NUR 6001 - GI/MS/Neuro PE Exam Latest Update with complete solutions -William Paterson University

GI/MS/Neuro PE Exam Introduction: Your name, title, & you’re the examiner. Would you please tell me your full name & DOB. Please have a seat. How are you today? Can you tell me where you are? What is today’s date? Any pain or discomfort anywhere or recent trauma? Advise GI/MS/Neuro exam & get permission & for video. State, “cranial nerves #1-12 were examined during your last visit, as such I will not be testing them during today’s visit.” Before we begin, do you have to use the lavatory? General appearance: A&O - good historian - pleasant mood - follows commands - maintains eye contact - skin color appropriate for race GI - Exam in this order: Inspect, auscultate, percussion, and palpation (always last as it can shift organs & masses) - Stand on patient’s right side during the exam Gastrointestinal Abdomen - pt lay down - Inspect, auscultate, percussion, and palpation (always last as it can shift organs & masses) - Stand on patient’s right side during the exam ● Inspect skin -symmetry, no mass, no discoloration, no protruding vessels, no indication of of peristalsis - no distention notated, no abnormal pulsations ● Auscultate bowel sounds - bowel sounds are high-pitched, use diaphragm of scope & clockwise: RLQ, RUQ, LUQ, LLQ - dx of hypo bowel sounds, 3-5 min continuous listening - bowel sounds positive in all 4 ● Auscultate vascular sounds: ○ Aortic - midline, 2 fingerbreadths above the umbilicus - no bruit heard ○ Renal - 3 cm superior & lateral to umbilicus R&L, no bruit heard ○ Iliac - 3 cm inferior & lateral to umbilicus R&L, no bruit heard ○ Femoral - along crease midway between pubic bone & anterior iliac crest, no bruit heard ● Percuss - two sounds heard, tympanic (organs containing air) or dull (fluid-filled or dense) ○ all quadrants - tympany ○ Percuss liver - dullness - begin below umbilicus, R MCL, percuss upward until dullness is heard then at above nipple, between 5-7 ICS, R MCL, downward until dullness heard, 6 cm ○ Percuss spleen - supine, arms above head, percuss lowest ICS L AAL (anterior axillary line) tympany ● Palpate: light (1 cm depth) one hand and deep (5-8 cm depth), use two hands, one overlapping the other - look pt’s face for grimacing - ask if has any pain, do that area last ○ All 4 quad - non tender ○ abdominal aorta - 2 fingerbreadths above the umbilicus, it bifurcates at umbilicus, continue to palpate, under 3 cm - no tenderness or enlargement ○ Palpate liver border - MCL, below umbilicus, move vertically use rolling technique, no enlargement or tenderness or masses ○ Palpate “balloting” kidneys - L kidney, stand pt R side, place L hand behind pt left flank, lift left flank w/ L hand & press down w/ R; not palpable, normal finding. R kidney, stay R side, lift R flank w/ L hand, R to palpate deep. R palpable; feel firm, smooth, and solid. No tenderness or boogie ○ Palpate spleen - start at umbilicus at a diagonal up to LUQ, non palpable on inspiration ○ Bladder is not palpable unless distended, which it is not