sem 2 304 exam 2 Flashcards
(178 cards)
1
Q
Inflammation or tenderness, swelling, tuft of hair, or dimple at tip of coccyx may indicate _________
A
pilonidal cyst
2
Q
First test for a _______ by standing on the person’s right side. Place the ulnar edge of another examiner’s hand or the patient’s own hand firmly on the abdomen in the midline . (This stops transmission across the skin of the upcoming tap.) Place your left hand on the person’s right flank. With your right hand reach across the abdomen and give the left flank a firm strike.
A
fluid wave
3
Q
typically starts as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness localized in RLQ (McBurney point). Pain is aggravated by movement, coughing, deep breathing; associated with anorexia, then nausea and vomiting, fever.
A
Appendicitis (Appendix.)
4
Q
you must listen for ______ by your watch before deciding if bowel sounds are completely absent
A
5 minutes
5
Q
Testosterone production declines after age ____ but very gradually, so resulting physical changes are not evident until later in life.
A
30
6
Q
is excessive fat in the stool, from malabsorption of fat as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn disease.
A
Steatorrhea
7
Q
PSA at age 50 & earlier for those w/ family hx & African-American men 45 years of age
A
Benign Prostatic Hypertrophy (BPH
8
Q
Abdominal Distention where
Inspection. Uniformly rounded. Umbilicus sunken (it adheres to peritoneum, layers of fat are superficial to it).
Auscultation. Normal bowel sounds.
Percussion. Tympany. Scattered dullness over adipose tissue.
Palpation. Normal. May be hard to feel through thick abdominal wall.
A
Obesity
9
Q
The nurse anticipates auscultating hypoactive bowel sounds (BS) when assessing which patient?
A pt. c/o hunger
A pt. w/ diarrhea
A pt. w/ borborygmus
A pt. recovering from abdominal surgery
A
A pt. recovering from abdominal surgery
10
Q
Begins as red, raised, warty growth or as an ulcer with watery discharge.
As it grows, may necrose and slough. Usually painless. Almost always on glans or inner lip of foreskin and following chronic inflammation. Enlarged lymph nodes are common.
A
Carcinoma
11
Q
Swelling, may have pain with straining
Enlarged, may reduce when supine, does not transilluminate
Soft, mushy mass; palpating fingers cannot get above mass. Mass is distinct from testicle that is normal
Nontender swelling of scrotum
A
Scrotal Hernia
12
Q
part of acute renal failure where sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
A
postrenal
13
Q
has moderate, colicky pain of gradual onset in lower abdomen and bloating. Irritable bowel syndrome (IBS) has sharp or burning cramping pain over a wide area; does not radiate. Brought on by meals; relieved by bowel movement.
A
Large bowel obstruction (Colon)
14
Q
—circumscribed brown macular or papular areas—are common on the abdomen.
A
Pigmented nevi (moles)
15
Q
Prolonged painful erection of penis without sexual stimulation and unrelieved by intercourse or masturbation, most common in men in 30s and 40s.
A rare condition but when lasting 4 hours or longer can cause ischemia of penis, fibrosis of tissue, erectile dysfunction.
Can occur as a side effect of some medications and street drugs; with sickle-cell trait or disease; with leukemia in which increased numbers of white blood cells produce engorgement; with malignancy; from local trauma; or as a result of spinal cord injuries with autonomic nervous system dysfunction.
A
Priapism
16
Q
The second test for ______ is percussing for shifting dullness. In a supine person ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel to the periumbilical space. You will hear a tympanitic note as you percuss over the top of the abdomen because gas-filled intestines float over the fluid. Then percuss down the side of the abdomen. If fluid is present, the note will change from tympany to dull as you reach its level. Mark this spot.
A
ascites
17
Q
blood in urine
A
Hematuria
18
Q
—Diminished quantity of urine
A
Oliguria
19
Q
Meatus opens on the dorsal (upper) side of glans or shaft above a broad, spadelike penis.
disabling because of associated urinary incontinence and separation of pubic bones.
A
Epispadias
20
Q
__________ stool with distinct malodor indicates upper GI bleeding with blood partially digested.
A
Black tarry
21
Q
the anterior axillary line, a change in percussion from tympany to a dull sound with full inspiration is a positive spleen percussion sign, indicating ________
A
splenomegaly.
