abdominal assessment

light palpation What do you expect to find

-Light- ½ inch into each quadrant -Expect soft with no nodules or guarding -Palpate bladder only if full

referred pain

-Felt in more distant sites -Develops as initial pain becomes more intense -Seems to radiate or travel from original site -May refer to other region of body -May start in other region and refer to abdomen

kidney percussion Where at

-Fist percussion -Costovertebral angles at the scapular lines on the back -Should not be tender

Shape or contour -flat -convex -concave -distended

-Flat- horizontal line from the xiphoid process to the symphysis pubis -Convex- rounded -Concave or Scaphoid- sunken appearance -Distended- protrusion on the abdomen due to fat, fluid, hernias or flatus

Parietal pain What does it feel like What makes it worst

-From inflammation of parietal peritoneum -Steady, aching pain -Usually more severe than visceral -More precisely localized -Aggravated by movement or coughing -Patients prefer to lie still

equipment for physical examination

-Good lighting -Stethoscope -Tape measure with centimeter markings

classic finding of alcohol abuse (6)

-Hepatosplenomegaly -Ascites -Caput medusa (superficial abdominal veins) -Spider angiomas -Peripheral edema -Palmar erythema

auscultation expected finding auscultation

-High pitched clicks and gurgles -5 to 35 times in a minute -Absent bowel sounds listen for a full 5 minutes

Abdominal pain visceral pain When severe

-Hollow organs -May be difficult to localize -Typically palpable near midline -Varies in quality -May be gnawing burning, cramping, or aching -When severe, may be associated with sweating, pallor, nausea, vomiting, and restlessness

rebound tenderness How to test it

-Irritation or inflammation somewhere in the abdominal cavity. May be referred to as a Blumberg's sign -Apply firm pressure for 4 seconds with the hand -After releasing the pressure observe the client -If releasing the pressure caused pain then this is a positive test

liver percussion Lower boarder Liver span

-Liver span- size of the liver at the right midclavicular line -Establish the lower border by percussing upward from below the umbilicus at the right midclavicular line until tympany turns to dullness. -make a mark

concerning finding cont.

-Lower abdominal pain and discomfort -Acute lower abdominal pain -Right lower quadrant -Sharp and continuous? -Intermittent and cramping? -Rebound? -Doubled over?

acute pleurisy

abdominal pain and tenderness may result. When unilateral may mimic acute cholecystitis or appendicitis, but rigidity and rebound tenderness are less common w/ acute pleural inflammation while chest signs are present

blood-stained red

blood in your ppop could be a symptoms of cancer

light-color or white

could be a bile duct obstruction or some meds can cause this

Fluid

the flanks protrude and when the client turns the fluid moves to the dependent side

other GI symptoms

-Dysphagia? -Odynophagia? -Change in bowel habits? -Diarrhea- Acute < 2 weeks Chronic > 2 weeks -Constipation- Medications? Diet? Water intake? -Jaundice? -Color of stools?

right lower quadrant

-bladder -rectum overy -prostate -small intestine

fat

areas of fat tissue. Skin does not look taunt

liver percussion cont Upper boarder

-Establish an upper border by percussing downward starting at the right midclavicular line over the lung until resonance turns to dullness -Make a mark -Measure. The distance between the two marks is the liver span. -Should be 6 cm to 12 cm.

Health history gastrointestinal

-Abdominal pain: acute and chronic -Indigestion, nausea, vomiting, including blood, loss of appetite, early satiety -Dysphagia (difficulty swallowing) and/or odynophagia (painful swallowing) -Change in bowel function -Diarrhea or constipation -Jaundice

Hepatitis B cont CDC recommendations Vaccine

-All adults in high-risk settings -In primary care or specialty settings -Adults in occupations involving exposure to blood or other potentially infectious body fluids -all pregnant women at first prenatal visit

percussion tympany dullness over the liver/spleen

-All four quadrants -Tympany- over the majority of the abdomen -Dullness over the liver/spleen or full bladder. If the bladder is empty then it will be tympanic as well.

auscultations unexpected findings borborygmi hyperactive sounds friction rubs venous hum

-Borborygmi- loud growling sounds -Hyperactive sounds- increased motility -Friction Rubs- inflammation in the peritoneum (like hairs rubbing together) -Venous hum- humming sound that indicates cirrhosis or portal vein HTN

concerning finding cont.... chronic lower abdominal pain Related to you bowel

-Change in bowel habits? -Alternating diarrhea and constipation? -Change in form of stool? -Intermittent pain with relief from defecation

Documetation

-Contour -Tenderness -Palpation -Percussion -Bowel sounds -Abnormal structures

colorectal cancer cont protective factors

-Diet high in fruits and vegetables -Diet high in fiber -Regular physical activity -Use of aspirin or NSAIDs

question for the urinary tract (7)

-Difficulty passing urine? -How often do you go? -Get up at night? How often? -How much urine do you pass? -Pain or burning? -Ever leak urine/wet self involuntarily/trouble getting to restroom in time? -Know when bladder is full?

