Page 384 - Saunders Comprehensive Review For NCLEX-RN

percussed and measured.
c. Tympany should predominate over the
abdomen, with dullness over the liver
and spleen.
d. Percussion over the kidney at the 12th
rib (costovertebral angle) should
produce no pain. This is also known as
costovertebral tenderness.
6. Palpation
a. Begin with light palpation of all 4
quadrants, using the fingers to depress
the skin about 1 cm; next perform deep
palpation, depressing 5 to 8 cm.
b. Palpate the liver and spleen (spleen
may not be palpable).
c. Palpate the aortic pulsation in the upper
abdomen slightly to the left of midline;
normally it pulsates in a forward
direction (pulsation expands laterally
if an aneurysm is present).
7. Refer to Chapter 48 for diagnostic tests related to the
gastrointestinal system.
8. Client teaching
a. Encourage the client to consume a
balanced diet; obesity needs to be
prevented.
b. Substances that can cause gastric
irritation should be avoided.
c. The regular use of laxatives is
discouraged.
d. Lifestyle behaviors that can cause
gastric irritation (e.g., spicy foods)
should be modified.
e. Regular physical examinations are
important.
f. The client should report gastrointestinal
problems to the PHCP.
J. Musculoskeletal system

1. Subjective data: Joint pain or stiffness; redness,

swelling, or warm joints; limited motion of joints;
muscle pain, cramps, or weakness; bone pain;
limitations in activities of daily living; exercise
patterns; exposure to occupational hazards (e.g.,
heavy lifting, prolonged standing or sitting);
medications being taken; history of joint, muscle, or
bone injuries; history of surgery of the joints, muscles,
or bones

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