22
Q
A small mound of breast and nipple develops; the areola widens.
The breast and areola enlarge; the nipple is flush with the breast surface.
The areola and nipple form a secondary mound over the breast.
A
Breast bud stage:
23
Q
The isthmus of the uterus softens at 6 to 8 weeks.
A
(Hegar sign)
24
Q
no Pap tests for women under age __ years, regardless of sexual activity
Pap test interval of __years for women ages 21-30 years; (3) HPV and Pap “co-testing”
every __ years for women ages 30 to 65 years.
A
21 years
3
5
25
Foreskin is retracted and fixed.
Once retracted behind glans, a tight or inflamed foreskin cannot return to its original position.
Constriction impedes circulation, so glans swells. A medical emergency; the constricting band prevents venous and lymphatic return from the glans and compromises arterial circulation..
Paraphimosis
26
prompt a sudden onset of severe, colicky flank or lower abdominal pain.
Kidney stones (Kidney)
27
is a normal and common variation. An extra nipple along the embryonic “milk line” on the thorax or abdomen is a congenital finding.
Usually it is 5 to 6 cm below the breast near the midline and has no associated glandular tissue. It looks like a mole, although a close look reveals a tiny nipple and areola. It is not significant; merely distinguish it from a mole.
A supernumerary nipple
28
Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years.
Pica:
29
Striae look purple-blue with____________ (excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching).
Cushing syndrome
30
is cessation of the menses
Menopause
31
Pinpoint, constricted opening at meatus or inside along urethra.
Occurs congenitally or secondary to urethral injury. Gradual decrease in force and caliber of urine stream is most common symptom. Shaft feels indurated along ventral aspect at site of stricture.
Urethral stricture
32
is biliary colic, sudden pain in RUQ that may radiate to right or left scapula and that builds over time, lasting 2 to 4 hours, after ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting and with positive Murphy sign or sudden stop in inspiration with RUQ palpation
Cholecystitis (Gallbladder)
33
The cervix softens at 4 to 6 weeks
(Goodell sign)
34
you should urinate __-___ times a day
4-6
35
(heartburn), a burning sensation in esophagus and stomach, from reflux of gastric acid.
Pyrosis
36
If the stool is Hematest positive, it indicates _________. The fecal immunochemical test (FIT) is newer and can be used without the diet or medication restrictions of the older guaiac-based tests.
occult blood
37
is present with gaseous distention.
Hyperresonance
38
__________—Absent bile pigment (e.g., obstructive jaundice)
Gray, tan stool
39
may have mild-to-moderate dull pain in right upper quadrant (RUQ) or epigastrium, along with anorexia, nausea, malaise, low-grade fever.
Hepatitis (Liver.)
40
are benign growths that commonly appear on the cervix after childbirth. They are small, smooth, yellow nodules that may be single or multiple. Less than 1 cm, they are retention cysts caused by obstruction of cervical glands.
Nabothian cysts
41
With the first four fingers close together, depress the skin about 1 cm. Make a gentle rotary motion, sliding the fingers and skin together. Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen.
light palpation.
42
Perform when the acute abdominal pain of appendicitis is suspected.
With the person supine, lift the right leg straight up, flexing at the hip then push down over the lower part of the right thigh as the person tries to hold the leg up. When the test is negative, the person feels no change.
Iliopsoas Muscle Test.
43
The complete rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut with radiating lines.
When incomplete, only the mucosa bulges. When complete, it includes the anal sphincters.
Occurs following a Valsalva maneuver such as straining at stool or with exercise. Caused by weakened pelvic support muscles and requires surgery.
Rectal Prolapse
44
is persistent passing of stools into clothing in a child older than 4 years, at which age continence would be expected.
Encopresis
45
—Involuntary urine loss from overactive detrusor muscle in bladder.
Urge incontinence
46
These painless, flabby papules are caused by a varicose vein.
When thrombosed, it contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation.
When it resolves, it leaves a painless, flabby skin sac around the anal orifice.
When the person performs a Valsalva maneuver, it may appear as a red mucosal mass.
