I learned in my physical assessment class how to measure the span of a person's liver (its lenght, etc)
Do any RN's actually do this on a regular basis? I have never had my liver span measured when I go to the doctors! Or is this something only done when hepatomegaly is suspected?
It seems like we learn alot of stuff in NS that is never done during a physical assessment on a regular basis...so how do we know WHEN to do it?
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.
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.
The scratch test. Very nice technique, also can be used on the spleen if you know what you're doing (I don't). Personally, I like to percuss out the liver, not because I think it's any more accurate, but just because it makes me feel cool.
In truth though, I don't know that I see a whole lot of utility in measuring liver span. Say it comes up big, what are you going to do? Unless they actually have symptoms or conditions referable to the liver, it's probably of no significance. Plus there are a variety of odd anatomic variants that can appear to be "enlarged" when really they're normal. Check this out:
That's Riedel's lobe, and it's totally normal.
Plus, when people have hepatic disease, there's usually so much more going on than just an aymptomatic big liver.
All I'm saying is to be weary of physical exam findings in the absence of other correlating symptoms or findings. I once saw an Ortho consult for "abnormal hip range of motion". Totally normal guy, no pain or functional impairments, just a more external rotation than the NP expected. We sent the gentleman on his way with our appologies for wasting his time.
It probably depends on your scope of practice, my assessment instructor said it's good to know in case you're working in home health care and suspect a problem. I think it's good to have as many "tools in your toolbox" as possible.
I have done this in practice before. I was screening patients for a hepatic study and hepatomegaly was one of the inclusion criteria. Of course we had imaging done also for definitive measurements. I too do the "scratch test". I have bad hearing so percussion is a little difficult for me.
I saw it once on a physical assessment video in class but have never used it. I pretty much forgot about it to be perfectly honest. My preceptor in ICCU never brought it up.
The video that I watched in school and some of the things that we were taught I never see an RN perform outside of my instructors. Ever.
Personally, I like to percuss out the liver, not because I think it's any more accurate, but just because it makes me feel cool.
I learned in my physical assessment class how to measure the span of a person's liver (its lenght, etc)
Do any RN's actually do this on a regular basis? I have never had my liver span measured when I go to the doctors! Or is this something only done when hepatomegaly is suspected?
It seems like we learn alot of stuff in NS that is never done during a physical assessment on a regular basis...so how do we know WHEN to do it?
getoverit, BSN, RN, EMT-P
432 Posts
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.