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Sem. A - PAM 1 > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

On the Exam

A

end of bed assessment

safety

time critical

Pt general appearance

JACCO

Level of consciousness

obvious pain?

obs/vital signs

is the a temp?

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2
Q

Identify pain…

A

ask about pain…

SOCRATES

ask the Pt to point to the site of pain with 1 finger (assess that area last)

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3
Q

SOCRATES…

A

Site of the pain

Onset time

Character of the pain

Radiates

Associated symptoms

Timing

Exacerbating/relieving factors

Severity - ‘10/10’

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4
Q

Character of the pain…

A

Burning/cramping/stabbing?

What do they mean?

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5
Q

Types of, and referred pain…

A
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6
Q

Referred pain sites

A
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7
Q

Associated symptoms…

A

Weight loss

blood in the vomit or stools

haematuria

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8
Q

Start assessment…

A

Gain consent:

  • if possible ask pt to empty bladder
  • remember pt modesty
  • set room/vehicle temp
  • raise pt head to approx 30 degrees

begin a systematic approach:

  • Inspect
  • Auscultate
  • Percuss
  • Palpate
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9
Q

Mentally divide the abdomen into 4 quadrants…

A
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10
Q

Consider what lies beneath the surface of each quadrant…

A
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11
Q

Inspection - Hands Off!

A

Look for symmetry, lumps, bumps, scars, striae, colour

Look for signs of bruising:

  • Cullen’s sign at the umbilicus
  • Grey Turner’s sign at the flanks

Pulsating masses:

  • in thin Pt you may visibly see pulsation of the Aorta
  • marked pulsation may indicate AAA/Hypertension
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12
Q

Cullen’s Sign

A
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13
Q

Grey Turner’s Sign

A
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14
Q

Abdominal Bruising

A

ALthough protected beneath the bony ribcage, the spleen remains the most commonly affected organ in blunt injury to the abdomen in all age groups.

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15
Q

Auscultate all 4 quadrants

A
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16
Q

Auscultation…

A

Warm your stethoscope.

Lightly place the diaphragm slightly below and to the Right of the umbilicus in the lower Right quadrant.

Continue in a clockwise fashion in each of the 4 quadrants.

Make note of the quality and character of the bowel sounds.

17
Q

Abdominal Auscultation Landmarks

A
18
Q

Abdominal Sounds

A

Normal sounds are high pitched.

Normal variation between 5 to 34 sounds per minute.

Bowel sounds are classified as hypoactive, normal, or hyperactive.

19
Q

Percuss…

A

All 4 quadrants.

Normal/Tympanic/Dull.

PN - Percussion Note.

Begin in the lower Right quadrant the proceed clockwise to cover all 4 quadrants.

20
Q

Do NOT Percuss the Abdomen of…

A

A Pt with a suspected abdominal aortic aneurysm.

or

The abdomen of a Pt with a transplanted abdominal organ.

21
Q

Palpation

A

Detects tenderness of organs, masses or fluid accumulation.

Light palpation is used to assess tenderness and guarding.

Deep palpation is used to assess for masses(not recommended for Paramedics)

22
Q

Palpation Technique

A

Talk to the Pt.

Light palpation.

With fingertips make gentle rotating movements(1/2 inch/1.5 cm).

Don’t look at the abdomen, look at the Pt face guarding.

Palpate in all 4 quadrants, leaving painful areas till last.

23
Q

Special Tests

A

Rebound Tenderness

Psoas sign

Rovsings sign

Obturator sign

Murphy’s sign

24
Q

? Appendicitis

A

Red flags

Psoas’ sign

Rovsing’s sign

McBurney point

25
Q

McBurney Point

A
26
Q

Murphy’s Sign

A
27
Q

Challenges

A

Importance of quality History.

Life threatening causes.

Women & abdominal pain.

Lots of possible causes, of which some are life threatening & time critical.

28
Q

Documentation

A

Document all findings.

+ve & -ve are of equal value.

Can use diagrams to denote findings.

29
Q

Abbreviations

A

RUQ - Right Upper Quadrant

LUQ - Left Upper Quadrant

LRQ - Lower Right Quadrant

LLQ - Lower Left Quadrant

BS - Bowel Sounds

PN - Percussion Note

30
Q

Documenting Abbreviation example

A

I - no scars, bruising, masses

A - Normal BS x 4Q

P - PN normal x 4Q

P - Abdo soft, non-tender, ºrebound, ºguarding, Murphy’s -ve, Psoas -ve

31
Q

Big sick vs Little sick?

A

Abdominal pain red flags include (but aren’t limited to)…

A concerning global overview

Systemically unwell

Rigid abdomen

Signs of dehydration

Absent/altered bowel sounds

Involuntary guarding/rebound tenderness

tenderness on percussion

Sem. A - PAM 1 (4 decks)

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