Abdominal Assessment - earlier you indicated that you had some pain in your right upper quadrant so we will do that part last. We're going to switch up the order of our assessment so we're going to do inspection, auscultation, percussion, then palpation last. I'm going to leave you with a pillow, I'm going to get you to flex your knees up and leave your arms at your side. I'm going to look at your abdomen straight down. I'm going to squat down and I'm going to assess your contour which we can say is flat - it could either be flat, protuberant, round or scaphoid. We're going to go to the base of the bed and we're gonna assess - we're gonna say that your abdomen is symmetrical. I'm just going to shine a light here looking for any sort of bulging and masses. No bulging and masses present, your umbilicus is midline, inverted, no redness, no dry skin, your skin is uniform color, no redness, no lesions, no striae present, uniform hair growth, your facial expressions calm relaxed, your respirations are even and silent. I see a slight pulsation in the epigastric area associated with your aortic pulse and I see no other pulsations or movements. No peristalsis, no abdominal breathing, I am going to auscultate your bowel sounds as well as your vascular sounds. When we also take your bowel sounds we're going to use our diaphragm and when we auscultate your vascular sounds we are going to use the bell. We'll auscultate your bowel sounds first and what we're going to note is two characteristics for your bowel sounds as well as one for your frequency. What we're going to do is landmark approximately one inch outside of your umbilicus and each quadrant starting at the right lower quadrant because that's where your ileocecal valve drains and where we are most likely to hear bowel sounds. So we're gonna listen for approximately 10 seconds per quadrant if they're normal if or hyperactive, if they're less than five or hypoactive we're going to listen for a full minute, if they're absent you listen for a full five minutes per quadrant. Bowel sounds were normal meaning they were within five to thirty sounds per minute, they were irregular, high-pitched, cascading, gurgling sounds which are all normal. Now we're going to listen to your vascular sounds so I'm going to switch it over to my bell and then we are going to landmark and name them as we go along. In your epigastric area is your aorta, your renal, iliac and your femoral sounds. We're going to compare a site-to-site Renal, iliac with your iliac crest and then your femoral. No bruit present which is fantastic. Now we are going to do percussion, starting in your lower quadrant. We're going to use the same technique as we've previously been taught and we're going to do about three areas per quadrant starting in your right lower quadrant so we cover the whole area. We're going to note general tympany throughout and we also heard some liver dullness in your right upper quadrant, we potentially hear some splenic dullness in your left upper quadrant, potentially in your right lower or left lower we might hear some bladder dullness or if there's some feces in there we might hear that. So that's fantastic, now we are going to perform our scratch test. We will take our stethoscope and place our diaphragm over the liver and we're going to scratch rapidly from the right lower quadrant and as the sound magnifies we're gonna identify that as our lower liver border. My lower liver border would be right there, and then we are going to sit our client up and we are going to assess our costovertebral angle of tenderness. Essentially we're going to find that at our twelfth vertebrae and our spine. We're gonna landmark seven, eight, nine, ten, eleven, twelve - we're going to come across and do this bilaterally. You put your hand over the costal vertebral angle, you're going to strike your client and ask if there's any pain or tenderness. No pain or tenderness present so that's fantastic. Now we're going to lay you back down and we are going to palpate. We're going to palpate using your four fingers, we're going to use a gentle pressure going about one centimeter deep. Start in the right lower quadrant - our client noted that they had right upper quadrant pain so we're going to do that area last. We're going to use three fingers in a gentle circular motion with our hand parallel as opposed to straight down. Then we're gonna do the upper quadrant, so any pain or tenderness? No pain or tenderness noted, no masses felt, no guarding, no rigidity felt, so that concludes our assessment. Any questions? No.