CHEST TO ABDOMEN ASSESSMENT

ASSESSMENT WHAT TO DO FINDINGS

PROCEDURES
POSTERIOR THORAX
1. Inspect • Ask the patient to sit upright and cross The patient’s scapulae are symmetric and
Configuration their arms in front of their chest. This non-protruding, the shoulders and
position will help to relax the muscles of scapulae are at equal horizontal
the back and allow for easier inspection. positions.
• Observe the back: note for deformities,
asymmetry especially in the scapulae, The ratio of anteroposterior to
skin lesions, note for shape and contour transverse diameter is 1:2. Spinous
of the back as well as any areas of processes appear straight, and thorax
tenderness or swelling. appears symmetric, with ribs sloping
• Inspect the spine: Use your fingers to downward at approximately
palpate the spine from the base of the a 45-degree angle in relation to the spine.
neck to the sacrum. Note any areas of
tenderness or deformity and check for
curvatures such as scoliosis.
2. Observe use • Watch as the client breathes and note The patient does not use accessory
of accessory the use of muscles. muscle such as the trapezius to assist
muscles • Note for shallow or rapid breathing or breathing.
use of accessory muscles such as
shoulders, rectus and transverse The diaphragm is evident as it should be
abdominis, external and internal the major muscle at work.
oblique, and pectoralis major.
3. Inspect the • Note the client’s posture and ability to Patient is sitting up and relaxed,
client’s support weight while breathing breathing easily with arms at sides or in
positioning comfortably lap
4. Palpate for • Use fingers to palpate for tenderness, The patient reports no tenderness nor
tenderness, warmth, pain, or other sensations. pain, or any unusual sensations.
sensation, • Start toward the midline at the level of
and crepitus the scapula (over the Temperature is equal bilaterally
apex of the lung) and
move your hand left
to right, comparing
findings bilaterally.
• Don’t forget to
ask the patient if
they feel any pain every time, you’ll be
putting pressure on the said areas.
5. Palpate for • Also called “subcutaneous emphysema, No palpable crepitus
crepitus (popping, clicking, or crackling sound in
a joint)
• Occurs when air passes through fluid or
exudate
6. Palpate • Put on gloves and use your fingers to The patient’s skin and subcutaneous
surface palpate any lesions tissue are free of lesions and masses
characteristics • Feel for any unusual masses
• The skin should be smooth and even,
without any lumps, bumps, or areas of
roughness
 CHEST TO ABDOMEN ASSESSMENT
7. Palpate for • Following the sequence in item number Fremitus is symmetric and easily
fremitus 4, use the ball or ulnar edge of one identified in the upper regions of the
hand to assess for fremitus (vibrations lungs.
of air in the bronchial tubes transmitted
to the chest wall). A decrease in the intensity of fremitus is
• Ask the patient to say “ninety-nine”. normal as I move toward the base of the
Assess all 10 points for symmetry and lungs. Fremitus remained symmetric for
intensity for vibration. bilateral positions.
• If fremitus is not palpable on either side,
the client may need to speak louder
8. Assess chest • Place hands on the The expansion is symmetric. My thumb
expansion posterior chest wall with moved 5-10 cm apart symmetrically
thumbs at the level of T9 and
T10 and press together a small
skin fold.
• Observe the movement of your thumbs
as the client takes a deep breath.
9. Percuss the • Start at the apices of the scapulae and The tone elicited is Resonance over the
tone percuss across the tops of both patient’s normal lung tissue.
shoulders.
• Percuss the intercostal spaces across and Flat tone over the scapulae
down, comparing sides.
Percuss the lateral
aspects at the bases
of the lungs,
comparing sides.

