may indicate an acute issue.\r\n\r\nUnusual findings may indicate compromised GI function.\r\n\r\n&nbsp;<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Auscultate Bowel Sounds<\/strong>\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_324\" align=\"aligncenter\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-300x199.jpg\" alt=\"\" width=\"300\" class=\"wp-image-324 size-medium\" \/><\/a> Auscultate for bowel sounds[\/caption]\r\n\r\n[caption id=\"attachment_3681\" align=\"aligncenter\" width=\"200\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants.jpg\" alt=\"\" width=\"200\" class=\"wp-image-3681 size-full\" \/><\/a> Figure 2.21 Abdominal quadrants[\/caption]<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Divide the abdomen into quarters. Auscultate in each quadrant for evidence of gurgling, which suggests peristalsis.\r\n\r\nHyperactive bowel sounds may indicate bowel obstruction, gastroenteritis, or subsiding paralytic ileus.\r\n\r\nHypoactive or absent bowel sounds may be present after GI surgery or when peritonitis or paralytic ileus are present.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Palpate\u00a0Lightly in All Four Quadrants for Distension, Firmness, Masses, Pain<\/strong>\r\n\r\n<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-325 alignleft\" \/><\/a><\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Firmness may indicate excess gas, ascites, peritonitis.\u00a0Always ask the patient \"is this normal for you?\"<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Observe stool to identify important characteristics.<\/strong><\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Sometimes observing stool is an important part of the assessment process. Characteristics of bowel movements can assist with diagnosis and to help determine effectiveness of treatment for bowel related conditions.\r\n\r\n&nbsp;\r\n\r\nResource: Bladder and Bowel Foundation (nd).\u00a0 Bristol Stool Chart.\u00a0 <a href=\"https:\/\/www.bladderandbowel.org\/wp-content\/uploads\/2017\/05\/BBC002_Bristol-Stool-Chart-Jan-2016.pdf\">https:\/\/www.bladderandbowel.org\/wp-content\/uploads\/2017\/05\/BBC002_Bristol-Stool-Chart-Jan-2016.pdf<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<table style=\"border-collapse: collapse;width: 100%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 100%\">\r\n<h5 style=\"text-align: center\"><strong>Subjective Data<\/strong><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">\r\n<ul>\r\n \t<li>Ask about last bowel movements and normal bowel patterns. Changes to bowel patterns may indicate a larger GI issue. Normal bowel patterns vary across individuals. Knowing what is normal will help the nurse differentiate if there is a new or emergent concern requiring attention.<\/li>\r\n \t<li>Ask about flatus,\u00a0nausea, vomiting, and pain. Any of these may be symptoms of a GI issue.<\/li>\r\n \t<li>Ask about dietary habits. What kinds of foods does the patient normally eat? Has this changed?<\/li>\r\n \t<li>Ask about recent weight gain or weight loss. Unexplained weight loss or weight gain may indicate a larger issue and may need investigation. In the surgical context, significant weight loss can result in delayed wound healing and risk of wound dehiscence.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 100%\">Focused GI assessment may also include ostomy assessment.\u00a0<span style=\"font-size: 16.8px\">See<\/span><span style=\"font-size: 16.8px;color: #ff0000\">\u00a0<\/span><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/part\/chapter-11-ostomy-care\/\" style=\"font-size: 16.8px\">Chapter 11: Ostomy Care<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 100%\">Potential GI related nursing diagnoses:\r\n<ul style=\"font-size: 16.8px\">\r\n \t<li>Need for information in relation to low fat foods.<\/li>\r\n<\/ul>\r\n<ul style=\"font-size: 16.8px\">\r\n \t<li>Alteration in bowel function (constipation or diarrhea) related to \u2026.<\/li>\r\n \t<li>Potential for delayed wound healing due to altered nutrition status (10 kg unexplained weight loss in 1 month)<\/li>\r\n<\/ul>\r\n<ul style=\"font-size: 16.8px\">\r\n \t<li>Alteration in dietary intake secondary to slowed GI function post op<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 100%\">Data sources: Assessment Skill Checklist, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Potter et al., 2019; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>A patient who experiences intermittent constipation asks what they might do to promote bowel regularity. Describe three nursing interventions that the nurse might discuss.<\/li>\r\n \t<li>Describe the character of stool expected from an ileostomy.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<h2>Attributions:<\/h2>\r\nFigure 2.18\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Digestive_system_diagram_en.svg\">Gastrointestinal Tract<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:LadyofHats\">Mariana Ruiz<\/a>, <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Jmarchn\">Jmarchn<\/a> is in the public domain.\r\n\r\nFigure 2.19\u00a0<a href=\"https:\/\/www.flickr.com\/photos\/mikebaird\/2598629775\">Big Man Big Stomach<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/mikebaird\/\">Mike Baird<\/a> is used under a CC BY 2.0 license.\r\n\r\nFigure 2.20\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_with_bag.jpg\">Ileostomy with Bag<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Salicyna\">Remedios44<\/a> is used under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\">Creative Commons Attribution-Share Alike 4.0 International license<\/a>.