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Appendicitis Assessment Advanced Level

Written By SALWA store on Sunday, May 27, 2012 | 5:49 AM

A. Percussion to determine the position and size of hepatic
1. Perform percussion ranging from at or below the line midklavikularis uymbilikus heading up through the tympanic area until a faint sound which is the lower limit of the liver. With a pencil mark on the place began to dim the sound was found.

2. Do percussion on the line that starts from the right midklavikularis resonant area of ​​lung to dim down until it was sound that indicates the upper limit mark on the liver and found the place began to dim sound.
3. Measure the distance between two marks before (upper and lower limit of the liver) in centimeters which states the size of the liver.
Normally the liver on the line length is 6-12 cm midklavikularis to the lower limit is at or slightly below the rib cage.

B. Percussion to determine the position and size of the lien
Lien easy diperkusi if enlargement. Percussion performed along the line of the left midclavikularis up and down. Record the place where the voice sounded faint. Normally heard in the area between the ribs between the 6th to the sidelines of the 10th rib with a length of about 7 cm in adults.

C. Palpation of the liver
Palpation of the liver can be performed with the aim of bimanual primarily to determine the presence of enlarged
1. Stand beside the patient's right
2. Put your left hand on the posterior wall of the piston is approximately at the rib cage to the 11 and 12
3. Emphasize the left hand is slightly raised up so that the chest wall
4. Put your right hand on the lower limit of the right side of the ribs with an angle of about 45o to the abdominal rectus muscle or parallel to the abdominal rectus muscle with the fingers towards the rib cage.
5. While patients ekhalasi, apply pressure depth of 4 to 5 cm below the top down toward the bone
6. Keep your hands and tell patients inhaled / a deep breath
7. While the patient's inhalation, hepatic btas feel your hand moving against a normally felt with regular contours. When the liver does not feel / felt clearly, then tell the patient to breathe in while you still maintain the position of the hands or put pressure on the hands or give a little more pressure in the liver is the difficulty in feeling often experienced in obese patients.
8. When the liver is enlarged, then do dibatas palpation under the right rib. Note the enlargement occurs below the rib cage.

D. Lien palpation
Spleen was not palpable in normal adults. Spleen palpation is done by using a pattern like on palpation of the liver.
1. Instruct the patient to the right so that the lien kesisi tilted closer to the abdominal wall
2. Perform palpation at the lower limit by using the left rib-like pattern on palpation of the liver.

E. Kidney palpation
Anatomically, the upper lobe of both kidneys touches the diaphragm down during inhalation, and kidneys. Right kidney is normally more easily palpated than the left kidney, because under the right kidney is located more than the left kidney. Right kidney is located parallel to the rib cage to the left kidney-12 and parallel to the rib cage to 11 cm, a width of 4 to 7 cm and 2.5 cm thick.

Palpate the kidneys, then position the patient supine set dn nurses palpate standing here / right patient. Palpation of the kidneys is the working steps:
1. Palpation in the right kidney, place your left hand under the pelvis and kidney elevasikan anterior direction.
2. Put your right hand on the anterior abdominal wall at garias midclavikularis from the bottom edge of the costal margin
3. Emphasize your right hand straight up while the patient took a deep breath. In the normal adult, the kidney was not palpable but the people who are very thin, the bottom of the right kidney can be felt.
4. When the kidneys palpable, feel the contour (shape), size, presence of tenderness
5. To palpate the kidneys run, do the opposite side of the patient's body and place your left hand under the pelvis and then do the action as on palpation of the right kidney.

F. Bladder palpation
Palpation of the bladder can be done dengtan use one or two hands. Palpable bladder, especially when it distends due to accumulation of urine. If found there then do distended bladder percussion in the area to find the sound / level of ruination.

G. Assessment Rectum
The rectum is the most distal part of the gastrointestinal fraktus. The general objective here is to obtain assessment data on the condition of the  rectum and rectum. In the assessment of male patients is also useful to know the state of the prostate.
Equipment that needs to be prepared, including a blanket to cover the body parts that are not checked, sterile gloves / disposable and lubricants. Working steps:
1. Help the patient to adjust the position of the dorsal rekomben. Arrange thighs rotated out, knee flexion and close the body parts that are not checked
2. Nampakkan the buttocks and instruct the patient to focus attention
3. Place the inspection of the rectum to determine presence / absence of hemorrhoids, lesions or reddish.  Rectum  appear normal intact skin, no hemorid, lesions or redness.
4. Wear gloves and put grease on the pointer finger and slowly insert a finger into the  rectum and rectum.
5. Perform palpation of the rectum wall and feel the presence or absence of nodules, masses and tenderness
6. In men, did palpation on the anterior wall to find the prostate gland.
7. In women, do seruik palpation of the uterus through the anterior rectal wall
8. When finished, drag your finger from the rectum and  rectum, observe the state of the stool on the glove. Normal stools
9. Record the results of your examination.


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