I. Overview of the gastrointestinal (GI)  System:

The gastrointestinal (GI) system is responsible for the ingestion of food, the absorption of nutrients, and eliminating waste as stool.  The genitourinary (GU) system, also called the renal or urinary system is responsible for electrolytes and pH balance, blood volume and pressure,  and eliminates waste as urine.

II. Anatomy and Physiology of the Gastrointestinal System:

Please use the following videos and other learning tools to review the Anatomy and Physiology of the Gastrointestinal system and Genitourinary systems.  The first picture is of all organs within the gastrointestinal system. Use this picture to identify organs within each abdominal quadrant or within each region when utilizing the four quadrants and/or the 9 region methods to systematically exam the abdomen and/or document the findings.

Gastrointestinal System

There are (a) nine abdominal regions and (b) four abdominal quadrants in the peritoneal cavity

The GI tract has three priority functions: digestion of food,  absorption of nutrients, and elimination of waste.

Digestion involves breaking down into its smallest parts so nutrients can be absorbed.

• There are two types of digestion.
  • The first is mechanical and this process is completed in the mouth and stomach by chewing food into smaller pieces.
  • Chemical digestion occurs later and chemicals are used to break down food molecules even more to even smaller molecules for easier absorption.

The small intestine is the area in which most digestion and absorption occurs. 

There are three sections called the duodenum, jejunum, and Ileum.

1. Duodenum: creates the digestive juices and enzymes that finish breaking up food into building blocks. This process is assisted by two other organs the gallbladder that delivers bile and the pancreas that delivers digestive enzymes.
2. Jejunum: “churn food back and forth and mix it with digestive juices (Cleveland Clinic).” Peristalsis ensures that the food travel in one direction only moving toward your ileum.
3. Ileum: absorbs nutrients from digested food e.g., vitamins, minerals, amino acids, fatty acids, nucleosides, and sugar. The ileum also stores and moves the remaining waste toward the large intestine.

Therefore, the small intestine is responsible for completion of proteins, carbohydrates and lipid digestion.  Most water  reabsorbed occurs here also. when nutrients pass through to the bloodstream or lymph system and is circulated throughout the body.

The video below demonstrates peristalsis in the large intestines.

The large intestine also called the Colon processes chyme, reabsorbs water, electrolytes, and vitamins from waste prior to it becoming feces. It also produces vitamins B and K .

There are five parts to the large intestine and these include:

1. Cecum: receives “food waste” from the small intestines and directs it to the ascending portion of the colon
2. Ascending colon: removes water and electrolytes
3. Transverse colon: carries waste to the descending colon
4. Descending colon: continues to convert waste to feces
5. Sigmoid colon: solidifies feces/stool

Reflection:
Food is broken down into the building blocks amino acids, fatty acids, nucleosides, and glucose and are solely digested in the small intestine. These nutrients and water are then absorbed through the bloodstream or lymph system to nourish the cells of the body. Anything not digested and/or absorbed is moved to the anus for elimination.

III. Medical Terminology

IV. Assessment of the gastrointestinal system (GI) includes obtaining relevant subjective and objective data and is focused on the parts of the GI tract we can inspect- the mouth and abdomen.

Focused GI health history (obtaining subjective data) includes inquiring about:

