????????? ???? Health Assessment of The Digestive System

1
????????????? Health Assessment of The
Digestive System

• ???
• ??????????
• 2006?4?26?

2
????

• ???????????
• ???????????
• ???????????
• ??????????
• ?????????????????????

3
GI System Assessment ??????

• ???
• ????Biographical and demographic data
• ?????? Current Health
• ?????? Past Health history
• ??? Family Health
• ?????? Psychosocial Factors
• ???? Review of system

4
Demographic Data??????

• Gender
• Age
• Marital Status
• Working condition
• Women (calcium), elderly (inadequate food intake,
  gastric ulcer, colon cancer), teenagers (Duodenal
  ulcers, gastric cancers) may have different
  health problem and nutritional needs.

5
Current Health Assessment ??????

• ????????
• ?????
• ?????????
• ??? ?????
• ??
• ?????
• ?????
• ??
• ??
• ???????.

6
Past Health History ????

1. Bleeding-iron deficiency anemia
2. Liver Disease protein malnutrition
3. Peptic Ulcer With bleeding

1. Jaundice
2. Gallbladder sisease
3. Pancreatitis
4. Cancer
5. Change of bowel habits
6. Tarry stools
7. Unexplained weight loss or gain

7
Health History of The GI System

• Health Perception-health management pattern
• Nutritional-metabolic pattern
• Elimination pattern
• Activity-exercise pattern
• Sleep-Rest Pattern
• Congitive-preception pattern
• Self-Perception, self-concept pattern
• Role-relationship pattern
• Sexuality-reproductive pattern
• Coping-stress tolerance pattern
• Value-belief pattern

Lewis, 2004, p.955
8
Assess for Medications????

• Use of Aspirin, NAISD (Nonsteroidal
  anti-inflammatory drugs) gastritis/bleeding??????
  ??,???????,???
• Antacids type and frequency ???,?????
• Laxatives or stool softeners? ???
• Dietary Supplement vitamins,minerals, herbs,
  amino acids ????,??????????

9
Assessment for Allergies ?????

• Food allergies hives or dyspnea
• Food intolerance GI abdominal cramping,
  flatulence, or diarrhea (lactose intolerance)
• Comment food allergies items nuts, shellfish,
  cows milk, food additives

10
Assessment for Family History

• GI problem may associate with family history and
  environment factors.
• Ulcerative colitis ??????
• Crohns Disease ????
• Alcoholism ??
• Liver diseases ????
• Family history of DM, anemia, jaundice,
  hepatitis, Pancreatitis, obesity, irritable bowel
  syndrome. ??????????????????????????????

11
Psychosocial History ??????

• Occupation environmental toxins (lead, mercury,
  carbon tetrachloride)
• Travel Pathogens (protozoa, parasites),eating
  raw shellfish, swimming in polluted water
• Diet habits change

12
Assessment of GI SystemAbdomen

• Inspection ??
• skin intact, smooth ???????
• Contour flat, rounded, no distention or
  irregular contour ??,????????
• Rashes, discoloration, scares, petechiae,
  striate, dilated veins ???????????????????
• Peristaltic movement if pt has obstruction of the
  bowel ???????????
• Abdominal pulsation ??????

13
Review of System????

• Mouthoral lesions, excessive salivation, mouth
  dryness, oral ulcer
• Dental cavity floss usage
• Water supply with fluoridate?
• Dentist for teeth cleaning
• Periodontal disease
• Trouble tasting, chewing or swallowing?

14
Assessment of the GI systemMouth

• Lips symmetry, color, hydration, lesions,
  nodules, position of teeth (malocclusion), dental
  caries, color of mucosa and gums, swelling or
  lesions, leukoplakis lesion (??)
• Tonsils redness, swelling, lesions, ulcers,
• Tongue color, moisture, atrophy, abnormal
  coating, swelling, lesions, symmetry movement,
  difficulty to swallow (Dysphagia ????)

15
Assessment for Oral Disorders

• Stomatitis
• Aphthous ulcer (unknown), ????
• Herpes Simplex (HSV infection), ??
• Oral candidiasis-Thrush (Candida Albicans fungus
  infection)??????
• Assess for immunosuppression, prolonged
  antibiotic use, pain, tenderness, bleeding, oral
  intake/nutrition (?????,????????????????????????)

16
Assessment of Oral Disorder

• Premalignant tumor??????
• Leukoplasia ??
• Erythroplakia ??
• Tumor of the oral cavity Basal cell or Squamous
  cell carcinoma
• Risk factor tobacco and long term alcohol
  consumption, Very Hot beverages, ??

17
?????? (Dysphagia)????

• ????????,????????,
• ????
• ????
• ??
• ???????
• ????
• ????
• ??

18
Assessment of the Salivary Glands ???

• Sings of inflammation
• Inactivity of the gland caused by medication or
  prolonged NG tube, NPO
• Dry mouth
• Bad breath order from bacteria accumulated in the
  mouth due to insufficient salivary.

19
Assessment of Esophagus????

• Dysphagia ????
• Regurgitation ?? reflux can affect respiratory
  tract
• Pain ??
• Heartburn or pyrosis ???

20
??????(Dysphagia) ????

• ???
• ????
• ????
• ??????????
• ?????
• ???????
• ???

21
Assessment of GI SystemAbdomen

• Auscultation Air and fluid move through the GI
  tract, soft clicks and gurgles q5-15 sec.
• Normal bowel sound irregular 4-5/min
• Hyperactivity Loud, high-pitch sound of the GI
  tract, gt 10/min-GI bleeding, acute
  gastroenteritis
• 3. Hypoactivity few bowel sound (listen for 5
  minutes or 1 minute each quadrant (absence of
  bowel sounds does not mean absence of bowel
  peristalsis)

22
Assessment of GI SystemAbdomen

• Percussion/Palpation
• ???????(????)???????????????????????????(??),?????
  ?????????????????????????(???),???????(???),??????
  (??)
• ????,????????,???????????? ( abdominal
  rigidity)??????

