2 replies
tatty2021
2replies1.pdf
Elizabeth
GI And Musculoskeletal Systems
GI System
When you are assessing a patient for abdominal pain. They are some questions you ask
to get a picture to deliver patient-centered care. Here are some good questions to ask: Any
abdominal pain? Please point to it. Is the pain in one spot, or does it move around? How
did it start? How long have you had it? Constant, or does it come and go? Occur before
meals? Does it peak? When? How would you describe the character: cramping (colic type),
burning in the pit of the stomach, dull, stabbing, aching? Is the pain relieved by food or
worse after eating? (Jarvis, 2019, p. 534). When we are examining the patient here are
some other questions to ask: Is the pain associated with a menstrual period or
irregularities, stress, dietary indiscretions, fatigue, nausea, vomiting, gas fever, rectal
bleeding, frequent urination, vaginal or penile discharge? What makes it feel worse: food
position, stress, medication, activity? What have you tried to relieve pain: rest, heating pad,
change in position, medication? (Jarvis, 2019, p. 535). To Assess a mass, I would “Place
the palmar aspect of the fingers on your dominant hand flat and together on your patient's
abdomen. Using a light, gentle, dipping motion, palpate for abnormalities, such as muscle
guarding, rigidity, or superficial masses. Palpate clockwise, lifting your fingers as you move
from one location to another” (Mehta, 2020). To document the findings I would for
example if the mass was at the McBurney point I would say: Patient is in pain or feeling of
distress in the epigastrium or precordial region on continued firm pressure over the
McBurney point. Writing this would bring me to the conclusion that the patient is suffering
from Acute appendicitis.
GI And Musculoskeletal Systems
While working in the hospital a patient came in with vomiting and pain in the
stomach. Once the patient was assessed, it was found that her appendix had ruptured, and
she was rushed into surgery. They saved her life and she and her family were very
thankful.
Musculoskeletal System
Osteoarthritis- Noninflammatory localized, a disorder involving deterioration of
articular cartilages (cushion between the ends of bones) and subchondral bone remodeling,
synovial inflammation, and formation of new bone (osteophytes) at joint surfaces (Jarvis,
2019, p. 612). Rheumatoid Arthritis- Chronic inflammatory pain condition that is possibly
started by an autoimmune response, inflammatory event, or infection (Jarvis, 2019, p. 611)
Compare and Contrast Osteoarthritis and Rheumatoid Arthritis
. Osteoarthritis
(Links to an external site.)
occurs when the smooth cartilage joint surface wears out. Osteoarthritis usually begins
in an isolated joint.
Rheumatoid arthritis
(Links to an external site.)
is an autoimmune disease, which means that the immune system malfunctions and
attacks the body instead of intruders. In this case, it attacks the synovial membrane that
encases and protects the joints. Rheumatoid arthritis often targets several joints at one
time. The symptoms of rheumatoid arthritis include:
● the symmetrical nature of the disease (arthritis in both hips, for example), ● fever ● anemia ● fatigue ● loss of appetite ("Difference between osteoarthritis and rheumatoid
arthritis," 2020).
References
Difference between osteoarthritis and rheumatoid arthritis. (2020). University of
Michigan | Michigan Medicine.
https://www.uofmhealth.org/conditions-treatments/cmc/difference-between-osteoa
rthritis-and-rheumatoid-arthritis#
Jarvis, C. (2019). Physical examination and health assessment (8th ed.). Saunders.
Mehta, M. (2020, June 1). Assessing the abdomen: Nursing2020 critical care. LWW.
https://journals.lww.com/nursingcriticalcare/fulltext/2010/01000/assessing_the_ab
domen.11.aspx
Week4WrittenAssignmentNUR418.docx Lisandra
GI
Abdominal pain can be due to so many reasons so it is important to gather relevant
information during your assessment. Gastroenteritis, appendicitis, stomach virus, bowel
obstruction, acute pancreatitis, and even gas can all be the root cause of abdominal pain.