10. Percuss for • Ask the client to exhale forcefully and Excursion is bilaterally equal and has a
diaphragmati hold the breath. measurement of 3-5 cm.
c excursion • Beginning at the scapular line (T7),
percuss intercostal spaces of the right *The diaphragm may be higher on the
*Percuss for dullness posterior chest wall. right because of the position of the liver.
to locate the • Percuss downward until the tone
diaphragm and mark changes from resonance to dullness and In well-conditioned clients, excursion can
the location using a then mark this level and allow the client measure up to 7 or 8 cm.
pen to breathe.
*Ask the patient to • Next is to ask the patient to inhale
inhale deeply to deeply and hold it.
percuss for the level • Percuss the intercostal spaces from the
of the diaphragm mark downward until resonance
then mark with a pen changes to dullness.
• Measure the distance between the two
marks.
• Perform on both sides of posterior
thorax.
• THE DISTANCE BETWEEN THE TWO
LEVELS IS NORMALLY 3-5 CM.
 CHEST TO ABDOMEN ASSESSMENT
11. Auscultate for • Place the diaphragm of the stethoscope Normal breath sounds may be
breath sounds firmly and auscultated
directly on (1) Bronchial
the posterior (2) Bronchovesicular
chest wall at (3) Vesicular
the apex of
the lung at
C7.
• Ask the
patient to
breath
deeply
through the mouth for each area of
auscultation
12. Auscultate for BRONCHOPHONY BRONCHOPHONY
voice sounds • Ask the patient to repeat the phrase • Voice transmission is soft,
“ninety-nine” while you auscultate the muffled, and indistinct
chest wall • The voice may be heard but the
EGOPHONY actual phrase cannot be
• Ask the patient to repeat letter “E” distinguished
WHISPERED PECTORILOQUY EGOPHONY
• Ask the client to whisper the phrase • Voice transmission is be soft and
“one-two-three” muffled but the letter “E” is
distinguishable
WHISPERED PECTORILOQUY
• Transmission of sound is very
faint and muffled, may be
inaudible
ANTERIOR THORAX
13. Inspect for • Have the client sit with arms at the • The anteroposterior diameter is
shape and sides. less than the transverse diameter.
configuration • Stand in front of the client and assess • The ratio of anteroposterior
shape ang configuration. diameter to the transverse
diameter is 1:2

14. Inspect • Observe the sternum from an anterior • The sternum is positioned at
position of and lateral viewpoint midline and straight
the sternum
15. Watch for • Retractions of the sternum or Retractions not observed
sternal suprasternal notch, intercostal
retractions retractions reflect increased respiratory
effort. This may be due to obstructive
diseases such as asthma or upper airway
obstruction, pneumonia, or restrictive
disease.
 CHEST TO ABDOMEN ASSESSMENT
• Visible pag hinihingal ang pasyente
16. Inspect the • Assess the ribs from an anterior and Ribs slope downward with symmetric
slope of the lateral viewpoint intercostal spaces.
ribs
17. Observe • Note breathing characteristics as well as • Respirations are relaxed
quality and rate, rhythm, and depth effortless, and quiet.
pattern of • They are of a regular rhythm.
respirations • Normal depth at a rate of 10-20
per minute in adults.
• Tachypnea (rapid breathing) and
bradypnea (slow breathing rate)
may be normal in some patients
18. Inspect • Ask the patient to breathe normally and • No retractions or bulging of
intercostal observe the intercostal spaces. intercostal spaces are noted
spaces • Look to see if the patient uses accessory
muscles of respiration. Observe for
intercostal retractions, nasal flaring, or
pursed lip breathing, all of which
indicate airflow obstruction and poor
ventilation.
19. Observe for • Ask the patient to breathe normally and • The patient is not using accessory
use of observe for us of accessory muscles. muscles such as sternomastoid,
accessory • Note for shallow or rapid breathing or rectus and transverse abdominis,
muscles use of accessory muscles such as rectus external and internal oblique.
and transverse abdominis, external and
internal oblique, and pectoralis major.

