Competency Flashcards
hyperactive auscultation
(> 34 clicks/ gurgles/min): diarrhea, early intestinal obstruction
hypoactive auscultation
(< 5 clicks/ gurgles/min): peritonitis
normal auscultation
5-34 clicks or gurgles every min
abdominal screening options
fist percussion
finger percussion
palpation
kehrs sign
abdominal screening
left shoulder pain with palpation/pressure placed on upper abdomen
renal disease or irritation screening
percussion
palpation
hepatomegaly screening
finger percussion
fist percussion
palpation
cholecystitis screening
murphys sign
splenomegaly screening
finger percussion
fist percussion
palpation
appendicitis screening
palpation of McBurney’s point
Rovsing sign
peritonitis screening
rebound testing
Slightly lift tested side from table by placing hand under posterior surface of inferior costal margin and lifting
Palpate anteriolateral abdomen between umbilicus & inferior costal margin
Abnormal Findings:
Tenderness
Enlargement
Rough surface
kidney palpation
Place the left hand (open) on pt’s thorax with the 2nd or 3rd digit along mid-clavicular line
Beginning with 2nd or 3rd digit inferior to inferior border of liver, percuss dorsum of digit and observe for sound quality
Repeat as the hand is re-positioned cephalically
Abnormal Findings: Span of dull sound > 10 cm
liver finger percussion
Dummy Hand: Over anteriolateral surface of right inferior ribs
Percuss with fist on dorsum of dummy hand
Abnormal Findings: Tenderness with percussion
liver fist percussion
Slightly lift right side from table by placing left hand under posterior surface of inferior costal margin and lifting
Palpate with pads of fingers anteriolateral abdomen inferior to costal margin
Instruct pt to inhale deeply, as you palpate posteriorly & superiorly
At maximal inspiration, displace fingers anteriorly
Abnormal Findings: ability to palpate anterior edge of liver
liver palpation
Standing, left side of pt.
Percuss inferior intercostal space that is vertically aligned with the anterior axillary line
Repeat at full inspiration
Abnormal Findings:
Dullness, or dullness with full inspiration
Castell’s finger percussion of the spleen
Examiner Position: Standing to left side of pt.
Percuss area overlaying the spleen
Abnormal Findings: Tenderness with percussion
spleen fist percussion
Examiner Position: Standing superior to pt’s left shoulder
Curl fingertips under left costal margin in posterior & superior direction
Abnormal Findings: Palpable Spleen
Middleton palpation method
Examiner Position: Standing to right side of pt.
Slightly lift right side from table by placing left hand under posterior surface of inferior costal margin and lifting
Palpate with pads of fingers anteriolateral abdomen inferior to costal margin
Instruct pt to inhale deeply, as you deeply palpate right upper quadrant
Abnormal Findings:
Tenderness
Inspiratory arrest
Murphy’s sign for the gallbladder
Deep palpation at a point 1/2 – 1/3 distance from the ASIS to the umbilicus
Rebound tenderness has also been described
Abnormal Findings: Tenderness
palpation of McBurney’s point (appendix)
Examiner Position: Standing to right side of pt.
Rebound tenderness testing administered at the lower left quadrant
Abnormal Findings: right lower quadrant tenderness with remote rebound testing at the left lower quarter
Rovsing signs for appendix
Gently grasp a fold of abdominal skin over McBurney’s point and pull away
Allow the skin to quickly recoil back against peritoneum
Positive Test: pain upon release of the skin fold
Pinch an inch
for appendix or peritonitis
Examiner Position: Standing to right side of pt.
Rebound tenderness is administered in each quadrant
Abnormal Findings: Tenderness
rebound tenderness for peritonitis
psoas
- ACTIVE– Iliopsoas muscle test– have the Pt actively perform a SLR and apply resistance to the distal thigh
- PASSIVE– place client in supine position and have them unweight their leg from you as you are palpating
heel tap– Gently pick up the pt’s involved leg and tap the heel
–> Positive test: RLQ pain
obturator muscle test– resisted IR (make sure hip is in ABD)
obturator or psoas abscess
Administer finger percussion in supine
If pattern of dullness observed in perimeter of abdomen, repeat in side-lying
Abnormal Findings: Dullness shifts to dependent side during side-lying position
shifting dullness for ascites
Tap one side with fingertips while palpating other side
Abnormal Findings: Palpable fluid wave
fluid wave for ascites
Palpate (deep palpation) for aortic pulse superior & slightly left of umbilicus
Place palms on abdomen with index fingers on each side of aorta
Abnormal Findings: width > 3cm
abdominal aortic aneurysm
