NCLEX Review Guide: Gastrointestinal & Nutrition Assessment

Physical Assessment Sequence

• Inspection, Auscultation, Percussion, Palpation - GI assessment follows this specific order to prevent altering bowel sounds through manipulation
• Inspect abdomen for contour, symmetry, visible peristalsis, pulsations, and skin changes in supine position with knees slightly flexed
• Auscultate all four quadrants for bowel sounds, bruits, and venous hums using diaphragm of stethoscope for 30 seconds minimum per quadrant

Anthropometric Measurements

• Body Mass Index (BMI) calculated as weight (kg) divided by height (m²) with normal range 18.5-24.9
• Triceps skinfold thickness measures subcutaneous fat stores and indicates protein-energy malnutrition when below 10th percentile
• Mid-arm circumference reflects muscle mass and protein stores with measurements compared to standard reference values

Protein Status Markers

• Serum albumin (normal 3.5-5.0 g/dL) reflects long-term protein status but has 21-day half-life making it slow to change
• Prealbumin (transthyretin) normal 15-36 mg/dL with 2-day half-life provides rapid assessment of protein synthesis changes
• Transferrin levels (normal 250-300 mg/dL) indicate iron transport capacity and protein-energy nutritional status

Abnormal Findings & Clinical Significance

• Rebound tenderness (Blumberg's sign) indicates peritoneal irritation and potential appendicitis requiring immediate medical attention
• Murphy's sign (inspiratory arrest during palpation of RUQ) suggests acute cholecystitis
• Shifting dullness and fluid wave indicate ascites from liver disease, heart failure, or malignancy

1. Always inspect abdomen before auscultation to avoid altering bowel sounds
2. Listen to bowel sounds for minimum 30 seconds per quadrant
3. Document absent bowel sounds only after listening for full 5 minutes
4. Remember prealbumin changes faster than albumin for nutritional monitoring