NURS612 Key Points to Review
EXAM #3 CUMULATIVE FINAL EXAM
KEY POINTS FOR WEEKS 9-14
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Key Point to Review- Abdomen STUDENT NOTES
What are examples of appropriate
history of present illness (HPI)
questions you may ask a patient with a
chief complaint of an abdominal issue?
1. Onset and duration: when it began;
sudden or gradual
2. Character: dull, sharp
3. Location and onset: change in
location over time, radiating
4. Associated symptoms: nausea,
vomiting, diarrhea
Describe how you would inspect the
abdomen.
inspect the abdomen, perform the
following.
• Using tangential lighting,
inspect the abdomen for four
surface characteristics.
First, observe the skin
color. It may vary greatly
but should have no
jaundice, cyanosis, redness,
bruises, or discoloration.
Second, check for nodules
and other lesions, which
should not be present.
Third, note any scars and
draw their location,
configuration, and relative
size on an illustration of the
abdomen.
Fourth, assess the venous
return. Above the
umbilicus, venous return
should be toward the head.
Below the umbilicus, it
should be toward the feet.
Next, inspect the abdominal
contour and symmetry.
The contour is the
abdominal profile from the
rib margin to the pubis. It
normally may be flat,
rounded, or scaphoid. The
umbilicus should be
centrally located and may
be inverted or may protrude
slightly.
N. Zimmermann Spring 2016
NURS612 Key Points to Review
EXAM #3 CUMULATIVE FINAL EXAM
KEY POINTS FOR WEEKS 9-14
**Please note this is an optional tool for students to use in preparation for
Exam #3. Completing and comprehending this review may or may not contain
all of the content on Exam #3.
Contralateral areas of the
abdomen should be
symmetrical in appearance
and contour and should
have no distention or
bulges.
To elicit hidden masses or
bulges, have the patient
take a deep breath and hold
it. The abdomen should
remain smooth and
symmetrical. Next, have the
supine patient raise their
head from the table as you
inspect the abdomen. Note
any masses, hernia, or
muscle separation.
With the patient’s head at
rest, observe for three types
of abdominal movement.
First, inspect for smooth,
even movement with
respiration.
Second, assess for surface
motion from peristalsis. In
a thin patient, it normally
may be visible. Otherwise,
it may signal an intestinal
obstruction.
Third, note any aortic
pulsation in the upper
midline. Although
pulsations may be visible in
a thin patient, marked
pulsations suggest a
disorder.
Why do you auscultate the abdomen
before you percuss or palpate?
Remember to auscultate before you
percuss or palpate because these
techniques can alter bowel sounds.
Describe how and where you auscultate
the abdomen. What are the three
Using the diaphragm of a
warmed stethoscope, listen
N. Zimmermann Spring 2016
NURS612 Key Points to Review
EXAM #3 CUMULATIVE FINAL EXAM
KEY POINTS FOR WEEKS 9-14
**Please note this is an optional tool for students to use in preparation for
Exam #3. Completing and comprehending this review may or may not contain
all of the content on Exam #3.
additional sounds you assess? What is
normal when you auscultate the
abdomen? What is abnormal?
for bowel sounds and note
their frequency and
character.
Expect to hear clicks and
gurgles at a rate of 5 to 35
per minute.
Note unexpected findings,
such as increased or
decreased bowel sounds or
high-pitched tinkling
sounds.
Auscultate for three
additional sounds.
First, use the stethoscope
diaphragm to detect highpitched friction rubs over
the liver and spleen.
Second, use the stethoscope
bell to check for bruits
over the aortic, renal, iliac,
and femoral arteries.
Third, use the stethoscope
bell to assess for a soft,
continuous, low-pitched
venous hum in the
epigastric area and around
the umbilicus.
Describe how you palpate the abd.
What are you assessing when you
palpate, light, moderate and deep
palpation? What are the normal and
abnormal findings? What do the
abnormal findings indicate as possible
differential diagnosis? How do you
palpate for the various abd structrues?
What are the normal and abnormal
findings? What do the findings indicate
as possible differential diagnoses?
To palpate the abdomen, perform the
following.
Using light palpation,
systematically assess all
quadrants. But first, try to
relax the abdominal
muscles. For example,
place a small pillow under
the patient’s head and
slightly flexed knees, warm
your hands, take a slow and
gentle approach, and save
any tender areas for last.
For light palpation, press in
N. Zimmermann Spring 2016
NURS612 Key Points to Review
EXAM #3 CUMULATIVE FINAL EXAM
KEY POINTS FOR WEEKS 9-14
**Please note this is an optional tool for students to use in preparation for
Exam #3. Completing and comprehending this review may or may not contain
all of the content on Exam #3.
no more than 1 cm with the
palmar surface of your
fingers.
Expect the abdomen to feel
smooth and soft.
Note any resistance or
tenderness. And watch for
guarding, which should
alert you to proceed with
caution.
Using moderate palpation,
systematically assess all
quadrants in two ways.
First, palpate with the
palmar surface of your
fingers. This may elicit
tenderness that was not
produced by light
palpation.
Second, palpate with the
side of your hand
throughout the respiratory
cycle. As the patient
inhales, you may feel the
liver and spleen bump
gently against your hand.
Using deep palpation,
systematically assess all
quadrants with the palmar
surface of your fingers. If a
patient’s obesity or
muscular resistance makes
deep palpation difficult, try
bimanual palpation with
one hand on top of the
other. With either
technique, feel for the
rectus abdominis muscles,
aorta, and portions of the
colon. Note any tenderness.
If you detect a mass,
evaluate its location, size,
shape, consistency,
N. Zimmermann Spring 2016
NURS612 Key Points to Review
EXAM #3 CUMULATIVE FINAL EXAM
KEY POINTS FOR WEEKS 9-14
**Please note this is an optional tool for students to use in preparation for
Exam #3. Completing and comprehending this review may or may not contain
all of the content on Exam #3.
tenderness, pulsation,
mobility, and movement
with respiration. To see if
the mass is superficial or
intraabdominal, palpate as
the patient lifts his or her
head off the table. A
superficial mass will
remain palpable; an
intraabdominal mass will
not.
Palpate the umbilical ring
and periumbilical area.
The umbilical ring should
feel round and regular. The
area should have no bulges,
nodules, or granulation.
Palpate for specific
abdominal structures.
For the liver, press in and
feel for its edge at the right
costal margin as the patient
takes a deep breath. If
palpable, the liver should
feel firm, smooth, even, and
nontender.
For the gallbladder,
palpate below the liver
margin at the lateral border
of the rectus abdominus
muscle. A healthy
gallbladder is not palpable.
For the spleen, press in
over the left costal margin
as the patient takes a deep
breath. The spleen is not
usually palpable.
For the kidneys, assess the
right and left organs
separately, placing one
hand on the flank and the
other hand on the costal
margin. As the patient [Show Less]