GI symptoms associated with abdominal pain

-Nausea? -Retching? -Vomiting? -Regurgitation? -Odor? -Anorexia?

the bladder physical examination

-Normally cannot be examined unless distended above symphysis pubis -Check for tenderness -Percussion for dullness

prevention of urinary incontinence

-Pelvic muscle training- Kegel exercises -Biofeedback- bladder training -Incontinence is not NORMAL

what to tell the patient

-Relaxed, well-draped -Exposed abdomen from xiphoid process to symphysis pubis -Groin visible, genitals draped

auscultation cont

-Result from a movement of air and fluid in the intestines. -Best heard between meals. -Technique: listen with the DIAPHRAM for in all four quadrants

Health promotion

-Screening for alcohol abuse -Risk factors for hepatitis A, B, and C -Screening for colon cancer

colorectal cancer (3)

-Screening for colorectal cancer -Assessing risk factors -Past colorectal cancer or adenomatous polyp? -History of inflammatory bowel disease? -Family history of colorectal cancer or adenomatous polyp?

hepatitis C risk factors cont

-Sex partners using IV drugs -Blood transfusion or organ transplant before 1992 -Occupational exposure -Multiple or infected sex partner -Treatment and cure now available for Hepatitis C

three risk categories for hepatitis B

-Sexual contacts -People with percutaneous or mucosal exposure to blood -Others: travelers, patients with chronic liver disease or HIV infection, people seeking protection for hepatitis B

what to inspect (5)

-Skin -Umbilicus -Contour -Peristalsis -Pulsations

urinary incontinence stress Women Men

-Small amounts of urine are leaked due to a weak urethral sphincter. -Women: weakness of the pelvic floor -Men: prostate surgery

Health history with renal systems

-Suprapubic pain -Dysuria, urgency, or frequency -Hesitancy, decreased stream in males -Polyuria or nocturia -Urinary incontinence -Hematuria -Kidney or flank pain -Ureteral colic

questions cont

-Suprapubic pain? -Dysuria? Urgency? Frequency? -Polyuria? Nocturia? -Urinary incontinence? -Hematuria? -Gross vs. microscopic -Kidney or flank pain? -Ureteral colic?

tips for the physical exam

-Tangential lighting -Empty bladder -Warm your hands. -Watch patient's face for signs of discomfort. -Explain what you will be doing

tips for the abdominal examination

-Tangential lighting -Empty bladder!!!!!!! -Patient comfortable in supine position, pillow under head and perhaps knees, low back flat on table. -Patient's arms at side or folded across chest. -Warm your hands and stethoscope. -Watch patient's face for signs of discomfort.

Hepatitis A Treatment Prevention

-Transmission via fecal-oral -Children often asymptomatic -Vaccine available -Prophylaxis: serum globulin -Stress good handwashing techniques

concern Finding with the Health History

-ask about acute pain -with chronic upper abdominal discomfort or pain -dyspepsia -discomfort -heartburn -atypical respiratory symptoms -alarm symptoms

Left lower quuadrant

-bladder -descending colon -sigmoid colon ureter

Dysphagia odynphagia alarming symptoms

-difficulty swallowing -painful swallowing

left lower quadrant or diffuse abdominal pain S/s

-fever -loss of appetitie -absent bowel sounds -firmness -guarding -rebound tenderness

yellow

-greasy, foul-smelling yellow poop indicates excess fat with can be related malabsorption or celiac disease

order of examination

-inspect -auscultate -percuss -palpate

Shades of Poop brown

-it is naturally brown due to the bile produced in your liver

left upper quadrant

-left kidney -pancreas spleen -stomach

What is in the right upper quadrant?

-liver -pancreas -transverse colon -right kidney duodenum

alarm symptoms cont

-recurrent vomiting -gastrointestinal bleeding -palpable mass

Pulsations Where can it be seen

-regular beats of movement midline above the umbilicus -seen in thin adults or in a mass

possible ascites

-testing for shifting dullness -observe for fluid wave

peristalsis

-wavelike movement and can be seen in thin adults and adults with intestinal obstruction

colorectal cancer cont Risk factors

Diabetes Alcohol use Obesity Smoking High-fat diet

overflow

Continuous dribbling of urine. Bladder may be enlarged. Impaired bladder sensation. Ex: Diabetic Neuropathy

documentation

Contour Tenderness Palpation Percussion Bowel sounds Abnormal structures

kidney or percussion

Costovertebral angle tenderness Assess during examination of back

urinary incontinence functional

Inability to get to the bathroom in time because of health or environmental concerns.

urinary incontinence urge

Moderate amounts of urine are leaked due to small bladder capacity. Due to stroke, brain tumor, dementia, or spinal cord lesions.

Hepatitis B When do symptoms become present

More serious threat to health Vaccine available Most asymptomatic until develop symptoms of advanced liver disease

Hernia Seen best when

Protrusions are visible through the abdominal wall. Seen better when the patient raises the arm.

screening for alcohol abuse

Remember CAGE assessment: Cut down, Annoyed by criticism, Guilty, and Eye Opener

Hepatitis C risk factors

Repeated percutaneous exposure to blood No vaccine available IV drug users Transfusion with clotting factors before 1987 Hemodialysis

deep palpation

Two hand approach- the bottom hand assess for masses or enlargement of organ while the top hand depresses about 1-3 inches

shades of poop green

food may be moving through your large intestine too quickly or alot of green vegetable

Acute Salpingitis

infection and inflammation in the fallopian tubes

Acute appendicitis

inflammation of the appendix

acute cholecystitis

inflammation of the gallbladder

acute pancreatitis

inflammation of the pancreas

black

mean you could be bleeding interally due to ulcer or cancer and some vitamins containing iron

physical examination palpation

normal is not to feel anything

palpation

palpate tender areas last

flatus

protusion is midline and the flanks are normal