Abdominal assessment
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| Prior to an abdominal assessment, what should you have your client do | empty their bladder, lay flat with knees slightly flexed and take slow deep breaths to promote relaxation before exam
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| Sequence of assessment for the abdomen | Inspect, Auscultate, Percuss, Palpate
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| purple discoloration at the flanks indicate | bleeding within the abdominal wall
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| Pale, taut skin may be seen with | ascites (fluid accumulation in the abdominal cavity) usually results from liver failure or liver disease
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| Dilated veins may be seen with | cirrhosis of the liver, obstruction of the inferior vena cava, portal hypertension or ascites
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| normal findings of Striae (stretch marks) | old, silvery, white straie. bluish-pink striae are associated with cushing syndrome.
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| Bluish or purple discoloration around umbilicus indicates | intra-abdominal bleeding
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| A deviated umbilicus may be caused by | pressure from a mass, enlarged organ, hernia, fluid or scar tissue
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| Keloids are more common in | African Americans and Asians
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| Abdominal contours | Flat (-)
Scaphoid- (u)
Rounded- (n)
Distended/protuberant (d)
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| A bulging in the abdominal wall may indicate | hernia
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| The patient head is slightly lifted while assessing the abdomen this helps identify | masses
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| Vigorous, wide spread pulsation may been seen with | abdominal aortic aneurysm (slight pulsation is normal)
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| With intestinal obstruction, peristaltic waves are incrased and progress in a rippled-like fashion from the ___ to the ___. | Left upper quadrant (LUQ) to the right lower quadrant (RLQ)
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| What is the rate of normal bowel sounds. | 5-30 bowel sounds per minute. (intermittent, soft clicks and gurgles)
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| Hypoactive bowel sounds indicate.. Hyperactive bowel sounds indicate.. Decreased or absent bowel sounds indicate.. | Hyperactive-diarrhea, gastroenteritis or early bowel obstruction
Hypoactive- diminished bowel motility and caused by abdominal surgery or late bowel obstruction
Absent or decreased- requires emergency referral
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| When a bruit is heard over the abdominal aorta? | aneurysm or arterial stenosis
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| Generalized tympany(high pitched) is usually heard over the abdomen because | of air in the stomach and intestines
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| Hepatomegaly is | when the liver span exceeds normal limits (enlarged) is characteristic of liver tumors, cirrhosis, abscess, or vascular engorgement
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| The normal liver span at the MSL (mid-sternal line) is | 4-8 cm
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| Light palpation depth | 1 cm
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| Deep palpation depth | 5-6 cm
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| The spleen is normally palpable, if the spleen is palpable this may indicate | chronic blood disorder, cancer, mononucleosis
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| Blumberg's sign is | when the client has rebound tenderness when he or she perceives sharp, stabbing pain as the examiner releases pressure form the abdomen
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| Pain in the RLQ during pressure in the LLQ is a positive _____ sign. | Rovsing's It suggests acute appendicitis
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| Polyuria | Increased frequency of urine
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| Oliguria | Decreased frequency of urine
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| Anuria | Without urine
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| Nocturia | Getting up in the middle of the night to use to the bathroom (frequent)
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| Dysuria | Painful urination
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| Incontinence | Cant go to the bathroom
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| Character of abdominal pain & implications | Dull & achy
Burning, gnawing
pressure
Colicky (permanent, tight muscles)
sharp, knifelike
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| Referred pain | Travels or refers from the primary site and becomes highly localized at the distant site. Example: right neck pain-gallbladder, left shoulder pain-pancreas or spleen
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| Risk factors for gallbladder | women, obesity, smoking, diet
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Created by:
Jmariez
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