8. Assess and compare bilateral lower
extremities
• Movement and strength
• Temperature and color
• Dorsalis pedis and posterior tibial
• pulses
• Capillary refill
• Sensation
9. Finishing steps
• Listen to posterior lung sounds if not done
earlier
• Reposition patient for comfort
• Place call light within reach
• Open curtain and wash hands
Notes de l'éditeur
Examination Inspection Auscultation Percussion Palpation Complete in this order so as not to disrupt the normal abdominal sounds & movement with percussion & palpation.
Four quadrants of the abdomen include the: Right upper quadrant Left upper quadrant Right lower quadrant Left lower quadrant Imaginary line from the sternum to the pubis, through the umbilicus. Second imaginary line is perpendicular to the first, horizontally across the abdomen through the umbilicus.
Auscultation Auscultate for: Bowel Sounds Auscultate all 4 quadrants Note frequency & character Usually 5 - 35 per minute Absence is established only after 5 minutes of continuous listening. Vascular Sounds Bruits in the aortic, renal, iliac, and femoral arteries Friction rubs over the liver & spleen Venous hum in the epigastric region - occurs with increased collateral circulation between portal & systemic venous systems. soft, low pitch & continous.
Percussion To detect fluid, air, and an fluid-filled or solid masses. Stomach & intestines - tympanic Organs & solid masses - dullness Percuss all 4 quadrants in a systematic route (May begin on the right side just below the liver, span hortizontally to the spleen & pancreas, travel down the stomach, the horizontally once again across the lower abdomen Note: Liver span (at midsternal line usually 2-3 cm) - Usual span is 6-12 cm. On right Spleen - just posterior to the midaxillary line on the left Gastric bubble - Left lower anterior rib cage and the left epigastric region The tympany produced by the gastric bubble is lower in pitch than the tympany of the intestine.
Palpation Light, moderate, & deep palpation Palpate for masses, tenderness, organ enlargement, and ascites Palpation of specific structures: (TO BE REVIEWED IN LAB) Liver: with finger hooked over costal margin also push up from back & mead down Gallbladder (Murphy sign): two handed Spleen: push up from the left back and mead downward on the abd. Kidneys: Side of hand or fist over flank area, also pushing up from back, then down. Aorta:Slightly left of the midline. Feel for aortic pulsation. Urinary Bladder: Not palpable in the healthy pt. unless the bladder is distended. Abdominal reflexes: Stroke away from umbilicus. Should see contraction of the rectus abdominus muscles & a pulling of the umbilicus toward the stroked side
