HEALTH ASSESSMENT

FINALS 9 REGIONS OF THE ABDOMEN

REVIEWER 4 1. EPIGASRTRIC
2. UMBILICAL
ASSESSMENT OF THE ABDOMEN, GENITALS AND
3. HYPOGASTRICT PUBIC
RECTUM
4. RIGHT HYPOCHONDRIAC
5. LEFT HYPOCHONDRIAC
LANDMARKS OF THE ABDOMEN 6. RIGHT LUMABR
7. LEFT LUMBAR
- Xiphoid Process 8. RIGHT INGUINAL
- Midline 9. LEFT INGUINAL
- Costal Margin
- Umbilicus
- Poupart Ligament EXAMINATION
- Anterosuperior Iliac Crest
- IPPA
- Superior Margin of OS Pubis

INSPECTION OF THE ABDOMEN

4 QUADRANTS OF THE ABDOMEN
- Contour
- Symmetry
1. RUQ - Umbilicus
2. LUQ - Skin
3. RLQ - Pulsation or Movement
4. LLQ - Demeanor (Behavior)
 - Umbilicus EXAMINATION OF THE EXTREMITIES

REGIONAL CONSIDERATIONS
ABDOMINAL PROFILES
 Remember that the CLAVICLE is
part of the shoulder.
 Be sure to include it in your
examination
 The PATELLA is much easier to
examine if the leg is extended and
relaxed
 Be sure to palpitate over the
SPINOUS PROCESS of each
vertebrae
 It is always helpful to observe the
patient STANDING and WALKING
 Always consider REFERRED PAIN,
from the neck or chest to the
6 “F” of Abdominal Distention shoulder, from the back or pelvis
1. Fat to the hip, and from the hip to the
2. Flatus knee
3. Fluid  Pain with, or limited of,
4. Fetus ROTATION is often the first sign

5. Feces of hip disease

 Diagnostic hints based on
6. Fatal Growth
LOCATION of pain
INSPECTION
- Looks for scars, rashes, or other lesions
- Look for asymmetry, deformity, or
atrophy (smaller than normal)
- Always compare with the other side
PALPATION
- Examine each major joint and muscle
group in turn
- Identify any areas of tenderness
- Identify any areas of deformity
- Always compare with the other side
RANGE OF MOTION
- Start by asking the patient to move
through an active range of motion (joints
moved by patient)
- Proceed to passive range of motion (joint
moved by examiner)
- If active range of motion is abnormal
ACTIVE
- Ask patient to move each joint through a
full range of motion
- Note the degree and type (pain,
weakness, etc.) of any limitation
- Note any increased range of motion of
stability
- Always compare with the other side
- Proceed to passive range of motion if
abnormalities are found
PASSIVE
- Ask patient to relax and allow you to
support the extremity to be examined
- Gently move each joint through its full
range of motion
- Note the degree and type (pain or
mechanical) of any limitation
- If increased range of motion is detected
perform special test for instability as
appropriate
- Always compare with the other side
 - flexion/extension, abduction/adduction,
internal/external rotation
SPECIFIC JOINT
Knee
Fingers
- flexion/extension,
- flexion/extension, abduction/adduction
Ankle
Thumb
- flexion (plantar flexion) extension
- flexion/extension, abduction/adduction,
(dorsiflexion)
opposition
Foot
Wrist
- inversion/eversion
- flexion/extension, radial/ulnar deviation
Toes
Forearm
- flexion/extension,
- pronation/supination (function of both
elbow and wrist) Spine

Elbow - flexion/extension, right/left bending,

right/left rotation
- flexion/extension

Shoulder
CHAPTER 8: ASSESSING GENERAL HEALTH
- flexion/extension, internal/external
STATUS AND VITAL SIGNS
rotation; abduction/adduction

Hip
Preparation for Survey of General Health Status
 - Perform systematic examination and  Behavior, body movements and affect
recording general characteristics  Facial expression
impressions if the client  Speech
- Observe any significant abnormalities  Vital Signs

OBSERVE SIGNIFICANT ABNORMALITIES INTERVIEW

 Skin color  General survey questions

 Dress  History of present health concern
 Hygiene  Personal history
 Posture and gait  Family history
 Physical development  Lifestyle and health practice
 Body built
 Apparent age
 Gender ACCURATE GENERAL SURVEY #1

