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Health Assessment > Exam 1 - Abdomen > Flashcards

Exam 1 - Abdomen Flashcards

1
Q

Blumbergs Sign

A

To diagnose appendicitis…rebound tenderness RLQ.

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2
Q

McBurneys Point

A

1 cm above the anterosuperior iliac spine, between the ileum and the umbilicus.

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3
Q

Borborygmi

A

Stomach growling

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4
Q

Dysphagia

A

Difficulty swallowing

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5
Q

Peritonitis

A

Local or generalized infection of the peritoneal membrane of the abdomen

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6
Q

Referred Pain

A

a pain at a location other then the site of the painful stimulus

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7
Q

Melena

A

Black tarry stools

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8
Q

Steatorrhea

A

excess fat in stool, oily, floats, fowl smelling

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9
Q

Abates

A

to reduce in amount, degree, or intensity

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10
Q

What history questions should be asked when assessing the abdominal system?

A

Weight loss?

Change in color of stool?

Nausea and vomiting?

Unrelenting constipation?

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11
Q

Organs for Deep Palpation

A

Liver, Spleen, Kidneys, Aorta, Bladder

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12
Q

Rovsings Sign

A

referred pain press in LLQ w/quick release pain results in McBurneys point RLQ

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13
Q

Blumberg sign

A

rebound tenderness - RLQ stabbing pain as compressed area

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14
Q

Murphy’s Sign

A

test for CHOLECYSTITIS - gall bladder palpate liver - right costal border

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15
Q

Pulsation

A

aorta to epigastric area can see on normal thin person w/ good muscle relaxation

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16
Q

Organomegaly

A

enlargement of system organs

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17
Q

Organs for RLQ

A

appendix, ascending colon, cecum, right ovary, right spermatic cord, right kidney lower pole

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18
Q

Organs for RUQ

A

liver, gall bladder, ascending and transverse colon, right adrenal glad, right upper pole of kidney, ureter

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19
Q

Organs for LUQ

A

pancreas, spleen, stomach, transverse colon, left upper pole of kidney, splenic flexure of colon

20
Q

Organs for LLQ

A

descending and sigmoid colon, left ovary and tube, left spermatic cord, left kidney lower pole, left ureter

21
Q

Solid Organs

A

liver, pancreas, spleen, kidneys, ovaries, uterus

22
Q

Hollow Organs

A

stomach, gall bladder, small intestine, colon, bladder

23
Q

Order of Assessment of the Abdomen

A

inspection

auscultation - begin in RLQ, to RUQ, to LUQ to LLQ

percussion

palpation

24
Q

Bowel Obstruction

A

Subjective - pt has cramping, bloating, belly pain Objective - vomiting, large, hard belly Cause - tumors, scar tissue

25
Q

Organ perforation

A

Subjective - pt has burning pain, flatulence, dyspepsia

Objective - rigidity of abdomen, rebound tenderness

Cause - gastric ulcer, appendicitis, GI cancer

26
Q

Peptic Ulcer

A

Subjective - pt has severe heartburn, pain radiates to back or flank Objective - vomiting, bloating, weight loss or gain, melena(black tarry stool)

27
Q

Duodenal Ulcer

A

Subjective - pt has pain in upper abdomen just below sternum

Objective - bloating and retching

Cause - H. pylori, anti-inflammatory meds (NSAIDS)

28
Q

Malignancy of abdominal organ

A

Subjective - depends on organ and extent of cancer

Objective - increased abdominal girth, enlarged organ, lymph nodes, or ascites

Cause - metastasis, spread from other organs

29
Q

Paralytic Illeus

A

Subjective - pt has fullness, gas, constipation

Objective - distended abdomen, diarrhea, foul-smelling breath

Cause - electrolyte imbalance, gastroenteritis, appendicitis, surgical complications, certain drugs

30
Q

What is diastasis recti?

A

separation of the rectus abdominis muscles that run vertically down the midline of the abdomen

31
Q

How do you assess it?

A

http://www.youtube.com/watch?v=EsTR4i9yZxM

32
Q

Where is McBurney’s Point?

A

on a line between the ileum and umbilicus

33
Q

Assessment techniques for appendicitis

A
  1. Psoas
  2. Obturator
  3. Rovsing
  4. Blumberg
34
Q

What are common causes of Ascites?

A

CHF, cirrohis, renal failure, cancer

35
Q

How does the nurse assess a painful abdomen?

A

look for nonverbal cues of discomfort

look at facial expressions

examine the most painful area last and superficially to prevent rupture

36
Q

What are developmental considerations when assessing the abdomen?

A

Age - infants, children, elderly Pregnancy

37
Q

What is guarding?

A

involuntary abdominal muscle contractions

38
Q

How does a nurse lightly palpate the abdomen?

A

on the skin soft and non-tender to assess for tenderness or guarding

39
Q

Where does the nurse palpate the aorta?

A

below the xiphoid process average aorta is 1.17 inch wide

40
Q

What are abnormal bowel sounds on auscultation?

A

Hypoactive - post-op, infection, trauma, hypothyroidism

Hyperactive - frequent high pitched sounds

absent - ileus or bowel obstruction

borborygmus - stomach growling

succusion splash -sloshing of fluids

41
Q

What are diseases of the liver?

A

cirrhosis, portal hypertension, liver failure, cancer, hepatitis

42
Q

What is an abdominal aortic aneurysm?

A

an enlarged area in the lower part of the aorta, the major blood vessel that supplies blood to the body.

43
Q

What are bowel sounds upon auscultation?

A

high pitched, intermittent gurgling sounds, heard in all quadrants, occur 5-30 times per minute

44
Q

Psoas sign

A

place examiner’s hand just above the client’s knee

instruct client to lift right leg which contracts psoas muscle

or have pt flex thigh at hip

positive test results in increased pain in the abdomen

45
Q

Obturator Sign

A

stretch the obturator muscle by lifting the right leg, bend the knee and move the bent knee medially to stretch the muscle.

Positive results in pain in the hypogastric or suprapubic region

46
Q

Rovsing Sign

A

Press in LLQ with quick release

Positive sign results in pain over McBurney’s point in RLQ(referred pain)

Health Assessment (5 decks)

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