Hemorrhoids
47
__________—Also occurs with ingesting iron or bismuth preparations.
Black stool
48
```
Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord
```
are in what portion of the abdomen
Right Lower Quadrant (RLQ)
49
Match the conditions listed with the appropriate description
____ Diminished urine output
____ Excessive voiding at night
____ Increased frequency & amount of voiding
____ Visible blood in urine
Polyurina
Oliguria
Gross Hematuria
Nocturia
1-a
2-d
3-b
4-c
50
Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.
Epigastric Hernia
51
```
Liver
Gallbladder
Duodenum
Head of pancreas
Right kidney and adrenal
Hepatic flexure of colon
Part of ascending and transverse colon
```
are in what portion of the abdomen
Right Upper Quadrant (RUQ)
52
2 Auscultation techniques for abdomen
Bowel sounds (4 quadrants), vascular sounds (bruit)
53
occurs with stomach or duodenal ulcers and esophageal varices.
Hematemesis
54
is a hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary. or pancrea
Sister Mary Joseph nodule
55
Black stools may be tarry due to occult blood from GI bleeding or nontarry from iron medications. Gray stools occur with hepatitis.
melena
56
_______________—Increased fat content (steatorrhea), as occurs with malabsorption syndrome.
Pale yellow, greasy stool
57
Treatable Factors
Contributing to Incontinence
“DIAPPERS”
```
Delirium
Infection – Urinary, Symptomatic
Atrophic Urethritis and Vaginitis
Pharmaceuticals
Psychologic Disorders
Excessive Urine Output (Heart Failure/ Hyperglycemia)
Restricted Mobility
Stool Impaction
```
58
Any pain or burning with urinatin
Dysuria
59
The nurse is examining a pt. with suspected peritoneal inflammation. How does the nurse elicit rebound tenderness?
Using lt. palpation noting tenderness over area
Using deep palpation over the affected area
Pressing the area firmly w/ one hand & releasing pressure while maintaining fingertip contact
Pressing the area firmly w/ one hand, releasing pressure quickly & noting tenderness on release
Pressing the area firmly w/ one hand, releasing pressure quickly & noting tenderness on release
60
silvery white, linear, jagged marks about 1 to 6 cm long. They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching as in pregnancy or excessive weight gain. Recent striae are pink or blue; then they turn silvery white.
striae (lineae albicantes)
61
for BSE, with fingertips close together in which 3 motions
down, up, down
in toward nipple
circular motion
62
, abdominal distention
Protuberant abdomen
63
The nurse is assessing a 51 year- old female experiencing an increased involuntary loss of urine with physical activity and sneezing. Her PMH is significant for abdominal surgery. What type of incontinence does the nurse know this patient is experiencing?
Urge
Functional
Stress
Reflex
Stress
64
when Palpateing the Anus and Rectum Ask the man to take a deep breath and hold it. Place the pad of your index finger gently against the ______ You will feel the sphincter tighten and then relax.
As it relaxes ask the man to exhale and flex the tip of your finger and slowly insert it into the anal canal in a direction toward the _________
Never approach the anus at ________ with your index finger extended. Such a jabbing motion does not promote sphincter relaxation and is painful.
Rotate your examining finger to palpate the entire muscular ring. The canal should feel _____&______
Note the intersphincteric groove circling the canal wall. To assess tone, ask the person to tighten the muscle. The sphincter should tighten evenly around your finger with no pain to the person.
anal verge
umbilicus.
right angles
smooth and even.
65
2 Palpation techniques for abdomen
Light and deep palpation.
66
if you feel an enlarged ______ refer the person but do not continue to palpate it. An enlarged _____ is friable and can rupture easily with overpalpation.
spleen,
67
Inability of the intestine (bowel) to contract normally and move waste out of the body.
Paralytic Ileus
68
A urine filled bladder is __________ to percussion,
while an empty bladder is __________.
Dull, unavailable to percussion
Resonant, flat
Tympanic, dull
Dull, unavailable to percussion
69
Episodes of local pain, dysuria, fever.
This STI often presents as clusters of small, shallow vesicles with surrounding erythema; erupts on genital areas and inner thigh. Also inguinal adenopathy, edema. Vesicles on labia rupture in 1 to 3 days, leaving painful ulcers. Initial infection lasts 7 to 10 days. Virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.