• Any past medical diagnoses of GI conditions or diseases e.g., Irritable Bowel Syndrome
• Any past procedure or surgeries related to a GI condition or disease e.g. Diverticulitis
• Is the patient taking any prescribed or  herbal medication specific for a GI condition or disease e.g., GERD or Ginger tea
• Does the patient have a family history of gastrointestinal problems
• Is the patient under a great deal of stress? This can lead to peptic ulcers disease
• Is the patient experiencing any pain? This is a common complaint in patients complaining of GI problems. Assess whether food, activity, or recent actions triggered or increased the pain.
  • OLD CART the pain
• When was the patient’s last bowel movement? What did it look like? Are stools bloody (hematochezia); dark, tarry stools (melena); bloating (abdominal distention); or vomiting of blood (hematemesis). Was pain associated with having a bowel movement?
• Is the patient experiencing any nausea, vomiting, diarrhea, or constipation?
  • Remember that anesthesia, lack of mobility, change in diet, and pain medication affect a hospitalized patient’s ability to have a bowel movement.
    • Assessing and documenting about bowel movements and passing flatus while a patient is in the hospital is a part of all patients’ plan of care.
    • If a patient is experiencing diarrhea or vomiting, it is important to assess and monitor for signs of dehydration or electrolyte imbalances.  Dehydration can be indicated by dry skin, dry mucous membranes, or sunken eyes. These symptoms may require contacting the health care provider for further treatment.
    • If the patient is nauseous ask about triggers? How is the nausea affecting appetite and food intake? Is it limiting activity?
      • Potential causes for nausea and vomiting include:
        • Morning sickness during pregnancy
        • Gastroenteritis and other infections
        • Migraines
        • Motion sickness
        • Food poisoning
        • Side effects of medicines, including those for cancer chemotherapy
        • GERD and ulcers
        • Intestinal obstruction
        • Poisoning or exposure to a toxic substance
        • Diseases of other organs (cardiac, renal, or liver)
• Immediate medical intervention is needed for:
  • Vomiting for longer than 24 hours
  • Blood in the vomit (hematemesis)
  • Severe abdominal pain
  • Severe headache and stiff neck
  • Signs of dehydration, such as dry mouth, infrequent urination, or dark urine
• Is the patient having difficulty swallowing food or liquid?  If so when did this begin?

Additional specialized assessments of GI system function can include examination of the oropharynx and esophagus. For example, patients who have experienced a cerebrovascular accident (CVA), also called a “stroke,” may experience difficulty swallowing (dysphagia). The nurse is often the first to notice these difficulties when swallowing pills, liquid, or food and can advocate for treatment to prevent complications, such as unintended weight loss or aspiration pneumonia.

IV. Step by Step Focused Hand On Assessment (obtaining objective data) for the Gastrointestinal (GI) system

• Perform hand hygiene.
• Check room for contact precautions.
• Introduce yourself to the patient.
• Confirm patient ID using two patient identifiers (e.g., name and date of birth).
• Explain the process to the patient.
• Assemble equipment prior to starting the exam.
• Be organized and systematic in your assessment.
• Use appropriate listening and questioning skills.
• Listen and attend to patient cues.
• Ensure patient’s privacy and dignity.
• Apply principles of asepsis and safety.
• Check vital signs.

