PA Exam 3 Abdominal

Question 1

non-Hispanic, Hispanic, and Asian/Pacific Islander people have a higher risk for stomach cancer than ________

Answer 1

whites

Question 2

stomach cancer has an association with the prevalence of ________

Answer 2

H pylori

Question 3

asia, latin america, caribbean have hightest incidence in ____ and the lowest are _______

Answer 3

stomach cancer
North America, Africa

Question 4

Asia, Latin America, Caribbean have highest incidence in ____ and the lowest in _______

Answer 4

stomach cancer , North America and Africa

Question 5

Asian Americans have low rates of esophageal carcinoma, but high in _________

Answer 5

squamous cell carcinoma and Asians

Question 6

Highest rate of gallbladder cancer is among _______, ______

Answer 6

Native Americans and Mexicans

Question 7

peptic ulcer disease risk factors that CAN be controlled…..

Answer 7

NSAIDS, anti coagulatins, low dose asprin,(SSRI’s) aldronate, risedronate, tobacco, stress, spicy food, alcohol.

Question 8

peptic ulcer disease risk factors that CANNOT be controlled…..

Answer 8

H pylori in the GI tract, hypersecretory condion ( stomach produce much acid) **Zollinger- Ellison ( tumor in pancreas relase high acid producing hormone) family history, radiation, **

Question 9

what do you tell patients to prevent peptic ulcer dieases _____

Answer 9

wash hands, food cooked completely avoid alcohol, avoid tobaccok use,

Question 10

Risk factors for GERD ( gastroesophageal reflux disease)

Answer 10

obesity, hiatal hernia (top stomach bulges through diaphragm chest cavitiy) pregnancy, smoking, dry mouth, asthma, diabetes, DSE, large meals at night, diary, spicy, and fried foods. some NSAIDS asthma meds and antihypertensives

Question 11

teach client how to prevent GERD________

Answer 11

avoid alcohol, stress, food that cause swallowing air (chewing or sucking candy) avoid sodas, eat 5 to 6 small meals a day. chew food slow, dont lie down after eating, avoid tight fitting clothes around the stomach raise head of bed 6-8 inches, try sleeping on left, keep relaxed atmosphere when eating meals.

Question 12

cold spa

Answer 12

character : describe issue
onset: when does it happen
location: point where
duration: how long

severity: how bad
pattern: when does it occur
association: other symptoms that happen with it

Question 13

Abdominal examination is preformed for many reason such as _____________…

Answer 13

comprehensive health examination, assess abdominal pain, tenderness and masses. or monitor client postoperatively.

Question 14

what is the sequence of abdominal assessment ?

Answer 14

inspect, auscultate, percuss then palpate.

Question 15

client my empty their ________before exam begins

Answer 15

bladder

Question 16

your can place a pillow or rolled blanket under knee to ________ abdominal muscle

Answer 16

Releax

Question 17

painful and tender areas should be assessed at the _____ of the exam ination

Answer 17

end

Question 18

Oberve coloration of the skin

normal
abnormal

Answer 18

normal: abdominal skin pale, less exposure
Abnormal: Grey turner sign purple discoloration of flanks ( bleeding in wall) due to trauma to K, P, DU.Pancreatitis

yellow: jaundice
Redness: inflammation
Bruises

Question 19

Vasculatrity of the skin

normal: ________veins
abnormal: ______ veins common in (_______) and seen in obstruction to the ____, portal hypertension and __________

Answer 19

normal: scattered veins
abnormal: diated veins (cirrhosis of liver)
obstruction to IVC, portal hypertension, ascites (fluid in abdominal spaces)

Question 20

Note any striae

Normal: new striae are ____ and ____ in color. Old is silver, ____linear uneven from preg, or weight loss

abnormal: _____, _____ pink associated with _______

Answer 20

normal: pink, white
abnormal: dark, bluish cushings’s syndrome

Question 21

striae can be due to _____ that stretched skin and _____ results from liver failure of liver disease

Answer 21

ascites, ascites

Question 22

**inspect scars **

normal: smooth, minimally raised old scars
abnormal: non-_____ wounds,______, ________, deep irregular scars may be due to burns