\r\n\r\nFigure 2.21\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0005_AbdominopelvicQuadrants.png\">Abdominopelvic Quadrants<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">Bruce Blaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\">Creative Commons Attribution 3.0 Unported license.\u00a0<\/a>\r\n<div><\/div>","rendered":"<p>Checklist 19 provides a guide for subjective and objective data collection in an abdominal \/\u00a0 gastrointestinal assessment.<\/p>\n<table style=\"border-collapse: collapse;width: 99.9268%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h3 style=\"text-align: center\"><a id=\"checklist19\"><\/a>Checklist 19: Abdominal \/ Gastrointestinal Assessment<\/h3>\n<figure id=\"attachment_339\" aria-describedby=\"caption-attachment-339\" style=\"width: 212px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1.png\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-212x300.png\" alt=\"\" width=\"212\" height=\"300\" class=\"wp-image-339 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-212x300.png 212w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-65x92.png 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-225x319.png 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1-350x496.png 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/423px-Digestive_system_diagram_en-1.png 423w\" sizes=\"auto, (max-width: 212px) 100vw, 212px\" \/><\/a><figcaption id=\"caption-attachment-339\" class=\"wp-caption-text\">Figure 2.18 GI system<\/figcaption><\/figure>\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.<\/em><\/h5>\n<p style=\"text-align: center\"><strong>\u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\n<ul>\n<li><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\n<li><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.\u00a0<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse;width: 99.9268%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h3 style=\"text-align: center\">Objective Data<\/h3>\n<h5 style=\"text-align: center\"><span style=\"font-size: 16.8px;text-align: left\">Consider the following observations:<\/span><strong><br \/>\n<\/strong><\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\n<h4 style=\"text-align: center\">Additional information<\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Overall Appearance:<\/strong> Observe for abdominal distension, stretch marks, contour, symmetry, presence and type of ostomy, overweight or underweight.<\/p>\n<figure id=\"attachment_4171\" aria-describedby=\"caption-attachment-4171\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag.jpg\" alt=\"\" width=\"200\" class=\"wp-image-4171 size-full\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag.jpg 206w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/ileostomy-bag-65x76.jpg 65w\" sizes=\"(max-width: 206px) 100vw, 206px\" \/><\/a><figcaption id=\"caption-attachment-4171\" class=\"wp-caption-text\">Figure 2.20 Ileostomy bag<\/figcaption><\/figure>\n<figure id=\"attachment_3680\" aria-describedby=\"caption-attachment-3680\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension.jpg\" alt=\"\" width=\"200\" class=\"wp-image-3680 size-full\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension.jpg 159w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/abd-distension-65x98.jpg 65w\" sizes=\"(max-width: 159px) 100vw, 159px\" \/><\/a><figcaption id=\"caption-attachment-3680\" class=\"wp-caption-text\">Figure 2.19 Abdominal distension<\/figcaption><\/figure>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Abdominal distension may indicate ascites associated with conditions such as heart failure, cirrhosis, cancer, and pancreatitis.<\/p>\n<p>An abdomen that appears thin with little adipose tissue might suggest nutrition issues.<\/p>\n<p>It is important for the nurse to ask &#8220;is this normal for your abdomen&#8221; to help differentiate patient &#8220;norm&#8221; to signs and symptoms that may indicate an acute issue.<\/p>\n<p>Unusual findings may indicate compromised GI function.<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Auscultate Bowel Sounds<\/strong><\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_324\" aria-describedby=\"caption-attachment-324\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-300x199.jpg\" alt=\"\" width=\"300\" class=\"wp-image-324 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2287-1-350x232.jpg 350w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-324\" class=\"wp-caption-text\">Auscultate for bowel sounds<\/figcaption><\/figure>\n<figure id=\"attachment_3681\" aria-describedby=\"caption-attachment-3681\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants.jpg\" alt=\"\" width=\"200\" class=\"wp-image-3681 size-full\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants.jpg 160w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/AbdominopelvicQuadrants-65x98.jpg 65w\" sizes=\"(max-width: 160px) 100vw, 160px\" \/><\/a><figcaption id=\"caption-attachment-3681\" class=\"wp-caption-text\">Figure 2.21 Abdominal quadrants<\/figcaption><\/figure>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Divide the abdomen into quarters. Auscultate in each quadrant for evidence of gurgling, which suggests peristalsis.<\/p>\n<p>Hyperactive bowel sounds may indicate bowel obstruction, gastroenteritis, or subsiding paralytic ileus.<\/p>\n<p>Hypoactive or absent bowel sounds may be present after GI surgery or when peritonitis or paralytic ileus are present.