Herpes Simplex Virus—Type 2 (Herpes Genitalis)
70
:This STI begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge.
Palpation—Nontender indurated base; can be lifted like a button between thumb and finger. Nontender inguinal lymphadenopathy. May go unnoticed; resolves spontaneously. But secondary syphilis follows: fever, lymphadenopathy, mucocutaneous red rash, sore throat.
Syphilitic Chancre
71
when you feel your “stomach growling,” termed _______
borborygmus.
72
abdomen caves in
Scaphoid
73
An enlarged liver span indicates liver enlargement or _____
hepatomegaly.
74
Ventral location of meatus
Hypospadias
75
2 Percussion techniques for abdomen
Tone (4 quadrants), *Ascites assessment
76
to detect the lower border of the liver.
Place the stethoscope over the xiphoid while lightly stroking the skin with one finger up the MCL from the RLQ and parallel to the liver border.
When you reach the liver edge, the sound is magnified in the stethoscope.
if the abdomen is distended, obese, or too tender for palpation or if muscles are rigid or guarded.
Scratch Test.
77
a sebaceous secretion in the folds of the skin, especially under a man's foreskin
smegma
78
Diminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis; from paralytic ileus as following abdominal surgery; or from late bowel obstruction. Occurs also with pneumonia.
Hypoactive Bowel Sounds
79
To assess the kidney place one hand over the 12th rib at the costovertebral angle on the back. Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain
Sharp pain occurs with inflammation of the kidney or paranephric area.
Costovertebral Angle Tenderness
80
in people with ________, in which the liver is displaced downward by the hyperinflated lungs. Although you hear a dull percussion note well below the right costal margin, the overall span is still within normal limits.
chronic emphysema
81
Assess _______. Palpate the posterior parts of the labia majora with your index finger in the vagina and your thumb outside at 5 and 7 o'clock positions . Normally the labia feel soft and homogeneous.
Bartholin glands
82
part of acute renal failure where direct damage to the kidneys by inflamation, toxins, drugs, infection, or reduced blood supply
intrarenal
83
A hair-containing cyst or sinus located in the midline over the coccyx or lower sacrum. Often opens as a dimple with visible tuft of hair and possibly an erythematous halo. Or may appear as a palpable cyst
Pilonidal Cyst or Sinus
84
Begins within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge.
Palpation reveals a nontender indurated base that can be lifted like a button between the thumb and the finger. Lymph nodes enlarge early but are nontender.
This is an STI easily treated with penicillin G; but untreated it leads to cardiac and neurologic problems and blindness.
Syphilitic Chancre
85
. Pain due to local condition (hemorrhoid, fissure) or constipation.
Dyschezia
86
Palpate the horizontal chain along the groin inferior to the inguinal ligament and the vertical chain along the upper inner thigh.
It is normal to palpate an isolated node on occasion; it then feels small (<1 cm), soft, discrete, and movable
this asesment technique is for _______
Inguinal Lymph Nodes
87
has acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea, and vomiting.
Pancreatitis (Pancreas)
88
: History of skin contact with allergenic substance in environment, intense pruritus.
Primary lesion—Red, swollen vesicles. Then may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching. May result from reaction to feminine hygiene spray or synthetic underclothing.
Red Rash—Contact Dermatitis
89
responds to ibuprofen because it works on uterine smooth muscle.
Dysmenorrhea
90
* T =
* S =
* E =
* T = timing, once a month
* S = shower, warm water relaxes scrotal sac
* E = examine, check for changes, report changes immediately
91
A pt. reports abd. pain. How will the RN proceed with the assessment?
1. Deep palpation
2. Assessing the painful area first
3. Assessing the painful area last with light palpation
4. Checking for warmth at the painful area
3. Assessing the painful area last with light palpation
92
typically has dull, aching, gnawing pain; does not radiate; may be relieved by food; and may awaken the person from sleep.
Duodenal ulcer (Duodenum)
93
Urethral meatus opens on the ventral (under) side of glans or shaft or at the penoscrotal junction.
A groove extends from the meatus to the normal location at the tip. This congenital defect is important to recognize at birth.
