lOMoARcPSD|26582732
ASSESSMENT & REASONING
GI-GU SYSTEM 2025-2026
Jenna simpson, 24 years old
Suggested gi/gu nursing assessment skills to be demonstrated:
Gi/gu:
Inspection: skin (coloration, vascularity, striae, scars, lesions, rashes)
contour – (flat, rounded, scaphoid, protuberant/distended)
• Umbilicus – contour
• Symmetry (relaxed, supine position)
• Abdominal movement during breathing
• Aortic pulsations
Auscultation: ( completed before palpation/percussion to not alter bowel sounds )
• Bowel sounds – 1 minute per quadrant up to 5 minutes with the diaphragm
• Intensity, pitch, frequency
• Vascular sounds – listen for bruits with bell.
Percussion:
• Percuss for tone in a systematic fashion to all quadrants percuss liver span
• Dull percussion to liver and kidney (costovertebral angle – 12 th rib)
• Tympany to other parts of the abdomen palpation:
• Light palpation to all quadrants – 1 to 2 cm to detect tenderness
• Deep palpation to all quadrants – 5 to 6 cm for masses (location, size, shape, pulsatility, mobility, tenderness)
palpate bladder- light palpation only; you only want to assess to see if it is distended
• Palpate liver
• Palpate spleen
• Palpate kidneys
Make learning active!
• Role play or go through the interview/body assessment process – student to student or as a group.
• Review the case study as an application exercise in small groups or together as a class.
• Depending on your program, some content in the case study may not have been taught. Do not let that
prevent you from utilizing this case study! Use it to promote learning by having students identify what
they do not yet know and guide where they can find the information in the textbook or on the internet to
address knowledge gaps. This is educational best practice and another way to scaffold knowledge!
© 2019 Keith Rischer/www.KeithRN.com
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Present problem:
Jenna simpson is a 24-year-old caucasian female who weighs 210 pounds (95.5 kg-bmi of 36.5) who presents to the
emergency department with sudden onset of sharp pain in the right side of her lower back that radiates to the right side
of her abdomen and into her groin. The pain started ten hours ago, but lasted only 15 minutes and then went away. She
took ibuprofen 600 mg po an hour ago but has not helped, and the pain persists.
She states that this pain is different than when she has epigastric pain because of gastroesophageal reflux disease
( gerd). She feels nauseated but has not vomited. Jenna appears uncomfortable and pleads with the triage nurse, “please
do something to get rid of this pain! What is wrong with me?”
What data from the present problem are relevant and must be interpreted as clinically significant by the nurse?
( reduction of risk potential )
Relevant data from present problem: Clinical significance:
-sharp pain r side of her lower back that Based on the location and onset of pain, renal calculi is suspected.
radiates to the r side of her abdomen and into - Pain areas: in the back or side part of the body
her groin.
- Pain types: can be severe, sharp, or sudden in the abdomen
-pain started 10 hours ago and lasted 15
minutes - Pain circumstances: can occur during urination
- took ibuprofen 600 mg po one hour ago - Gastrointestinal: nausea or vomiting
-hx of gerd- but this is a different pain Nsaids may temporarily relieve pain, but because a kidney stone is suspected,
-nauseated- has not vomitted the relief will be minimal, if any.
What is the relationship of your patient’s past medical history (pmh) and current meds?
( which medication treats which condition? Draw lines to connect. )
Pmh: Home meds: Pharm. Class: Mechanism of action (own words):
Anxiety Alprazolam 0.5 mg po every Benzodiazepine Gaba’s inhibit excitatory stimulation,
8 hours prn which will relax patient due to anxiety.
Gastroesophageal reflux Pantoprazole 10 mg po Proton pump Inhibits the production of gastric acid
disease (gerd) Bid Inhibitor Which will relieve the s/s associated with
Gerd
Jenna is quickly brought to a room. You are the nurse and
quickly collect the following assessment data:
Patient care begins:
Current vs: P-q-r-s-t pain assessment:
T: 98.9 f/ 37.2 c (oral) Provoking/palliative: Nothing changes the level of pain
P: 92 (regular) Quality: Sharp, severe
R: 28 (regular) Region/radiation: Right back/flank that radiates into rlq and groin
Bp: 148/84 Severity:
O2 sat: 99% room air Timing: Constant the past hour
What vital signs are abnormal? What is the reason (pathophysiology) for these findings?