Steps	Additional Information
1. Conduct a focused interview related to the Gastrointestinal system.	Ask relevant questions to obtain subjective data relevant to: is there any history of gastrointestinal disease in the family? (Eshogeal, stomach, colon or rectal cancer) is there any difficulty chewing and/or swallowing? ( overlap from the HEENT system) is there any problem with teeth or does the patient wear dentures? (overlap from the HEENT system) what type of diet does the patient follow? Has there been a recent change in food tolerance? What medication is the patient taking including laxatives or enemas? has there been an unexplained weight loss or weight gain in the last six weeks? is heartburn a problem and if it is when and how often is it experienced? is the patient experiencing more flatus than normal? is the patient experiencing nausea, vomiting, diarrhea, or constipation? Are there any bloody stools including hematochezia; melena; bloating (abdominal distention), or hematemesis? When was the last bowel movement and what did it look like? is there any pain or tenderness to the abdomen and if so point to the area? Utilize OLD CART to obtain symptoms.
2. Inspect: the mouth, teeth, and the ability to swallow the skin and oral mucosa for signs of dehydration the skin for uniformity of color, intactness, scars, or striae. the sclera, nails bed, and palm/soles for signs of jaundice and anemia the abdomen for color, shape, contour, symmetry, scars, striae, distention, or any visible masses. Abdominal distension may indicate ascites associated with conditions such as heart failure, cirrhosis, and pancreatitis. While observing the abdominal wall, ask the patient to cough. No bulging from anywhere on the abdominal wall should be noted as bulging could be a sign of a hernia. the umbilicus for shape, positioning, herniation, or discharge. Observe for any abdominal movements associated with respiration, or any pulsations or peristaltic waves.	Normal abdominal contour is described as: flat, rounded, scaphoid (sunken), or protuberant (convex/bulging), or obese Abdominal distension may indicate ascites associated with conditions such as heart failure, cirrhosis, and pancreatitis. Markedly visible peristalsis with abdominal distension may indicate intestinal obstruction. Inspect for masses or bulges as these may indicate structural deformities e.g., Hernias or abdominal organ disease               Above are pictures of an Epigastric hernia (picture #1 and Umbilical Hernia (picture #2)
3. Auscultate the abdomen in all four quadrants Auscultation is performed prior to palpation to prevent altering the regularity of bowel sounds. Abdominal examination Auscultation of the abdomen as it relates to the GI system is performed to assess for intestinal function, specifically bowel sounds. Bowel sounds are produced by the movement of fluid, gas, and contents through the intestines. As a nurse, auscultating for bowel sounds with the stethoscope’s diaphragm is a common part of health assessment. The diaphragm is best for detecting high-pitched sounds such as bowel sounds. Bowel sounds are sometimes loud enough to hear without a stethoscope. Auscultation of the abdomen follows inspection, so the abdomen is already exposed. The picture to the right top presents the pattern of auscultation. Always begin in the right lower quadrant because this is the location of the ileocecal valve, which is a muscular sphincter that allows contents to move from the ileum of the small intestine to the cecum of the large intestine; then to the right upper quadrant, to the left upper quadrant and lastly to the left lower quadrant. Assess the presence, frequency, and quality of bowel sounds. Presence. Normally, bowel sounds are present in all four quadrants. This means that peristalsis is occurring and contents are moving through the intestines. Only document the absence of bowel sounds after listening in each quadrant for five minutes. Absent bowel sounds are a cue that suggest there may be a problem with the movement of contents through the intestines: common causes include peritonitis, a complete bowel obstruction, or perforation of the small or large intestine. However, keep in mind that movements of contents and contraction of the intestines do not always create sound. Frequency. (i.e., the rate of occurrence, how often do you hear them). There is no need to count the number of bowel sounds; instead, estimate whether they are considered normoactive, hypoactive, or hyperactive. Quality. Describe the quality of the bowel sounds (e.g., the description, how they sound). You might describe the quality as high-pitched with a series or mixture of sounds (e.g., gurgling, rumbling, bubbling, and even clicking). The quality might also be described as irregular (i.e., no specific/constant rhythm). The quality of bowel sounds is typically less important than the presence and frequency, but an extremely high-pitched bowel sound can be a cue suggestive of an early bowel obstruction. When bowel sounds are not present, a minimum of 5 minutes should be auscultated before determining the bowel sounds are absent.	