Module 4 Abdomen & Musculoskeletal

Question 1

Anatomy of the abdomen: how many quadrants are there?

Answer 1

4 quadrants:
RUQ. LUQ
RLQ. LLQ

Question 2

Anatomy of the abdomen: how many regions are there?

Answer 2

9 regions:
Epigastric for the area between the costal margins
Umbilical for the area around the umbilicus
Hypogastric or suprapubic for are above pubic bone

Question 3

An atomic location of organs by RUQ: (7)

Answer 3

Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, part of ascending and transverse colon

Question 4

An atomic location of organs by LUQ: (7)

Answer 4

Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon

Question 5

An atomic location of organs by RLQ: (5)

Answer 5

Cecum, appendix, right ovary and tube, right ureter, right spermatic cord

Question 6

An atomic location of organs by LLQ: (5)

Answer 6

Part of descending colon, sigmoid colon, left ovary tube, left return, left spermatic cord

Question 7

Inspection of abdomen
CONTOUR

Answer 7

• determine profile from rib margin to pubic bone (flat, scaphoid, rouded, protuberant
• contour describes nutritional state and normally ranges from flat to rounded

Question 8

Inspection of abdomen
SYMMETRY

Answer 8

• Abdomen should be symmetric bilaterally
• Note any localized bulging, visible mass, or asymmetric shape
• Ask client to take a deep breath, which may make masses and enlarged organs more visible

Question 9

Inspection of abdomen
UMBILICUS

Answer 9

Normally midline and inverted, with no sign of discoloration, inflammation, or hernia

Question 10

Skin inspection

Answer 10

• Surface smooth and even, with homogeneous color
   Pigmented nevi (moles), circumscribed brown macular or
  papular areas, common on abdomen
   Normally lesions and rashes are not present
   Surgical scars may be present; if a scar is present, assess it’s
  cause and document location and length
   Fine venous network may be visible in thin persons
   One common pigment change is striae

Question 11

Inspection:
Pulsation or movement

Answer 11

 Normally, you may see pulsations from aorta beneath skin
in epigastric area, particularly in thin persons with good
muscle wall relaxation
 Respiratory movement also shows in abdomen,
particularly in males
 Waves of peristalsis sometimes are visible in very thin persons

Question 12

When auscultating with diaphragm, what are you noting?

Answer 12

Character & frequency of bowel sounds, beginning in RLQ.

Question 13

When auscultating, normal sounds are:

Answer 13

High pitched, gurgling, cascading in nature

Question 14

In Auscultation, hyperactive BS =

Answer 14

loud, high pitched, rushing, tinkling sounds d/t
increased motility associated with early obstruction, gastroenteritis, diarrhea, laxatives, subsiding paralytic ileus

Question 15

In auscultating, hypoactive or absent BS =

Answer 15

d/t abdominal surgery, peritonitis, paralytic
ileus or complete obstruction

Question 16

When do you establish abscense in auscultation?

Answer 16

Establish absence only after 5 mins. of continuous auscultation to 4 quadrants

Question 17

What kind of sounds do we auscultate for?

Answer 17

Auscultate for vascular sounds or bruits over abdominal
aorta, renal, iliac & femoral arteries

Question 18

What is a bruit?

Answer 18

Swishing sound and it is considered abnormal

Question 19

What is percussion?

Answer 19

Percuss to assess relative density of abdominal contents, to locate organs, and to screen for abnormal fluids or masses

Question 20

What are the 3 types of percussion?

Answer 20

1. Tympany
   -high pitched, musical
   -presence of air in stomach & intestine
2. Dullness
   -medium intensity, duration, & pitch
   -solid organs, masses, fluid, adipose tissue & distended bladder
3. Hyperresonance
   -very loud intensity, low pitch, long duration
   -gaseous distention

Question 21

Light palpitation

Answer 21

▪ Depress abdominal wall ~ 1cm
▪ Objective is not to search for organs but to form an overall impression of skin surface and superficial musculature
▪ Note increased resistance or muscle guarding & tenderness (normally abdomen is soft & smooth)

Question 22

Deep palpatation

Answer 22

• Depress abdominal wall ~ 5-8 cm
  ▪ Use bimanual technique for very large or obese patient

Question 23

Rebound tenderness

Answer 23

▪ Determines presence of peritoneal irritation or inflammation
▪ Firmly & slowly press into abdomen at 90 degree angle at non-
tender area
▪ Quickly withdraw fingers
▪ Normally no pain occurs when fingers withdrawn

Question 24

Musculoskeletal system

Answer 24

Assessment of joints, muscles, and bones
➢ Functional assessment of ADLs

Question 25

Types of joints

Answer 25

Fibrous joints ▪ Bones united by interjacent fibrous tissue or cartilage and do not move (sutures in skull) ➢ Cartilaginous joints ▪ Separated by fibrous cartilage and are slightly moveable (vertebrae) ➢ Synovial joints ▪ Freely moveable joints separated from one another and enclosed in a cavity lined with synovial membrane that secretes fluid

Question 26

Inspection of joints

Answer 26

➢ Note size & contour of joints ➢ Inspect skin and tissue overlying joints for color, swelling, masses or deformity

Question 27

Palpation of joints

Answer 27

➢ Palpate each joint for: ▪ Skin temperature ▪ Muscles ▪ Bony articulations ▪ Joint capsule ➢ Joints normally non-tender when palpated

Question 28

ROM w/ joints

Answer 28

➢ Have client move through active ROM ➢ If limitation occurs, move joint through passive ROM ➢ Compare joints bilaterally ➢ Normally no tenderness, pain, or crepitation is present

Question 29

Skeletal muscles produce the following ROM movements:

Answer 29

 Flexion: bending limb at joint  Extension: straightening limb at joint  Abduction: moving limb away from midline of body  Adduction: moving limb toward midline of body  Pronation: turning forearm so that palm is down  Supination: turning forearm so that palm is up  Circumduction: moving arm in circle around shoulder  Inversion: moving sole of foot inward at ankle  Eversion: moving sole of foot outward at ankle  Rotation: moving head around central axis

Question 30

Head-to Toe Approach:

Answer 30

TMJ Hip Cervical spine Knee Shoulder Ankle & Foot Elbow Spine Wrist & Hand

Question 31

Muscle strength

Answer 31

➢ Assess strength of muscles surrounding each joint through same motions as for AROM ➢ Muscle strength should be equal bilaterally and fully resist opposing force ➢ Grade on 5-point scale

Question 32

Abnormal findings in a joint:

Answer 32

Dislocation (complete loss of contact between the two bones in a joint) Subluxation (2 bones in a joint stay in contact, but their alignment is off) Contracture (shortening of a muscle leading to limited ROM of joint) Ankylosis (stiffness or fixation of a joint) Articular and extra- articular disease Crepitation (crunching or grating)