abdominal assessment - exam 2 Flashcards
What should you ask the patient to do prior to abdominal assessment?
empty bladder
Observation- Asymmetries:
the umbilicus should be ______
surface contour; any distention could be bowel obstruction, mass, etc.
swelling or ascites- possibility indicated by an inverted umbilicus
midline
Discoloration -
Jaundice:
Eccymosis:
Vein detention:
jaundice w/ liver dysfunction, ecchymosis indicating bleeding, vein detention indicating liver or vena cava obstruction
Markings such as
scars, rashes, stretch marks
A pulsatile mass may indicate __________________ but is not unusual in lean individuals
abdominal aortic aneurysm
A wavelike motion may indicate intestinal obstruction:
peristalsis
What can indicate an hernia:
sudden bulging w lifting of the head or a cough indicate a hernia
Auscultations should be performed before ___________ and ________ to avoid altering the bowel sounds
percussion and palpation
Utilize stethoscope for ________mins. in each quadrant
2 min.
Bowel Sounds:
—check each quadrant in a one spot T or F?
False- check in multiple spots
What is a normal sound for the bowel?
—-abnormal? (2)
high-pitched clicks and gurgling every 5-10 secs.
non may indicate bowel obstruction, particularly w/cramping
more may indicate overactivity i.e., w/lactotse intolerance
Abdominal Aorta- just ______ of midline and _______ at peri-sternal line
_________indicate turbulent blood flow
left; umbilicus
Bruits
Percussions Procedure:
-hyperextend and apply firm pressure w/ the non-dominant and distal aspect of the middle finger
-Avoid contact w/ any other part of the head
-Position dominant hand close to surface w/ wrist extended
-Strike the non-dominant middle finger quickly and sharply w/ flexed dominant middle finger
-Strike twice
What are normal sounds of percussions?
tympanic or hollow sound over stomach and bowels or more air-filled organs unless one is full of “substance”
Deep________ or lasting _______ over thorax and lung
_______ sound over more solid or dull organs or even tumors
—-ex
resonance; sound
Dull; liver, heart, & diaphragm or spleen
Location of the stomach to perform percussion?
Empty -sound? Full- Sound?
close to the lower left rib cage just inf. sternum
Emtypy- tympanic or hollow ; Full - dull
Mid-clavicular percussion of liver location?
sounds: starts/changes to ….
just above the umbilicus, along the midclavicular line -progress superiorly
starts w/ tympany or hollow sound of bowel —> changes to dullness @ liver for 2.5 to 5 inches
Abnormal sound of mid-clavicular percussion of the liver:
larger area of dullness
Percussion of Spleen:
–Location
–Normal/ Abnormal sound
starts left lower rib cage anterior axillary line
Normal: tympany or hollowness should be produced; move posteriorly toward mid-axillary line —–> dull (present between 9th and 11th ribs)
Abnormal: dullness noted more medially and inferiorly, more dullness while inspiring.
Kidney percussion (Murphy Test ) in sitting or prone with a firm
fist thumping on the contralateral flat hand over costovertebral angle looking for P!
Kidney palpations you should start with:
-hand placement:
-be sure to look for _______ & _______
-Normal feel:
firm, light pressure in a slow circular fashion within each quadrant
broad hand contact, and possibly palpate through the patient’s hands
masses & mm. guarding
pressure
Kidney palpations
Abnormal feel:
–confirm by doing:
–progress to:
–crepitus or crunchiness indicate ______
tenderness or muscle gauding may indicate swelling or dysfunction
confirm for a similar response with percussion or cough
progress to rebound tenderness if necessary by applying pressure then quickly release
excess air
Hernia is common around the umbilicus and inguinal areas. T or F
True
Notable areas of potential swelling during palpation:
Gastritis (stomach inflammation)
Diverticulitis (intestinal inflammation)
Appendicitis (appendix inflammation)
Hepatitis (liver inflammation)
Pancreatitis (pancreas inflammation)
Spleen
Abdominal Aorta Artery:
—pt. position
—PT should utilize:
—find pulse just to the_________
hook lying
two index fingers
left of the umbilicus or left peri sternal line and masses up and down abdominal region
what are the grades to assess strength of someone’s abdominal aortic artery?
0 = absent
2+ = normal
4+ = bounding
You can assess the width of the abdominal aortic artery by
–normal width
—abnormal width –> confirm with?
slowly moving fingers apart
1 inch
≥ 3cm may indicate aneurysm; auscultation
How do you perform neuro testing for the abdomen:
T7-T12 w/ light and sharp touch from xiphoid process to inguinal ligament
Superficial abdominal reflex for UMN lesion is assessing _______ lesion
– test by:
–normal:
UMN
diagonally stroking from umbilicus to outer border of each quadrant
the umbilicus should move in the direction of the stroke