The newborn should NOT be circumcised because surgical correction may need to use foreskin tissue to extend urethral length.
Hypospadias
94
An alternative method of palpating the liver is to stand up at the person's shoulder and swivel your body to the right so you face the person's feet. Hook your fingers over the costal margin from above. Ask the person to take a deep breath. Try to feel the liver edge bump your fingertips.
Hooking Technique.
95
Number of births.
Para
96
when the person reports abdominal pain or when you elicit tenderness during palpation.
Choose a site away from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply then lift up quickly
A normal, or negative, response is no pain on release of pressure. Perform this test at the end of the examination because it can cause severe pain and muscle rigidity
Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis.
Rebound Tenderness (Blumberg Sign)
97
Often the spleen is obscured by stomach contents, but you may locate it by percussing for a dull note from the ___-____ intercostal space just behind the left midaxillary line
9th to 11th
98
An exquisitely painful longitudinal tear in the superficial mucosa at the anal margin.
Pain is described as passing “shards of glass”;
may have bright red blood in the stool.
may be caused by trauma (passing a large hard stool) or from irritant diarrheal stools.
Treat with stool softeners, fiber, warm soaking baths, topical analgesics. Healing may be enhanced with topical nitroglycerin ointment or Botox injection.9
Fissure
99
Enlarging testis
has feel of increased weight
does not transilluminate
Firm palpation does not cause usual sickening discomfort as with normal testis
Nontender swelling of testis
maintains shape of testis.
Diffuse Tumor
100
part of acute renal failure where sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
prerenal
101
Unrelated to peristalsis, this is a very loud splash auscultated over the upper abdomen when the infant is rocked side to side. It indicates increased air and fluid in the stomach, as seen with pyloric obstruction or large hiatus hernia
Succussion Splash
102
has diffuse, generalized abdominal pain with nausea, diarrhea.
Gastroenteritis (Small intestine)
103
a separation of the rectus muscles with a visible bulge along the midline
The condition is more common with Black infants, and it usually disappears by early childhood.
diastasis recti
104
During adolescence it is common for the male breast tissue to enlarge temporarily, producing ___________
gynecomastia
105
The nurse assesses the patient’s abdomen and inspects a concave contour. The nurse will document this finding as:'
Distended
Rounded
Scaphoid
Protuberant
Scaphoid
106
output ___mL am hour of urine
30
107
Aorta
Uterus (if enlarged)
Bladder (if distended)
are in what portion of the abdomen
Midline
108
A complete colon blockage by hard, desiccated immovable stool in the rectum, which presents as constipation or overflow incontinence.
Results from decreased bowel motility as in hospitalized older adults and people with spinal cord injuries; also with low-fiber diet, hypothyroidism, opiate use.
Abdominal palpation or DRE reveals mass. Treat with laxatives, enemas, suppositories. Community-dwelling older adults are at risk, especially those with dementia who cannot communicate. Use extreme caution in treating this group.6
fecal impaction
109
Male breast examination is done
| during the ______ assessment
thorax
110
failure of the kidneys to produce urine.
Anuria
111
Empty scrotal half
Absent Testis, Cryptorchidism
112
Abdominal Distention where
Inspection. Localized distention.
Auscultation. Normal bowel sounds.
Percussion. Dull over mass if reaches up to skin surface.
Palpation. Define borders. Distinguish from enlarged organ or normally palpable structure.
Tumor
113
are loud, high-pitched, rushing, tinkling sounds that signal increased motility.
Hyperactive sounds
114
This scoring system combines findings to assist evaluation in patients with RLQ pain. Also called the MANTRELS score, from the mnemonic in the following list, a score of 4 or less significantly decreases the probability of appendicitis.
The Alvarado Score.
115
Marked pulsation of aorta occurs with widened pulse pressure (e.g., hypertension, aortic insufficiency, thyrotoxicosis) and aortic aneurysm.
Marked visible peristalsis, together with a distended abdomen, indicates_________
intestinal obstruction.
116
```
Breast changes: pain, lump, discharge, rash, swelling
Trauma or Injury?
Hx of breast disease and/or surgery?
Family hx of breast cancer?
Performance of BSE?
Have you ever had a mammogram?
