Nursing 206 Exam 4
Nursing History for Abdominal Assessment - correct answer ✔pg. 248 wilson
landmarks of abdomen - correct answer ✔pg. 255, 256
abdominal cavity a&p (pg. 246 wilson) - correct answer ✔1. largest cavity in
the body
2. The peritoneum covers
-The outside of abdominal organs
-Lines the abdominal walls
-Allows organs to glide against each other and the wall
3. Esophagus: lies above the diaphragm
-Moves ingested food to stomach by peristalsis
4. Stomach
-Liquefies food into chyme ( HCl, pepsin, enzymes)
5. Small intestines: duodenum, jejunum, ileum
-Longest organ
-Absorption of nutrients
6. Large intestines (colon)
-Ascending, transverse, descending
-Sigmoid: the end of the descending colon (S-shaped)
-Absorbs water and electrolytes
-Holds feces until defecation
7. Liver: located in R upper quadrant
-Protein, carb, and fat metabolism
,-Glucose converted to glycogen
-Production of clotting factors
-Detoxification of drugs and alcohol
-Bile production: aids digestion
8. Gallbladder: stores bile made by liver, lower aspect of liver
9. Pancreas: upper quadrant location
-Endocrine: Beta cells make insulin, glucagon, gastrin
-Exocrine: enzymes that when released into duodenum, break down protein,
carbs and fat to be absorbed
10. Spleen: lateral L upper quadrant
-Erythrocyte production, storage and removal
-Activation of T cells and B cells: immune response
rectum a&p - correct answer ✔1. below the sigmoid
2. Rectum: 5" long. Has 3 valves
3. Anus has
-Internal sphincter: involuntary muscle
-External sphincter: voluntary muscle
4. External anus is moist, hairless, slightly darker pigmentation
urinary tract a&p (pg. 246 wilson) - correct answer ✔1. two kidneys: located
in posterior abdominal cavity, partly protected by lower ribs
-Fluid & electrolyte balance
-Renin: increases BP
-Erythropoetin: to stimulate RBC production
2. Ureters
-through peristalsis, delivers urine to bladder
,3. Bladder: behind symphysis pubis
-Holds urine until 300ml volume, then urge to go
-Rises above the symphysis pubis, but below the umbilicus when distended (+
300ml)
-Will be dull to percussion
4. Urethra: urine exits body through the meatus
-Female: examine meatus with client in the dorsal recumbent position; with
gloved hand separate the labia
-Male: meatus should be centrally located at tip of penis
-With gloved hands, retract foreskin, if present
-There should be no lesions or drainage at the meatus
inspection of abdomen - correct answer ✔1. Skin color - may be lighter due
to lack of sun exposure
2. Should be smooth
3. Faint veins
-Possible silver-white striae
4. Contour: should be smooth and symmetric
5. No visible movements with peristalsis is normal
-upper midline pulsation may be visible in thin individuals (aortic), seen in
extremely thin people
-area of pulsation is not palpated because it may indicate an abdominal
aneurysm
6. In males, abdominal movement with respirations
-In females, thoracic movement with respirations
7. Patient's behavior and position
-should be relaxed
-Should have unlabored respirations
, -Should be sitting or lying quietly
8. umbilicus should not be displaced upward, downward, or laterally
9. note any bulges or masses, particulalrly of the liver or spleen
auscultation of abdomen - correct answer ✔1. Auscultation of bowel sounds:
always before palpation
-Palpation may alter the bowel activity
2. Bowel sounds are a reflection of peristalsis: the wavelike, involuntary
muscular contractions of the GI tract
3. Use diaphragm of stethoscope
4. Bowel sounds are created by the movement of air and fluid through the
large and small intestines
-High pitched gurgles or clicks
-Vary from moment to moment
-Absent bowel sounds are concerning and need to be reported to provider
-Determine if bowel sounds are present or not
-Listening over each quadrant is not necessary
5. Vascular sounds
-Use bell of stethoscope
-should not be able to be auscultated
-Above umbilicus
-Midline is aorta
-R and L of aorta: renal arteries
-a venous hum directly over umbilicus is normal
-swishing sounds over abdominal aorta is abnormal
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