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Health Assessment > Exam 4 - Abdomen > Flashcards

Exam 4 - Abdomen Flashcards

1
Q

Subjective data to ask about abdomen

A 
Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vomiting
Bowel habits
Past abdominal history
Medications
Nutritional assessment
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2
Q

What should you ask a patient about food intolerance?

A

What food?

What happens when you eat that food?

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3
Q

What should you ask pt about abdominal pain?

A

Find out where

Document which quadrant

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4
Q

What should you ask patient about vomiting?

A

How many times?

What color?

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5
Q

What should you ask pt about bowel habits?

A

How often?
Color?
Consistency?

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6
Q

What should you ask pt about past about past abdominal history?

A

Surgeries? (Appendectomy, gallbladder, hernia?)
Hepatitis?
Jaundice?

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7
Q

What should you ask patients about medications?

A

Do they take over the counter meds like NSAIDS?
Alcohol?
Smoking?

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8
Q

What should you ask pt about nutritional assessment?

A

24 hour diet recall (to assess risk of nutritional deficit)

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9
Q

How should you prepare to do physical exam for patient?

A

Empty bladder
Lighting and draping
Use proper draping (only undrape what you are assessing)

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10
Q

Order of abdominal examination

A

Inspection
Auscultation
Percussion
Palpation

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11
Q

Why do you do the order of examination with auscultation second instead of last?

A

Don’t want to stimulate sounds that weren’t already there

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12
Q

Types of abdominal contour

A

Flat
Rounded
Scaphoid
Protuberant

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13
Q

Abdominal shape that is inverted?

A

Scaphoid

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14
Q

Abdominal shape that is more round than typical rounded abdomen?

A

Protuberant

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15
Q

What should you document while inspecting abdomen?

A 
Contour
Symmetry
Umbilicus
Skin
Pulsations
Hair distribution
Demeanor
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16
Q

What should you document about pt’s umbilicus?

A

Is it in the midline?

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17
Q

What should you document about skin?

A

Scars (size, location, and if vertical, diagonal, or transverse)
Striae (if visible and where)

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18
Q

What should you document about pulsations?

A

Look for pulsations in aorta

Can be normal in thin patients

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19
Q

What should hair distribution be like?

A

Diamond shape in males and inverted triangle in females

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20
Q

What causes hair patterns on abdomen to be altered?

A

Endocrine or hormone abnormalities

Chronic liver disease

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21
Q

How should you measure abdominal girth?

A

While pt is lying down, around belly button

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22
Q

How should you auscultate bowel sounds?

A

Use diaphragm with light pressure
Begin in RLQ (then RUQ, LUQ, LLQ)
Must listen to all 4 quadrants

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23
Q

What do bowel sounds sound like?

A

Gurgling
Irregular
Should be 5-30 sounds per minute

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24
Q

What happens if you don’t hear any bowl sounds?

A
  • Must listen for 5 minutes in that quadrant before saying bowel sounds are absent
  • Go get physician
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25
Q

What do hyperactive bowel sounds sound like?

A

Loud, rushing, tingling sounds

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26
Q

What do hyperactive bowel sounds indicate?

A

Increased motility

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27
Q

Term for stomach growling

A

Borborygmus

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28
Q

Abnormal abdomen sounds

A

Hypoactive or absent (silent abdomen)

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29
Q

When would a patient have a silent bowel?

A

After abdominal surgery especially

Or after any anesthesia

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30
Q

What should you do when you document vascular sounds in abdomen?

A

Note location, pitch, and timing

31
Q

How should you listen to vascular sounds in abdomen?

A 
Use diaphragm with firm pressure
Listen to 7 areas:
- Aorta
- Left and right renal artery
- Left and right iliac artery
- Left and right femoral artery
32
Q

How should you percuss the abdomen?

A

All 4 quadrants

Use defined zigzag pattern starting at RLQ, moving up and around, and ending in LLQ

33
Q

Normal sound heard over abdomen while percussing? (Spelling)

A

Tympany

34
Q

What would the abdomen of an obese person sound?

A

Tympany with scattered dullness

35
Q

What would the abdomen of someone with air or gas in their abdomen sound like?

A

Tympany

36
Q

Would would someone’s abdomen sound like if they has ascites?

A

Tympany over intestines with dullness over ascitic fluid

37
Q

If a patient has a palpable aortic aneurysm, what symptoms would you find?

A
  • A palpable, focal bulging >5 cm
  • Feels like a pulsating mass in upper abdomen just left of midline
  • You will hear a bruit
  • Femoral pulses are present but decreased
38
Q

Where is the liver located?