Answer 22

non- healing, inflammation, redness

Question 23

scarring should be an alert for possible _______ adhesions

Answer 23

internal

Question 24

keloids are more common in ____,______

Answer 24

african americas and asians

Question 25

**assess for lesions and rashes **

normal:

abnormal:

Answer 25

normal: flat or raised moles
abnormal: border symmetry and bleeding

Question 26

inspect umbilicus

normal:

abnormal
cullen’s sign:
grey turners sign:

Answer 26

normal: color similar to abdominal skin or even pinkish

abnormal: cullens sign: bluish or purple discolor around umbilicus (periumbilical ecchymosis) intra -abdominal bleeding

abnomal : grey turners sign: bluish or purple dicoloration on the abdominal flanks

Question 27

umbilicus location
normal
abnormal

Answer 27

normal : midline of lateral line
abnormal: deviated umbilicus, maybe due to mass pressure, fluid, enlarged organs scar tissue, hernia

Question 28

Assess contour of umbilicus
normal:
abnormal:

Answer 28

normal: recessed (inververted) or protruding no more than 0.5cm

Abnormal: Everted umbilicus seen in abnormal distension . Enlarged Everted umbilicus (umbilical hernia)

Question 29

Inspection note: when inspecting you would go betwwen the ______ and the ______ measure the abdomial girth

Answer 29

lower ribs and the pubic bone.

Question 30

● Generalized protuberant (bulging) or distended abdomen may be due to _______,__________,__________

● Distension below the umbilicus may be due to _______,________,_______/________

Answer 30

● obesity, air (gas), or fluid accumulation
● full bladder, uterine enlargement, or an ovarian tumor/cyst

Question 31

● Distension of upper abdomen may be seen with ________ of the pancreas or ________
● A scaphoid (sunken) abdomen may be seen with severe ________ or ________

Answer 31

● masses or gastric dilation
● weight loss or cachexia

Question 32

6 F’s of abdominal distension

Answer 32

fat, flatulence, fetus, fibroids, feces, fluid,

Question 33

to assess **hernia **or **diastasis recti **(separation of muscle), or to differentiate a _______ within the abdominal wall ask the client to _________

Answer 33

mass, raise the head

Question 34

**Assess Abdominal Symmetry **

Normal: Abdomen is symmetric and does not bulge when client raises head
Abnormal:

● Asymmetry:

● A hernia:

Answer 34

Asymmetry: May be seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction

Hernia: protrusion of the bowel through abdominal wall

Question 35

**Assess Abdominal Symmetry **

● Diastasis recti:

● Incisional hernia

Answer 35

**Assess Abdominal Symmetry **

Diastasis recti: bulge between vertical midline separation of the abdominis rectus muscles (during and after pregnancy)

Incisional Hernia: defect develops in abdominal muscles due to surgical incision.

Question 36

Answer 36

Question 37

Answer 37

Question 38

Inspect Abdominal Movement When Client Breathes

Normal: Abdominal respiratory movement may be seen especially with _______

Abnormal: Diminished abdominal respirations or change to thoracic breathing in _______ clients may reflect _______________

Answer 38

male
male, peritoneal irritation

Question 39

Observe Aortic Pulsations

Assessment note: Abdominal palpation has poor accuracy and is** not recommended for screening**→use _________(high sensitivity)

Answer 39

ultra sound

Question 40

Observe Aortic Pulsations

Normal: slight pulsation of the abdominal aorta, visible in the ______ (_____ ______ region of the abdomen), extends full length in thin ______

Abnormal: Vigorous, wide ________ pulsations may be seen with abdominal aortic _________

Answer 40

epigastrium, upper central

exaggerated, aneurysm

Question 41

Observe Peristaltic Waves

Normal: Typically not see, although in very______ people may be able to see a ________

Abnormal:
● Peristaltic waves are increased and progress in a _____-like fashion from _______ to the R______ with i_________ _________
● Abdominal distension seen with ________ _________ obstruction

Answer 41

• thin, ripple
• intestinal obstruction
• intestinal wall

Question 42

Auscultate Bowel Sounds:

• Apply light to no pressure on a tender abdomen
• Begin in _____ and proceed _____
• Listen for at least _____ min. before determining no bowel sounds present
• Confirm bowel sounds in each quadrant. Listen for 1 minute and up to _____ minute if no sound seems present
• Note intensity, pitch, and frequency of the sounds

