NURS612 Key Points to Review for Exam 3

NURS612 Key Points to Review for Exam 3 • Onset and duration: when it began; sudden or gradual; persistent, recurrent, intermittent • Character: dull, sharp, burning, gnawing, stabbing, cramping, aching, colicky • Location: of onset, change in location over time, radiating to another area, superficial or deep • Associated symptoms: vomiting, diarrhea, constipation, passage of flatus, belching, jaundice, change in abdominal girth, weight loss or weight gain • Relationship to: menstrual cycle, abnormal menses, intercourse, urination, defecation, inspiration, change in body position, food or alcohol intake, stress, time of day, trauma • Recent stool characteristics: color, consistency, odor, frequency • Urinary characteristics: frequency, color, volume congruent with fluid intake, force of stream, ease of starting stream, ability to empty bladder • Medications: high doses of aspirin, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs) Proper steps to examine abdomen: inspection, auscultation, percussion, and palpation Using tangential lighting, inspect the abdomen for 4 surface characteristics 1. Observe the skin color. It may vary greatly but should have no jaundice, cyanosis, redness, bruises, or discoloration 2. Check for nodules and other lesions, which should not be present 3. Note any scars and draw their location, configuration, and relative size on an illustration of the abdomen 4. Assess the venous return. Above the umbilicus, venous return should be toward the head. Below the umbilicus, it should be toward the feet Inspect the abdominal contour and symmetry • The contour is the abdominal profile from the rib margin to the pubis. It normally may be flat, rounded, or scaphoid. The umbilicus should be centrally located and may be inverted or may protrude slightly. • Contralateral areas of the abdomen should be symmetrical in appearance and contour and should have no distention of bulges • To elicit hidden masses or bulges, have the patient take a deep breath and hold it. The abdomen should remain smooth and symmetrical. Next, have the supine patient raise their head from the table as you inspect the abdomen. Note any masses, hernia, or muscle separation. With the patient’s head at rest, observe for 3 types of abdominal movement 1. Inspect for smooth, even movement with respiration 2. Assess for surface motion from peristalsis. In a thin patient, it normally may be visible. Otherwise, it may signal an intestinal obstruction 3. Note any aortic pulsation in the upper midline. Although pulsation may be visible in a thin patient, marked pulsation suggest a disorder. Abnormal: • Jaundice or cyanosis • Ascites: a glistening, taut appearance • Redness may indicate inflammation • Cullen sign: bluish periumbilical discoloration that may indicate intraabdominal bleeding • Striae: result of weight gain or pregnancy • GI diseases often produce skin changes: inspect for lesions or nodules • Sister Mary Josephs’ nodule: a pearl-like, enlarged and sometimes painful umbilicus nodule can indicate abdominal malignancy • Distension from umbilicus to pubic area may indicate ovarian tumor, pregnancy, uterine fibroids, or distended bladder • Distension of upper half above umbilicus may indicate tumor pancreatic cyst, or gastric dilation • Asymmetric distension or protrusion may indicate hernia, tumor, cysts • Incisional hernia: caused by defect in abdomen musculature that develops after surgical incision • Umbilical hernia: protrusion of naval • Rippling movement across abdomen may indicate intestinal obstruction • Abdomen aortic pulsation may indicate aneurysm