Pattern of auscultation seen in the above image How to Auscultate the abdomen: 1. Cleanse the stethoscope. 2. With a complete seal and light touch, place the diaphragm of the stethoscope on the abdomen in the right lower quadrant and listen. Next, lift the diaphragm and place it in the next quadrant. 3. Identify the presence and location of bowel sounds. Normally, bowel sounds should be present and heard in all four quadrants. 4. Identify the approximate frequency of bowel sounds. You do not need to count them. 5. Identify the quality of bowel sounds. 6. Note the findings. Normal findings might be documented as: “Normoactive bowel sounds heard in all four quadrants. High-pitched, gurgling sounds.” Abnormal findings might be documented as: “Hypoactive bowels sounds in all four quadrants.” Types of bowel sounds: Normoactive: 5–30 bowel sounds per minute (about 2 sounds every 5 seconds). Generally, you will only need to listen for a few seconds to estimate this frequency. Hypoactive: less than 5 bowel sounds per minute. Because the frequency of hypoactive sounds is less frequent, you will need to listen a bit longer in order to assess them. These sounds indicate that intestinal activity has slowed, which is normal when a person is sleeping. Hypoactive bowel sounds should act as a cue in other situations, which should always be assessed further. For example, bowel sounds may become hypoactive post-surgery due to anesthetic use and with certain medications (e.g., narcotics). Constipation is also a common cause of hypoactive bowel sounds. Hyperactive: more than 30 bowel sounds per minute. Again, you will only need to listen for a couple seconds in order to estimate this frequency. These sounds indicate that intestinal activity is quicker than normal. You will often hear hyperactive bowel sounds after a client has just eaten; these sounds may also be associated with diarrhea and early/partial intestinal obstruction. When bowel sounds are not present, a minimum of 5 minutes should be auscultated before determining the bowel sounds are absent.   Please focus on the auscultation portion of the video. For bruits at the Aortic, Renal, and Iliac arteries.  Most of the time nurses do not auscultate for abdominal bruits at main blood vessels. Nurses do not assess the Hepatic and Splenic arteries.
4. Palpate the abdomen Palpation of the abdomen provides information about the organs associated with the GI system. The palpation technique follows auscultation, so the abdomen is already exposed. Additionally, you should not palpate the abdomen if vascular bruits are present (e.g., aortic, renal, iliac, and femoral). If the patient has experienced a physical injury or trauma to the abdomen, you also might not palpate the abdomen. Assess the following: Begins farthest away from pain press abdomen lightly (1-2 cm) in all four quadrants. Remember, always palpate on bare skin. Palpation of the abdomen involves the following steps (see Video 5.3): If not already, ask the patient to bend their knees up and ensure they are draped. Ask the patient if they have any pain and if so, palpate that area last. Use the pads of your four fingers to gently palpate the abdomen, keeping your fingers together and your wrist and forearm at about the same plane as the patient’s body. Avoid a more angled position: this will create a feeling that you are poking the client in the abdominal region, which can be uncomfortable and also does not permit you to assess the area as well. Only the pads of your fingers should be touching the client during light palpation. Begin in the right lower quadrant and proceed clockwise. If the patient indicates that pain is present in the right lower quadrant, begin in the right upper quadrant instead and palpate the area with pain last. Press down about one to two centimeters(light palpation) and move your fingers together in a circular motion. Sometimes, voluntary guarding (tense abdominal muscles) will be noted as a result of nervousness, pain, cold room temperature or hands of the nurse, or ticklishness. The tenseness of the muscles usually covers the whole abdomen (i.e., bilateral). It can help to ask the patient to take a deep breath