Medications?
```
subjective data for Breast and Regional Lymphatics
117
Abdominal Distention where
Inspection. Single curve. Umbilicus protruding. Breasts engorged.
Auscultation. Fetal heart tones. Bowel sounds diminished.
Percussion. Tympany over intestines. Dull over enlarging uterus.
Palpation. Fetal parts. Fetal movements.
Pregnancy
118
Hemoglobin 6.8
Burning Sensation in epigastric region
No Appetite
Nausea/Vomiting
are signs for
active bleeding ulcer
119
Bright red blood on stool surface indicates__________. Bright red blood mixed with feces indicates possible _______________.
rectal bleeding
colonic bleeding
120
Clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans, foreskin, or anus.
These rupture to form superficial ulcers. May have mild tingling before outbreak or shooting pain in buttock or leg.
A STI, the initial infection lasts 7 to 10 days and is treated with oral acyclovir. The virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.
Genital herpes
| HSV-2 Infection
121
(crystals of calcium oxalate or uric acid) form in kidney tubules and then migrate and become urgent when they pass into ureter, become lodged, and obstruct urine flow. Cause abrupt severe flank pain with radiation to the groin or abdomen, nausea and vomiting, restlessness, gross or microscopic hematuria
Renal stones
122
—Number of pregnancies
Gravida
123
Abdominal Distention where
Inspection. Single curve. Everted umbilicus. Bulging flanks when supine. Taut, glistening skin; recent weight gain; increase in abdominal girth.
Auscultation. Normal bowel sounds over intestines. Diminished over ascitic fluid.
Percussion. Tympany at top where intestines float. Dull over fluid. Produces fluid wave and shifting dullness.
Palpation. Taut skin and increased intra-abdominal pressure limit palpation.
Ascites
124
S: Urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia.
O: A symmetric nontender enlargement; commonly occurs in males beginning in the middle years. The prostate surface feels smooth, rubbery, or firm (like the consistency of the nose), with the median sulcus obliterated.
Benign Prostatic Hypertrophy (BPH)
125
—Involuntary urine loss with physical strain, sneezing, or coughing.
Stress incontinence
126
Absolute stillness, resisting any movement, occurs with the pain of __________
Knees flexed up, facial grimacing, and rapid, uneven respirations also indicate pain.
peritonitis.
127
(belching).
Eructation
128
If _____ is present, the blow will generate a fluid wave through the abdomen, and you will feel a distinct tap on your left hand. If the abdomen is distended from gas or adipose tissue, you will feel no change.
ascites
129
This is a soft, skin-covered mass, the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring. It is accentuated by increased intra-abdominal pressure as with crying, coughing, vomiting, or straining; but the bowel rarely incarcerates or strangulates.
More common in premature infants. Most resolve spontaneously by 1 year; parents should avoid affixing a belt or coin at the hernia because this will not help closure and may cause contact dermatitis. In an adult it occurs with pregnancy, chronic ascites, or chronic intrathoracic pressure
Umbilical Hernia
130
Loud, gurgling sounds, “borborygmi,” signal increased motility. They occur with early mechanical bowel obstruction (high-pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus.
Hyperactive Bowel Sounds
131
is dull, aching, gnawing epigastric pain, usually brought on by food and radiates to back or substernal area. Pain of perforated ulcer is burning epigastric pain of sudden onset that refers to one or both shoulders.
Gastric ulcer pain (Stomach)
132
clear nipple discharg
Galactorrhea.
133
Painless warty growths; may be unnoticed by woman
.
Pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in a cauliflower-like patch.
Occur around vulva, introitus, anus, vagina, cervix.
most common STI, especially in adolescents. Risk factors: early age at menarche and multiple sexual partners. Genital warts are less common than cervical lesions but must be treated with topical medication or surgical removal. Abstain from sex while warts are present.