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Palpate\u00a0Lightly in All Four Quadrants for Distension, Firmness, Masses, Pain<\/strong><\/p>\n<p><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1.jpg\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-325 alignleft\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2286-1-350x232.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Firmness may indicate excess gas, ascites, peritonitis.\u00a0Always ask the patient &#8220;is this normal for you?&#8221;<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Observe stool to identify important characteristics.<\/strong><\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Sometimes observing stool is an important part of the assessment process. Characteristics of bowel movements can assist with diagnosis and to help determine effectiveness of treatment for bowel related conditions.<\/p>\n<p>&nbsp;<\/p>\n<p>Resource: Bladder and Bowel Foundation (nd).\u00a0 Bristol Stool Chart.\u00a0 <a href=\"https:\/\/www.bladderandbowel.org\/wp-content\/uploads\/2017\/05\/BBC002_Bristol-Stool-Chart-Jan-2016.pdf\">https:\/\/www.bladderandbowel.org\/wp-content\/uploads\/2017\/05\/BBC002_Bristol-Stool-Chart-Jan-2016.pdf<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 100%\">\n<h5 style=\"text-align: center\"><strong>Subjective Data<\/strong><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">\n<ul>\n<li>Ask about last bowel movements and normal bowel patterns. Changes to bowel patterns may indicate a larger GI issue. Normal bowel patterns vary across individuals. Knowing what is normal will help the nurse differentiate if there is a new or emergent concern requiring attention.<\/li>\n<li>Ask about flatus,\u00a0nausea, vomiting, and pain. Any of these may be symptoms of a GI issue.<\/li>\n<li>Ask about dietary habits. What kinds of foods does the patient normally eat? Has this changed?<\/li>\n<li>Ask about recent weight gain or weight loss. Unexplained weight loss or weight gain may indicate a larger issue and may need investigation. In the surgical context, significant weight loss can result in delayed wound healing and risk of wound dehiscence.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 100%\">Focused GI assessment may also include ostomy assessment.\u00a0<span style=\"font-size: 16.8px\">See<\/span><span style=\"font-size: 16.8px;color: #ff0000\">\u00a0<\/span><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/part\/chapter-11-ostomy-care\/\" style=\"font-size: 16.8px\">Chapter 11: Ostomy Care<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 100%\">Potential GI related nursing diagnoses:<\/p>\n<ul style=\"font-size: 16.8px\">\n<li>Need for information in relation to low fat foods.<\/li>\n<\/ul>\n<ul style=\"font-size: 16.8px\">\n<li>Alteration in bowel function (constipation or diarrhea) related to \u2026.<\/li>\n<li>Potential for delayed wound healing due to altered nutrition status (10 kg unexplained weight loss in 1 month)<\/li>\n<\/ul>\n<ul style=\"font-size: 16.8px\">\n<li>Alteration in dietary intake secondary to slowed GI function post op<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 100%\">Data sources: Assessment Skill Checklist, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Potter et al., 2019; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>A patient who experiences intermittent constipation asks what they might do to promote bowel regularity. Describe three nursing interventions that the nurse might discuss.<\/li>\n<li>Describe the character of stool expected from an ileostomy.<\/li>\n<\/ol>\n<\/div>\n<h2>Attributions:<\/h2>\n<p>Figure 2.18\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Digestive_system_diagram_en.svg\">Gastrointestinal Tract<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:LadyofHats\">Mariana Ruiz<\/a>, <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Jmarchn\">Jmarchn<\/a> is in the public domain.<\/p>\n<p>Figure 2.19\u00a0<a href=\"https:\/\/www.flickr.com\/photos\/mikebaird\/2598629775\">Big Man Big Stomach<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/mikebaird\/\">Mike Baird<\/a> is used under a CC BY 2.0 license.<\/p>\n<p>Figure 2.20\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_with_bag.jpg\">Ileostomy with Bag<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Salicyna\">Remedios44<\/a> is used under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\">Creative Commons Attribution-Share Alike 4.0 International license<\/a>.<\/p>\n<p>Figure 2.21\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0005_AbdominopelvicQuadrants.png\">Abdominopelvic Quadrants<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">Bruce Blaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\">Creative Commons Attribution 3.0 Unported license.\u00a0<\/a><\/p>\n<div><\/div>\n","protected":false},"author":397,"menu_order":9,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3715","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3715","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3715\/revisions"}],"predecessor-version":[{"id":5188,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3715\/revisions\/5188"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3715\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=3715"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=3715"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=3715"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=3715"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}