20. Palpate for • Use your fingers to palpate for • No tenderness or pain is palpated
tenderness, tenderness and sensation. over the lung area with
sensation and • Start with your hand positioned over respirations.
surface the left clavicle (over the apex of the left
masses lung)
• Move hand left to right, comparing
findings bilaterally

21. Palpate for • In the thoracic wall, it occurs where the The patient did not feel any pain while
tenderness at bone ends, and cartilage begins. the costochondral junctions are being
 CHEST TO ABDOMEN ASSESSMENT
costochondral • COSTOCHONDRAL JUNCTIONS: bars of palpated so there is no elicited
junctions of hyaline cartilage that connect the ribs to tenderness.
ribs the sternum

22. Palpate for • Follow the figure of sequence for • No crepitus is palpated.
crepitus palpating the anterior thorax in item 20 DEVIATION:
In areas of extreme congestion or
consolidation, crepitus may be palpated,
particularly in clients with lung disease.
23. Palpate for • use the ball or ulnar edge of one hand • Fremitus is symmetric and easily
fremitus to assess for fremitus (vibrations of air in identified in the upper regions of
the bronchial tubes transmitted to the the lungs.
chest wall). • Decreased intensity of fremitus is
• Ask the patient to say “ninety-nine”. expected toward the base of the
lungs.
• Fremitus is symmetric bilaterally
24. Palpate for • Place hands on the patient’s • Thumbs move outward in a
anterior chest anterolateral wall with your thumbs symmetric fashion from the
expansion along the costal margins and pointing
toward the xiphoid process.
• As the patient
takes a deep breath,
observe the
movement of your
thumbs

25. Percuss the • Percuss the
tone apices above the
clavicles.
• Percuss the
intercostal spaces
across and down,
comparing sides
midline
• Was able to elicit resonance as
the percussion tone over the
normal lung tissue
• Dullness over the breast tissue,
heart, and the liver
• Tympany over the stomach
• Flatness over the muscles and
bones
 CHEST TO ABDOMEN ASSESSMENT
26. Auscultate for •Place the diaphragm of the stethoscope • Same
breath sounds firmly and directly on the anterior chest findings as
wall. with the
• Auscultate from the apices of the lungs posterior
slightly above the clavicles to the bases thorax
of the lungs at the SIXTH RIB
• Ask the client to breathe deeply through
the mouth in an effort to avoid
transmission of sounds that may occur
with nasal breathing.
BREAST AND LYMPHATIC SYSTEM
27. Inspect the • Have the client disrobe and sit with arms • Upon inspection, breasts are
size and hanging freely. round and pendulous.
symmetry • Explain what you are observing to help
ease patient anxiety.
• Patient should sit with arms hanging
freely at sides during assessment of
breast size and symmetry
28. Inspect color • Note client’s overall skin tone when • Color varies depending on the
and texture inspecting the breast skin patient’s skin tone.
• Note for any lesions • Texture is smooth with no edema
• Linear stretch marks may be seen
during and after pregnancy or
with significant weight or gain
loss
29. Inspect for • Observe visibility and pattern of breast • Veins radiate either horizontally
superficial veins and toward the axilla (transverse)
venous or vertically with lateral flare
pattern (longitudinal).
• Veins are more prominent during
pregnancy
30. Inspect • Note the color, size, shape, and texture • Areolas vary from dark pink to
areolas of the areolas of both breasts dark brown, depending on the
client’s kin tones.
• They are round and varies in size
• Small montgomery tubercles are
present
31. Inspect the • Note the size and direction of the • Nipples are nearly equal
nipples nipples of both breasts bilaterally in size and are in the
• Note for any dryness, lesions, bleeding, same location on each breast
or discharge • Nipples are usually everted, but
they may be inverted or flat
• Supernumerary nipples may
appear along the embryonic
“milk line”.
• No discharge should be
 CHEST TO ABDOMEN ASSESSMENT
32. Inspect for • Ask the patient to remain seated while • The patient’s breast rises
retraction and performing several different maneuvers. symmetrically with no dimpling
dimpling • Ask the patient to raise her arms or retraction
overhead.
• Press her hands against her hips
• Press hands together
• THESE ACTIONS CONTRACT THE
PECTORAL MUSCLES
33. Palpate • Using pads of 3 fingers, start at the outer • Palpation reveals smooth, firm,
texture and edge moving in a circular motion elastic tissue
elasticity towards the nipple
• Use firm, but gentle pressure
• Note for any lumps, thickening, or
changes in texture
• DO BIMANUAL PALPATION

