Health Assessment (Lecture)
STUDENT ACTIVITY SHEET
BS NURSING / FIRST YEAR
Session # 16
LESSON TITLE: The Gastrointestinal and Renal Systems
(Part 1)
LEARNING OUTCOMES: Materials:
Upon completion of this lesson, the nursing student can: Book, pen and notebook, index card/class list
1. Identify the structures and function of the gastrointestinal
and renal systems;
2. Identify the four quadrants and the organs in each
quadrant; References: Bates’ Nursing Guide to Physical
3. Collect an accurate health history of the GI and renal Examination and History Taking (Second Edition)
systems; by Beth Hogan-Quigley, Mary Louise Palm, and
4. Describe the physical examination techniques and the Lynn Bickley.
order performed to evaluate the GI and renal systems.
MAIN LESSON (60 minutes)
The students will study and read Chapter 16 of their book about this lesson:
THE FOUR QUADRANTS OF THE ABDOMEN
The Right Upper Quadrant:
In the right upper quadrant, the soft consistency of the liver makes it difficult to feel through the abdominal wall.
The lower margin of the liver, the liver edge, is often palpable at the right costal margin.
The gallbladder, which rests against the inferior surface of the liver, and the more deeply lying duodenum are
generally not palpable.
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At a deeper level, the lower pole of the right kidneymay be felt, especially in thin people with relaxed abdominal
muscles. Moving medially, the examiner encounters the rib cage, which protects the stomach; the xiphoid process
lies in the midline.
The abdominal aortaoften has visible pulsations and is usually palpable in the upper abdomen.
The Left Upper Quadrant:
In the left upper quadrant, the spleenis lateral to and behind the stomach, just above the left kidney in the left
midaxillary line. Its upper margin rests against the dome of the diaphragm.
The 9th, 10th, and 11th ribs protect most of the spleen. The tip of the spleen may be palpable below the left costal
margin in a small percentage of adults.
The pancreasin healthy people escapes detection.
The Left Lower Quadrant:
In the left lower quadrant, the firm, narrow, tubular sigmoidcolonis often felt and portions of the transverse and
descending colon may also be palpable.
The Right Lower Quadrant
In the lower midline the bladdermay be palpated. In the right lower quadrantare bowel loops and the appendix
at the tail of the cecum near the junction of the small and large intestines. In healthy people, there will be no
palpable findings.
The Urinary Bladder
A distended bladdermay be palpable above the symphysis pubis. The bladder accommodates roughly 300 ml of
urine filtered by the kidneys into the renal pelvis and the ureters. Bladder expansion stimulates contraction of
bladder smooth muscle, the detrusor muscle,at relatively low pressures.
Rising pressure in the bladder triggers the conscious urge to void.
The Kidneys
The kidneysare posterior organs. The ribs protect their upper portions.
The costovertebral angle—the angle formed by the lower border of the 12th rib and the transverse processes of
the upper lumbar vertebrae—defines the region to assess for kidney tenderness (flank area).
THE HEALTH HISTORY
Gastrointestinal: Urinary and Renal:
Suprapubic pain
Abdominal pain, acute and chronic Dysuria, urgency, or frequency
Indigestion, nausea, vomiting including blood, Hesitancy, decreased stream in males
loss of appetite, early satiety Polyuria or nocturia
Dysphagia and/or odynophagia Urinary incontinence
Change in bowel function Hematuria
Diarrhea, constipation Kidney or flank pain
Jaundice Ureteral colic
Patterns and Mechanisms of Abdominal Pain
Visceral Pain:
Visceral painoccurs when hollow abdominal organs such as the intestine or biliary tree contract unusually
forcefully or are distended or stretched.
Parietal Pain:
Parietal painoriginates from inflammation in the parietal peritoneum. It is a steady, aching pain that is usually
more severe than visceral pain and more precisely localized over the involved structure.
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Referred Pain:
Referred pain is felt in more distant sites, which are innervated at approximately the same spinal levels as the
disordered structures.
Referred pain often develops as the initial pain becomes more intense and thus seems to radiate or travel from
the initial site. It may be felt superficially or deeply but is usually well localized.
History of Abdominal Pain or Discomfort:
Onset: First determine the timing of the pain. Is it acute or chronic? Acute abdominal pain has many patterns. Did
the pain start suddenly or gradually? When did it begin?
Location: Then ask the patient to point to the pain. Patients are not always clear when they try to describe in
words where pain is most intense. The quadrant where the pain is located can be helpful. Often underlying organs
are involved. If clothes interfere, repeat the question during the physical examination.
