Health Assessment

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Author:
Samilou
ID:
75259
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Health Assessment
Updated:
2011-03-26 17:04:57
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Examination GI
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Description:
Ch 14
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  1. What comes first? Auscultation or Palpation?
    Auscultation
  2. Cholectcystitis is suspected if pain is felt when patient takes a deep breath while the nurse is deep palpating and patient abruptly stops. This is referred to as what?
    Murphy's sign
  3. Costalvertebral angle CVA tenderness or severe pain may be caused by what?
    pyelonephritis
  4. What part of the stethescope do you use when listening to bowel sounds?
    diaphragm
  5. What part of the stethescope is used when listening to arterial and venous sounds in the abdomen?
    bell
  6. Swooshing sounds, occuring during systole, occurs over which six regions?
    • Right and Left
    • Renal, Iliac, and Femoral arteries
  7. ______ indicates turbulent blood flow caused by narrowing of blood vessels.
    Bruits
  8. Deep palpations checking for abdominal tenderness and masses should push __ to __ cm.
    4-6
  9. This technique uses both hands for deep palpation where top hand exerts the pressure.
    Bimanual technique
  10. When percussing the abdomen, _______ tone should be heard most and is due to the presence of _____.
    • Typanic
    • Gas
  11. Percussion of suprapubic area may sound _____ when urinary bladder is distended.
    dull
  12. An enlarged _______ is brought forward on inspiration and produces a ____ tone when percussed.
    • spleen
    • dull
  13. Which three organs are nonpalpable?
    • Gallladder
    • Spleen
    • Kidneys
  14. Palpable and tender gallbladder may indicate ________.
    Cholecystitis
  15. What does a nontender enlarged gallbladder indicate?
    common bile duct obstruction
  16. When checking for cholecystitis, client experiences pain and abruptly stop inhaling during palpation. This is known as what?
    Murphy's sign
  17. How do you check for abdominal reflexes?
    Using a reflex hammer, stroke upper ab in an upward motion away from umbilicus, and a downward stroke of the lower abdomen away from the umbilicus.
  18. What should be observed when checking abdominal reflexes?
    Movement of umbilicus towards the area stroked
  19. 2 tests that determine if there is fluid in the abdominal cavity
    • Shifting dullness test
    • Fluid wave test
  20. 3 conditions CVA tenderness may indicate.
    • pyelonephritis
    • glomerulonephritis
    • kidney stone
  21. Describe shifting dullness test.
    • Used when abdominal cavity fluid is suspected.
    • Client lies supine.
    • Line is drawn midline.
    • Patients rotates to each side for percussion.
    • Dullness shifts to dependent side where fluid is.
  22. Describe the fluid wave test.
    • Client lies supine.
    • Nurse places hands on both sides of abdomen.
    • Taps one side and feels wave hit other hand.
  23. When is rebound tenderness present?
    When the pain is less when pressure is applied and returns when pressure is removed.
  24. What is a positive McBurney sign indicative of?
    Appendicitis
  25. Where is McBurney's point located?
    Halfway between the umbilicus and the right anterior iliac crest.
  26. This muscle test indicates appendicitis.
    Iliopsoas muscle test
  27. A positive obturator muscle test may indicate what two things?
    • Ruptured appendix
    • Pelvic abscess
  28. What is Ballottement?
    Palpation technique used to determine a floating mass.
  29. This method is used when one hand pushes down on the abdomen and the other hand pushes upward to determine size and shape of floating mass.
    Bimanual method

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