Physical examination abdomen, musculoskeletal and neurological system
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Transcript of Physical examination abdomen, musculoskeletal and neurological system
PHYSICAL EXAMINATION
THE ABDOMEN
TechniquesInspection Palpation PercussionAuscultation
EquipmentsExamining lightStethoscopeTape measureWater soluble skin marking pencil
Four abdominal quadrants
Nine abdominal regions
Abdomen
• Inspect the abdomen for – skin integrity
– Contour and symmetry and measure the abdominal girth
– Observe abdominal movements
– Observe vascular pattern
• Auscultate the abdomen for– Bowel sounds
– Vascular sounds
– Peritoneal friction rub
Auscultation of the abdomen
Abdomen
• Percussion of the abdomen
– Use indirect percussion
– Start from the RLQ
– Normally there is generalized tympany over the bowels.
• Percuss the liver to determine its size.
– 6-12 cm in the midclavicularline
Abdomen
• Palpation of the abdomen
– Perform light palpation to detect areas of tenderness.
– Perform deep palpation to asses masses and underlying structures
• Palpate the liver to detect enlargement and tenderness
• Palpation of the bladder
THE MUSCULOSKELETAL SYSTEM
•Muscles•Bones and•Joints
MUSCLES• Inspect the muscle for
– Size
– Contractures
– Tremors
• Palpate for muscles at rest to determine muscle tonicity
• Palpate muscles while the client is active for– Flaccidity
– Spasticity and smoothness of movements
• Test muscle strength (compare the right side with the left side)
Grading of muscle strength
Bones and jointsBONES
• Inspect the skeleton for structure
• Palpate the bones to locate any areas of edema or tenderness
JOINTS Inspect the joint for swelling
Palpate each joint for tenderness, smoothness of movement, swelling, crepitation and nodules
Assess joint Range of motion
THE NEUROLOGIC
SYSTEM
The neurological system
• Mental status– Language
– Orientation (time, place and person)
– Memory (immediate, recent and remote memory)
– Attention span and calculation
• Level of consciousness (GCS scale )
• Cranial nerves
• Reflexes
• Motor and sensory function
Cranial nerves
I. Olfactory nerve
II. Optic nerve
III. Oculomotor nerve
IV. Trochlear nerve
V. Trigeminal nerve
VI. Abducens nerve
VII. Facial nerve
VIII.Vestibulocochlear nerve
IX. Glossopharyngeal nerve
X. Vagus nerve
XI. Accessory nerve
XII. Hypoglossal nerve
Cranial nerves
REFLEXES
Reflexes Spinal cord level
Biceps reflex C5C6
Triceps reflex C7C8
Brachioradialis reflex C5C6
Pattellar reflex L2 L3 L4
Achillis reflex S1s 2
Plantar reflex Superficial reflex
REFLEXES
Biceps Triceps Brachioradialis
Pattellar Achillis Babinski
Motor function
• Walking gait
• Romberg test
• Standing on one foot with eye closed
• Heel toe walking
• Toe or heel walking
• Finger to nose test
• Alternating supination and pronation of hands on knees
• Finger to nose to the nurse’s finger
• Finger to fingers
Motor function
• Finger to thumb (same hand)
• Heel down opposite shin
• Toe or ball of foot to the nurse’s finger
• Light touch sensation
• Pain sensation
• Temperature sensation
• Position or kinesthetic sensation
• Tactile discrimination
• Extinction phenomenon
Genital and inguinal area
• Male
– Inspect the distribution ,amount and characteristics of pubic hair
– Penis :
• Inspect the penile shaft & glands penis for lesions , nodules swelling and inflammation
• Inspect the urethral meatus for swelling ,inflammation and discharge
• Palpate the penis for tenderness ,thickening and nodules
• Male– Scrotum:
• Inspect scrotum for appearance ,general size, and symmetry
• Palpate the scrotum to assess status of underlying testes, epidydimisand spermatic cord.
– Inguinal area:
• Inspect both inguinal area for bulges
Genital and inguinal area
Genital and inguinal area
• Female
– Inspect the distribution , amount and characteristics of pubic hair
– Insects parasites, inflammation, swelling and lesions .
– Inspect clitoris
– Palpate the inguinal lymph nodes
THE RECTUM AND ANUS
TechniquesInspection Palpation Digital examination
PositionsLithotomyLeft sims lithotomyDorsal recumbent
The rectum and anus
• Inspect the anus and surrounding tissue for color ,integrity and skin lesions.
• Palpate the rectum for anal sphincter tonicity ,nodules, masses and tenderness