A

R MCL

Upper right quadrant

39
Q

How should you percuss the liver?

A

Percuss from lung resonance down to where sound changes to dull (from upper)
Percuss from Tympany of abdomen to where sound changes to dull (from lower)

40
Q

How should you palpate the liver?

A

Have pt bend knees and put feet flat on bed
Use tips of fingers
Have them take deep breath in and feel under their rib cage

41
Q

Where should you percuss when looking for the spleen?

A

Percuss 9-11th ICS

Percuss lowest interspace in left anterior axillary line

42
Q

What should you have patient do when percussing the spleen?

A

Take a deep breath

43
Q

What should percussion sound like when percussing the spleen?

A

Tympany in full inspiration

44
Q

What does an abnormal sound while percussing the spleen sound like? And what does this mean?

A

If Tympany changes to dullness with full inspiration = splenomegaly

45
Q

How should you check a patient for CVA tenderness?

A

Use indirect fist percussion

46
Q

How do you perform indirect fist percussion for CVA tenderness?

A

Place hand at 12th rib at costovertebral angle (CVA)

Thump hand with ulnar edge of other fist

47
Q

What is a normal result when checking for CVA tenderness?

A

Pt will feel thud but no pain

48
Q

What would an abnormal result of CVA tenderness feel like and what would it mean?

A

Sharp pain

Means inflammation of kidney

49
Q

How would you perform light palpation of the abdomen?

A

Use first four fingers close together
Depress skin about 1 cm
Use gentle rotary motion
Overall impression of skin surface and superficial musculature

50
Q

How should you perform deep palpation of the abdomen?

A

For use on very large or obese abdomens

Use bimanual technique

51
Q

What is a normal result of palpating the abdomen?

A

No pain

52
Q

What should you document if you notice a mass while palpating a patient’s abdomen?

A 
Location
Size
Shape
Consistency: soft, firm, hard
Surface: smooth or nodular
Mobility: including movement with respirations
Pulsatility
Tenderness
53
Q

Which structures in the abdomen are palpable?

A 
Normal liver edge
Right kidney lower pole
Pulsatile aorta
Rectus muscles, lateral borders
Sacral promontory
Ascending colon
Sigmoid colon
Cecum
Uterus
Full bladder
54
Q

Where is the liver located?

A

Right upper quadrant

55
Q

How should you palpate the liver?

A

Place left hand under back (11-12th rib)
Right hand on RUQ
Push deeply
Ask pt to take deep breath

56
Q

What would a normal liver feel like

A

Normal = not palpable
Or
Feel firm edge of liver hit your fingers as diaphragm pushes it down during inhalation

57
Q

Explain the alternate “hooking technique” to palpate the liver

A

Hook both hands around rib cage and ask pt to take deep breath

58
Q

How should you palpate a patient’s spleen?

A

Left hand behind left side (11-12th rib)
Place right hand just inferior to rib margin
Push deeply down and under left costal margin
Ask pt to take deep breath

59
Q

What does a normal person’s spleen feel like?

A

Not palpable

60
Q

How large would a person’s spleen be if it was palpable?

A

3x normal size

61
Q

How should you palpate a patient’s kidneys?

A

Place hands together and press together

Ask pt to take deep breath

62
Q

What would the right kidney feel like while palpating?

A

Normal = not palpable
Or
May feel lower pole of kidney

63
Q

Which kidney is higher? By how much?

A

Left kidney is 1 cm higher

64
Q

What would the left kidney feel like while palpating?

A

Not palpable

65
Q

How should you palpate the aorta?

A

Palpate upper abdomen slightly left of midline and above belly button

66
Q

What does a normal aorta feel like while palpating?

A

2.5 to 4 cm wide

Pulsates in anterior direction

67
Q

What is the procedure to test for rebound tenderness called?

A

Blumberg’s sign

68
Q

What is Blumberg’s sigh used for?

A

To test rebound tenderness
Abdominal pain
Or elicit tenderness during palpation

69
Q

How do you test for Blumberg’s sign?

A

Push hand down slowly and deeply in LRQ and LLQ
Then, lift up quickly
Pain on release of pressure = rebound tenderness

70
Q

Why does rebound tenderness occur?

A

Peritoneal irritation

71
Q

What is a positive / negative result of the Blumberg’s test?

A

Pain = positive

No pain = negative

72
Q

Which test is used to detect pain in the appendix?

A

McBurney’s point

73
Q

Which test is done to detect pain in the gallbladder?

A

Murphy’s sign

Health Assessment (17 decks)

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