34. Palpate for • Assess this together with texture and • There is generalized increase in
tenderness elasticity nodularity(lumpy) and
and tenderness that is associated
temperature with the menstrual cycle or
hormonal medications and the
breasts are at a normal body
temperature
35. Palpate for • Note location, size in centimeters, • No masses are
masses shape, mobility, consistency, and palpable
tenderness.
• Note the condition of skin over the mass A firm imframammary
• If lumps is detected, refer the client for transverse ridge may
further evaluation normally be palpated
• Lump siya kapag gumagalaw. at the lower base of
FIBROCYSTIC BREAST- can be felt right before the breast
menstrual cycle or period • Fibrocystic breast tissue that feels
ropy, lumpy, or bumpy in texture
is referred to as nodular or
grandular
WEAR GLOVES
36. Palpate the • Wear gloves to compress the nipple • The nipple became erect and
nipples gently with thumb and index finger pucker in response to stimulation
• Note for any discharge • A milky discharge is usually
normal only during pregnancy
and lactation
• Some women may normally have
a clear discharge
37. Inspect and • Ask the patient to sit up • No rash or infection noted
palpate the • Inspect the axillary skin for rashes or • No palpable nodes or one to two
axillae infection. small(less than 1 cm), discrete,
• Hold the client’s elbow with one hand non-tender, movable nodes in
and use 3 finger pads of your other hand the central area
to palpate firmly the axillary lymph
nodes
 CHEST TO ABDOMEN ASSESSMENT
38. Demonstrate • Stand in front of a mirror with arms at •
how to your sides, inspect for size, color, shape
perform • Raise arms above head and look for any
Breast Self- changes in the contour of your breasts
Exam • Place hands on your hips and press
firmly to flex your chest muscles,
observe again for any changes in contour
and shape
• Lie down on your back with a pillow
under your right shoulder and arm
behind your back
• Use finger pads to examine your right
breast, you can start at the outer edge of
the breast and move your finders in a
circular motion towards the nipple,
COVER THE ENTIRE BREAST INCLUDING
ARMPIT AREA
• Gently squeeze the nipple to check for
any discharge
• Finally, stand up and repeat step 1 to
observe any changes in breast
appearance that may be more
noticeable when standing
HEART AND NECK VESSELS
39. Observe the • Inspect the jugular venous pulse by • The jugular venous pulse is visible
jugular standing on the RIGHT side of the when the patient is in a supine
venous veins patient position
• Patient should be in a supine position
with the head and torso on the same
plane
• Ask the client to turn head slightly to the
left
• Shine a tangential light onto the neck to
increase visualization
• Inspect suprasternal notch or the area
around the clavicles for pulsations of
internal jugular veins
40. Evaluate • Evaluate jugular distention (state of • The jugular vein is not distended
jugular being stretched beyond normal or swollen
venous dimensions) • Not bulging or potruding at 45
pressure • It is normal for the jugular vein to be degrees or greater
visible when in a supine position
• Position the client in a supine position
with the head of the bed elevated
(30,60,90 degrees)
• Shine a tangential light onto the neck to
increase visualization then observe for
distention, protrusion, or bulging
 CHEST TO ABDOMEN ASSESSMENT
41. Auscultate • Place the bell of the stethoscope over
carotid the carotid artery and ask the client to
arteries hold his or her breath for a moment so
that the breath sounds do not conceal
any vascular sounds
• STRENGTH OF THE PULSE IS EVALUATED
ON A SCALE FROM 0-4
• No blowing or swishing or other
sounds are heard.
• Pulse are equally strong
• Has 2+ or normal with no
variations in strength from beat
to beat
• Contour is smooth and rapid on
the upstroke and slower and less
abrupt on the downstroke