( reduction of risk potential/health promotion and maintenance )
Abnormal vs: Clinical significance:
R: 28 Normal value 12-20 : this could be related to pain and anxiety
Bp: 148/84 Normal value 120/80: this could be related to pain and anxiety
© 2019 Keith Rischer/www.KeithRN.com
Downloaded by NELSON KIIRU ()
ASSESSMENT & REASONING
GI-GU SYSTEM 2025-2026
Jenna simpson, 24 years old
Suggested gi/gu nursing assessment skills to be demonstrated:
Gi/gu:
Inspection: skin (coloration, vascularity, striae, scars, lesions, rashes)
contour – (flat, rounded, scaphoid, protuberant/distended)
• Umbilicus – contour
• Symmetry (relaxed, supine position)
• Abdominal movement during breathing
• Aortic pulsations
Auscultation: ( completed before palpation/percussion to not alter bowel sounds )
• Bowel sounds – 1 minute per quadrant up to 5 minutes with the diaphragm
• Intensity, pitch, frequency
• Vascular sounds – listen for bruits with bell.
Percussion:
• Percuss for tone in a systematic fashion to all quadrants percuss liver span
• Dull percussion to liver and kidney (costovertebral angle – 12 th rib)
• Tympany to other parts of the abdomen palpation:
• Light palpation to all quadrants – 1 to 2 cm to detect tenderness
• Deep palpation to all quadrants – 5 to 6 cm for masses (location, size, shape, pulsatility, mobility, tenderness)
palpate bladder- light palpation only; you only want to assess to see if it is distended
• Palpate liver
• Palpate spleen
• Palpate kidneys
Make learning active!
• Role play or go through the interview/body assessment process – student to student or as a group.
• Review the case study as an application exercise in small groups or together as a class.
• Depending on your program, some content in the case study may not have been taught. Do not let that
prevent you from utilizing this case study! Use it to promote learning by having students identify what
they do not yet know and guide where they can find the information in the textbook or on the internet to
address knowledge gaps. This is educational best practice and another way to scaffold knowledge!
© 2019 Keith Rischer/www.KeithRN.com
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Present problem:
Jenna simpson is a 24-year-old caucasian female who weighs 210 pounds (95.5 kg-bmi of 36.5) who presents to the
emergency department with sudden onset of sharp pain in the right side of her lower back that radiates to the right side
of her abdomen and into her groin. The pain started ten hours ago, but lasted only 15 minutes and then went away. She
took ibuprofen 600 mg po an hour ago but has not helped, and the pain persists.
She states that this pain is different than when she has epigastric pain because of gastroesophageal reflux disease
( gerd). She feels nauseated but has not vomited. Jenna appears uncomfortable and pleads with the triage nurse, “please
do something to get rid of this pain! What is wrong with me?”
What data from the present problem are relevant and must be interpreted as clinically significant by the nurse?
( reduction of risk potential )
Relevant data from present problem: Clinical significance:
-sharp pain r side of her lower back that Based on the location and onset of pain, renal calculi is suspected.
radiates to the r side of her abdomen and into - Pain areas: in the back or side part of the body
her groin.
- Pain types: can be severe, sharp, or sudden in the abdomen
-pain started 10 hours ago and lasted 15
minutes - Pain circumstances: can occur during urination
- took ibuprofen 600 mg po one hour ago - Gastrointestinal: nausea or vomiting
-hx of gerd- but this is a different pain Nsaids may temporarily relieve pain, but because a kidney stone is suspected,
-nauseated- has not vomitted the relief will be minimal, if any.
What is the relationship of your patient’s past medical history (pmh) and current meds?
( which medication treats which condition? Draw lines to connect. )
Pmh: Home meds: Pharm. Class: Mechanism of action (own words):
Anxiety Alprazolam 0.5 mg po every Benzodiazepine Gaba’s inhibit excitatory stimulation,
8 hours prn which will relax patient due to anxiety.
Gastroesophageal reflux Pantoprazole 10 mg po Proton pump Inhibits the production of gastric acid
disease (gerd) Bid Inhibitor Which will relieve the s/s associated with
Gerd
Jenna is quickly brought to a room. You are the nurse and
quickly collect the following assessment data:
Patient care begins:
Current vs: P-q-r-s-t pain assessment:
T: 98.9 f/ 37.2 c (oral) Provoking/palliative: Nothing changes the level of pain
P: 92 (regular) Quality: Sharp, severe
R: 28 (regular) Region/radiation: Right back/flank that radiates into rlq and groin
Bp: 148/84 Severity:
O2 sat: 99% room air Timing: Constant the past hour
What vital signs are abnormal? What is the reason (pathophysiology) for these findings?
( reduction of risk potential/health promotion and maintenance )
Abnormal vs: Clinical significance:
R: 28 Normal value 12-20 : this could be related to pain and anxiety
Bp: 148/84 Normal value 120/80: this could be related to pain and anxiety
© 2019 Keith Rischer/www.KeithRN.com
Downloaded by NELSON KIIRU ()
