BERTULFO, Ma. Emilia Nicole D.

Sec 15 Instructional Script – Assessing Chest to Abdomen

ASSESSMENT PROCEDURES Instructional Script Tagalog/Taglish Translation

PREPARATION
1. Introduce yourself and “Good morning, Ma’am. May I “Magandang umaga po.
verify client’s identity. know your full name? What do Maaari ko po bang malaman
Explain to the client you want me to call you, ang inyong buong pangalan?
what you are going to Ma’am? I am Nicole Bertulfo, Ano po ba ang gusto mong
do, why it is necessary, your student nurse for today. itawag ko sainyo? Ako po si
and how the client can Before we start, what we will be Nicole Bertulfo, ang iyong
cooperate. doing for this day is the chest to student nurse para sa araw na
abdomen assessment. I might ito. Bago po tayo magpatuloy,
be asking you to show me your ang mga gagawin po natin sa
chest, breast, abdomen and I araw na ito ay patungkol sa
will be observing, palpating, chest to abdomen assessment. I
percussing and auscultating might be asking you po to show
your posterior and anterior me your chest, breast, abdomen
thorax, heart and lymphatic and I will be observing,
system, and abdomen. Will that palpating, percussing and
be okay with you?” auscultating your posterior and
anterior thorax, heart and
“The information that you will lymphatic system, and
be sharing and imparting with abdomen. Okay lang po ba sa
me today will be utilized for us inyo ito?”
to create the best individualized
care plan. You also don’t have “Gagamitin lamang natin lahat
to worry because all the pieces ng impormasyong makakalap
of information are highly ko sa araw na ito sa
confidential and private. It will pagpaplano sa pangangalaga
only remain in our hospital and sa inyo. Huwag po kayong mag-
will only be used by health care alala, lahat ng sasabihin mo ay
professionals to help you get mananatiling kumpidensiyal at
better. I am hoping for your pribado. Ang mga
cooperation. This assessement impormasyong makakalap ko
will only last for 30 minutes. ay hindi makakalabas sa ospital
Will that be okay with you?” at magagamit lamang po ng
mga tao o health professionals
na makakatulong para sa
pangangalaga at ikakabuti ng
inyong kalusugan. Inaasahan po
namin ang iyong kooperasyon
at pakikisama para mapabilis
po ang inyong paggaling.
Magtatagal lamang po itong
abdomen to chest assessment
ng tatlumpung minuto. Okay
lang po ba ito sa inyo?”

POSTERIOR THORAX “Ma’am I’ll be now first “Ma’am mag-aassess na po ako

asessing your posterior thorax. ng inyong posterior thorax. Ok
Is it okay with you?” lang po ba iyon? ”
(To assess the thorax, ask the (Upang mag-assess ng thorax,
client to breathe normally) sabihan ang client na huminga
ng normal)
2. Inspect Configuration While the client sits with arms Habang ang client ay nakaupo
at the side; stand behind the ng maayos at ang kamay ay
client, observe position of nasa tagiliran, tumayo sa likod
scapulae, and shape and of niya. At tingnan ang position ng
configuration of chest wall. scapula at ang shape at
configuration ng likod ng dibdib.
“Ma’am, please sit-up straight
as I observe the configuration of “Ma’am, umupo po kayo ng
your posterior thorax.” maayos at oobserbahan ko po
ang likod ng inyong dibdib.”
3. Observe use of Watch as the client breaths, and Obserbahan ang paghinga ng
accessory muscles note use of muscles. client at tingnan ang kanyang
accessory muscles
“Ma’am, kindly breathe just like (trapezius/shoulder).
how you would normally do it
so I will be able to observe your “Ma’am, hinga po kayo para po
accessory muscles.” ma-obserbahan kop o ang
inyong accessory muscles.”
4. Inspect the client’s Note the client’s posture and Obserbahan ang pagkakaupo ng
positioning ability to support weight while client at ang kaniyang ability to
breathing comfortably. support weight habang siya ay
humihinga.
“Ma’am, please breathe in and
out again as I observe your “Ma’am hinga po kayo ulit para
posture and positioning.” ma-obserbahan ko po ang
inyong posture at positioning.”
5. Palpate for tenderness Palpation may be performed Ang palpation ay maaaring
and sensation and with one or both hands, but the gawin gamit ang isa o parehong
crepitus sequence of palpation is dalawang kamay. Ngunit
established. Use your fingers to kailangang sundin ang naaayong
palpate for tenderness, warmth, sequence ng palpation. Gamitin
pain, or other sensations. Start ang mga daliri sa pag-palpate ng
toward the midline at the level tenderness, warmth, pain at iba
of the left scapula (over the pang sensations. Magsimula sa
apex of the left lung) and move gitna sa may bandang parte ng
your hand left to right, kaliwang scapula (over the apex
comparing findings bilaterally. of the left lung) at galawin ang
Move systematically downward kamay mula kaliwa papuntang
and out to cover the lateral kanan. Ihambing ang findings
portions of the lungs at the bilaterally. Pagkatapos nito ay
bases. galawin ang kamay pababa at
palabas para maabot ang lateral
“Ma’am, is it okay with you that portion ng lungs at bases.
I will touch and palpate your
back for a few minutes? Please “Ma’am, okay lang po ba sa
just relax as I palpate for inyo na hahawakan ko po ang
tenderness, crepitus and likod ninyo ng ilang minuto? I-
sensation in your posterior papalpate ko lang po ang
thorax. Tell me if you feel any inyong posterior thorax for any
pain or unusual sensation. Will signs of tenderness, crepitus at
that be okay with you?” sensation. Relax lang po kayo,
Ma’am. Kung maaari po ay
sabihin niyo sa akin kung meron
po kayong naramdaman na
pananakit o unusual sensation.
Okay lang po ba iyon sa inyo?”
6. Palpate surface Put on gloves and use your Gumamit ng gloves at i-palpate
characteristics fingers to palpate any lesions ang likod ng client kung
that you noticed during mayroong lesions o kakaibang
inspection. Feel for any unusual bukol.
masses.
“Ma’am, okay lang po ba na
“Ma’am, is it okay with you that hawakan ko po ulit ang inyong
I will touch and palpate your likod? I-papalpate ko lang po ito
back for any lesions or unusual para malaman ko po kung
masses? mayroong lesions o bukol.”
7. Palpate for fremitus Following the sequence Sundin ang parehong sequence
described previously, use the ng pag-palpate sa posterior
ball or ulnar edge of one hand thorax, subalit ngayon ay
to assess for fremitus gagamitin ang ulnar edge ng
(vibrations of air in the kamay para i-assess ang
bronchial tubes transmitted to fremitus ng client. Sa paggalaw
the chest wall). ng kamay mula sa isang parte ng
As you move your hand to each likod ng client, itanong sa client
area, ask the client to say kung maaari niyang sabihin ang
“ninetynine.” Assess all areas ninety-nine.
for symmetry and intensity of
vibration. “Ma’am, i-papalpate ko po ang
inyong likod at kung okay lang
“Ma’am, I will be palpating your po sa inyo ay banggitin niyo po
posterior thorax using the ulnar ang salitang ninety-nine kapag
edge of my hand to assess minove ko po yung kamay ko
fremitus and areas of symmetry from one area to another. Okay
and intensity of vibration. If it is lang po ba iyon? I-aassess ko
alright with you, can you say lamang po ang symmetry at
the word ninety-nine as I move intensity ng vibration.”
my hand to each area of your
back?”

