PA Exam 3 Abdominal Flashcards
(56 cards)
1
Q
non-Hispanic, Hispanic, and Asian/Pacific Islander people have a higher risk for stomach cancer than ________
A
whites
2
Q
stomach cancer has an association with the prevalence of ________
A
H pylori
3
Q
asia, latin america, caribbean have hightest incidence in ____ and the lowest are _______
A
stomach cancer
North America, Africa
4
Q
Asia, Latin America, Caribbean have highest incidence in ____ and the lowest in _______
A
stomach cancer , North America and Africa
5
Q
Asian Americans have low rates of esophageal carcinoma, but high in _________
A
squamous cell carcinoma and Asians
6
Q
Highest rate of gallbladder cancer is among _______, ______
A
Native Americans and Mexicans
7
Q
peptic ulcer disease risk factors that CAN be controlled…..
A
NSAIDS, anti coagulatins, low dose asprin,(SSRI’s) aldronate, risedronate, tobacco, stress, spicy food, alcohol.
8
Q
peptic ulcer disease risk factors that CANNOT be controlled…..
A
H pylori in the GI tract, hypersecretory condion ( stomach produce much acid) **Zollinger- Ellison ( tumor in pancreas relase high acid producing hormone) family history, radiation, **
9
Q
what do you tell patients to prevent peptic ulcer dieases _____
A
wash hands, food cooked completely avoid alcohol, avoid tobaccok use,
10
Q
Risk factors for GERD ( gastroesophageal reflux disease)
A
obesity, hiatal hernia (top stomach bulges through diaphragm chest cavitiy) pregnancy, smoking, dry mouth, asthma, diabetes, DSE, large meals at night, diary, spicy, and fried foods. some NSAIDS asthma meds and antihypertensives
11
Q
teach client how to prevent GERD________
A
avoid alcohol, stress, food that cause swallowing air (chewing or sucking candy) avoid sodas, eat 5 to 6 small meals a day. chew food slow, dont lie down after eating, avoid tight fitting clothes around the stomach raise head of bed 6-8 inches, try sleeping on left, keep relaxed atmosphere when eating meals.
12
Q
cold spa
A
character : describe issue
onset: when does it happen
location: point where
duration: how long
severity: how bad
pattern: when does it occur
association: other symptoms that happen with it
13
Q
Abdominal examination is preformed for many reason such as _____________…
A
comprehensive health examination, assess abdominal pain, tenderness and masses. or monitor client postoperatively.
14
Q
what is the sequence of abdominal assessment ?
A
inspect, auscultate, percuss then palpate.
15
Q
client my empty their ________before exam begins
A
bladder
16
Q
your can place a pillow or rolled blanket under knee to ________ abdominal muscle
A
Releax
17
Q
painful and tender areas should be assessed at the _____ of the exam ination
A
end
18
Q
Oberve coloration of the skin
normal
abnormal
A
normal: abdominal skin pale, less exposure
Abnormal: Grey turner sign purple discoloration of flanks ( bleeding in wall) due to trauma to K, P, DU.Pancreatitis
yellow: jaundice
Redness: inflammation
Bruises
19
Q
Vasculatrity of the skin
normal: ________veins
abnormal: ______ veins common in (_______) and seen in obstruction to the ____, portal hypertension and __________
A
normal: scattered veins
abnormal: diated veins (cirrhosis of liver)
obstruction to IVC, portal hypertension, ascites (fluid in abdominal spaces)
20
Q
Note any striae
Normal: new striae are ____ and ____ in color. Old is silver, ____linear uneven from preg, or weight loss
abnormal: _____, _____ pink associated with _______
A
normal: pink, white
abnormal: dark, bluish cushings’s syndrome
21
Q
striae can be due to _____ that stretched skin and _____ results from liver failure of liver disease
A
ascites, ascites
22
Q
**inspect scars **
normal: smooth, minimally raised old scars
abnormal: non-_____ wounds,______, ________, deep irregular scars may be due to burns
A
non- healing, inflammation, redness
23
Q
scarring should be an alert for possible _______ adhesions
A
internal
24
Q
keloids are more common in ____,______
A
african americas and asians
25
**assess for lesions and rashes **
normal:
abnormal:
normal: flat or raised moles
abnormal: border symmetry and bleeding
26
**inspect umbilicus**
normal:
abnormal
cullen's sign:
grey turners sign:
normal: color similar to abdominal skin or even pinkish
abnormal: cullens sign: bluish or purple discolor around umbilicus (periumbilical ecchymosis) intra -abdominal bleeding
abnomal : grey turners sign: bluish or purple dicoloration on the abdominal flanks
27
umbilicus location
normal
abnormal
normal : midline of lateral line
abnormal: deviated umbilicus, maybe due to mass pressure, fluid, enlarged organs scar tissue, hernia
28
Assess contour of umbilicus
normal:
abnormal:
normal: recessed (inververted) or protruding no more than 0.5cm
Abnormal: **Everted** umbilicus seen in abnormal distension . **Enlarged Everted** umbilicus (umbilical hernia)
29
Inspection note: when inspecting you would go betwwen the ______ and the ______ measure the abdomial girth
lower ribs and the pubic bone.
