Question about Rebound Tenderness

[colleen10]

Hi everyone,

I have a question regarding re-bound tenderness and am interested in what you think.

I am currently finishing up Peds. and reading about GI diseases and complications. I was reading about Appendicitis and have a question regarding assessing for Appendicitis using "rebound tenderness".

I know that appendicitis may present with abd. pain/tenderness in the Lower Right Quadrant (where the appendix is located).

I also know that if you are going to assess for rebound tenderness you would press into the abd. then release quickly. If the patient experiences more pain when you release your hand, that is positive for rebound tenderness and means that there is peritonitis/inflammation of the bowel, possibly appendicitis.

Now, the issue I have with my Peds. book and study guide is that the book makes no reference as to what quadrant you would perform rebound tenderness. My study guide (in one of the questions) says that you would perform rebound tenderness in the Right Quadrant. The problem I have with this is that if I remember correctly last semester when we were learning about GI assessment our Assessment book said to never palpate or do rebound tenderness testing in the same quadrant as the appendix or where the patient if feeling the most pain because you could rupture the appendix or perforate the bowel if you press directly on the painful area. My understanding was that to perform rebound tenderness you should move to the opposite side of where the patient is experiencing pain and then press and release.

I don't have my Assessment book on me right now and was just wondering what other students and nurses out there were taught and practiced.

Thanks and interested in hearing your responses, wondering if my book is just all wrong.

Col :)

[Mrs.Yost]

I think that you are correct about assessing for rebound tenderness in the left lower quandrant. I think that there is a possibility of rupturing the appendix (if there is in fact appendicitis present) if you palpate the right lower quadrant. The appendix is in the right lower quadrant at McBurney's point (halfway between the umbilicus and the right iliac crest).

My clinical guide just has palpate the abdomen. Not too much information there.

[Altra, BSN, RN]

Colleen,

We just touched on this (no pun intended ) briefly in assessment in Nursing Concepts I, but what we were taught is that the definition of rebound tenderness is discomfort on the opposite side, when you palpate and then let it go quickly. So I think you're correct. We were taught that not many GI conditions will present that way - rebound tenderness is almost a sure indicator of acute appendicitis.

[RN_N_05]

We just finished up a unit on GI disorders and we were taught to palpate at McBurney's point in the right lower quadrant. That's also how we were taught in assessment.

:uhoh21: Kinda scares me if we've been taught the wrong way.