42. Palpate • Palpate each carotid artery alternatively • Arteries are elastic and no thrills
carotid as bilateral palpation may affect the are noted.
arteries circulation of blood in the brain
• Note for amplitude and contour of the
pulse, elasticity of the artery, and any
thrills (similar to purring cat)
• OCCLUSION: Blockage of blood flow
through an artery
43. Inspect • With the patient in supine position with • The apical impulse may or may
pulsations the head of the head elevated between not be visible
LOCATION OF APICAL 30 and 45 degrees, STAND ON THE • If apparent, it would be in the
IMPULSE: 5TH RIGHT SIDE OF THE PATIENT AND LOOK mitral area
INTERCOSTAL SPACE FOR APICAL IMPULSE AND ANY
ABNORMAL PULSATIONS THE APICAL IMPULSE IS THE RESULT OF
THE LEFT VENTRICLE MOVING
OUTWARD DURING SYSTOLE

44. Palpate the • Remain on the patient’s right side and • The apical impulse is palpated in
apical impulse ask them to remain supine the mitral area and may be the
• Use one or two finger pads to palpate size of nickel (1-2 cm)
the apical impulse in the mitral area • In obese clients or clients with
• You may ask the patient to roll to the left large
side to better feel the impulse using breasts,
palmar surfaces of your hand the apical
impulse
may not
be
palpable.
 CHEST TO ABDOMEN ASSESSMENT
45. Palpate for • No pulsations or vibrations are
abnormal palpated in the areas of the apex,
pulsations left sternal border, or base.

• Use palmar surfaces to palpate the apex,

left sternal border, and base.
46. Auscultate • Place the diaphragm of the stethoscope • Rate should be 60-100 bpm with
heart rate and at the apex and listen closely to the rate regular rythym
rhythm and rhythm of the apical impulse • A regularly irregular rhythm, such
• Listen for 1 min as sinus arrhythmia when the
heart rate increases with
inspiration and decreases with
expiration, may be normal in
young adults.
LOCATION
AORTIC AREA: 2nd intercostal space at the
right sternal border
PULMONIC AREA: 2ND or 3rd intercostal
space at the left sternal border- The base
of the heart
ERB’S POINT: 3rd to 5th intercostal space
at the left sternal border
MITRAL(APICAL): 5TH intercostal space
near the left mid-clavicular- the apex of
the heart
TRICUSPID AREA: 4th or 5th intercostal
space at the left lower sternal border
47. Auscultate to • Auscultate the 1st heart sound (S1 or • S1 is loudest at the top of the
identify S1 “lub”) and the second heart sound (S2 heart, where the carotid artery is
and S2 or “dubb”) beating the fastest. S2 comes
LISTEN TO S1: Use the diaphragm of the right after S1, and the loudest
stethoscope to best hear S1 part of it is at the base of the
heart.
48. Auscultate for • Use the diaphragm first, then the bell to • Most of the time, no sounds are
extra heart auscultate over the entire heart area. heard.
sounds • A physiologic S3 heart sound is a
harmless sound that is often
heard at the start of the diastolic
pause in children, teens, and
young adults. It is rarely heard in
people over the age of 40. Near
the end of diastole, a physiologic
S4 heart sound can be heard in
 CHEST TO ABDOMEN ASSESSMENT
well-trained athletes and adults
over 40 or 50 with no signs of
heart disease.
49. Auscultate for • A murmur is a swishing sound caused by • No murmurs are heard
murmurs turbulent blood flow through the heart
valves or great vessels.
• Use the diaphragm and the bell of the
stethoscope in all areas of auscultation
because murmurs have a variety of
pitches Auscultate for murmurs across
the entire heart area

