You note that the Emergency Department staff did not assess Mr. Jones’s abdomen. What are the steps for assessing the abdomen?

Mr. Jones, a 50 year old man, has been admitted to your hospital unit with a diagnosis of gastrointestinal bleeding. He drove himself to the emergency department after vomiting bright red blood twice within 6 hours. The emergency department staff reported that he arrived on the unit oriented times three but is anxious, slurring his words, and smells of alcohol. He was not able to provide a full history upon admission, but admits to drinking a “few” drinks that day and believes he may have ingested “cleaning fluid or something” by accident. He also states that he is “supposed to stop drinking” and takes “something for his stomach,” but could not recall the name of the medication. Once the patient is admitted and brought to your unit, he is able to give more history information. He reports intermittent dizziness and fatigue that has been worsening over the past 2 days. His skin is dry and pale. His abdomen is very distended. Capillary refill is greater than 3 seconds, blood pressure is 140/90mm Hg, pulse rate is 110 beats/min, respiratory rate is 24 breaths/min, and temperature 99 degrees F. He reports that he has been passing black, sticky, foul smelling stools x 3 days. He further complains of epigastric burning that has also been worsening over the past 2 days. He reports that he smokes two packs of cigarettes per day and occasionally smokes cigars. He has been treated for hypertension in the past, but denies taking hypertension medications now.

Questions:

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1. You note that the Emergency Department staff did not assess Mr. Jones’s abdomen. What are the steps for assessing the abdomen?

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2. What is the order for assessing the abdomen? What is the rationale for the order?

3. What are some important questions to ask during the abdominal assessment and why?

4. Mr. Jones’s abdomen is distended-Discuss the significance of this finding.

5. Describe how you will discuss Mr. Jones’s alcohol consumption with him.

6. What patient teaching will you perform while Mr. Jones is on your hospital unit? What health promotion topics are a high priority for you to review with him?

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