30
● Generalized protuberant (bulging) or distended abdomen may be due to _______,__________,__________
● Distension below the umbilicus may be due to _______,________,_______/________
● obesity, air (gas), or fluid accumulation
● full bladder, uterine enlargement, or an ovarian tumor/cyst
31
● Distension of upper abdomen may be seen with ________ of the pancreas or ________
● A scaphoid (sunken) abdomen may be seen with severe ________ or ________
● masses or gastric dilation
● weight loss or cachexia
32
6 F's of abdominal distension
fat, flatulence, fetus, fibroids, feces, fluid,
33
to assess **hernia **or **diastasis recti **(separation of muscle), or to differentiate a _______ within the abdominal wall ask the client to _________
mass, raise the head
34
**Assess Abdominal Symmetry **
Normal: Abdomen is symmetric and does not bulge when client raises head
Abnormal:
● Asymmetry:
● A hernia:
Asymmetry: May be seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction
Hernia: protrusion of the bowel through abdominal wall
35
**Assess Abdominal Symmetry **
● Diastasis recti:
● Incisional hernia
**Assess Abdominal Symmetry **
Diastasis recti: bulge between vertical midline separation of the abdominis rectus muscles (during and after pregnancy)
Incisional Hernia: defect develops in abdominal muscles due to surgical incision.
36
37
38
Inspect Abdominal Movement When Client Breathes
Normal: Abdominal respiratory movement may be seen especially with _______
Abnormal: Diminished abdominal respirations or change to thoracic breathing in _______ clients may reflect _______________
male
male, peritoneal irritation
39
Observe Aortic Pulsations
Assessment note: Abdominal palpation has poor accuracy and is** not recommended for screening**→use _________(high sensitivity)
ultra sound
40
Observe Aortic Pulsations
Normal: slight pulsation of the abdominal aorta, visible in the ______ (_____ ______ region of the abdomen), extends full length in thin ______
Abnormal: Vigorous, wide ________ pulsations may be seen with abdominal aortic _________
epigastrium, upper central
exaggerated, aneurysm
41
Observe Peristaltic Waves
Normal: Typically not see, although in very______ people may be able to see a ________
Abnormal:
● Peristaltic waves are increased and progress in a _____-like fashion from _______ to the R______ with i_________ _________
● Abdominal distension seen with ________ _________ obstruction
* thin, ripple
* intestinal obstruction
* intestinal wall
42
Auscultate Bowel Sounds:
- Apply light to no pressure on a tender abdomen
- Begin in _____ and proceed _____
- Listen for at least _____ min. before determining no bowel sounds present
- Confirm bowel sounds in each quadrant. Listen for 1 minute and up to _____ minute if no sound seems present
- Note intensity, pitch, and frequency of the sounds
* RLQ, clockwise
* 5 mins
* 5 mins
43
Post op bowel sounds resume gradually depending on
the type of surgery
● Small intestine?____________
● Stomach Emptying?_________
● Colon? 3-5 days for __________
* First few hours
* 24-48 hours
* propulsive activity
44
- Bowel Sounds normally occur every ___-_____ seconds (one bowel sound to one breath sound)
5-15 seconds
45
Normal: Series of intermittent, _-______ clicks and gurgles at a rate of ________ per minute
soft, 5-30
46
Increasing pitch of bowel sounds is most ______ _______ because it signifies __________ distension
Borborygmus: _________ bowel sounds that are loud, prolonged gurgles often associated with “_________ ____________”