ABDOMEN
50. Observe the • Abdominal skin varies with the
coloration of patient’s skin tone, it is much
the skin. lighter as it is less exposed to
natural elements
51. Note the • Scattered fine veins may be visible • The skin is warm to the touch
vascularity of indicating good blood flow and
the circulation in the area
abdominal • Has normal skin turgor
skin. • Blood in the veins located above
the umbilicus flows toward the
head
• blood in the veins located below
the umbilicus flows toward the
lower body
52. Inspect for • Ask about the source of a scar and use a • Pale
scars. centimeter ruler to measure the scar’s • Smooth or no scars
length. • Minimally raised old scars may be
• Document the location by quadrant and seen
reference lines, shape, length, and any
specific characteristics (e.g., 3-cm
vertical scar in RLQ 4 cm below the
umbilicus and 5 cm left of the midline).
53. Assess for • Abdomen is free of lesions or
lesions and raised brown moles, however, are
rashes. normal and may be apparent
54. Inspect the • Note the color of the umbilical area • Umbilical Umbilical skin tones are
umbilicus. similar to surrounding abdominal
skin tones or even pinkish
55. Inspect • Sitting at the client’s side, look across • Abdominal is flat, rounded, or
abdominal the abdomen at a level slightly higher scaphoid
contour and than the client’s abdomen. • Evenly rounded
symmetry • Inspect the area between the lower ribs
and pubic bone.
• Measure abdominal girth.
 CHEST TO ABDOMEN ASSESSMENT
• Look at the abdomen as the client lies in • Abdomen is symmetric
a relaxed supine position.
56. Inspect • RESPIRATORY MOVEMENTS • Abdominal respiratory movement
abdominal may be seen
movement
when the
client
breathes
57. Observe • Place your fingertips on the abdomen • A slight pulsation of the
aortic and press gently but firmly to feel for the abdominal aorta, which is visible
pulsations. pulsations of the aorta in the epigastrium, extends full
• Take note of the location, size, and length in thin people.
strength of the pulsations, as well as any
abnormal or unusual findings, such as
tenderness or an enlarged aorta.
58. Observe for • Ask the patient to lie down on their back • Peristataltic waves are not seen
peristaltic with their knees bent and their feet flat • May be seen in very thin people
waves. on the exam table. as slight ripples on the abdominal
• Place your fingertips on the patient's wall
abdomen, using a light touch, and
observe for any visible movements or
waves in the abdominal area.
• Take note of the frequency, strength,
and direction of the peristaltic waves, as
well as any abnormal or unusual
findings, such as absent or hyperactive
bowel sounds.
•
59. Auscultate for • Use the diaphragm of the stethoscope • A series of intermittent, soft
bowel and make sure that it is warm before clicks and gurgles are heard at a
sounds. you place it on the client’s abdomen. rate of 5–30 per minute
• Apply light pressure or simply rest the • Hyperactive bowel sounds
stethoscope on a tender abdomen. referred to as “borborygmus”
• Begin in the RLQ and proceed clockwise, may also be heard.
covering all quadrants. • These are the loud, prolonged
• Listen for at least 5 minutes before gurgles characteristic of one’s
determining that no bowel sounds are “stomach growling.”
present and that the bowels are silent.
60. Auscultate for • Use the bell of the stethoscope to listen • Bruits are not normally heard
vascular for bruits (low-pitched, murmur-like over abdominal aorta or renal,
sounds. sound) over the abdominal aorta and iliac, or femoral arteries.
renal, iliac, and femoral arteries However, bruits confined to
systole may be normal in some
clients depending on other
differentiating factors.
 CHEST TO ABDOMEN ASSESSMENT