when you palpate to help them relax the muscles. Remember to use light palpation and do the painful area last. Only expose the abdomen as long as needed so the patient stays warm, and warm your hands by rubbing them together. If the patient is ticklish, use a sandwich technique: put their hand on top of your palpating hand, and place your other hand over top of both to control the pressure. Lift fingers up together and move on to the next location, ensuring that you palpate every square centimeter of the abdomen in all four quadrants. Overall consistency (soft or firm) and associated pain/tenderness. The abdomen is usually soft upon palpation. Note the location of any firmness and any associated pain/tenderness. The consistency of the abdomen is influenced by the amount of adipose tissue or muscle, but these are symmetrical across the abdomen. Presence of masses. Describe any masses in terms of location, size (dimensions), shape, consistency (soft or firm), and associated pain/tenderness. Presence of swelling. Note the location of any swelling. Presence of pain. If the client feels pain/tenderness upon palpation, note the location and ask them to rate the severity on a scale of 0 to 10. Presence of rigidity and spasms. Rigidity is involuntary firmness/hardness of the abdominal muscles associated with peritoneal inflammation. This rigidity is felt over the inflamed area; it is not bilaterally symmetrical and not voluntary like guarding. You may also feel spasms which are muscle contractions that are often painful Document the findings. Normal findings might be documented as: “Abdomen soft, non-distended, and non-tender to touch with no masses, swelling, pain, and rigidity and bowel sounds noted to all four quadrants.” Abnormal findings might be documented as: “Client noted generalized pain all over abdomen upon palpation, rating it 5/10. Abdomen firm to touch in all quadrants. Left lower quadrant mass, circular in shape, 5 x 5 cm.”	In the Montgomery college nursing program, percussion is considered an advanced practice skill and is not an expectation for students. Therefore, the next step of the abdominal assessment will be palpation. Nurses complete light palpation only. All four quadrants need to be palpated.
Percussion of the Abdomen: Percussion of the abdomen involves tapping the body to elicit sounds and determining whether the sounds are appropriate for the underlying structure of the quadrant. This provides information about the overall consistency of the abdomen as well as the size and borders of some of the underlying structures. For example, percussion sounds of the abdomen can tell you whether the underlying structures are: Fluid filled with a mixture of air and contents (e.g., intestines, bladder, stomach). Fluid results in a tympanic sound (like a drum, usually high pitched with a long duration). General tympany with scattered dullness is the dominant sound heard over the abdomen because of the intestines. Dense (e.g., liver, an abnormal mass close to the surface, intestines filled with stool). Density results in a dull sound (like a quiet thud, usually high pitched with a short duration).	Percussion involves tapping the body to elicit sounds and determining whether the sounds are appropriate for a particular organ or area of the body. Each body part percussed provides information about the consistency as well as the size and borders of the underlying structure. For example, the percussion sounds can tell you if the organ is: Air filled (e.g., lungs) Fluid filled (e.g., bladder and stomach) Dense (e.g., liver) Percussion can also help reveal the presence of masses, particularly if they are close to the surface of the body. There are three approaches to percussion, but the most widely used is indirect percussion, which is the application of a mediated force using parts of both of hands. Indirect percussion is often used to assess the lungs and the abdomen (e.g., bowels, bladder, liver). The steps of this technique are as follows: Non-dominant hand: is placed parallel to the body, and the distal interphalangeal joint of the pleximeter (middle) finger is placed firmly on the body region to be percussed. Ensure that only the interphalangeal joint is touching the body (do not rest the hand on the body) and ensure that the finger is fully extended. Dominant hand: Flex (bend) the pleximeter finger of the dominant hand and with the tip of your finger, tap twice on the distal interphalangeal joint of the non dominant hand. The pleximeter finger of the dominant hand should be at a 90-degree angle to the surface of the body. The motion should be firm and quick with a very short duration. To