In general, the assessment that will be performed on the patient will include:
- Patient history (drinking, smoking, viral infections, and signs and symptoms)
- Family history (family history of liver cancer, family history of cancer or other risk factors).
- Physical examination
- Diagnostic tests and procedures.
PATIENT HISTORY
The Health Care Provider will ask you personal health history questions. These may include questions about your life style, signs & symptoms and medical history:
FAMILY HISTORYThe health care provider will ask questions concerning your family history such as:
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Sager, J. (2018). Liver disease symptoms can't be ignored: but do you know who's at risk? Retrieved from: https://www.healthyway.com/content/liver-disease-symptoms-cant-be-ignored-but-do-you-know-whos-at-risk/
Stutter Health. (2019). Alcoholic liver disease care. Retrieved from: https://www.sutterhealth.org/services/liver/alcoholic-liver-disease
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Integument/skin assessment
The purpose of the integument assessment is to assess for the superficial signs and symptoms associated with liver cancer and gather further objective data to ultimately assist in the production of the patient's plan of care [2]. The nurse will perform a thorough head to toe skin assessment assessing for:
Jaundice - The yellowing of the skin and eyeballs [1]. Jaundice can be caused by liver cancer [2].
Edema & Ascites - The nurse will be examining extremities and the abdomen for any signs of swelling or abnormal fluid build-up [1]. Abnormal fluid build-up can be a sign of liver cancer [2]. The nurse will note any other abnormal skin assessment findings such as masses, rashes, lesions [1]. |
Government of Alberta. (2019). Jaundice care instructions. Retrieved from: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1011
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Abdominal Assessment
The abdominal assessment examines the liver directly and can assess for various signs of liver cancer [1]. Throughout this assessment, the nurse is examining for Ascites (abnormal fluid buildup in the abdomen that can be caused by liver cancer) [1]. Ascites often accompanies liver cancer and is important to monitor for in the patient [1]. This assessment is not diagnostic but it provides health care practitioners with data regarding the physical state of the patient's abdomen [1].
Inspection
With the patient laying flat on their back the nurse will look at the abdomen from various points of reference [1]. The size and shape of the abdomen is assessed [1]. The nurse looks for any masses or bulges, symmetry, hair distribution, pulsations/movement, and any skin abnormalities [1].
Auscultation
The nurse will use their stethoscope and listen to the patient's abdomen starting with the lower right quadrant. The nurse listens to both bowel sounds and vascular sounds (blood flow within the arteries) [1].
*The nurse may listen for a long time, this does not mean there is anything wrong. Sounds in the abdomen are normally irregular thus it is important for the assessor to listen over a longer period of time [1].
Percussion
The nurse will use their fingers to tap in various locations on the abdomen. This tapping is called percussion and is used to assess for tympany or dullness which indicate the relative dullness of organs [1]. The nurse will start with tapping in the lower right quadrant of the abdomen continuing clockwise ending in the lower left quadrant [1]. The nurse will determine the size of the liver and assess for liver inflammation using the Liver Span Test or Scratch Test [1].
Palpation
During palpation, the patient will be encouraged to breathe deeply and slowly and remain relaxed throughout the palpation [1]. The nurse will first lightly palpate the abdomen and assess for any masses, rigidity, tenderness or pain [1]. Then the nurse will then palpate the abdomen deeply assessing for masses, rigidity, tenderness, pain as well as the location, size, shape, consistency, surface texture, pulsation, mobility, and tenderness of various organs within the abdomen [1].
Inspection
With the patient laying flat on their back the nurse will look at the abdomen from various points of reference [1]. The size and shape of the abdomen is assessed [1]. The nurse looks for any masses or bulges, symmetry, hair distribution, pulsations/movement, and any skin abnormalities [1].
Auscultation
The nurse will use their stethoscope and listen to the patient's abdomen starting with the lower right quadrant. The nurse listens to both bowel sounds and vascular sounds (blood flow within the arteries) [1].
*The nurse may listen for a long time, this does not mean there is anything wrong. Sounds in the abdomen are normally irregular thus it is important for the assessor to listen over a longer period of time [1].
Percussion
The nurse will use their fingers to tap in various locations on the abdomen. This tapping is called percussion and is used to assess for tympany or dullness which indicate the relative dullness of organs [1]. The nurse will start with tapping in the lower right quadrant of the abdomen continuing clockwise ending in the lower left quadrant [1]. The nurse will determine the size of the liver and assess for liver inflammation using the Liver Span Test or Scratch Test [1].
- Liver Span: According to the percussion heard, the nurse will mark the top and bottom of the liver on the skin with a marker and use a ruler to measure [1].
- Scratch Test: The nurse will use their stethoscope, listen over the liver and will lightly scratch up and down the abdomen. The edges of the liver will be marked with a marker and measured with a ruler [1].
Palpation
During palpation, the patient will be encouraged to breathe deeply and slowly and remain relaxed throughout the palpation [1]. The nurse will first lightly palpate the abdomen and assess for any masses, rigidity, tenderness or pain [1]. Then the nurse will then palpate the abdomen deeply assessing for masses, rigidity, tenderness, pain as well as the location, size, shape, consistency, surface texture, pulsation, mobility, and tenderness of various organs within the abdomen [1].
- Liver: The nurse will then place one hand on the back with the other under the right side of the rib cage [1]. They will ask the patient to breath in deeply while they palpate the edge of the liver [1]. Any tenderness upon palpation should be verbalized and addressed by the patient [1].
Mental Status Examination/assessment
The nurse will perform Mental Status examinations throughout all stages of the cancer journey.
This assessment can be thought of as a physical assessment of the brain [3]. The nurse will focus primarily on the patient's coping abilities as well as the patient's pain. This is performed by the health care provider via an interview-like process [3].
This assessment does not include any physical body assessments but it is an assessment primarily focused on the mental, emotional and psychological state of the patient as well as their current coping strategies regarding illness, diagnosis and pain. This assessment is often overlooked in health care scenarios, however it is a crucial assessment which provides significant and valuable information to assist the patient and health care provider produce an optimal action and treatment plan for all parts of the liver cancer process [3].
This assessment can be thought of as a physical assessment of the brain [3]. The nurse will focus primarily on the patient's coping abilities as well as the patient's pain. This is performed by the health care provider via an interview-like process [3].
This assessment does not include any physical body assessments but it is an assessment primarily focused on the mental, emotional and psychological state of the patient as well as their current coping strategies regarding illness, diagnosis and pain. This assessment is often overlooked in health care scenarios, however it is a crucial assessment which provides significant and valuable information to assist the patient and health care provider produce an optimal action and treatment plan for all parts of the liver cancer process [3].
References
1. Jarvis, C. (2014). Physical examination & health assessment (2nd Cdn Ed). Elsevier: Canada.
2. Gimenes, F. R., Reis, R. K., da Silva, P. C., Silva, A. E., & Atila, E. (2015). Nursing assessment tool for people with liver cirrhosis. Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates, 39(4), 264–272.
3. Haddox, J. D. (1999). Pain-focused mental status examination. Current Review of Pain, 3(1):42-47.
2. Gimenes, F. R., Reis, R. K., da Silva, P. C., Silva, A. E., & Atila, E. (2015). Nursing assessment tool for people with liver cirrhosis. Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates, 39(4), 264–272.
3. Haddox, J. D. (1999). Pain-focused mental status examination. Current Review of Pain, 3(1):42-47.
Image Reference
Klepper, B. (2018). High-value healthcare: is it the wave of the future? Retrieved from: https://thedoctorweighsin.com/high-value-healthcare-new-approaches/