61. Auscultate for • Listen over the right and left lower rib • No friction rub over liver or
a friction rub cage with the diaphragm of the spleen is present.
over the liver stethoscope.
and spleen.
62. Percuss for • Lightly and systematically percuss all • UPPER RIGHT QUADRANT: Dull
tone. quadrants thud which is indicative of the
liver
• UPPER LEFT QUADRANT: Dull
thud which indicates presence of
stomach or spleen
• LOWER RIGHT QUADRANT:
Tympanic or hollow sound which
is indicative of small intestine or
colon
• LEFT LOWER QUADRANT:
Tympanic or hollow sound which
indicates the presence of large
intestine or colon
63. Percuss the • To assess the lower border, begin in the • On deep inspiration, the lower
span or height RLQ at the midclavicular line (MCL) and border of liver dullness may
of the liver by percuss upward. descend from 1 to 4 cm below
determining • Note the change from tympany to the costal margin.
its lower and dullness • The upper border of liver dullness
upper • Mark this point: It is the lower border of is located between the left fifth
borders. liver dullness. and seventh intercostal spaces.
• To assess the descent of the liver, ask the • The normal liver span at the MSL
client to take a deep breath and hold; is 4 – 8 cm.
then repeat the procedure. Remind the
client to exhale after percussing.
----------------------------------------------------------------
• To assess the upper border, percuss over
the upper right chest at the MCL and
percuss downward, noting the change
from lung resonance to liver dullness.
• Mark this point: It is the upper border of
liver dullness.
----------------------------------------------------------------
• Repeat percussion of the liver at the
midsternal line (MSL)
64. Perform blunt • This is to assess for tenderness in • No tenderness is elicited
percussion on difficult-to-palpate structures • No tenderness or pain is elicited
the liver and or reported by the patient
the kidneys.
 CHEST TO ABDOMEN ASSESSMENT
• Percuss the liver by placing your left • Dull thud can be sensed
hand flat against the lower right anterior
rib cage
• Use the ulnar side of your right fist to
strike your left hand.
----------------------------------------------------------------
• Perform blunt percussion on the kidneys
at the costovertebral angles (CVA) over
the twelfth rib

65. Perform light • Light palpation is used to identify areas • Abdomen is nontender and soft.
palpation. of tenderness and muscular resistance There is no guarding.
• Using the fingertips, begin palpation in a
nontender quadrant, and compress to a
depth of 1 cm in a dipping motion
• Then gently lift the fingers and move to
the next area
• To minimize the client’s voluntary
guarding (a tensing or rigidity of the
abdominal muscles usually involving the
entire abdomen)

66. Deeply • Using the palmar surface of the fingers, • Normal (mild) tenderness is
palpate all compress to a maximum depth (5–6 cm) possible over the xiphoid, aorta,
quadrants to • Perform bimanual palpation if you cecum, sigmoid colon, and
delineate encounter resistance or to assess deeper ovaries with deep palpation.
abdominal structures
organs and
detect subtle
masses.
67. Palpate the • Note consistency and tenderness • The liver is usually not palpable,
liver. • To palpate bimanually, stand at the although it may be felt in some
client’s right side and place your left thin clients. If the lower edge is
hand under the client’s back at the level felt, it should be firm, smooth,
of the eleventh to twelfth ribs and even. Mild tenderness may
• Lay your right hand parallel to the right be normal.
costal margin (your fingertips should
point toward the client’s head)
• Ask the client to inhale, then compress
upward and inward with your fingers
68. Palpate the • Palpate for a distended bladder when • An empty bladder is neither
urinary the client’s history or other findings palpable nor tender.
bladder. warrant (e.g., dull percussion noted over
the symphysis pubis)
• Begin at the symphysis pubis and move
upward and outward to estimate
bladder borders
 CHEST TO ABDOMEN ASSESSMENT
69. Assess for • If the client has abdominal pain or • No rebound tenderness is
rebound tenderness, test for rebound tenderness present.
tenderness. by palpating deeply at 90 degrees into
the abdomen away from the painful or
tender area then suddenly release
pressure.
• Listen and watch for the client’s
expression of pain.
• Ask the client to describe which hurt
more - the pressing in or the releasing -
and where on the abdomen the pain
occurred.
CHEST TO ABDOMEN ASSESSMENT