Do nurses actually measure liver span during physical assessment?

I guess if it originally had a problem or you suspected enlarged liver, but I would think that would be more of a docs assessment. I have never had to do that, even in class for school (I just graduated in '07). I work in ICU at a major teaching hospital and we have a lot of liver patients, I've never seen it done anywhere else. Maybe thats just me.

no measuring a persons liver is not the nurses responsibility.a nurse may note that its enlarged but it is upto the physcian to measure it.the only nurse who may do this is an np.

I've never done it. If you actually had a patient with an inflamed liver you're liable to get punched or something if you try to palpate it (it would be VERY painful to do that to someone with a liver problem). I made the mistake of lightly pressing the LRQ of a person with appendicitis (just a little too hard) and she screamed in pain. I felt terrible and apologized but she looked like she was going to cry...big mistake...I'll be much lighter with my touches from now on.

That being said, It's probably just one of those things that's good to know. It's not hard to do, and at least what someone is talking about if you ever hear about it being done.

I remember learning this at nursing school. I have never done this, nor have i seen this done by other nurses anywhere. I don't understand why they are teaching it but there are a lot of things that we were taught that simply don't apply to nursing practice.

First, I observe the abdomen for any obvious deformities (acities, bulging hernia, etc.), then, I check for bowel sounds in all quadrants and then I lightly palpate for tenderness. I was taught in nursing school that deep palpation was done by Advanced Practice nurses, PAs and physicians.

If the liver is prominent on light palpation, then it should be noted as such.

Is this a physical assessment in a MSN program that is preparing you for your APN? Or are you in an ADN or BSN program? The assessment class I took for my BSN did not have us measuring liver span or any other deep palpation.

Blee

My physical assessment class my 1st semester also taught us to do deep palpation and to measure liver span. I have never seen a nurse do deep palpation or measure a liver span. Doc's don't even measure livers through palpation, but instead use imaging.

About all you would need to palpate the liver for is for basic landmark purposes. The RN doesnt need to know how large the liver is or if it is enlarged on a physical assessment. I agree that is the doctors responsiblity to measure and treat. Possibly if you had a trauma and there were injuries that would cause the liver to be displaced or at risk you may need to watch the edge landmark for assessment purposes.

I'm sure some of you all have seen this or include it in your own assessment, but when we have a liver patient (or suspected) I auscult the borders of the liver. You can place your stethoscope on the left lower quadrant and then gently rub a finger in several lines over the right upper quadrant. You'll hear a definite change in the sound when you leave the border of the liver and as far as my experience goes it's completely painless.

of course you guys are correct, it's the MD/PA/NP responsibility and imaging studies are the best way to define the size.

I am in a BCSN program and we used Jarvis book for physical assessment class...it seems like a few things we learned in class I doubt nurses do on a regular basis. this is why i find it hard because I don't know what we are supposed to be performing on a daily basis during the time we examine patients and do a head to toe. For all I knew (before you guys told me) was that nurses measure liver spans every day during their initial head to toe examination....some clinical preceptors made students in their clincal group do this every day during their clinical time to their patients.

I find it hard to know what we are supposed to be doing on a regular basis and not doing in case we get brought to court or something and they ask the nurse why they didnt include a certain skill in their patient assessment if they learned it in School

we were also taught to do deep palpation as well

I am in a BCSN program and we used Jarvis book for physical assessment class...it seems like a few things we learned in class I doubt nurses do on a regular basis. this is why i find it hard because I don't know what we are supposed to be performing on a daily basis during the time we examine patients and do a head to toe. For all I knew (before you guys told me) was that nurses measure liver spans every day during their initial head to toe examination....some clinical preceptors made students in their clincal group do this every day during their clinical time to their patients.

I find it hard to know what we are supposed to be doing on a regular basis and not doing in case we get brought to court or something and they ask the nurse why they didnt include a certain skill in their patient assessment if they learned it in School

i used the barbara bates book myself....anyway, you're point is a good one. What if you're asked in court about something you learned in school? #1. you probably aren't going to create a mistake that you end up being sued for. In 16+ years I've been threatened to be taken to court before (over trivial things that never even got into a lawyer's office much less out of one--no DNR but a family insisted that we not attempt to resuscitate, etc.), but the only times I've been depositioned were cases involving a crime.

and #2. in court you would be held to a reasonable-mans test and you would be able to parade an endless line of people in on your behalf to attest that you wouldn't need to measure a liver margin.

My advice, it's worth is certainly arguable, is that when you get out of school and start working---pay close attention to your preceptor because they will be able to help tailor your assessment to your situation. for example, If neuro is grossly intact then I don't do a detailed cranial and spinal root exam on a patient complaining of chest pain. that's something you don't learn in the classroom.