optimize this motion, the wrist of the dominant hand should be relaxed and loose with the forearm parallel to the person’s body. Perform indirect percussion using a zig-zag pattern beginning in the right lower quadrant and progressing clockwise. Percuss about three times per quadrant. For indirect percussion This skill requires lots of practice, so start by practicing the technique on a table or your leg. See hand placement below: Nurses need to be familiar with the expected percussion sounds in order to identify what is normal and what is abnormal. See the picture below, for the expected location of percussion sounds and the table for an explanation of the types of percussion sounds heard including resonance, hyperresonance, tympany, dullness, and flatness. The image below indicates the areas of the body that are percussed in a head to toe examination. Expected location of percussion sounds:   Explanation of Percussion sounds Sound Body locations Resonance is a low-pitched sound that is hollow in terms of sound quality with a moderate duration. Resonance is the normal sound heard when percussing the lungs because they are filled with air rather than dense tissue. However, it may be more of a dull or flat sound if a client has adipose tissue or a muscular chest, because this increased density modifies the sound. For example, findings may include “resonance anteriorly in all lobes of the lungs.” Hyperresonance is also low-pitched but is more of a booming sound in terms of sound quality and has a longer duration than resonance. Hyperresonance can be a normal lung sound in small children or children with thin chest walls when percussing because of the round anatomical shape of their thorax. However, hyperresonance in older children and adults can be a cue that should alert you to the possible hyperinflation of lungs that occurs with many conditions (e.g., emphysema, pneumothorax). In this case, hyperresonance occurs because trapped air hyper-inflates the lungs over time and changes the anatomical shape of the thorax. For example, findings may include “resonance in lungs equal bilaterally” or “resonance in right lung and hyperresonance in left lung.” Tympany is high-pitched and sounds like a drum in terms of quality with longer duration than resonance and hyperresonance. When performing percussion, tympany is normally heard over fluid-filled organs such as the stomach, bladder, and bowels. The combination of air and fluid creates a drum-like sound. However, the sound may be more dull or flat if a client has adipose tissue or muscles over the abdomen, because of the increased density. This can also occur if the bowels are full of stool or in the presence of ascites . For example, findings may include “tympany with scattered dullness through all quadrants of the abdomen with dullness in upper portion of right upper quadrant.” Dullness is a quiet thud in terms of quality with a high pitch and short duration. Dullness is the normal sound heard when percussing tissues that are dense in consistency, such as the liver. Dullness is typically considered an abnormal sound if elicited with percussion over the lungs or the intestines, stomach, or bladder. In this case, it could represent intestines that are filled with stool, indicating constipation, a bowel obstruction, or some sort of mass. For example, findings may include “dullness in left lower quadrant.” Flatness is even more quiet than dullness with an even shorter duration and a high pitch. Flatness is elicited when percussing muscle and bone because they are very dense tissues and often close to the body’s surface, but these areas are usually not percussed because this does not generally provide relevant data. Hearing flatness over an area that typically elicits resonance or tympany should be a cue for you to engage in more careful examination. Although it may suggest adipose or muscular tissue, it can also indicate a mass.   Listen to the quality of the sound and identify the location. Areas to percuss on the abdomen: Note the findings. Normal findings might be documented as: “General tympany with scattered dullness heard in all quadrants. Dullness heard in upper right quadrant over the liver.” Abnormal findings might be documented as: “Dullness heard in left lower quadrant with general tympany and scattered dullness in all other quadrants.” The video below will demonstrate how to percuss the abdomen:   If the video will not open here is the link: https://youtu.be/jD2uauNk-1Q
5. Report and document assessment findings and related health problems according to agency policy.	Accurate and timely documentation and reporting promote patient safety.

