This content is based upon The Correctional Nurse Educator class entitled Abdominal Assessment: Basic Assessment for the Correctional Nurse.
This is a little bonus for those of you who are following the posts in our Abdominal Assessment series – a listing with explanations of some Special Maneuvers that can be used to further evaluate the patient during an abdominal assessment.
Special Maneuvers
There are a few special maneuvers that can be used during examination to rule in/out certain conditions.
Rebound Tenderness
Slowly press over the abdomen with your fingertips and hold that position until the pain subsides or the patient adjusts to the discomfort, then quickly remove the pressure. Rebound pain, a sign of peritoneal inflammation, is present if the patient experiences a sharp discomfort over the inflamed site when pressure is released.
Rovsing’s Sign
There is referred pain in the right lower quadrant when you press deeply in the left lower quadrant and then quickly release the pressure. If this occurs, then appendicitis is suggested.
Heel Strike
Ask the patient to stand with straight legs and to raise up on his/her toes. Then ask him/her to relax, allowing the heels to strike the floor; the body will be jarred. If pain is felt in the abdomen, then this positive heel strike test is indicative of appendicitis and peritoneal irritation. Alternatively, you may have the patient lay supine on the examination table while you strike the plantar aspect of his/her feet with your fist. Pain elicited means there is a positive heel strike test.
Obturator Sign
Pain elicited with the passive inward rotation of the hip with the knee bent (so that the obturator internus muscle is stretched) is indicative of appendicitis. This is done with both legs independently.
Psoas Sign
Place your hand on the patient’s thigh just above the knee, and ask him/her to raise the thigh against your hand. This contracts the psoas muscle and produces pain in patients with an inflamed appendix.
Murphy’s Sign
Position your fingers at the liver border at the bottom of the rib cage and ask the patient to take a deep breath in. The gall bladder will touch the fingers, and if inflamed, pain will be experienced by the patient. This is positive in cholecystitis.
Hepatojugular Reflux
Apply firm, sustained hand pressure to the abdomen in the mid-epigastric region while the patient breathes normally. Observe the neck for elevation of the jugular venous pressure (JVP) when the hand applies pressure, and the sudden drop of the JVP when the hand pressure is released. This is exaggerated when the patient has right heart failure.
I hope that you have enjoyed this series on Abdominal Assessment! Your feedback is much appreciated.