Duration: How long does it last? What is its pattern over a 24-hour period? Over weeks or months? Are you
dealing with an acute illness or a chronic and recurring one?
Characteristic Symptoms: Ask patients to describe the pain in their own words. Pursue important details: “Where
does the pain start?” “Does it radiate or travel anywhere?” “What is the pain like?”
If the patient has trouble describing the pain, try offering several choices:
“Is it aching, burning, gnawing . . . ?”
Ask the patient to rank the severity of the pain on a scale of 1 to 10. Note that severity does not always
help you to identify the cause. Sensitivity to abdominal pain varies widely and tends to diminish in older
patients, masking acute abdominal conditions. Pain threshold and how patients accommodate to pain
during daily activities also affect ratings of severity.
Associated Manifestations: Ask the patient if he or she is experiencing any other symptoms (e.g., nausea,
vomiting, or indigestion).
Relieving Factors: As you probe factors that aggravate or relieve the pain, pay special attention to any association
with meals, alcohol, medications (including aspirin and aspirin-like drugs and any over-thecounter medications),
stress, body position, and use of antacids. Ask if indigestion or discomfort is related to exertion and relieved by
rest.
Treatment: Determine what remedies the patient has tried and the results of each.
CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:
Multiple Choice
1. A patient being admitted is complaining of right upper quadrant pain. Upon ultrasonography, the physician has
diagnosed the patient to have cholecystitis. Which of the following best describes this disease?
a. Inflammation of the liver
b. Inflammation of the pancreas
c. Inflammation of the stomach
d. Inflammation of the gallbladder
ANSWER:
RATIONALE:
2. Nurse Mito is admitting a patient who has right lower quadrant pain of the abdomen. Upon palpation of the right
lower quadrant, the nurse has observed for rebound tenderness. This may be an indication of which of the
following conditions?
a. Appendicitis
b. Pancreatitis
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c. Gastritis
d. Gastroenteritis
ANSWER:
RATIONALE:
3. Which of the following is NOT true with regard to visceral pain?
a. It originates from inflammation in the parietal peritoneum
b. It occurs when hollow abdominal organs such as the intestine contract unusually or forcefully
c. It may be difficult to localize
d. It is typically palpable near the midline
ANSWER:
RATIONALE:
4. A patient named Erina is experiencing pain from the stomach brought about by hyperacidity. Which region of the
abdomen will this type of pain be felt at?
a. Hypogastric
b. Umbilical
c. Epigastric
d. Right iliac
ANSWER:
RATIONALE:
5. In early acute appendicitis, the initial complaint of abdominal pain is usually felt at
a. Right hypochondriac
b. Left hypochondriac
c. Epigastric
d. Umbilical
ANSWER:
RATIONALE:
6. A patient named Soma is currently experiencing pain at the costovertebral angle or the flank area. The nurse
must know that the pain is originating from which of the following organs?
a. Uterus
b. Kidneys
c. Stomach
d. Liver
ANSWER:
RATIONALE:
7. The nurse must ask which following questions when the patient is experiencing abdominal pain?
a. “Where does the pain start?”
b. “Does it radiate or travel anywhere?”
c. “Does the pain have an aching, burning, or gnawing quality?”
d. All of the above
ANSWER:
RATIONALE:
8. Which of the following microorganisms can cause the patient to suffer from peptic ulcer disease?
a. Escherichia coli
b. Helicobacter pylori
c. Staphylococcus aureus
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d. Streptococcus pyogenes
ANSWER:
RATIONALE:.
9. Which of the following diseases does NOT cause the patient to have chronic upper abdominal pain?
a. Dyspepsia
b. Peptic ulcer disease
c. Gastroesophageal reflux disease
d. Acute cholecystitis
ANSWER:
RATIONALE:
10. Which of the following foods can aggravate the occurrence of heartburn?
a. Toast
b. Coffee
c. Rice
d. Apple
ANSWER:
RATIONALE:
LESSON WRAP-UP (10 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
CAT 3-2-1
After the instructor collects all papers, he/she will now summarize the topic. After the lesson, have each student record
three things he or she learned from the lesson. Next, have them record two things that they found interesting and that they
like to learn more about or ask students if they still have something to clarify or clarify about the topic. After answering the
question, station yourself at the door and collect the paper as students depart from the room. Respond to students’
answer during the next class meeting or as soon as possible
*All these must be done giving importance to social, distancing, hygienic practices, and wearing of mask at all times.
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