* diagnostic obstruction, intestinal
* hyperactive, stomach growling
47
Abnormal bowel sounds
● Hyperactive bowel sounds that are ________, ________,_______ may be abnormal, indicating very rapid motility hear in early (4)__________
● Hypoactive bowel sounds indicate diminished bowel motility. Common causes include paralytic ________following abdominal surgery, inflammation of ________, or late _______ _________
● Decreased or absent bowel sounds signify the absence of bowel ________→emergency, immediate _______
● Absent bowel sounds may be associated with ________ or paralytic _______
● High-pitched tinkling and rushes of high-pitched sounds with abdominal _______ usually indicate ________
* Hyperactive bowel sounds : rushing, tinkling, and high pitched, obstruction, gastroenteritis, diarrhea, or with use of laxatives
* Hypoactive bowel sound: ileus, peritoneum, bowel obstruction
* Decreased or absent bowel sounds: motility, referral
* Absent bowel sounds: peritonitis, paralytic ileus
* cramping, obstruction
48
Auscultate for Vascular Sounds
Assessment Note: Uses the bell of the stethoscope to listen for bruits ________), over the abdominal (4) ___________
* (low-pitched, murmur-like sound)
* aorta, renal, iliac, and femoral arteries
49
Auscultate for Vascular Sounds
Normal: ________ are not normally heard over the abdominal aorta, or renal, iliac, or femoral arteries. HOWEVER, ______ confined in ________ may be normal in some clients depending on other differentiating factors
Abnormal:
● Bruit with _____ or ______ components? Artery ______ or obstructed, may indicate an _____ or ______ (RAS)
- The absence of a bruit does not exclude the possibility of _______RAS
most accurate is to do a ______ or _________
normal: Bruits,bruits, systole
abnormal: bruits, systolic and diastolic
turbulent
aneurysm or renal stenosis
ultrasound or an angiogram
50
**venous hum: **
Using _____ of the stethoscope, listen for a venous hum in the _______ and _________
- Normal: Not normally heard over__________ and ___________areas
-Abnormal:
● Rare, but an accentuated venous hum heard in the epigastric or umbilical areas suggests increased_________ __________ between the portal and systemic venous systems, as in cirrhosis of the liver
NORMAL
* * epigastric and umbilical areas
* epigastric and umbilical areas
ABNORMAL
* collateral circulation
* portal and systemic
51
**Auscultate for a friction rub over the over the liver and spleen **
Assessment note: Listen over the_____ and ______ _______ rib cage with the diaphragm of the stethoscope
Normal: No friction rub over liver or spleen is present
Abnormal:
● RARE, if heard they have a _____________________________ produced when the ______ surface area of the liver or spleen rubs the _______, in association with respiration
● Lower right costal area?_______ abscess or _______
● _______ line in the lower left costal area? Associated with _______ infarction abscess, infection, or tumor.
normal: right and left lower
abnormal: high-pitched, rough, grating, sound
large, peritoneum
* Hepatic or metastases
* Anterior axillary,
splenic
52
**Perform Light Palpation:** Assessment Note: Used to identify areas of tenderness and muscular resistance.
- Use fingertips and begin in a ______ quadrant
- Compress to a depth of_____ cm.
**Normal**: Abdomen is nontender and soft. There is no _______ (tensing)
**Abnormal:**
● Involuntary _____guarding? Serious________ irritation.
