REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING
BATCH SAPPHIRE

RLE WORKSHEET (ABDOMEN)

Name Fiel Andrei L. Borata Level I Section _A__ Date JUNE 18, 2020 Score _____

Provide the best possible answer after each question on the space provided.

1. Enumerate the STEPS OF ABDOMINAL EXAMINATION. Rationalize its order.

A fundamental part of physical examination is examination of the abdomen, which consists
of inspection, auscultation, percussion, and palpation. Instruct the patient to lie down and expose the
patient's abdomen. The examination begins with the patient in supine position, with the abdomen
completely exposed. The skin and contour of the abdomen are inspected, followed by auscultation,
percussion, and palpation of all quadrants. Auscultation of the abdomen should be performed prior
to percussion and palpation, as physical manipulation of the abdomen may induce a change in bowel
sounds. Then percuss over all four quadrants. Lastly is the palpation of the abdomen, liver and the
spleen. Observe the patient's face during abdominal palpation, as it is the main indicator of the
intensity and location of pain. Depending on the findings or patient complaints, a variety of
examination techniques and special maneuvers can provide additional diagnostic information.

2. What is the PATHOPHYSIOLOGY of HEPATOMEGALY?

 REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION
COLLEGE OF NURSING
BATCH SAPPHIRE

RLE WORKSHEET (ABDOMEN)

Name Fiel Andrei L. Borata Level I Section _A__ Date JUNE 18, 2020 Score _____

3. Explain the basis for the REFERRED SHOULDER PAIN in ACUTE

CHOLECYSTITIS.
• Acute cholecystitis occurs secondary to obstruction of the cystic duct, resulting in bile
stasis, with inflammation and edema of the gallbladder wall. It can cause referred shoulder
pain because the inflammation from the gallbladder increases intra-abdominal pressure
that activates nociceptors present in the diaphragm which sends afferent signals via
• C3, 4, 5 to the dorsal horn in the cervical spinal cord. The signals are then subject to
processing by the interneurons before travelling on towards the brain they are experienced
as pain. The C4 dermatome covers the shoulder and converges on the same area of the
spinal cord. As such the signal is sometimes interpreted by the CNS as coming from the
shoulder.

4. Name a possible UNDERLYING ETIOLOGY of APPENDICITIS. Expound the

changes that occur.

Appendicitis is thought to result from obstruction of the appendiceal lumen, typically by

lymphoid hyperplasia but occasionally by a fecalith, foreign body, or even worms. This can be from
an appendicolith (stone of the appendix), or some other mechanical etiologies. Appendiceal tumors
such as carcinoid tumors, intestinal parasites, and hypertrophied lymphatic tissue are all known causes
of appendiceal obstruction and appendicitis. Often, the exact etiology of acute appendicitis is
unknown. When the appendiceal lumen gets obstructed, bacteria will build up in the appendix and
cause acute inflammation with perforation and abscess formation. One of the most popular
misconceptions is the story of the death of Harry Houdini. After being unexpectedly punched in the
abdomen, the rumor goes, his appendix ruptures, causing immediate sepsis and death. The facts are
that Houdini did die from sepsis and peritonitis from a ruptured appendix, but it had no connection
to him being struck in the abdomen. It was more related to widespread peritonitis and the limited
availability of effective antibiotics at the time.
 REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION
COLLEGE OF NURSING
BATCH SAPPHIRE

RLE WORKSHEET (ABDOMEN)

Name Fiel Andrei L. Borata Level I Section _A__ Date JUNE 18, 2020 Score _____

5. What will be your FIRST NURSING INTERVENTION in patients with CHEST

PAIN? Justify.

If chest pain is detected, the nurse should immediately assess any reports of chest pain further to
determine if it is due to cardiac ischemia, which is a medical emergency requiring immediate
assessment and intervention. By assessing if the chest pain is due to cardiac ischemia, proper
intervention can be done. Treatment for myocardial ischemia involves improving blood flow to the
heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty)
or bypass surgery.