10a ABDOMINAL

PREP:
*Assemble equipment*
Good morning, I am Mahreen Qadri, I will be your nurse for today
What is your name/wristband
We will check your abdomen
to see if it is functioning properly
I will be touching your stomach and using stethoscope to inspect
You can cooperate by ...
*give privacy curtain, consent*
*wash hand

Hx
1. Pain: where, when, quality, frequency
2. Bowel patterns, constipation/diarrhea
3. Diet, Appetite, Intolerances, recent meals
4. Signs, Symptoms
5. Prev Problems and Treatments

Position: dorsal recumbent (supine, knees up, pillow under head and knees) - reduce
tension on abdominal muscles

Ask patient to void (pee) - bladder in the way

Expose chest line --> pubic area

INSPECTION
- Skin Integrity:
1. lesions
2. jaundice
3. scars - history (c sec, appendicitis)
4. hernia
5. ask if its a birthmark
6. stretchmarks
- Deep Breath: check from right side of patient, foot of the bed
1. Contour: flat or protuberant
2. Symmetry
3. Distension: Measure circumference/girth
- Vascular pattern
- Abdominal movements - inhaling (diaphragm pushes down)
AUSCULTATION
Auscultate first, Percuss second, Palpate last (displaces organs)
→ rub diaphragm/bell warm, earpiece forward
→ if no specific pain: RLQ
→ Diaphragm
● Bowel sounds - peristalsis: 5-30, 6-34 sounds/min
● Vascular Bruit (BELL) - turbulent
○ abdominal aorta - below xiphoid process
○ renal
○ iliac
○ femoral
● Peritoneal friction - inflammation

PERCUSSION
→ middle finger, no palms, Distal IPJ, wrist movement
Systematic: LLQ → RLQ → RUQ → LUQ
● tympanic - musical: hollow organs (intestine)
● dull: solid organs (liver, spleen)
● resonance: lung
● flat: bone, muscle
Upper Liver (below nipple, MCL, ICS) resonance --> dull
Lower Liver (below umbilical, MCL) tympanic --> dull
Liver span (6-12cm)

PALPATION:
→ rub hands warm
Light (1-2 cm): detect areas of tenderness, muscle guarding
● Finger pads: circular pattern, check tenderness, ask pain
● Dorsal: temperature

Deep (4-5 cm): enlarged organs, masses

● Finger pads, dom hand over nondom

● Liver: nondom under pt back push up, dom finger pads below liver (normal if liver
palpable 3 cm below costal margin)

● Bladder: check for urinary retention (geriatric, prostate)

→ Inform pt you're done, cover them → DOCUMENT

10b BREASTS AND AXILLA

Position: sitting

ASSESSMENT:
Whole Breast
● symmetry, size, shape (teardrop), contour
● lesions
● hyperpigmentation
● hypervascularization (cancer, preg)
● retractions: ask pt to raise arms, flexed elbow hands pressed

Arriola
Nipples: discharge (cancer), lactation (pus infection in preg)
Lymph Nodes: pt abducts arms (nodes have matted appearance)
axillary, supraclav, subclav

→ Ask if tumour present (normal if during period)

PALPATE:
Breast: Mass, Tenderness
Nipple: Discharge (colour, odour, consistency, amount) milk the breast along its radius to
identify the discharge producing lobe

→ instruct pt on how to do self-exam

DOCUMENT: in chrono order

11a Female Genital:

ASSESSMENT
● Pubic hair: distribution, amount, characteristics (to test sexual maturity like if old with
no pubic hair)
● Skin: lesions, mass, warts, discharge, lacerations
→ separate the labia majora and labia minora
● Clitoris: clitoromegaly → hermaphrodite
● Urethral Orifice
● Vaginal Orifice
● Inguinal lymph nodes
11b Male Genital:

ASSESSMENT:
Pubic hair: lice, patchy (fungal)
Shaft, Glans:
● sores (herpes)
● lesions, nodules, swelling
● discharge (always abnormal)
○ compress glans to open meatus
○ If present, instruct pt to strip penis from base to urethra
● meatus position
Scrotum:
● symmetry
● herniated intestine
Inguinal: (inspect at rest, then strained) hernia, lymph nodes

PALPATE:
penis: tenderness, thickening, nodule
scrotum: (ask client to hold penis) testes, epididymis, spermatic cord
inguinal: palpate hernia
9 TEMPERATURE

https://www.youtube.com/watch?v=nvl1qQfgzuw&ab_channel=RegisteredNurseRN

Temp (36-37.5 C) - thermometer

● F = (C x 9/5) + 32
● palpate to check fever, chills (if dehydrated - dry skin and lips, sunken eyeballs →
hydrate them to increase blood V)
● hypothermia
● oral (side of frenulum), axillary, rectally, tympanic, temporal

Cleaning thermometer:

● before: distal → prox

● after: prox → distal