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NUR 109 - Health Assessment > Abdomen Assessment > Flashcards

Abdomen Assessment Flashcards

1
Q

MMSE (minimental state examination )

A 
30 max ::: LT 23=cog impairment 
orientation
registration 
attention and calculation
recall
language
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2
Q

thready vs bounding

A

barely felt and easily obliterated

easilty felt and hard to oblit

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3
Q

Percussion sounds

A 
Tympany 
dull
Resonance
hyper"
Flatness
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4
Q

Tympany

A

loud, high pitch, drumlike

heard over air filled viscera

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5
Q

Dull percussion

A

soft to moderate medium pitch, thud like

over fluid, organs, fat or distended bladder

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6
Q

Resonacnce

A

moderate to loud, hollow, low pitch

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7
Q

Hyperresonance

A

soft, booming, low pitch

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8
Q

flatness percussion

A

loud, dull, high ptich

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9
Q

Pallor

A

pale

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10
Q

cyanosis

A

blusih discoloration

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11
Q

AST and ALT aspartate/alanine aminotransferase

A

large amounts in liver and heart

LT but sig amounts in muscle, kidneys pancreas, brain

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12
Q

NH4 test

A

severe liver damage and at hepatic portal from AA breakdown

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13
Q

bilirubin test

A

heme catalysois from marrow liver spleen –>jaundice in skin and sclera

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14
Q

liver biopsy

A

determine cell morpho and abnormalitys

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15
Q

Liver and spleen ultrasound

A

for structure, size, and position

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16
Q

Hepatobilliary iminodiacetic acid scan (HIDA)

A

tracking bile production from liver to SI to ID gall, bile duct, liver problems

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17
Q

Amalyse lipase enymes indicate what

A

obstuction and acinar cell damage –> obstruc inflam early cancer

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18
Q

Esophagogastroduodenoscopy test

A

endoscope to assess mucose of upper GI, remove foreing bodies polyps and diagnosis

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19
Q

Stool analysis to ID what

A

volume, oder, shape, color, consistancy, mucus, pathogens and substances

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20
Q

Fecal Occult blood test (FOBT)

A

hidden blood in shit as first sign of colon cancer

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21
Q

Liver loci

A

most of RUQ

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22
Q

Gallbladder loci

A

RUQ

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23
Q

Pancreas loci

A

UQs touches lower spleen and bottom sits in duodenum

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24
Q

stomach loci

A

somewhere

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25
Spleen loci
LUQ to epigastric region under cage ()
26
(Veriform) appendix
9 cm RLQ | 2 in under McBurny's point
27
McBurny's point
Ileocecal valve here between umbilical and pelvis at ()
28
Kidney loci
Either side of T12 to L3 | R kidnet is 1-2 cm lower than L bc of libver
29
BUN test
blood urea test: [NH4] for kidney function
30
Creatinine
end product of muscle metab
31
GFR
glomerulaer filtration rate= blood that passes glom in 1 min
32
Ab major arteries
Aorta Renals Iliacs Femorals
33
Liver HH foci
``` ▲weight ▲appitite/tolerance dysphagia (diff swallowing) Nausia/vomiting Indigestion/Hearburn Ab/Pelvic pain Constipation/Diarrhea (narrow stools =obstuction) Gas Urination ▲skin travel ```
34
Pyrosis
burning sensation in epigastic area radiating to thraot
35
Exact sequence of Ab assessment
Inspection Ausculation Indirect Percussion Paplpation (light then deep)
36
9 quadrent system
LR hypochondriac mid=epigastric region RL lumbar mid=umbilical region LR Iliac mid: hypogastric
37
Organs in RUQ
``` Duodenum Gall liver pancreas head R kidney/adrenal hepatic flexure of colon part of asc/trans colon ```
38
LUQ organs
``` L lobe of liver stomach spleen body of panc L kid/adrenal splenic flexure of colon part of trans/desc colon ```
39
RLQ organs
``` Cecum Appendix R ovary/tube R ureter R spermatic cord part of ascending colon ```
40
LLQ organs
``` part of desc colon sigmoid colon L ovary/tube left ureter L spermatic cord ```
41
Midline organs
Aorta uterus bladder
42
Abnormal ab inspection
↑peristalic waves/pulsations distension hernia
43
↑ peri waves →
seen with obstruction
44
Ab pulastions →
aortic aneurysm
45
aneurysm
wakening and outpouching of artery
46
AB distension
fluid, fat, gas, fibroids baby
47
Asceites
fluid accumulation in peritoneal cavity
48
Diastasis recti
spliting of rectus abdominis muscuiles at midline (linea alba)
49
hernias
weaking of ab wall loops of intestines and tissues pass into the peritoneuam classifed by loci: inguinal, epigastric, ubmilical, incisional, Diastasis recti
50
Cullen's sign
ecchymosis arround the umbilicus → intra-ab bleeding
51
ecchymosis
superficial bleeding under skin
52
Bowel Ausc
Start at McBurny's point in RLQ to RUQ around
53
Normal clicks and gurges #
5-34
54
abnormal bowl asuc
hyperactive hypoactive no soiunds
55
Hyperactive bowel
loud high pitched sounds | in people with diarrhea, laxatives, gastroenteritis, and early obstruction
56
hypoactive bowel
slow ↓sounds | in epople with constipation, obstruction, medicatsions
57
no bowel sounds
may → paralytic ileus after surgery, bowel obstruction
58
Vascular bowl sounds
Use bell over 4 major arteries for no bruits
59
Bruits in bowels
liver disease or portal distension
60
Bruits
Turbulent, blowing sounds over partially or totally obstructed artery caused by buildup of plaque
61
Venous hum in bowel
continues medium pitched sound caused by bruits
62
Friction rub
grating sounds heard over inflamed organs with serous surfaces commonly over the RUQ liver or LUQ spleen
63
Ab Percussion
Indirect percussion for note and quality of sounds | Normally tympani in the 4 quadrants and dullness over organs
64
abnormal tympany over bowels can →
distension
65
abnomrnal dullness over bowels →
↑tissue density like organ enlargement or mass
66
pain in percussion →
peritoneal infammation
67
Splenic enlargement
expands ant, inf, and medially. replaces tymp of stomach and colon with dullness 3x to palpate
68
Palpation of ab
Light digs 1/2 deep and deep digs 1.5-2" deep | Paplate clockwise look for pain
69
Ab palp abnormals
Tenderness Light: nodule or mass felt Deep: mases enlarged organs
70
Rebound tenderness
indicative of peritoneal inflammation | check by slowly pressing on tender area and quickly let go
71
Bladder palpation
lightly palp for distended bladder between symphysis pubis and umbilicus. note size and loci
72
Bladder palp normal vs abnormal
N: empty not palp Partially filled is firm and smooth A: smooth round and firm mass extending as far up as the umbilicus Tenderness may → bladder infection
73
Aceites
abnormal fluid accumulation, detectable after 500 mL with percussion , fluid waves and ultrasound dull percussion laterally to fluid tympany at mid ab
74
Paracentesis
procedure to remove fluid from peritoneal cavity by needle insertion into the cavity. Usually done when person is respiratory distress or ad pain

NUR 109 - Health Assessment (6 decks)

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