The Genitourinary System:

The picture below identifies the different organs in the Genitourinary (GU) system.

The Genitourinary System (GU) system is made up of the kidneys, ureters, urinary bladder, and urethra. This system is responsible for:

• regulating pH
• synthesizing vitamin D
• producing erythropoietin
• cleaning the blood of waste
• reabsorbing sodium, water, glucose, amino acids, and vitamins
• produces renin for the Aldosterone-Renin-Angiotensin system
• producing urine to rid the body of waste. The GU system includes the kidneys, ureters, urinary bladder, and urethra.

Healthy kidney functioning is essential for regulating fluid and electrolyte balances, blood pH balance, blood pressure, and red blood cell production. Assessment of urinary system functioning includes obtaining a health history, performing a physical examination, and reviewing diagnostic test results. The genitourinary system assessment also needs subjective and objective data and focuses on the examination of the body’s ability to get rid of urine, the genitalia, and the urine itself.

Focused GU health history (obtaining subjective data) includes inquiring about:

• Any past medical history of diabetes, heart disease, renal disease, prostate disease, sexually transmitted infections, or trauma to the genitourinary system required catheterization?
• Any past medical history specific to the Genitourinary system: Kidney, bladder, or urinary diseases, urinary tract infections, pelvic inflammatory disease, incontinence, nocturia,
• Any past procedure/surgical history to any part of the Genitourinary system and if yes then when and why? e.g., removal of kidney stones
• Does the patient have a family history of  GU problems
• Is the patient taking any prescribed or  herbal medication specific for a GU condition or disease e.g., Antibiotics
• Has the patient has any recent or past labs, imaging or procedures related to the GU system?
• How often does the patient urinate and approximately how much?
• Is there any difficulty urinating?
• What is the color of the urine? Is there any Hematuria?
• Does the patient urinate once the urge to urinate is felt or hold urine for long periods of time?
• Is the patient experiencing any itching, burning, irritation, back, flank, or lower abdominal pain?
  • OLD CART the pain
• When was the patient’s last urination and was urgency, frequency, and stream normal?
• Is the patient experiencing any nausea, or vomiting?
• Has the odor or appearance of the urine changed recently?
• Has the patient noticed a change in energy level and eating habits?

The nursing assessment of the genitourinary system generally focuses on bladder function:

Assessing urine color, odor, consistency, and measuring fluid intake and comparing it with urine output.

Assessment findings that may indicate that further assessment is needed include:

• Changes to urinary pattern: urgency, frequency, hesitancy
  • Is the patient experiencing and urinary frequency?
    • Abnormally frequent urination (e.g., every hour or two) is termed urinary frequency. In older adults, urinary frequency often occurs at night and is termed nocturia
      • It can also be a symptom of a urinary tract infection, pregnancy in females, or prostate enlargement in males.
  • Is the patient experiencing any urinary urgency?
    • Urinary urgency is an abrupt, strong, and often overwhelming need to urinate.
      • Urgency often causes, a leakage of urine. When patients experience urinary urgency, the desire to urinate may be constant with only a few milliliters of urine eliminated with each voiding.
• New dysuria or discharge
  • Is the patient experiencing any Dysuria (any discomfort associated with urination) and often signifies a urinary tract infection.
    • Patients with dysuria commonly experience burning, stinging, or itching sensations. In elderly patients, changes in mental status may be the presenting symptom of a urinary tract infection. In women with dysuria, asking whether the discomfort is internal or external is important because vaginal inflammation can also cause dysuria as the urine passes by the inflamed labia.
• Pain to flank, back , pelvis, or lower abdomen
• Fever and/or chills
• Genital irritation

The frequency of normal urination varies considerably from individual to individual depending on personality traits, bladder capacity, or drinking habits.

IV. Step by Step Hands On Assessment for GU system

Steps	Additional Information
Inspect The face, upper and lower extremities for edema. Inspect the suprapubic area and abdomen for distention indicating bladder distention. Please click on the link below and scroll down to inspect a patient with a distended bladder:     A patient with visible bladder distention Gently palpate the suprapubic area. It should be felt soft, non-tender, and non-distended. A distended bladder is palpated as suprapubic fullness which indicates urinary retention. The patient may experience pain in the bladder, abdomen, and or lower back. nspect the color, odor, and volume of urine and send a sample for tests as ordered. Inspect weight and assess for unexpected weight gain or weight loss. Unexpected weight loss can occur with renal disease from a lack of appetite and fatigue. Unexpected weight gain can occur with fluid retention as kidneys cannot get rid of waste and fluid.
Inspect and protect treatment modalities Urinary Catheter If the patient has a Foley catheter, inspect the collection bag /container for urine amount, color, and clarity. Inspect skin at the insertion site (meatus)  for redness/breakdown.                       Dialysis access Agency protocols will dictate nursing and patient care of hemodialysis or the peritoneal dialysis accesses. For hemodialysis-do not take blood pressure readings or draws labs from the arm with the hemodialysis access. For peritoneal access-assess the abdominal insertion site for redness, odor, and ability to exchange the fluid that has been dwelling (siting in the abdomen) and now contains all the waste product for new fluid. The external access tubing must be inspected and strict sterile technique is needed during the preparation, the active dialysis period and post dialysis to prevent infection and maintain the peritoneal site.

