FHP: Nutrition

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FHP Nutrition Metabolism Part II

• Carole Howe, RN, PhD
• Fall 2006

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Objectives

• History and Physical Assessment of
• Thyroid
• Lymphatic
• Oral Cavity
• Abdomen
• Developmental Modifications
• Class Prep Bring text book and Nursing DX book.
  Be prepared to discuss the gastrointestinal
  system changes in the older adult.

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WoRDs and QUESTION of the Week

• Dysphagia
• Dysphasia
• What are the focus areas of Healthy People 2010
  as they relate to issues of the abdomen and
  gastrointestinal system?

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Endocrine System Thyroid Gland
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Vocabulary

• Dysphagia
• Tangential light

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Focused History (ROS)

• Do you have or have you ever had
• Lumps in your neck Difficulty swallowing
• Temperature intolerances Weight changes
• Sleep changes Mood changes
• Skin/hair changes Changes in vision
• Changes in menstrual pattern
• Cardiac changes

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HX cont.

• Medications
• Are you taking any medications for your
• thyroid?
• -Consider medications that might affect the
  functioning of the thyroid (e.g. lithium)

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Past History (PH)

• Surgical history
• Radiation
• Thyroid dysfunction

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Family History (FH)

• Thyroid disorders

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Thyroid Dysfunction

• Skin
• Cardiovascular
• Sleep/rest
• Gastrointestinal
• Reproductive
• What is the significance of the thyroid gland
  function given the list above?

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Assessment Guidelines

• Glass of water
• Tangential light
• Relaxed neck muscles
• Isthmus and two lobes
• Lobes under sternocleidomastoid muscle

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Location of the Thyroid Gland
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Assessment cont.

• Inspection
• What do you expect to see?
• How does pregnancy affect the thyroid gland?

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Assessment cont.

• Palpation
• Palpate for enlargement, consistency
• Palpate with and without swallow
• Palpate anterior and posterior
• Palpation is not required on the demo exam

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Diagnoses

• Alternation in usual energy level r/t
• AEB

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Sample Documentation of Subjective Data

• Reports no dysphagia, lumps in neck, irradiation
  of neck, surgery or treatment for thyroid problems

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Lymphatic System

• Function

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Vocabulary

• Matted
• Shotty
• Sentinel node

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CC

• Hits got arisin in its neck.
• My glands hurt

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History

• PI (or ROS or focused hx)
• Enlarged nodes
• Swelling
• Recent infections
• Piercings
• Medications

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History

• Past History
• Cancers
• Chronic illness
• Surgery
• Recurrent infections
• Environmental exposure
• Use of IV drugs
• Sexual practices
• Travel

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Physical Assessment

• Inspection
• Expected outcome Not visible
• Observe for swelling, lesions, erythema, red
  streaks

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Physical Assessment Palpation

• Gentle circular (rotary) motion
• Pads of 2nd, 3rd, 4th fingers
• Light palpation and increase pressure
• Bilateral palpation (except near carotid sinus)
• Relaxed neck muscles

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Palpable Nodes

• Occipital (suboccipital)
• Postauricular
• Preauricular
• Tonsilar (parotid retropharyngeal)
• Submaxillary (submandibular)
• Submental

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Palpable Nodes cont.

• Anterior cervical chain
• Posterior cervical chain
• Deep cervical chain
• Cervical neck chain
• Supraclavicular
• Inguinal (with abdominal exam)

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Documentation Physical Assessment

• Description
• Location
• Size
• Number
• Discreteness
• Consistency
• Tenderness
• Mobility
• Signs of inflammation

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Nodes and Infection

• Tender
• Matted
• Enlarged

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Nodes and Malignancy

• Enlarged
• Hard
• Discrete
• Asymmetrical
• Non-tender

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Sample Diagnoses
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Documentation of Physical Assessment

• Neck symmetric, no masses, tenderness,
  lymphadenopathy

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ORAL CAVITY
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Abdomen and Elimination

• Vocabulary
• Anorexia
• Tympany
• Borborygmus (i)
• Constipation
• Diarrhea
• Dysuria
• Incontinence
• Bruit

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Mapping of the Abdomen

• Four Quadrants (p 517)
• Nine Regions (517)

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History

• Reason for the visit (chief complaint)
• Present Health Status or PI
• Review of System (ROS)
• PH
• FH

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ROS

• Discuss questions you might ask.

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Past History

• G-I problems (ulcer, gallbladder disease,
  hepatitis, jaundice, appendicitis, colitis,
  hernia)
• Operations
• Abdominal studies

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FH

• G-I disease

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General Guidelines for thePhysical Assessment

• Empty bladder
• Avoid chilling
• Warms hands/short nails
• Relaxed muscles
• Pain free side first
• Assemble equipment

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Physical Examination

• Inspection
• Examiner stands in 3 positions WHY?
• Contour
• Symmetry
• Skin
• Pulsation/movement
• Hair distribution
• Demeanor of patient

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Physical Examination cont

• Auscultation (performed after inspection)
• Diaphragm
• 4 quadrants
• Character and frequency of bowel sounds (BS)
• Expected outcome Q 5-35 times/minute
• Absence of BS

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Physical Examination Percussion

• 4 quadrants
• Expected outcome
• Tympany throughout
• Dull over solid organs, fluid, mass, adipose
  tissue

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Physical Examination Light Palpation

• Gentle exploration
• 4 quadrants
• Smooth circular movements and slight dipping
• Pads of fingers
• Expected outcome smooth and soft, abdominal
  muscles may be palpated

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POINT to PONDER

• Consider how the
• nurse might need to
• alter the abdominal
• exam for an
• older adult.

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a toddler.
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FHP Elimination

• Describe urinary pattern
• Describe bowel pattern characteristics
• Stool for guiac

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Sample Diagnoses

• Risk for Constipation r/t overuse of laxatives
• Perceived Constipation r/t faulty appraisal AEB
  expected passage of stool at same time every day.

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Sample Documentation

• Healed scar RLQ (appendectomy), slightly obese,
  protuberant, symmetrical, no bulging, bowel
  sounds frequent, no masses.
• Membranes (oral cavity) pink moist, no
  lesions gums pink w/out inflammation 30 teeth
  present in good repair 4 silver fillings in
  upper and lower molars.

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REVIEW

• A scar is a________lesion.
• A. Primary
• B. Secondary
• C. Vascular