A physical assessment is being performed on patient Geoff by Nurse Tine. During the abdominal examination, Nurse Tine should perform the four physical examination techniques in which sequence?
A. Auscultation immediately after the inspection and then percussion and palpation.
B. Percussion, followed by inspection, auscultation, and palpation.
C. Palpation of tender areas first and then inspection, percussion, and auscultation.
D. Inspection and then palpation, percussion, and auscultation.
Correct Answer: A. Auscultation immediately after the inspection and then percussion and palpation
With an abdominal assessment, auscultation always is performed before percussion and palpation because any abdominal manipulation, such as from palpation or percussion, can alter bowel sounds. Assessing the patient’s abdomen can provide critical information about his internal organs. Always follow this sequence: inspection, auscultation, percussion, and palpation. Changing the order of these assessment techniques could alter the frequency of bowel sounds and make the findings less accurate.
Option B: Percussion should never precede inspection or auscultation, and any tender or painful areas should be palpated last. Assess for any visible mass, bulging, or asymmetry. Look for unusual coloring, scars, striae, lesions, petechiae, ecchymoses, spider angiomas, and suspicious-looking moles. Inspect the umbilicus and note any hernias. Look for pulsations. A thin patient may have a pulsation of the aorta in his epigastric area and possibly peristaltic waves.
Option C: Lightly percuss all four quadrants of the patient’s abdomen. You’ll hear dull sounds over solid structures (such as the liver) and fluid-filled structures (such as a full bladder). Air-filled areas (such as the stomach) produce tympany. Dullness is a normal finding over the liver, but a large, dull area elsewhere may indicate a tumor or mass.
Option D: Using a light, gentle, dipping motion, palpate for abnormalities, such as muscle guarding, rigidity, or superficial masses. Palpate clockwise, lifting fingers as you move from one location to another. After light palpation of the entire abdomen, place a non-dominant hand on the dominant hand to perform deeper palpation (1½ to 2 inches [3.8 to 5 cm]). However, avoid deep palpation if the patient may have a problem such as splenomegaly, appendicitis, or aneurysm or if palpation is painful for any reason.