Answer 42

• RLQ, clockwise
• 5 mins
• 5 mins

Question 43

Post op bowel sounds resume gradually depending on
the type of surgery

● Small intestine?____________
● Stomach Emptying?_________
● Colon? 3-5 days for __________

Answer 43

• First few hours
• 24-48 hours
• propulsive activity

Question 44

• Bowel Sounds normally occur every ___-_____ seconds (one bowel sound to one breath sound)

Answer 44

5-15 seconds

Question 45

Normal: Series of intermittent, _-______ clicks and gurgles at a rate of ________ per minute

Answer 45

soft, 5-30

Question 46

Increasing pitch of bowel sounds is most ______ _______ because it signifies __________ distension

Borborygmus: _________ bowel sounds that are loud, prolonged gurgles often associated with “_________ ____________”

Answer 46

• diagnostic obstruction, intestinal
• hyperactive, stomach growling

Question 47

Abnormal bowel sounds

● Hyperactive bowel sounds that are ________, ________,_______ may be abnormal, indicating very rapid motility hear in early (4)__________

● Hypoactive bowel sounds indicate diminished bowel motility. Common causes include paralytic ________following abdominal surgery, inflammation of ________, or late _______ _________

● Decreased or absent bowel sounds signify the absence of bowel ________→emergency, immediate _______

● Absent bowel sounds may be associated with ________ or paralytic _______

● High-pitched tinkling and rushes of high-pitched sounds with abdominal _______ usually indicate ________

Answer 47

• Hyperactive bowel sounds : rushing, tinkling, and high pitched, obstruction, gastroenteritis, diarrhea, or with use of laxatives
• Hypoactive bowel sound: ileus, peritoneum, bowel obstruction
• Decreased or absent bowel sounds: motility, referral
• Absent bowel sounds: peritonitis, paralytic ileus
• cramping, obstruction

Question 48

Auscultate for Vascular Sounds

Assessment Note: Uses the bell of the stethoscope to listen for bruits ________), over the abdominal (4) ___________

Answer 48

• (low-pitched, murmur-like sound)
• aorta, renal, iliac, and femoral arteries

Question 49

Auscultate for Vascular Sounds

Normal: ________ are not normally heard over the abdominal aorta, or renal, iliac, or femoral arteries. HOWEVER, ______ confined in ________ may be normal in some clients depending on other differentiating factors

Abnormal:
● Bruit with _____ or ______ components? Artery ______ or obstructed, may indicate an _____ or ______ (RAS)

• The absence of a bruit does not exclude the possibility of _______RAS

most accurate is to do a ______ or _________

Answer 49

normal: Bruits,bruits, systole
abnormal: bruits, systolic and diastolic
turbulent
aneurysm or renal stenosis
ultrasound or an angiogram

Question 50

**venous hum: **

Using _____ of the stethoscope, listen for a venous hum in the _______ and _________

• Normal: Not normally heard over__________ and ___________areas

-Abnormal:
● Rare, but an accentuated venous hum heard in the epigastric or umbilical areas suggests increased_________ __________ between the portal and systemic venous systems, as in cirrhosis of the liver

Answer 50

NORMAL
* * epigastric and umbilical areas
* epigastric and umbilical areas
ABNORMAL
* collateral circulation
* portal and systemic

Question 51

**Auscultate for a friction rub over the over the liver and spleen **

Assessment note: Listen over the_____ and ______ _______ rib cage with the diaphragm of the stethoscope

Normal: No friction rub over liver or spleen is present

Abnormal:
● RARE, if heard they have a _____________________________ produced when the ______ surface area of the liver or spleen rubs the _______, in association with respiration

● Lower right costal area?_______ abscess or _______
● _______ line in the lower left costal area? Associated with _______ infarction abscess, infection, or tumor.