VI. Related Laboratory and Diagnostic Procedures/Findings

Abdominal pain is the most common chief complaint related to abdominal assessment. This pain can be associated with the following: stomach/ intestine (digestion) problems, liver/gall bladder issues, pancreas problems, appendicitis, urinary tract problems, and or problems from the reproductive system. Therefore, in addition to information gathered from health history and physical assessment, some laboratory tests and diagnostic exams can assist in diagnosing the cause of the pain.

A complete blood count (CBC), is a blood test that can help determine if an infection is present in the body, like UTI (urinary tract infection) or peritonitis (infection of peritoneum).

Urinalysis is a urine test to determine if blood or infection is present in the urinary tract and may be ordered if the patient presents with pain to the abdomen, pelvis, back, or flank areas to check for a Urinary Tract Infection (UTI)

Liver Function Test (LFT), is a blood test to check the levels of liver enzymes. When liver enzymes are elevated the liver has been damaged and liver function may be impaired.

Amylase and Lipase are blood tests to check the enzyme levels produced by the pancreas. Patients with pancreatitis will have elevated levels of these two enzymes.

Occult Stool/Hemoccult Test is a stool test. It checks the blood in stool that cannot be seen with the bare eye. Positive results indicate a problem (may be bleeding) in the gastrointestinal (GI) tract.

An X-ray of the abdomen (KUB) examines the kidneys, ureters, bladder, intestines, and the bones of the pelvis and spine. The following are seen on this type of XRAY:  kidney stone, gas in the GI tract, or constipation.

Ultrasound uses sound waves to create images. It is often used to diagnose problems with the gallbladder or the kidneys

Computed tomography (CT) scan is used to create more detailed images of the body.

Magnetic resonance imaging (MRI) uses magnetic fields to produce images of the body. However, it cannot be performed in patients who have metal in their bodies.

Esophagogastroduodenoscopy (EGD) uses an endoscope with a camera is inserted and progressed through the patient’s mouth, to the esophagus, to the stomach, and finally to the duodenum. This test is used to directly inspect the GI tract (up to the duodenum). This test will help diagnose acid reflux, ulcers, or mass (cancer).

Colonoscopy, like EGD, is a test to examine the inside of the colon with an endoscope. This test will help to diagnose cancer, diverticulitis (infection of small, bulging pouches in the digestive tract), and colitis.

VII. Learning Exercises

VIII. Attributions and References

Azzouz, L. L., & Sharma, S. (2020). Physiology, large intestine. In StatPearls. StatPearls Publishing.
Physiology, large intestine.

BruceBlaus. (2017, August 3). Urinary system (male) [Medical illustration]. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Urinary_System_(Male).png

Boundless. (n.d.). Overview of the urinary system. Lumen Learning.

College of DuPage. (n.d.). Abdomen – Auscultation. Pressbooks. https://cod.pressbooks.pub/nursingphysicalassessment/chapter/abdomen-auscultation/

Lumen Learning. (n.d.). Gross anatomy of the kidney.
Gross anatomy of the kidney.

Medmastery. (2020, December 14). Auscultating the abdomen: Inspection, auscultation, and percussion [Video]. YouTube.
Auscultating the abdomen: Inspection, auscultation, and percussion [Video]

Narayan, R. (n.d.). How do our kidneys work? Khan Academy.
How do our kidneys work?

Narayan, R. (n.d.). Meet the gastrointestinal tract. Khan Academy.
Meet the gastrointestinal tract

Open Resources for Nursing. (n.d.). Gastrointestinal and genitourinary assessment. In Nursing skills. Wisconsin Technical College System.
Gastrointestinal and genitourinary assessment

OpenStax. (n.d.). The small and large intestines. In Anatomy and physiology.
The small and large intestines

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