Do Nurses Use Abdominal Percussion in the Field?

[j_tay1981]

We have to learn this in my health assessment class, and while fascinating, I can't ever recall being 'percussed' at the doctor's office by ANYBODY. Do you guys and gals engage in percussion in 'the real world'? It seems sort of...archaic...to me, and very subjective in terms of the findings one can obtain. I may judge a dullness or tympani differently than another nurse or doctor.

Thoughts?

[CountryGirlRN]

I don't use percussion as a nurse, but most every doctor, PA, and NP I've seen (and my kids have seen) has used it.

[Jolie, BSN]

It's becoming a lost art, unfortunately.

Most of us barely learned this in school and rarely, if ever use it as an assessment tool. Why bother, when there are chest x-rays, ultrasounds and other high-tech gadgets that will provide the same information without the effort on the practitioner's part, while leaving the patient with the impression that they've received the best and latest in high-tech care. Not to mention that they lawyers are less likely to accuse one of unsatisfactory care if s/he orders tests.

I spent some time with a group of general practitioners in a rural setting. They were amazing in their diagnostic abilities based upon their 5 senses.

It kind of reminds me of one of our older OBs who complains that young OBs have never learned how to do a lady partsl breech delivery and would be screwed if they ever had to. Same concept. Basic skills replaced by high-tech gadgets and expensive defensive medicine. Kind of sad.

[BCgradnurse, MSN, RN, NP]

I'm an FNP who uses it every day. It's not the most sensitive diagnostic test in the world, but it's helpful to hear if something is "off". I also percuss backs if there are respiratory issues. :)

[j_tay1981]

I kind of like the idea of learning to do more with out using gadgets and so forth - there is something fascinating about learning to diagnose and assess based on the five senses. Maybe it's the Luddite in me :)

I read an article somewhere online where a group of doctors where pushing to have medical schools focus more on teaching the newer docs how to auscultate more effectively with a stethoscope. Same concept - they claimed that the newer med students relied more on $1000 scans to diagnose things that could be diagnosed with enough practice on a good quality stethoscope. It would save everybody more money, but stethoscope auscultation is (according to this group) also a dying art.

[07302003, ASN, RN]

I watched a pulmonologist do a 3L pleural drain at bedside based on percussion... amazing.

From what I hear, NP's and MD's serving the uninsured use percussion to diagnose, since expensive testing for this population is not always available. Or even necessary, if the practioner can use the 5 senses.

But RN's do not use the all of the assessment tools we are taught, since the responsibility for diagnosis and treatment is in the hands of NP's, PAs, and MD's.

As an RN, you need to have a strong sense of "not normal".

[asfreeasabird]

I have never used percussion. If I hear something strange I look at the last chest x-ray, ask if they are having pain. I would ask questions, auscultate, and palpate. It seems like more of a diagnostic tool.

[SaraO'Hara]

I will if I'm not sure if that distended-looking belly is fluid, gassy bowels, or just blubbah. :)

[fromtheseaRN, BSN, RN]

i'm in school now and while we just learned about it, we are not being taught it. our instructors state that is for advanced practice nurses and doctors and out of our scope of practice.

[wooh, BSN, RN]

I've seen the occasional GI doc use it. I've seen the occasional pulmonologist do the back percussion to check lungs. I've used the tapping on a kidney thing occasionally, but NEVER have I percussed back or abdomen. I've also never had to run an IV at a specific rate without a pump in the real world or write a care plan. Some things you learn to use. Some you learn to understand the theory behind what you'll end up doing. And some things you just learn so they'll let you graduate.

[AugustRain]

I guess it depends where you work. In the last week, I've percussed an abdomen, hung four meds without a pump (we ran out), and did ten or twelve care plans.

[leslie :-D]

I will if I'm not sure if that distended-looking belly is fluid gassy bowels, or just blubbah. :)[/quote']

i've percussed only a handful of times, always abdominal...

esp when i sense that someone needs to be tapped, or is filled w/tumors.

you definitely get a sense of 'abnormal' when using your own senses w/capacity to use own knowledge base.

any sort of technical advancements, do everything for us.

i don't want to lose what i know.

leslie