Answer 51

normal: right and left lower
abnormal: high-pitched, rough, grating, sound
large, peritoneum

• Hepatic or metastases
• Anterior axillary,
  splenic

Question 52

Perform Light Palpation: Assessment Note: Used to identify areas of tenderness and muscular resistance.
- Use fingertips and begin in a ______ quadrant
- Compress to a depth of_____ cm.
Normal: Abdomen is nontender and soft. There is no _______ (tensing)
Abnormal:
● Involuntary _____guarding? Serious________ irritation.
- The abdomen is ____ and fails to relax when the client _____, typically seen on the _____ of the abdomen
- Concept Mastery: If this occurs, client should be assessed further for possible ______
- Right-sided guarding? May indicate _______ ( _________ inflammation)

Deeply Palpate all quadrants ** Assessment Note: We do this to delineate abdominal organs and detect subtle masses.
- Use the palmar surface of the fingers to compress ___-___ cm.
- Perform ________palpation if you encounter _______ or to assess _______structures
- Normal**: Normal (____) tenderness is possible over xiphoid, aorta, cecum, sigmoid, colon, and ovaries, with deep palpation
- Abnormal: _____ tenderness or pain may be related to trauma,_____, infection, tumors, or enlarged, or ______ organs

**-Palpate for Masses- **Assessment Note: Note their location, size, shape, consistency, demarcation, pulsatility, tenderness, and mobility.
- DO NOT confuse mass with an organ or ______
- Normal: No palpable masses are present
- Abnormal: A mass detected in any quadrant may be due to tumor,cyst, _______, enlarged organ, ______ or _______

Answer 52

Perform Light Palpation:
* nontender, 1,
Normal: guarding,
**Abnormal: **reflex, peritoneal, rigid, exhales, sides,
* Infection
* cholecystitis (gallbladder inflammation)

**Deeply Palpate all quadrants **
5-6
bimanual, resistence, deeper structures
Normal: mild
Abnormal: severe, peritonitis, diseased organs

Palpate for Masses
structure
normal
abnormal: abscess, aneurysm, adhesions

Question 53

-Palpate the umbilicus-
Assessment Note: Palpate umbilicus and surrounding area for swellings, bulges, or masses
- Normal: Free of swelling, bulges, or masses
- Abnormal:
● Soft center of umbilicus can be potential for ________
● Palpation of hard ______ in or around, may indicate _______ nodes from an occult (not detectable by clinicals method) __________ cancer

**-Palpate the Aorta- **
Assessment Note: Use your _ and _ or use _ and palpate deeply in the epigastrium
Clinical Tip: **DO NOT **palpate a ______ midline mass; may be a dissecting ______ that can rupture from palpation.
- Avoid deep palpation over tender organs ______ kidneys, _____ tumor, transplantation, or suspected _____trauma)
- Normal: Aorta is approx. ___-___ cm wide with ______ strong and regular pulses. Possibly ____ tenderness may be elicited
**- Abnormal: **
● ____ ______ pulse? Possible abdominal aortic aneurysm
● Prominent, _____ ______ masses above the umbilicus with an accompanying audible ____? Strongly suggests a aortic aneurysm **

Answer 53

-Palpate the umbilicus-
* herniation
* nodules, metastatic, gastrointestinal

**-Palpate the Aorta- **
* thumb and first finger
* two hands, epigastrium
* pulsating
* aneurysm
(polycystic, Wilms, transplantation, or suspected splenic trauma)

normal:
2.5-3.0
moderately, mild
abnormal:
Wide bounding
lateral pulsating, bruit

Question 54

____Palpate the Liver:

Assessment Note: Note consistency and tenderness
- To palpate bimanually, stand at clients______ side and place____hand under the clients _____ at ____ to ____ribs. Lay your right hand parallel to the right ____ margin (fingers should face the head).
● Ask the client to ____, then compress ____ and ____ with your fingers. Have the client ____ and hold your hand in place as the client ____ a second time. With deep _____, the edge of the liver is more easily palpated.