- The abdomen is ____ and fails to relax when the client _____, typically seen on the _____ of the abdomen
- Concept Mastery: If this occurs, client should be assessed further for possible ______
- Right-sided guarding? May indicate _______ ( _________ inflammation)
**Deeply Palpate all quadrants ** Assessment Note: We do this to delineate abdominal organs and detect subtle masses.
- Use the palmar surface of the fingers to compress ___-___ cm.
- Perform ________palpation if you encounter _______ or to assess _______structures
-** Normal**: Normal (____) tenderness is possible over xiphoid, aorta, cecum, sigmoid, colon, and ovaries, with deep palpation
- **Abnormal**: _____ tenderness or pain may be related to trauma,_____, infection, tumors, or enlarged, or ______ organs
**-Palpate for Masses- **Assessment Note: Note their location, size, shape, consistency, demarcation, pulsatility, tenderness, and mobility.
- DO NOT confuse mass with an organ or ______
**- Normal:** No palpable masses are present
**- Abnormal:** A mass detected in any quadrant may be due to tumor,cyst, _______, enlarged organ, ______ or _______
**Perform Light Palpation:**
* nontender, 1,
**Normal:** guarding,
**Abnormal: **reflex, peritoneal, rigid, exhales, sides,
* Infection
* cholecystitis (gallbladder inflammation)
**Deeply Palpate all quadrants **
5-6
bimanual, resistence, deeper structures
Normal: mild
Abnormal: severe, peritonitis, diseased organs
**Palpate for Masses**
structure
**normal**
**abnormal:** abscess, aneurysm, adhesions
53
**-Palpate the umbilicus-**
Assessment Note: Palpate umbilicus and surrounding area for swellings, bulges, or masses
- Normal: Free of swelling, bulges, or masses
- Abnormal:
● Soft center of umbilicus can be potential for ________
● Palpation of hard ______ in or around, may indicate _______ nodes from an occult (not detectable by clinicals method) __________ cancer
**-Palpate the Aorta- **
Assessment Note: Use your _ and _ or use _ and palpate deeply in the epigastrium
Clinical Tip: **DO NOT **palpate a ______ midline mass; may be a dissecting ______ that can rupture from palpation.
- Avoid deep palpation over tender organs ______ kidneys, _____ tumor, transplantation, or suspected _____trauma)
- Normal: Aorta is approx. ___-___ cm wide with ______ strong and regular pulses. Possibly ____ tenderness may be elicited
**- Abnormal: **
● ____ ______ pulse? Possible abdominal aortic aneurysm
● Prominent, _____ ______ masses above the umbilicus with an accompanying audible ____? Strongly suggests a aortic aneurysm **
**-Palpate the umbilicus-**
* herniation
* nodules, metastatic, gastrointestinal
**-Palpate the Aorta- **
* thumb and first finger
* two hands, epigastrium
* pulsating
* aneurysm
(polycystic, Wilms, transplantation, or suspected splenic trauma)
normal:
2.5-3.0
moderately, mild
abnormal:
Wide bounding
lateral pulsating, bruit
54
____**Palpate the Liver:**
Assessment Note: Note consistency and tenderness
**- To palpate bimanually**, stand at clients______ side and place____hand under the clients _____ at ____ to ____ribs. Lay your right hand parallel to the right ____ margin (fingers should face the head).
● Ask the client to ____, then compress ____ and ____ with your fingers. Have the client ____ and hold your hand in place as the client ____ a second time. With deep _____, the edge of the liver is more easily palpated.
