health assessment exam 3

• stomach - LUQ
• spleen - LUQ
• body of pancreas - LUQ
• left kidney - LUQ
• sigmoid colon - LLQ
• left ovary - LLQ
• left ureter - LLQ
• left spermatic cord - LLQ
• liver - RUQ
• gallbladder - RUQ
• duodenum - RUQ
• head of pancreas - RUQ
• right kidney - RUQ
• cecum - RLQ
• appendix - RLQ
• right ovary - RLQ
• right ureter - RLQ
• right spermatic cord - RLQ
• order of abdominal exam:

  1. inspection
  2. auscultation
  3. percussion
  4. palpation
• normal abdominal contour: ranges from flat to rounded
• scaphoid abdomen caves in
• protuberant abdomen indicates abdominal distention
• normal bowel sounds = 5-30 per minute
• hyperactive bowel sounds(borborygumus): loud, high-pitched, rushing sounds that indicate increased motility
• hypoactive bowel sounds are absent or reduced peristalsis of the bowel
• how to test for appecdicitis:

  1. rebound tenderness (Blumberg sign)
  2. rovsing's sign
  3. iliopsas muscle test
  4. obturator sign
• blumberg test/rebound tenderness: Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply, then lift up quickly, This makes structures that are indented by palpation rebound suddenly.

  o  A normal, or negative, response - no pain on release of pressure.

  o  Abnormal response - Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation
• rovsing's sign/ reffered rebound tenderness: Rebound tenderness occurring in the right lower quadrant when pressure is applied to the left lower quadrant may indicate appendicitis.
• iliopsas muscle test: 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.

  When the test is positive- pain in RLQ 
• oburator sign: lift the person’s right leg, flexing at the hip, and 90 degrees at the knee. Hold his or her ankle, and rotate the leg internally and externally. There should be no pain.

  o   An inflamed appendix irritates the obturator muscle, and this leg movement produces pain in a positive finding.
• where to start auscultation - RLQ
• liver percussion - Start at right chest, nipple area at MCL; percuss downward until lung resonance shifts to liver dullness. Mark that spot. normal liver span is 6-12cm
• CVA tenderness: while client is sitting up place one hand over the 12th rib(CVA) at the costovertebral angle on the back. Blunt percussion: Thump that hand with the ulnar edge of your other fist.

  • normally person feels a thud but no pain.Sharp pain occurs with inflammation of the kidney or perinephric area, as in pyelonephritis.
• murphy sign: Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder (cholecystitis), pain occurs. 
• tremor: Involuntary contraction of opposing muscle groups. Results in rhythmic, back-and-forth movement of one or more joints. May occur at rest or with voluntary movement. disappear while sleeping. Tremors may be slow (3 to 6 per second) or rapid (10 to 20 per second).
• Rest tremor: Occurs when muscles are quiet and supported against gravity, such as in a hand in a lap.
• Coarse and slow (3 to 6 per second) rest tremor partially or completely disappears with voluntary movement.
• Intentio tremor: Rate varies, is worse with voluntary movement as in reaching toward a visually guided target, and occurs with cerebellar disease and multiple sclerosis.
• Essential tremor: A type of intention tremor, it is the most common tremor of aging people.
• Benign essential tremor is not associated with any disease but causes emotional stress in business or social situations.