- To palpate by hooking, Stand to the _____ of the client’s _____. Curl (hook) the fingers over ______ hands over the edge of the right _____ margin
● Ask the client to take a deep breath and gently, but firmly pull ______ and ______with your fingers

-Normal: **Liver is usually not palpable, **although it may be felt in some clients. If the lower edge is felt, it should be firm, and _____, and even. Mild tenderness may be normal

**- Abnormal: **
● firm and ____ ? May indicate _____
● Nodularity? May occur with _______, ________ cancer, late cirrhosis or ______
● Tenderness? May be vascular _________ (CHF), acute _______, _______
- A liver more than __-___ cm below the costal margin is considered enlarged (unless displaced by the diaphragm)
● Enlargement? May be due to hepatitis, liver tumors, cirrhosis, and vascular engorgement

Answer 54

Palpate the Liver:

- To palpate bimanually
right, Left, back 11th to 12th, costal
inhale, upward then inward exhale, inhales
deep inhalation

- To palpate by hooking
right, chest, both, costal
inward and upward

normal: smooth
abnormal: hard, cancer
tumors, metastatic syphilis
vascular engorgement (CHF)
hepatitis or abscess

1-3 cm

Question 55

-Palpate the Spleen-
Assessment Notes: Stand, at the client’s _____ side, reach over the abdomen with your _____ arm, and place your hand under the ______ lower left ribs. Pull up gently. Place your _____ hand below left ______ margin (fingers toward head)
● Ask client to inhale and press______ and _____ as you provide support with your other hand
● Alternatively, ask the client to turn on the ______ side may facilitate splenic palpation by moving the spleen downward and forward
- Normal: The spleen is______ palpable. Rarely, the tip is palpable (soft and ______) in the presence of a low, flat diaphragm (chronic obstructive lung disease) or with deep _______ descent on inspiration.
- Abnormal:
● Palpable spleen suggests _______ (up to ___ normal size), which may result from infections, trauma, ______,chronic blood disorders and cancers
● Splenic Notch may be felt, which is an indication of splenic _______, but may not always be pathologic
● Spleen feels soft with a rounded edge when it is enlarged from _______.
● Sharp edges when it is enlarged from chronic disease
● CAUTION: Avoid traumatizing and possibly rupturing the organ, be gentle

Palpate the Kidney:
Assessment Notes: Palpate the right kidney, support the right posterior flank with your ____ hand and place your right in the RUQ just below the costal margin at _____
- To capture the kidney, ask the client to ____. Then compress your fingers deeply during _____ inspiration.
● Ask the client to exhale and ____ breath briefly. Gradually release the pressure of your right hand. If you have caught the kidney you will feel it slip beneath your fingers.
- Normal: Kidneys are not usually palpable (sometimes lower pole of right kidney with capture method). If palpated it should feel firm, smooth, and rounded. The kidney may or may not be slightly tender
- Abnormal:
● An enlarged kidney may be due to a cyst, tumor, or _______ (smooth rather than sharp edge, tympanic percussion)

Palpate the Urinary Bladder
Assessment Note: Palpate for ______ bladder when the client’s history or other findings warrant (dull percussion noted over the symphysis _____)
● Begin at the symphysis pubis and move ______ and _______ to estimate bladder _______
- Normal: An _____ bladder is neither palpable nor tender
- Abnormal:
● Distended bladder is palpated as a ______, ______ and somewhat firm mass extending as far as the _______. May be further validated by _____ percussion tones

Answer 55

Palpate the Spleen

right, left, posterior
right, costal

Inward and upward, right

normal: seldom nontender, diaphragmatic
abnormal:
enlargement, 3x, mononucleosis,
enlargement
infection
chronic
**
Palpate the Kidney:**

left, RUQ. MCL

inhale, peak inspiration
hold
normal:
abnormal: hydronephrosis

Palpate the Urinary Bladder:
distended
pubis
upward, outward, borders
normal: empty
abnormal: smooth, round, umbilicus, dull

Question 56

**-Specialized Tests-

→Ascites: (Fluid collection in the abdomen)
- Test for shifting _______
● If you suspect that the client has ascites because of a distended abdomen or bulging flanks, perform this special percussion technique. The client should remain supine. Percuss _______
● Note the change from dullness to ______ and mark this point. Now help the client turn onto the _____. Percuss the abdomen from the bed ______. Mark level where dullness changes to tympany
- This test is not always reliable, get definite answers with an ultrasound
- Normal: _____ between tympany and dullness remain relatively constant throughout position changes.
- Abnormal:
● Often a sign of severe liver disease due to portal _______ ( High BP in the blood vessels of the liver and low ______ levels)
- When the client is supine the fluid assumes a dependent position and produces a _____ percussion tone around the ______. Air rises to the top and tympany is percussed around the umbilicus.
- When the client turns to the side, fluid assumes a ______ position and air rises to the top. Air again rises to the _______.