The information you obtained during an assessment aids in formulating a diagnosis and
then executing a care plan and implementing a plan of action. Initially the level and
location of pain should be addressed. Next a review of past medical history and past family
history should be conducted. Risk factors and social history should also be reviewed as part
of a comprehensive assessment. Though questioning someone about the frequency of their
bowel movements, the color, the size, and even how firm or loose it may be can seem a bit
intrusive, it is also relevant information. A list of medication that the patient is taking
should be gathered as well as allergies. The patient should also be questioned about what
eases the pain and what makes it worse. The abdominal assessment provides lots of insight
and all sorts of information can be collected during this time. Prior to this assessment you
should ensure that the stomach is not full to avoid inducing vomiting. The abdominal
assessment is four parts and starts with Inspection. Inspection is a visual examination that
allows you to address skin abnormalities, abdominal masses, and movement of the
abdomen during respiration. The next step is auscultation where a stethoscope is used to
listen to all four quadrants. During this step, listening for regularities and irregularities in
bowel sounds and blood flow is important. Next is the percussion portion of the assessment
which helps locate organ borders, identify organ shape and position, and determine if an
organ is solid or filled with fluid or gas. Last is the palpation and information regarding
tenderness and pain should be gathered. Certain organs such as the liver and kidneys can
be palpated, abdominal masses would be an irregularity to look out for.
Assessing for a mass is done during an abdominal assessment and can be found in
various ways. As mentioned before, the inspection portion of the abdominal assessment
provides visual for abnormalities in shape, color, size, and even smoothness of skin. Given
the patient is in good shape, identifying a mass is easy and can be distinguished based on
the region. For example, a mass not in the right upper quadrant can be due to an issue with
the pancreas such as pancreatitis whereas a mass noted in the left lower region can be
attributed to an issue with your spleen. During auscultation an abdominal rub may
indicate a mass however further evaluation requires percussion and palpation. During this
phase of the assessment complaints of tenderness, feeling enlargement of organs, and even
dullness on percussion can all point towards an abdominal mass. Objective documentation
regarding your findings include mention of the exact anatomical region/quadrant the mass
was noted, any swelling or pain noted, bloating, if the mass feels hard or soft, any organs
noted as enlarged, and shape of abdomen. Any symptoms associated as mentioned by the
patient such as vomiting, nausea, issues with bowels and bladder, and fever should be
documented as well. So far as my clinical experience, I have yet to have palpated a mass
during an abdominal assessment. I have palpated an enlarged pancreas which led to a
diagnosis of gallstones.
Musculoskeletal
At first look osteoarthritis and rheumatoid arthritis may seem to mimic each other as
they both affect the joints. Taking a closer look at specific signs and symptoms is what
allows a correct diagnosis and treatment plan. Osteoarthritis is a degenerative joint
disorder where the cartilage is broken down causing the bones to rub against each other
which leads to pain and inflammation. Rheumatoid arthritis is an autoimmune disease
where your body attacks itself perceiving the soft lining in your joints as a bacterial or viral
threat. As a result of the attack fluid builds up around the joints causing pain, stiffness, and
inflammation around the joints. Osteoarthritis risk factors are being overweight, joint
deformity, diabetes, gout, and experiencing traumatic injury to your joints, whereas
rheumatoid arthritis risk factors are simply genetic. While there are a few similarities
between the two such as painful stiff joints, limited range of motion, warmth or tenderness
in the affected area, and increasing intensity of symptoms in the morning, one key thing to
remember is that osteoarthritis affects just the joints while rheumatoid arthritis can affect
your whale body due to it being systemic. An additional key difference between the two is
that An elevated ESR or CRP is typically present in patients with RA but not in those with
OA. Currently there is no cure for either OA or RA however treatments for both include
anti inflammatory and corticosteroid medication to manage the symptoms. Treatments
more specifically for RA are typically immunosuppressants to prevent the body from
attacking itself preventing damage.
References
Kahn, A. (2019, August 2). What You Need to Know About Abdominal Masses.
Healthline. https://www.healthline.com/health/abdominal-mass
Mealie, C. A. (2020, June 23). Abdominal Exam - StatPearls - NCBI Bookshelf.
Ncbi.Nlm.Nih.Gov. https://www.ncbi.nlm.nih.gov/books/NBK459220/
Rheumatoid Arthritis and Osteoarthritis: How to Assess Patients. (n.d.). Practical Pain
Management. Retrieved September 14, 2020, from
https://www.practicalpainmanagement.com/pain/myofascial/assessment-patients-r
heumatoid-arthritis-osteoarthritis#:%7E:text=Although%20there%20are%20for
mal%20guidelines,be%20helpful%20in%20initial%20evaluation.
Roth, E. (2020, August 6). Is It Rheumatoid Arthritis? The Differences Between RA and
OA. Healthline.
https://www.healthline.com/health/rheumatoid-arthritis/ra-vs-oa#affected-joints
