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?

[SaraO'Hara]

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

I do work at a SNF - so we don't really have the high-tech equip. No bladder scanner, no quick dash to CT... just your own hands and eyes. Even a portable CXR might have a 2-hour turnaround time, but if you can tell the doc about the localized diminished lung sounds, productive cough, dull percussion tones over the area, then treatment can be initiated before the CXR comes back.

[adrienne crunden]

No- never..total B.S! LOL!

[RNperdiem, RN]

I have seen it used maybe once by a MD assessing a distended abdomen.

I'll echo a previous poster and say that diagnosis made by physical assessment is a dying art.

If the doctor has concerns, it is off to CT scan with the patient.

[adrienne crunden]

Amen! Thanx for " keeping it real" !! Real nurses talk straight and to the point! no time for " dancing around"..that's right..any doubt CAT scan stat!! abd.percussion? too subjective! LOL!

[XingtheBBB, BSN, RN]

I've done it in ICU with pts who look like they're heading towards an ACS. Gives me a feel of whether or not it's time to page and tell then we need bladder pressures. Why do an invasive procedure that puts pts at risk for infections (that insurance won't cover!) if you can r/o the pathology from the outside for free?

Likewise, in ICU, I don't take a trip to CT lightly... it means I have to lug a pole of 5 running drips, pressure bags, a monitor, a portable vent, and an emergency med bag. Then, when I return, I have to spend time untangling my five primary and secondary lines from each other, the heart leads, the OG, the a-line, the CVP, and the ETT. (assuming the CT staff hasn't dislodged any of them) If it can be done for free at the bedside, it should be.

[adrienne crunden]

It is not a reliable asessment tool..because it is subjective...it is a hassle to lug all the equipment..should be done bedside with portable equipment.

[K+MgSO4, BSN]

Yes I palpate my colorectal pt abdomen when doing my assessments and if I find them hard I percuss them as well as listening for bowel sounds. I may only be 4yrs qualified but if I am concerned I go old school and will measure them as well and check the girth a few hours later to see if there has been a significant increase and no bowel sounds. Most of our interns don't want to be surgeons so are only there to make up their hours so we nurses have to be vigilant. I have no problem going over their head to the registrar and voicing my concerns :) esp this time of year where they have only been out of school for a few weeks! Admittedly they are sent to CT but if interns are only assessing when their consultants are going to be rounding it may only be twice an admission!

[adrienne crunden]

wow I almost fell over when i just read this reply. 'been a nurse 33 years..we were taught to measure girth! that is so old school! I have not seen this done again in at least 20 years! it's refreshing to see that you do do this ! the only thing I see or do measure myself iare wounds! but it's great to see that new nurses are striving to implement what is taught in clinicals..it's just that, really, it's just not done nor expected anymore..percussion is subjective..the tape measure makes findings objective but again, in today's world the physician is going to scan no matter-bottom line.

[K+MgSO4, BSN]

true but I worked in a regional hospital where the surgeons had to have rational for calling in a radiologist to interpret a CT after hours or at the weekend............if girth has been increasing for 6 hours and HB dropping...........? abdominal bleed.............rational for a CT. the radiologists were quick to read and report a CT if nesecary but it was the nurse that had to present the reasoning to a senior surgeon......interns weren't allowed to order out of hour CTs. The registrar had to of clinically reviewed the pt before "discussing" with the radiologist so clinical skills were required. Heck I still remember my mum fund raising to buy the first CT scanner for the hospital I trained at so cancer pt didn't have to go to Dublin 4 hr by road for a diagnostic CT! I was about 12 at the time!

[diane227, LPN, RN]

This is a skill that you have to practice A LOT to get good at. I limit myself to listening to bowel sounds, palpating the abdomen and taking a good history. And remember, always listen first, palpate second.