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OMED1401 - Patient Assessment > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

What is the very first step you take when you walk into the room with the patient?

A

Using your DRABC (Danger, Response, Airway, Breathing, Circulation), introduce yourself and gain consent from the patient.

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2
Q

Primary Survey - End of Bed Assessment - What are the 5 main things to look out for?

A

Have a look at the patient and note anything that looks wrong or abnormal. You will have done some of the end of bed assessment when you do DRABCDE.

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3
Q

What are the 6 main vital signs and their normal ranges?

A
  1. Temperature (36.5c - 37.3c) (Average is 37c)
  2. Blood Pressure (120/80 mm hg)
  3. Blood Glucose Level (Before eating: 4.0 - 5.9 mmol/L)(After eating: <7.8 mmol/L) REMEMBER: Diabetes patients will be higher.
  4. Heat Rate (60-100 BPM)
  5. Oxygen Saturation (95%+) REMEMBER: COPD patients (88-92%)
  6. Respiratory Rate (12-20 breaths per minute)
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4
Q

What makes a patient time critical?

A
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5
Q

What are the 6 main red flags and their associated symptoms in an abdominal assessment?

A
  1. AAA (Abdominal Aortic Aneurysm) - Sudden severe abdo/back pain (tearing characteristic), hypotension, pulsating mass
  2. Appendicitis - Pain starts in umbilical area, settles in lower right, rebound tenderness
  3. Intestinal obstruction - Cramping pain
  4. Acute pancreatitis - constant pain in upper left quadrant
  5. Ectopic pregnancy - Atypical presentation, pelvic pain
  6. Intussusception - paediatrics mainly, positioning, jelly stool
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6
Q

What are the 8 parts of the medical model for taking patient history?

A

PC - Presenting Complaint (What was the reason you called us today?)

HPC - History of Presenting Complaint (Use SOCRATES)

PMH - Patient Medical History (Do you have any previous medical history?)

PSH - Patient Surgical History (Have you had any previous surgeries?)

DH - Drug History (Are you taking any drugs? Have you got a list? Twice-a-day/Once-a-day? Recreational drugs?) Important: Ask for allergies here.

SH - Social History (Do they smoke/drink? How many a day/week? Do you use any illegal substances?)

FH - Family History (Do your family suffer from anything?)

ROS - Review of Systems

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7
Q

What are the 7 important things to ask about or consider when doing an abdominal assessment?

A
  1. Ask about surgical history (Were there any follow ups/complications/etc)
  2. Sexual history (The 5 p’s: partners, practices, protection from STIs, past history of STIs, prevention of pregnancy)
  3. Ask female patients about their menstrual periods (On time/painful/difference/etc)
  4. Urine colour (When did they last go/does it hurt when you urinate/what colour is it/strange smells/frequency/amount)
  5. Bowels (Any constipation/any diarrhoea/last time opened bowels/normal/was it watery/was it solid/what colour is it)
  6. Female genital mutilation (Ask about procedures)
  7. Vomiting (Colour/how often/one off/intermittent/projective/what was in it)
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8
Q

What acronym would you use to get a full patient history of pain, and what does each letter stand for?

A

SOCRATES

S - Site (Where is the pain? Could you point to it for me?)

O - Onset (When did it start? What is quite sudden or gradual?)

C - Character of Pain (Could you describe the pain for me?)

R - Radiation (Does the pain move anywhere?)

A - Associations (Apart from pain, is there any other other symptoms or problems?)

T - Time Course (Since your pain started, has it got better or worse or stayed the same?)

E - Exacerbating/Relieving Factors (Is there anything that you do that makes the pain worse/better?)

S - Severity (On a scale of 1-10, 1 being the lowest and 10 being the most pain you’ve ever felt what would you say your pain is?)

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9
Q

In what order do you inspect, percuss, palpate and auscultate on an abdomen assessment and why is it different?

A

IAPP - It is different because palpating/percussing could cause more problems in the abdomen so better to auscultate first.

