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Question 1

What do we do in the initial assessment of the patient and their environment?

Answer 1

Look at the patient from the end of the bed and comment on:

• Does the patient need any immediate intervention
• Is the patient distressed
• Is the patient drowsy or restless
• Is the patient cachexic/ BMI estimate

Look at the patients environment and comment on:

• Vomit bowls
• IV lines for fluids

Look at the NEWS chart and look at:

• Temperature
• Heart rate
• Respiratory rate
• Blood pressure

(Comment on any trends)

Question 2

What do we look for in the hands and palms?

Answer 2

Hands:

• Tar staining
• Leukonychia
• Anaemia
• Clubbing
• Koilonychia

Palms:

• Palmar erythema
• Palmar creases
• Dupuyten’s contracture

Question 3

What do we look for in the arms?

Answer 3

Arms:

• Brusing
• Scratch marks/pruritis
• Muscle wasting
• Track marks
• Loss of skin turgor (only need to do 1 arm)

DON”T FORGET TREMOR, PULSE, RR

• Fine tremor
• Flapping tremor
• Pulse, respiratory rate and blood pressure

Question 4

What do we look for in the face?

Answer 4

• Parotid swelling

Question 5

What do we look for in the eyes?

Answer 5

• Jaundice
• Anaemia

Question 6

What do we look for in the mouth

Answer 6

• Angular stomatitis
• Sore red tongue
• Detect the odour of foetor hepaticus

Question 7

Lymph nodes:

Answer 7

AAA

Question 8

What do we look for in the neckline region?

Answer 8

• Gynaecomastia
• Loss of body hair in males
• Spider naevi

(- Distended veins??? - Not in book but in video)

Question 9

What do we look for in the legs?

Answer 9

• Peripheral oedema
• Erythema nodosum
• Loss of body hair

Question 10

When inspecting the abdomen, what do we look for?

Answer 10

• Scars
• Skin lesions
• Scratch marks
• Stoma
• Striae (scarring around belly button)
• Movement with respiration (do this 1st - ask patient to breathe in and out)
• Abdominal distension
• Abdominal shape
• Distended veins (caput medusae)
• Visible pulsation
• Petechiae (rash/ red spots)

Question 11

When palpating the abdomen, what do we do we feel?

Answer 11

• Ask about any pain first
• Palpate away from the site of pain if applicable
• Watch the patients face
• Light palpation of the 9 regions of the abdominal wall Palpate for:
• Superficial masses
• Tenderness
• Rigidity (increased muscle tension)

Deep palpation:

• Masses
• Tenderness
• Rigidity/ guarding

Liver

• Radial edge of right hand in the right iliac fossa
• Ask patent to breathe in and out
• Press firmly on the abdomen during inspiration (liver descending)
• Release hand and move upwards towards liver edge during expiration

Spleen

• Radial edge of right hand in the right iliac fossa
• Ask patent to breathe in and out
• Press firmly on the abdomen during inspiration
• Release hand and move diagonally towards the spleen during expiration

(NORMALITY: Spleen not palpabale)

Kidneys