How should the patient be positioned for an abdominal exam?
Flat- supine
What should you ask a patient before an abdominal exam?
If they have any tummy pain
What are you looking for on inspection of the abdomen?
Scars, symmetry, masses, distension, bruising, spider naevi, capat medusa, stomas
When should you observe a patient during an abdominal exam?
All the time
If the spleen cannot be felt what should you do?
Perform the same manoeuvre again with the patient on their right side
If on a shifting dullness test, the patient rolls to the side and the note is still dull, what does this mean?
No ascites
If on a shifting dullness test, the patient rolls to the side and the note is now resonant, what does this mean?
Ascites- fluid has shifted
What should you say after an abdominal exam?
‘I would now perform a PR examination and examine the hernia orifices if this was necessary’
What are you looking for in the eyes?
Pallor, jaundice, Kayser Fleisher rings, corneal arcus, xanthelasma
What should you use when looking in the mouth?
A torch and wooden tongue depressor if available
What are you looking for in the mouth?
Buccal mucosa for ulcers, candida, angular stomatitis, dentition quality
What should you be looking for in the legs?
Bruising, oedema, muscle wasting
How should you wash your hands before a rectal exam?
Fully with water, not alcohol gel
What equipment should you gather for a rectal exam?
Gloves, lubricant, swabs and disposal bags
Once you have brought the equipment for a rectal exam, what should you do?
Ask the patient again if they are happy to proceed
What is the first step of a rectal exam?
Good inspection, part the buttocks and look for scars, lesions, haemorrhoids
Where should you lubricate for a rectal exam?
Your finger and then around the anus
How should you insert your finger into the anus?
Back of index finger against top of anus
What should you ask the patient to do as you withdraw?
Clench their buttocks
What should you do as you remove your finger from the anus?
Have a look at it for any stool or blood
What should you do after inspecting your finger in a PR exam?
Wipe the anus with swabs and ask the chaperone to cover the patient
What should you do after the patient is recovered in a rectal exam?
Put waste in orange bin and thoroughly wash your hands again before discussing findings with the patients
What about a PR exam would you record in notes?
The patients consent, the name of the chaperone and the findings of the examination
What should you ask a patient before taking blood?
Their name, DOB and if they have a preferred arm