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10
Q

Primary Survey - Assess Hands - What are the main 5 things to look out for in the hands?

A
  1. Cyanosis
  2. Clubbing
  3. Asterixis - Ask the patient to put their hands out in front of them and hold their fingers towards the ceiling. If they start to tremor from the wrist area, its a positive sign of liver flap.
  4. Palmar Erythema - Rash/redness of the inside of the hands
  5. Koilonychia - spoon nails sign of either a liver condition known as haemochromatosis or anaemia
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11
Q

Primary Survey - Assess Arms - What are the main 3 things to look out for in the arms?

A
  1. Purpura rash - can indicate blood clotting disorders - significant for increased bleeding from trauma (can also be caused by sun damage)
  2. Petechiae - Small tiny rashes (dot like) - leak in capillaries, can be sign of infection, chronic liver disease and trauma
  3. Track marks could make the patient high risk of hepatitis
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12
Q

Primary Survey - Assess face - What are the main 6 thinks to look for in the face?

A
  1. Cyanosis
  2. Jaundice
  3. Anaemia
  4. Xanthelasma
  5. Arcus Senilis
  6. Chemosis - Redness in the white/pink mist - sign of allergy or infection
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13
Q

How do you assess the JVP and what is the normal ranges? What is it indicative of if enlarged?

A
  1. Check pulses in both carotid arteries. IMPORTANT: Not at the same time. Are they beating at the same time with the radial pulse?
  2. Locate the external jugular vein (runs from the angle of the jaw to the mid-clavicle)
  3. Lay the patient down to approximately 30-45 degrees. Move the patient head so they are facing away from you. Look for pulsation of the IJV. Measure the point from the sternal notch.
  4. Normal range is >4cm. Abnormal ranges can indicate an enlarged liver.
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14
Q

What do you assess in the neck of a patient during an abdominal assessment?

A

Virchow’s Node - Check the left lateral supraclavicular neck for prominent Virchow’s node.

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15
Q

What are the 9 abdominal regions? (Starting from top right, going right, numerically)

A
  1. Right hypochondriac
  2. Epigastric
  3. Left hypochondriac
  4. Right Lumbar
  5. Umbilical
  6. Left Lumbar
  7. Right Iliac
  8. Hypogastric
  9. Left Iliac
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16
Q

What major organs can be found in each of the 9 abdominal regions? (Starting from top right, going right, numerically)

A
  1. Liver, gallbladder, right kidney
  2. Stomach, liver, pancreas, right and left kidneys
  3. Stomach, liver (tip), left kidney, spleen
  4. Liver (tip), small intestines, ascending colon, right kidney
  5. Stomach, pancreas, small intestines, transverse colon
  6. Small intestines, descending colon, left kidney
  7. Small intestines, appendix, cecum and ascending colon
  8. Small intestines, sigmoid, bladder
  9. Small intestines, descending colon, sigmoid colon
17
Q

Primary Survey - Inspection of abdomen - What are the 10 main things to look for when inspecting the abdomen?

A
  1. Hernia
  2. Stretch marks - could indicate a gastric band
  3. Caput medusae - engorged veins around the umbilicus - sign of portal hypertension
  4. Cushing’s Syndrome - People with portal hypertension can have crushing’s syndrome - Abdomen is swollen
  5. Spider Naevi - Small lesion on patient abdomen (can be found arms/face) looks like a small spider - indication of liver disease
  6. Scars - Previous surgeries?
  7. Masses - Pulsating masses (AAA)
  8. Stoma - Previous surgeries?
  9. Cullen’s Sign - Bruising around the umbilicus - commonly pancreatic disease
  10. Grey Turner’s Sign - Bruising around the pelvic area - commonly pancreatic disease
18
Q

Where do you auscultate in an abdominal assessment and what are you listening for?

A

Auscultate the 4 quadrants and listen for on bowel sound, maximum of 2-3 minutes on each quadrant. Listen out for aortic bruits and renal artery bruits.

