NURS 190 week 6

Techniques and Normal Findings

Flat: A straight horizontal line is observed from the costal margin to the symphysis pubis. This contour is common in a thin person. Rounded: a convex abdomen; The horizontal line now curves outward, indicating an increase in abdominal fat or a decrease in muscle tone. This contour is considered a normal variation in the toddler and the pregnant female.

A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client for which of the following findings as an indication of gastrointestinal perforation?

Sudden abdominal pain

CVAT (costovertebral angle tenderness)

Tenderness to percussion over the costovertebral angle; a common finding in pyelonephritis and other infections of the kidney and adjacent structures

Acute Kidney Injury (AKI)

rapid-onset disease of the kidneys resulting in a failure to produce urine -benign -Fluid loss (blood included)

IBS and duodenal ulcers are...

stress induced

Dullness may indicate ...

an enlarged uterus, distended urinary bladder, or ascites. Dullness in the LLQ may indicate the presence of stool in the colon.

A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?

Excessive uterine enlargement

Borborygmi

(stomach growling) may be due to bleeding or inflammatory bowel disease. loud. occurs with early bowel obstruction, A normal finding of gastroenteritis (S/S diarrhea)

inflammatory (itis) signs and potential dx

- constant pain - slightly elevated fever -slightly elevated WBC dx) Cholecystitis, pyelonephritis, pancreatitis, hepatitis

Stress induced abdominal issues are...

- duodenal ulcers - IBS

Cholecystitis

-Referred pain: shoulder pain (gallbladder->diaphragm->a nerve) -RUQ pain + Nausea/Vomiting positive Murphy's sign

Obstructive signs and potential dx

-colicky/restless -no fever - normal WBC dx) cholelithiasis, nephrolithiasis

What indication is positive for pyelonphritis? 175ml urine output in 8 hrs 1200ml of urine of 24 hrs Cloudy urine

....

GERD (gastroesophageal reflux disease)

A digestive disease in which stomach acid or bile irritates the food pipe lining. (acid reflux) - sleep on right side or elevate the head

The nurse observes bulging over the femoral artery during an assessment. Which diagnosis should the nurse suspect?

Femoral hernia

A nurse is caring for a client who has benign prostatic hyperplasia (BPH). The nurse should expect which of the following finding?

Difficulty starting the flow of urine

A nurse is completing a client assessment for admission to the medical unit. Which of the following abdominal assessment findings require further investigation by the nurse?

Eccymosis

Pancreatitis (acute)

Gallstones or alcohol

A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority?

Hematemesis

Hepatitis A vs C

Hepatitis A - acute, self-limiting illness - fecal-oral transmission via contaminated food/water - sx mild and non-specific Hepatitis C - acute illness and can lead to chronic infection, cirrhosis of liver, liver cancer, liver failure, and death - drugs= blood, body fluid transmission - First line agents: DAA combination (+ RBV if cirrhosis or not tx naive)

Tympany

High pitched sound is tympani Upon percussion: first sound you should hear is tympany. When the sound changes to dullness, you have identified the lower border of the liver

What is the similarity between Crohns and -itis

Inflammation

Hepatitis

Inflammation of the liver, usually caused by a viral infection, that causes fever, loss of appetite, jaundice, fatigue, and altered liver function.

During the examination of a male client, the nurse detects a bulge in the right inguinal area as the client is bearing down. Based on this data, which condition does the nurse suspect?

Inguinal Hernia

Divercultitis is palpated in what area?

Left lower quadrant?

A nurse is assessing a client's bowel sounds. At which of the following points in the assessment should the nurse auscultate the client's abdomen?

Prior to percussing the abdomen

A client asks the nurse what is the purpose of the Bartholin's gland. Which information should the nurse provide to the client?

Produce mucus to be released into the vagina

Abnormal Findings Special Considerations

Protuberant: Similar to the rounded abdomen, only greater. anticipated in pregnancy, adult with obesity, ascites (Taut, glistening skin could indicate ascites), and other conditions Scaphoid: Sometimes called a concave abdomen. The horizontal line now curves inward toward the vertebral column, giving the abdomen a sunken appearance; seen in very thin person.

McBurney's point

RLQ point (1/3 of the way from right hip to the umbilicus, pain starts peri-umbilical) tenderness indicative of appendicitis (PSOAS sign) (Rovsings sign)

Urine that is dark Ruddy color, cloudy, and cloudy urine is indicative of..

UTI? Urinary retention?

Psoas sign & what does this indicate?

With the patient in a supine position, place your left hand just above the level of the patient's right knee. Ask the patient to raise the leg to meet your hand - appendicitis

During the examination of a clients perineum, the nurse notes reddened areas on the labia and white curd-like vaginal discharge. Which condition should the nurse suspect?

Yeast infection

What is a hernia?

a rupture; is a protrusion of an organ or structure through an abnormal opening or weakened area in a body wall. -The abdominal wall is the most common site of hernias

hematemesis

abdominal bleeding and vomiting blood

Hypoactive sounds that are slow and sluggish are common following

abdominal surgery or bowel obstruction

Marked pulsations could indicate...

aortic aneurysm or increased pulse pressure. Increased peristaltic activity could indicate gastroenteritis or an obstructive process.

Diverticulitis

bulging pouch: out-pouches of mucosa through intestinal wall

Cullen's sign

ecchymosis (edema and bruising) in umbilical area, seen with pancreatitis

Bartholin's glands

produce a mucus secretion to lubricate the vagina

Appendicitis & what do you test for it?

inflammation of the appendix PSOAS sign & McBurney's sign (& Rovings?)

Pyleonephritis

inflammation of the kidneys

Hyperactive bowel sounds are...

loud, high- pitched, and rushing. (They may occur more frequently with gastroenteritis or diarrhea)

Hyperresonance is

louder than tympany and is heard over air-filled or distended intestines upon percussion.

peritonitis (peritoneal irritation)

motionless, guarding, rebound tenderness, board-like abdomen (muscle tightness). The experience of sharp stabbing pain as the compressed area returns to a noncompressed state is known as Blumberg's sign

Murphey's sign

nurse palpates gallbladder (URQ), pt takes deep breath -positive if pt c/o pain --> cholycystitis or gall bladder dx

Rovsing's sign and what does it indicate?

palpation of the left lower quadrant causes right lower quadrant pain that may indicate appendicitis

Absent bowel sounds may be indicative of...

paralytic ileus.

history of NSAIDs use can cause...

peptic ulcer disease

petechiae

pinpoint purple or red spots from minute hemorrhages under the skin -symptom of cirrhosis

Bulges could indicate...

tumors, cysts, or hernias.