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Nursing 235 Chapter 19 Questions And Answers With Verified Solutions 100% Correct!!!
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Nursing 235 Chapter 19 Questions And Answers With Verified Solutions 100% Correct!!!
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Nursing 235 Chapter 19 Questions AndAnswers With Verified Solutions 100%
Correct!!!
right upper quadrant - ANSWER✔✔ liver, gallbladder
left upper quadrant - ANSWER✔✔ pancreas, spleen, stomach
right lower quadrant - ANSWER✔✔ appendix, cecum
left lower quadrant - ANSWER✔✔ sigmoid colon
inspect skin color, integrity - ANSWER✔✔ -normal: normal for ethnicity but paler
than arms and legs, white striae (healed stretch marks), skin intact, warm and dry
-abnormal: purple flank color suggests hemorrhage, striae may be caused by
ascites, rashes and lesions (ABCDE)
ABCDE - ANSWER✔✔ -asymmetry
-border
-color
-diameter
-evolving
inspect venous pattern - ANSWER✔✔ -normal: scattered fine veins visible- might
be hard to see in dark skin tones
-abnormal: engorged, prominent veins suggest liver disease (portal hypertension
and ascites)
, inspect umbilicus - ANSWER✔✔ -normal: midline and centrally located, pinkish,
inverted, round or conical
-abnormal: deviated from midline, inflamed, crusted, bluish, everted, (if its recent
change then its abnormal because some naturally have everted ones)
inspect abdominal contour - ANSWER✔✔ -normal: flat, rounded, or scaphoid
(sunken), symmetric, if ascites (round and hard), MEASURE abdominal girth
-abnormal: distention suggests gas or fluid
-"6 Fs": fat, feces, fetus, fibroids, flatulence, and fluid, asymmetry suggests mass,
scaphoid suggests severe underweight
inspect vascular pulsations and peristaltic waves - ANSWER✔✔ -normal: no
pulsations unless thin, no peristaltic waves unless thin
-abnormal: vigorous, wide, exaggerated pulsations suggest AAA (abdominal aortic
aneurysm), increased peristaltic waves suggest SBO (small bowel obstruction)
auscultate - ANSWER✔✔ diaphragm then bell
auscultation with diaphragm of stethoscope for bowel sounds - ANSWER✔✔ -
normal: series of irregular intermittent, soft clicks and gurgles are heard at a rate of
5 to 30 per minute
-abnormal: hyperactive (higher pitched, more gurgles and clicks), hypoactive (must
listen for a full five minutes before documenting "absent" which a medical
emergency
auscultate with bell of stethoscope for abdominal vascular sounds-bruits
ESPECIALLY IMPORTANT IF PT HAS HTN OR SUSPECTED ARTERIAL
INSUFFICIENCY TO THE LEGS - ANSWER✔✔ -normal: bruits are not
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