 Preparing the Client

 Equipment
GENERAL SURVEY #1
 Thermometer
 Physical development and body built  Protective, disposable covers for type of
 Gender and sexual development thermometer
 Apparent as compared to reported age  Aneroid or mercury sphygmomanometer
 Skin condition and color or electronic blood pressure measuring
 Dress and hygiene equipment
 Posture and gait  Stethoscope
 Level of Consciousness  Watch with second hand
  General impression
 Observe physical development, body build
PULSE AMPLITUDE
and fat distribution
 Compare client's stated age with  0 Absent
apparent age and developmental stage  1+ Weak, diminished (easy to obliterate)
 Observe skin condition and color  2+ Normal (obliterate with moderate pressure)
 Observe posture and gait  3+ Bounding (unable to obliterate or required
firm pressure)

VITAL SIGNS
BLOOD PRESSURE
 Hands-on physical examination begins with vital
signs  Systolic blood pressure
 Provide data that reflect body systems status  is a measurement of the pressure of
 Cardiovascular the blood in the arteries when the
 Neurologic ventricles contracted
 Peripheral Vascular
 Respiratory  Diastolic blood pressure
 is a measurement of the pressure of
the blood in the arteries when the
ORDER OF VITAL SIGNS ventricles are relaxed.

 Temperature
 Pulse
PAIN
 Respirations
 Blood pressure  Fifth vital sign
 Observe comfort level
 ANS:

OLDER CLIENT CONSIDERATIONS #1 False,

Temperature may range from The rectal temperature is between 0.4 Degree Celsius
0.5 Degree Celsius (0.7 Degree Fahrenheit and 1
Degree Fahrenheit) Higher than the normal oral temp.

RISE IN TEMPERATURE
FACTORS AFFECTING BLOOD PRESSURE
 Strenuous exercise
 Cardiac output
 Stress
 Elasticity of arteries
 Ovulation
 Blood volume
 Hyperthermia
 Blood velocity (hear rate)
 Viral or bacterial infection
 Blood viscosity (thickness)
 Malignancies
 Trauma
 Various blood, endocrine, immune
CHARACTERISTICS OF RADIAL PULSE
disorder
 Rate
 Rhythm
QUESTION #1  Amplitude and contour
 Elasticity
Is the following statement true or false?

The rectal temp. is lower than the normal oral

temperature? QUESTION #2
Is the following true or false? DEFINITIONS

Normally, pulsation is lightly stronger in the left  International Association for the Study of Pain
wrist. (IASP)
 unpleasant sensory and emotional experience
ANS.
which we primarily associate with tissue
False damage or describe in terms of such damage
or, both
Normally, pulsation is equally strong in both wrists.
 McCaffery and Pasero
 Pain is whatever the person says it is
NORMAL AND ABNORMAL FINDINGS

 Share outcomes of assessment with peers PATHOPHYSIOLOGY

 Transduction
VALIDATING AND DOCUMENTING FINDINGS  A-delta primary afferent fibers
 Transmission
 Health promotion findings
 Perception
 Risk diagnoses
 Modulation
 Actual diagnoses
 Collaborative problems
 Medical problems ACUTE PAIN

 usually associated with a recent injury

CHAPTER 9 ASSESSING PAIN: THE FIFTH VITAL
SIGN
CHRONIC NONMALIGNANT
  usually associated with a specific cause or Radiating
injury and described as a constant pain that
- Perceived both at the source and
persists for more than 6 months
extending to other tissues

Phantom Pain
CANCER PAIN
- Perceived in nerves left by a missing,
 often due to the compression of peripheral amputated, or paralyzed body part
nerves or meninges or from the damage to
Neuropathic pain
these structures following surgery,
chemotherapy, radiation or tumor growth and - Causes an abnormal processing of pain
infiltration messages and results from past damage
to peripheral or central nerves due to
sustained neurochemical levels
PAIN DESCRIPTORS
Nociceptive
Cutaneous pain
- Response to noxious insult or injury of
- skin or subcutaneous tissues such as skin, muscles, visceral
organs, joints, tendons, or bones
Visceral pain
Inflammatory
- abnormal cavity, thorax, cranium
- A result of activation and sensitization of
Deep somatic pain
nociceptive pain pathway by a variety of
- Ligaments, tendons, bones, blood vessels, mediators released at a site of tissue
nerves inflammation
PHYSIOLOGIC REPONSES TO PAIN #1

 Anxiety, fear, hopelessness, sleeplessness,

GOD BLESS
thoughts of suicide

FUTURE
 Focus on pain, reports of pain, cries and moans,
frown and facial grimaces
 Decrease in cognitive function, mental
confusion, altered temperature, high

NURSE
somatization, and dilated pupils
 Increased heart rate; peripheral, systemic, and
coronary vascular resistance; and blood
pressure

REVIEW
WELL!!