Human Papillomavirus Genital Warts
134
```
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney and adrenal
Splenic flexure of colon
Part of transverse and descending colon
```
are in what portion of the abdomen
Left Upper Quadrant (LUQ)
135
pain that occurs with trauma, inflammation, infection, and benign breast disease
Mastalgia
136
when palpating the prostate gland
Size—___ cm long by __ cm wide; should not protrude more than __ cm into the rectum
Shape—_____shape, with palpable central groove
Surface—________
Consistency— ______,________
Mobility—_________
Sensitivity—___________ to palpation
Size—2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum
Shape—Heart shape, with palpable central groove
Surface—Smooth
Consistency—Elastic, rubbery
Mobility—Slightly movable
Sensitivity—Nontender to palpation
137
Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look. This condition suggests cancer.
Peau d'Orange
138
is a complex of symptoms of esophagitis, including burning pain in midepigastrium or behind lower sternum that radiates upward or “heartburn.” Occurs 30 to 60 minutes after eating; aggravated by lying down or bending over.
Gastroesophageal reflux disease (GERD) (Esophagus.)
139
Assess the ________&_______. Dip your gloved finger in a bowl of warm water to lubricate. Then insert your index finger into the vagina, and gently milk the urethra by applying pressure up and out. This procedure should produce no pain. If any discharge appears at 11 o'clock and 1 o'clock positions, culture it.
urethra and Skene glands
140
Palpate the inguinal canal. For the right side, ask the male to shift his weight onto the left leg.
Place your right index finger low on the right scrotal half so you carry as much skin as possible as you proceed. Palpate up the length of the spermatic cord, invaginating the scrotal skin as you go, to the external inguinal ring. It feels like a triangular slitlike opening. If positioned properly, it will admit your finger; gently insert it into the canal and ask the man to “bear down.”
Normally you feel no change. Repeat the procedure on the left side.
this asesment technique is for _______
Inguinal and Femoral hernia
141
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Part of descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
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are in what portion of the abdomen
Left Lower Quadrant (LLQ)
142
Common men > 50
Benign Prostatic Hypertrophy (BPH
143
Restlessness and constant turning to find comfort occur with the colicky pain of __________ or ________
gastroenteritis or bowel obstruction
144
occurs with disorders of the throat or esophagus.
Dysphagia
145
—Painful constriction of glans by retracted foreskin.
Paraphimosis
146
Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower-like patch.
Color may be gray, pale yellow, or pink in White males and black or translucent gray-black in Black males.
They occur on shaft of penis, behind corona, or around the anus where they may grow into large, grapelike clusters.
These are caused by the human papillomavirus (HPV) and are one of the most common STIs.
Genital warts
147
A bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up, by standing, or by the Valsalva maneuver.
Incisional Hernia
148
the vaginal mucosa and cervix look cyanotic at 8 to 12 weeks.
(Chadwick sign)
149
First ask her to lift her arms slowly over her head. Both breasts should move up symmetrically
Next ask her to push her hands onto her hips
and to push her two palms together. These maneuvers contract the pectoralis major muscle. A slight lifting of both breasts occurs.
Maneuvers to Screen for Retraction
150
in what order do you assess abdomen
inspection
auscultation
percussion
palpation
151
Severe pain of sudden onset in scrotum, relieved by elevation (positive ______sign); also rapid swelling, fever
Enlarged scrotum; reddened
indurated; hard to distinguish from testis.
Overlying scrotal skin may be thick and edematous
White blood cells and bacteria in urine
Tender swelling of epididymis
Epididymitis
Prehn sign positive
152
—Mean age at onset at 12 to 13 years; delayed onset suggests endocrine or underweight problem.
Menarche
153
Painless, found on examination; may have history of undescended testicle
Firm nodule or harder-than-normal section of testicle; testicular swelling occurs in most
Solitary nodule
Most occur between ages 18 and 35;
Early Testicular Tumor
154
A midline longitudinal ridge that is a separation of the abdominal rectus muscles. Ridge is revealed when intra-abdominal pressure is increased by raising head while supine. Occurs congenitally (here), and as a result of pregnancy or marked obesity in which prolonged distention or a decrease in muscle tone has occurred. It is not clinically significant.
Diastasis Recti
155
A rough, grating sound, like two pieces of leather rubbed together, indicates peritoneal inflammation. Occurs rarely. Usually occurs over organs with a large surface area in contact with the peritoneum.
Peritoneal Friction Rub
156
when Palpateing the Anus and Rectum Ask the man to take a deep breath and hold it. Place the pad of your index finger gently against the ______ You will feel the sphincter tighten and then relax.