**- To palpate by hooking**, Stand to the _____ of the client's _____. Curl (hook) the fingers over ______ hands over the edge of the right _____ margin
● Ask the client to take a deep breath and gently, but firmly pull ______ and ______with your fingers
**-Normal:** **Liver is usually not palpable, **although it may be felt in some clients. If the lower edge is felt, it should be firm, and _____, and even. Mild tenderness may be normal
**- Abnormal: **
● firm and ____ ? May indicate _____
● Nodularity? May occur with _______, ________ cancer, late cirrhosis or ______
● Tenderness? May be vascular _________ (CHF), acute _______, _______
- A liver more than __-___ cm below the costal margin is considered enlarged (unless displaced by the diaphragm)
● Enlargement? May be due to hepatitis, liver tumors, cirrhosis, and vascular engorgement
**Palpate the Liver:**
**- To palpate bimanually**
right, Left, back 11th to 12th, costal
inhale, upward then inward exhale, inhales
deep inhalation
**- To palpate by hooking**
right, chest, both, costal
inward and upward
normal: smooth
abnormal: hard, cancer
tumors, metastatic syphilis
vascular engorgement (CHF)
hepatitis or abscess
1-3 cm
55
**-Palpate the Spleen-**
Assessment Notes: Stand, at the client’s _____ side, reach over the abdomen with your _____ arm, and place your hand under the ______ lower left ribs. Pull up gently. Place your _____ hand below left ______ margin (fingers toward head)
● Ask client to inhale and press______ and _____ as you provide support with your other hand
● Alternatively, ask the client to turn on the ______ side may facilitate splenic palpation by moving the spleen downward and forward
- Normal: The spleen is______ palpable. Rarely, the tip is palpable (soft and ______) in the presence of a low, flat diaphragm (chronic obstructive lung disease) or with deep _______ descent on inspiration.
- Abnormal:
● Palpable spleen suggests _______ (up to ___ normal size), which may result from infections, trauma, ______,chronic blood disorders and cancers
● Splenic Notch may be felt, which is an indication of splenic _______, but may not always be pathologic
● Spleen feels soft with a rounded edge when it is enlarged from _______.
● Sharp edges when it is enlarged from chronic disease
● CAUTION: Avoid traumatizing and possibly rupturing the organ, be gentle
**Palpate the Kidney:**
Assessment Notes: Palpate the right kidney, support the right posterior flank with your ____ hand and place your right in the RUQ just below the costal margin at _____
- To capture the kidney, ask the client to ____. Then compress your fingers deeply during _____ inspiration.
● Ask the client to exhale and ____ breath briefly. Gradually release the pressure of your right hand. If you have caught the kidney you will feel it slip beneath your fingers.
- Normal: Kidneys are not usually palpable (sometimes lower pole of right kidney with capture method). If palpated it should feel firm, smooth, and rounded. The kidney may or may not be slightly tender
- Abnormal:
● An enlarged kidney may be due to a cyst, tumor, or _______ (smooth rather than sharp edge, tympanic percussion)
**Palpate the Urinary Bladder**
Assessment Note: Palpate for ______ bladder when the client’s history or other findings warrant (dull percussion noted over the symphysis _____)
● Begin at the symphysis pubis and move ______ and _______ to estimate bladder _______
- Normal: An _____ bladder is neither palpable nor tender
- Abnormal:
● Distended bladder is palpated as a ______, ______ and somewhat firm mass extending as far as the _______. May be further validated by _____ percussion tones
**Palpate the Spleen**
right, left, posterior
right, costal
Inward and upward, right
normal: seldom nontender, diaphragmatic
abnormal:
enlargement, 3x, mononucleosis,
enlargement
infection
chronic
**
Palpate the Kidney:**
left, RUQ. MCL
inhale, peak inspiration
hold
normal:
abnormal: hydronephrosis
**Palpate the Urinary Bladder:**
distended
pubis
upward, outward, borders
normal: empty
abnormal: smooth, round, umbilicus, dull
56
******-Specialized Tests-**
→Ascites: (Fluid collection in the abdomen)
- Test for shifting _______
● If you suspect that the client has ascites because of a distended abdomen or bulging flanks, perform this special percussion technique. The client should remain supine. Percuss _______
● Note the change from dullness to ______ and mark this point. Now help the client turn onto the _____. Percuss the abdomen from the bed ______. Mark level where dullness changes to tympany
- This test is not always reliable, get definite answers with an ultrasound
- Normal: _____ between tympany and dullness remain relatively constant throughout position changes.
- Abnormal:
● Often a sign of severe liver disease due to portal _______ ( High BP in the blood vessels of the liver and low ______ levels)
- When the client is supine the fluid assumes a dependent position and produces a _____ percussion tone around the ______. Air rises to the top and tympany is percussed around the umbilicus.