19
Q

What are the two main places to percuss anatomically and what are the normal measurements?

A
  1. Hepatomegaly - Normal 5th intercostal space, 8cm height, 6-12cm span
  2. Splenomegaly - Normal lying between 9th-11th rib, 3cm x 5cm x 7cm
20
Q

Primary Survey - Palpation of abdomen

A

Light palpation first, and then deep palpation after.

Light palpate away from the pain, do the other regions/quadrants first. If the patient then tolerates the light palpation, you will palpate deeply with your fingers away from the pain first.

If the patient does not tolerate the light palpation, do not deep palpate.

21
Q

What is referred pain?

A

Referred pain is pain perceived at a location other than the site of the painful stimulus/origin. This happens due to the network of interconnecting sensory nerves.

22
Q

What are the 7 common symptoms associated with appendicitis?

A
  1. Abdominal pain (most common)
  2. Nausea (61-92%)
  3. Anorexia (74-78%)
  4. Vomiting - nearly always follows after onset of pain: vomiting that then precedes pain suggests intestinal blockage
  5. Diarrhoea or constipation (18%)
  6. Rebound tenderness, pain on percussion, rigidity, guarding (most specific finding)
  7. Male infants and children occasionally present with an inflamed hemiscrotum
23
Q

What are the 3 special tests that can be undertaken to check the appendix?

A
  1. Rovsing sign (RLQ pain with palpation of the LLQ): suggests peritoneal irritation, specifically appendicitis
  2. Obturator sign (RLQ pain with internal and external rotation of the flexed right hip): suggests the inflamed appendix is located deep in the right hemipelvis
  3. Psoas sign (RLQ pain with extension of the right hip or with flexion of the right hip against resistance): suggests that an inflamed appendix is located along the course of the right psoas muscle
24
Q

How do you find McBurney’s point and what do you need to be careful of?

A

Draw an imaginary line from the right iliac crest to the umbilicus, McBurney’s point is one third from the iliac crest. Pain upon deep palpation at this location is a sign of acute appendicitis.

Be careful of palpating too hard as this will cause the patient to guard.

25
Q

What is rebound tenderness and how do you check for it?

A

Rebound tenderness is where there is pain upon removal of pressure.

When palpating an area, press down with your fingertips and watch the patient. Release pressure quickly and note any grimace/pain.

26
Q

How do you check for acute cholecystitis?

A

Murphy’s Sign - Ask patient to exhale and place hands below costal margin on the right side at the mid-clavicular line. The patient is then instructed to inspire.

If the patient stops breathing in and winces with a ‘catch’ in breath, its considered positive which indicates acute cholecystitis.

(Inflammation of the gall bladder)

27
Q

What are the 7 common symptoms for acute cholecystitis?

A
  1. Jaundice
  2. Fever & Leucocytosis
  3. Anorexia
  4. Fat intolerance
  5. Feeling of fullness
  6. Abdominal distention
  7. Pain in the right upper quadrant or right shoulder, may radiate to back, increases with deep breath
28
Q

What are the ‘5 F’ gallstone risk factors?

A
  1. Female
  2. Fair complexion
  3. 40+
  4. Fertile
  5. Fat
29
Q

How do you palpate the kidney?

A

Place your right hand on the right side of the abdomen just below the costal margin, above the umbilicus and place your left hand under the back below the liver.

Press firmly up with the left hand and down with the right. Repeat this on the left side. If the kidney is enlarged, it will be palpable.

30
Q

What are the 4 main symptoms of renal calculi?

A
  1. Nausea + vomiting
  2. Haematuria (blood in urine)
  3. Pain radiates flank area
  4. Sharp, sudden, severe pain: may be intermittent depending on stone movement
31
Q

What are the 6 main risk factors of renal calculi?

A
  1. Male
  2. 40+
  3. Infection
  4. Urinary stasis (not urinating)
  5. Immobility
  6. Hypercalcemia

OMED1401 - Patient Assessment (3 decks)

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