As it relaxes ask the man to exhale and flex the tip of your finger and slowly insert it into the anal canal in a direction toward the _________
Never approach the anus at ________ with your index finger extended. Such a jabbing motion does not promote sphincter relaxation and is painful.
anal verge
umbilicus.
right angles
157
The best time to perform BSE is right after the ________
menstrual period
158
In a person with inflammation of the gallbladder (cholecystitis), pain occurs.
Hold your fingers under the liver border. Ask the person to take a deep breath.
A normal response is to complete the deep breath without pain.
(NOTE: This sign is less accurate in patients older than 60 years)
Inspiratory Arrest (Murphy Sign).
159
Inspect the _______ region for a bulge as the person stands and as he strains down. Normally none is present.
inguinal
160
Cystic. Circumscribed collection of serous fluid in tunica vaginalis surrounding testis
Painless swelling, although person may complain of weight and bulk in scrotum
Enlarged mass does transilluminate with a pink or red glow
Nontender mass; able to get fingers above mass
Hydrocele
161
Abdominal Distention where
Inspection. Single round curve.
Auscultation. Depends on cause of gas (e.g., decreased or absent bowel sounds with ileus); hyperactive with early intestinal obstruction.
Percussion. Tympany over large area.
Palpation. May have muscle spasm of abdominal wall.
Air or Gas
162
a ______ palpated more than 1 to 2 cm below the right costal margin is enlarged
liver
163
—Heavy menses.
Menorrhagia
164
Tenderness
Enlarged, may be reddened (with local irritation)
Taut with pitting. Probably unable to feel scrotal contents
Accompanies marked edema in lower half of body (e.g., congestive heart failure, renal failure, and portal vein obstruction)
Scrotal Edema
165
Abdominal Distention where
Inspection. Curve in lower half of abdomen, midline. Everted umbilicus.
Auscultation. Normal bowel sounds over upper abdomen where intestines pushed superiorly.
Percussion. Top dull over fluid. Intestines pushed superiorly. Large cyst produces fluid wave and shifting dullness.
Palpation. Transmits aortic pulsation, whereas ascites does not.
Ovarian Cyst (Large)
166
or absent sounds follow abdominal surgery or with inflammation of the peritoneum Abnormal Bowel Sounds
Hypoactive
167
Abdominal Distention where
Inspection. Localized distention.
Auscultation. Normal bowel sounds
.
Percussion. Tympany predominates. Scattered dullness over fecal mass.
Palpation. Plastic-like or ropelike mass with feces in intestines.
Feces
168
This thick, yellow fluid is the precursor for milk, containing the same amount of protein and lactose but practically no fat.
produced the first few days after delivery
It is rich with antibodies that protect the newborn against infection;
colostrum
169
—Narrowed opening of prepuce so cannot retract the foreskin.
Phimosis
170
5 Inspection techniques for abdomen
Contour, symmetry, umbilicus, skin, pulsation
171
occur with portal hypertension or liver disease.
Lesions, rashes
Underlying adhesions are inflammatory bands that connect opposite sides of serous surfaces after trauma or surgery.
Cutaneous angiomas (spider nevi)
172
is superficial oedema and bruising in the subcutaneous fatty tissue around the umbilicus.
intraabdominal bleeding
cullens sign
173
When auscultating a pts. abd the RN detects gurgles over the RLQ. What does the RN suspect?
1. Decreased bowel motility
2. Nothing abnormal
3. Increased bowel motility
4. Cramping
2. Nothing abnormal
174
________ shreds mixed in stool indicate inflammation.
Jellylike mucus
175
starts with a small crust on the nipple apex and spreads to areola
Paget disease
176
Palpate the_______. Normally it feels thick, smooth, and muscular in the nulliparous woman and thin and rigid in the multiparous woman.
perineum
177
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Appetite/wt. change
Dysphagia
Abdominal Pain
Nausea/Vomiting
Indigestion
Bowel Habits
Stool Assessment
Meds
Nutrition
Social Hx/Alcohol
Past Abdominal Hx
Stress
Family Hx
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Subjective Data for abdomen
178
—Excessive quantity of urine
Polyuria