- When the client turns to the side, fluid assumes a ______ position and air rises to the top. Air again rises to the _______.
**- Fluid Wave Test: **
● Clients should remain supine. You will need assistance with this test. Ask the client or assistant to place the _____ side of the hand and the ______ side of the forearm firmly along the _____ of the abdomen. Firmly place the palmar surface of your fingers and hand against one side of the client’s abdomen. Use your other hand to tap the opposite side of the abdominal wall
- Normal: No fluid wave is transmitted
- Abnormal:
● Movement of a fluid wave against the ______ hand suggests large amounts of fluid are present
- Not reliable need an __________
Tests for _______/_______ Irritation
**Assess for rebound tenderness: **
● If the client has abdominal pain or tenderness, test for _______ tenderness by palpating deeply at _____ into the abdomen halfway between the umbilicus and the anterior iliac ______ (McBurney point)
● Clinical Tip: Test for rebound tenderness should always be performed ________ of the examination (pain and muscle spasm can interfere)
- Normal: No rebound tenderness is present
- Abnormal:
● Blumberg sign: _____, ______ pain as the examiner releases pressure from the abdomen, this is a sign of peritoneal irritation (_________)
↦ If the client feels pain at an area other than where you were assessing, consider that area as the source of the pain
● Rovsing Sign: Pain in _______ during pressure in the ______, suggests acute appendicitis
**→Assess for Psoas sign:**
● Ask the client to lie on the ______ side. _______ the clients ______ leg
- Normal: No abdominal pain is present
- Abnormal:
● Pain in the ________ (psoas sign), is associated with irritation of the ______ muscles(Conjunction of psoas major/minor and iliacus) due to appendicitis
**→Assess Obturator Sign:**
● Support the clients ________ knee and rotate the leg _______ and ______
- Normal: no abdominal pain present
- Abnormal: Pain in RLQ indicates ______ of the obturator muscle due to _______ or a _______ appendix
5. Describe the findings frequently seen when assessing the older client’s abdomen.
● Sensitivity to pain may ______ with aging. Therefore, assess older clients _______ for acute abdominal conditions.
● Older adult clients may experience a ______ in appetite from various factors such as altered _____, decreased taste sensation, decreased ______, and, possibly, ______. If appetite declines, the client’s risk for nutritional imbalance increases
● Older adult clients are especially at risk for potential complications with diarrhea–such as fluid volume deficit, dehydration, and electrolyte and acid-base imbalances–because they have a higher fat-to-______ muscle ratio.
● Older adult clients are prone to ______ because the activity of __________ bacteria in the urinary tract ______ with age.
● Dilated ________ capillaries without a pattern may be seen in older clients. They are more visible in _________
● USPSTF recommends ____-_____ screening for abdominal aortic aneurysm (AAA) for men between ____ and _____ years of age who have ever smoked; selectively offer screening for men 65-75 who have ______ smoked; and does not recommend routine screening for _____
● If the client is older than age ____ or has hypertension, assess the width of the ______
● General Routine Screening: Observe
● Focused Specialty Assessment: Auscultate percuss, palpate
**-Specialized Tests: **
dullness
umbilicus
tympany
side
upward
ultrasound
normal: Borders
abnormal: hypertension, albumin, dull, flanks
dependent, top
**-Fluid Wave Test:**
ulnar, lateral, midline
normal:
abnormal: resting
ultrasound
Appendicitis, Peritoneal
**Assess for rebound tenderness: **
rebound, 90°, iliac crest
at the end
normal: rebound
abnormal:Sharp, stabbing, appendicitis
RLQ, LLQ, appendicitis
**Assess for Psoas sign:**
left, Hyperextend, right
Normal:
Abnormal: RLQ , iliopsoas
**Assess Obturator Sign:**
right, internally, externally
normal:
abnormal: RLQ, irritation, appendicitis or perforated
Describe the findings frequently seen when assessing the older client’s abdomen.
diminish, carefully
decline, metabolism, mobility, depression
diarrhea, deficit, lean
UTIs, protective, declines
superficial, sunlight
one-time
65 to 75,
never, women, 50, aorta