**- Fluid Wave Test: **

● Clients should remain supine. You will need assistance with this test. Ask the client or assistant to place the _____ side of the hand and the ______ side of the forearm firmly along the _____ of the abdomen. Firmly place the palmar surface of your fingers and hand against one side of the client’s abdomen. Use your other hand to tap the opposite side of the abdominal wall
- Normal: No fluid wave is transmitted
- Abnormal:
● Movement of a fluid wave against the ______ hand suggests large amounts of fluid are present
- Not reliable need an __________
Tests for _______/_______ Irritation

**Assess for rebound tenderness: **

● If the client has abdominal pain or tenderness, test for _______ tenderness by palpating deeply at _____ into the abdomen halfway between the umbilicus and the anterior iliac ______ (McBurney point)
● Clinical Tip: Test for rebound tenderness should always be performed ________ of the examination (pain and muscle spasm can interfere)
- Normal: No rebound tenderness is present
- Abnormal:
● Blumberg sign: _____, ______ pain as the examiner releases pressure from the abdomen, this is a sign of peritoneal irritation (_________)
↦ If the client feels pain at an area other than where you were assessing, consider that area as the source of the pain
● Rovsing Sign: Pain in _______ during pressure in the ______, suggests acute appendicitis

→Assess for Psoas sign:

● Ask the client to lie on the ______ side. _______ the clients ______ leg
- Normal: No abdominal pain is present
- Abnormal:
● Pain in the ________ (psoas sign), is associated with irritation of the ______ muscles(Conjunction of psoas major/minor and iliacus) due to appendicitis

→Assess Obturator Sign:

● Support the clients ________ knee and rotate the leg _______ and ______
- Normal: no abdominal pain present
- Abnormal: Pain in RLQ indicates ______ of the obturator muscle due to _______ or a _______ appendix
5. Describe the findings frequently seen when assessing the older client’s abdomen.
● Sensitivity to pain may ______ with aging. Therefore, assess older clients _______ for acute abdominal conditions.
● Older adult clients may experience a ______ in appetite from various factors such as altered _____, decreased taste sensation, decreased ______, and, possibly, ______. If appetite declines, the client’s risk for nutritional imbalance increases
● Older adult clients are especially at risk for potential complications with diarrhea–such as fluid volume deficit, dehydration, and electrolyte and acid-base imbalances–because they have a higher fat-to-______ muscle ratio.
● Older adult clients are prone to ______ because the activity of __________ bacteria in the urinary tract ______ with age.
● Dilated ________ capillaries without a pattern may be seen in older clients. They are more visible in _________
● USPSTF recommends ____-_____ screening for abdominal aortic aneurysm (AAA) for men between ____ and _____ years of age who have ever smoked; selectively offer screening for men 65-75 who have ______ smoked; and does not recommend routine screening for _____
● If the client is older than age ____ or has hypertension, assess the width of the ______
● General Routine Screening: Observe
● Focused Specialty Assessment: Auscultate percuss, palpate

Answer 56

**-Specialized Tests: **

dullness
umbilicus
tympany
side
upward

ultrasound
normal: Borders
abnormal: hypertension, albumin, dull, flanks
dependent, top

-Fluid Wave Test:
ulnar, lateral, midline

normal:
abnormal: resting

ultrasound
Appendicitis, Peritoneal

**Assess for rebound tenderness: **
rebound, 90°, iliac crest
at the end
normal: rebound
abnormal:Sharp, stabbing, appendicitis
RLQ, LLQ, appendicitis

Assess for Psoas sign:
left, Hyperextend, right
Normal:
Abnormal: RLQ , iliopsoas

Assess Obturator Sign:
right, internally, externally
normal:
abnormal: RLQ, irritation, appendicitis or perforated

Describe the findings frequently seen when assessing the older client’s abdomen.
diminish, carefully
decline, metabolism, mobility, depression
diarrhea, deficit, lean
UTIs, protective, declines
superficial, sunlight
one-time
65 to 75,
never, women, 50, aorta