23
?????????? -1

• ????????? (Organ obstruction or twisting)
• intermittent collicky pain, ?????
• under umbilicus associate with small
  bowel?????????.
• distended abdomen with no flatus or bowel
  movement, ??,????????
• bowel sound may change from high pitch to absent
  ?????????

24
??????????-2

• ??????Peritoneal inflammation (Perforated ulcer,
  ruptured spleen, ruptured appendix)
• Steady aching pain over area of inflammation,
  ???????
• pain increased with motion, ???????
• may associate with shock if pain is severe
  ????????????

25
??????????-3

• ??????????? Vascular Catastrophe (Aortic aneurysm
  or mesenteric infarction)
• 2-3 days mild tomoderate pain and
  hyperperistalsis followed by severe abdominal
  pain ?????,?????,??????
• Back and flank pain are common with aortic
  aneurysms. ?????????????

26
Assessment for Regurgitation????(??)

• Regurgitation ???????????????
• ??????????????????,??????,??????????,????,??????
  ??????,??????

27
Assessment of Vomiting

• ????????????????????????????????????????????????,?
  ??????
• ??????????????????????
• ??????????????????????????????

28
????Assessment of Ascites

• ?????????,???????????????,?????????????????????
• ?????????????????????????????
• ?????????????????????????????????,????

29
????Assessment of Jaundice

• ?????????????????,?????????????,????
• ???????? 8.55-17.1 umol/L (0.5-1mg/dl,
  ???34.2umol/L (2mg/dl), ???????
• ??????????????,???????

30
Assessment of the Liver and Spleen

• Hepatomegaly ???? enlargement of liver, liver
  edge gt 1-2cm below costal margin (possible
  Hepatitis ??, venous congestion ????, metastatic
  carcinoma????)
• Splenomegaly???? Enlargement of spleen (possible
  portal hypertension ?????, infection??)

31
??????????

• ??
• ?????????,??????????
• ??????????,??????????,???????
• ????????,???????????????
• ??????????
• ??????????????????????????

32
????????

• ?????????????????????????????????????????????????
  ???(Rebound tenderness)
• ????? ????????????????????(Anal Fissure)???(Anal
  Fistula)???(Anorectal abscess)

33
Assessment of the Bowel Elimination

• ?????Colorectal cancer ??????????
• ?????? Ulcerative colitis ?????????,???
• Diverticular disease ????????????????

34
Assessment for Bowel Elimination

• Ascites ??
• Diarrhea ??
• Constipation ??
• Melena ??
• Pain in Rectal or Abdominal ?????????

35
Assessment of Diarrhea and Constipation

• Diarrhea acute or chronic (gt 2 months of
  diarrhea
• ????????????????????????????????????????
• ????????????????????,????

36
???? Diarrhea

• ??????????
• ???????????
• ?????????
• ?????????
• ??????????
• ??????????????????????????????????????????????

37
????

• ?????,?????,???????????????
• ??????,???????,???????
• ??????,????,Hb ????????,????? (Tarry Stool)
• ???????????,?????????????????????

38
????Constipation

• ?????????????,???????????
• ?????????????,??????,???????,????????,???????????
  ????, ????????????????

39
Physical Assessment Annus and Rectum

• Assess for
• Tenderness, ??
• Masses, ??
• hemorrhoids, ??
• Prolapsed, ??
• Rectal mucosa smooth, ??????
• Stool negative for blood ????

40
Aging Patient GI Assessment ?????????

• Mouth
• Loss of teeth
• Decreased taste buds, decreased sense of smell
  ????,????
• Decreased volume of saliva ????
• Atrophy of gingival tissue ????

41
Aging Patient GI Assessment ?????????

• Esophagus ??
• Decreased tone and motility ???????

42
Aging Patient GI Assessment ?????????

• Abdominal Wall
• Thiner and less taut
• Decrese in number and sensitivity of sensory
  receptors
• More visible peristalsis
• Stomach
• Decreased acid secretion, atrophy of gastric
  mucosa ??????,?????

43
Aging Patient GI Assessment ?????????

• Small Intestines ??
• Decreased secretion of most digestive enzymes,
  ???????
• Decreased moltility-complain of indigestion
  ????,?????
• Liver ??
• Decreased size and lowered in position
• ???????

44
Aging Patient GI Assessment ?????????

• Large intestine, anus, rectum ????????
• Decreased anal sphincter tone and nerve to rectal
  area-fecal incontinence ??????????????,??
• Decreased muscular tone, decreased
  motility-Flatulence, abdominal distension
  constipation, fecal impaction ??????,?????,???????
  ???

45
?????????????The importance of nutritional
health and digestive assessment

• Nutritional health requires a functional gut to
  receive,transport, absorb, and metabolize
  nutrients.
• Interdependence assessment of the
  gastrointestinal tract and nutritional status

46
??????Nutritional Health Assessment

• Dietary Intake?????????24?????????(Dietary
  intake recall)
• ?????????(Recommended Daily Allowance)
• ?????????????????
• 30-50 Calories/Kg
• 0.8-1.2 g of protein/Kg

47
Malnutrition ????

• Micronutrient Malnutrition ???????? (Chronic
  Pancreatitis), ????? (short-bowel syndrome),
  Pressure ulcer ???, Cancer ??, AIDS ???, Prior to
  gastric surgery

48
????

• ????,??????
• ????
• ??????
• ???
• ??????

49
??????????????????????????????????????

• ????????????????????????????????????,?????????????
  ???