8. Assess chest expansion Place your hands on the Ilagay ang dalawang kamay sa
posterior chest wall with your posterior chest wall ng client
thumbs at the level of T9 or T10 habang ang thumbs ay nasa
and pressing together a small may level T9 o T10 at i-press
skin fold. As the client takes a together para magkaroon ng
deep breath, observe the skin fold. Habang ang client ay
movement of your thumbs. humihinga ng malalim,
obserbahan ang galaw ng
“Ma’am, is it okay with you that inyong thumbs.
I place my hands on your
posterior chest wall? In this “Ma’am, okay lang po ba na
assessment of chest expansion, hawakan ang inyong posterior
I will now be pressing together chest wall? Sa pag-assess ng
a small skin fold. I want you chest expansion, i-press
take a deep breath, Ma’am.” together ko lang po Ma’am ang
inyong skin to create a small
skin fold. Hinga po kayo,
Ma’am, nang malalim.”
9. Percuss for tone Start at the apices of the Simulan ang pag-percuss sa
scapulae and percuss across the apices ng scapulae at kasunod
tops of both shoulders. Then nito ay ang pag-percuss sa top
percuss the intercostal spaces portion ng parehong balikat ng
across and down, comparing client. Sunod, i-percuss ang
sides. intercostal spaces pababa
Percuss to the lateral aspects at habang ikinokompara ang
the bases of the lungs, bawat tagiliran ng client. I-
comparing sides. percuss din at komparahin ang
tunog ng lateral aspects at
“Ma’am, the next thing that I bases ng lungs kapag
will assess is to percuss for tone. isinasagawa ang percussion.
In order to do this, I will lightly
and gently tap some areas of “Ma’am, ang susunod ko po na
your back. Will that be okay gagawin ay ang pag-percuss for
with you, Ma’am?” tone. Upang magawa ko ito,
dahan-dahan ko po na i-tatap
ang ibang parte ng inyong
likod. Okay lang po ba iyon?
10. Percuss for Ask the client to exhale Ipa-exhale ng malalim ang client
diaphragmatic forcefully and hold the breath. at i-hold muna ang paghinga.
excursion Beginning at the scapular line Magsimula sa scapular line (T7),
(T7), percuss the intercostal i-percuss ang intercostal spaces
spaces of the right posterior ng kanang posterior chest wall.
chest wall. Percuss downward I-percuss pababa hanggang ang
until the tone changes from tone ay magbago mula
resonance to dullness. Mark this resonance at marinig ang
level and allow the client to dullness. Markahan ang lebel na
breathe. Next ask the client to ito. Maaari ng huminga ulit ang
inhale deeply and hold it. client. Sunod, ipa-inhale ang
Percuss the intercostal spaces client at i-hold muli ang kanyang
from the mark downward until paghinga muna. I-percuss uit
resonance changes to dullness. ang intercostal spaces pababa
Mark the level and allow the simula sa isinulat na marka
client to breathe. Measure the hanggang marinig ang tone
distance between the two change from resonance to
marks. Perform this assessment dullness. Markahan ang lebel na
technique on both sides of the ito. Maaari ng huminga ulit ang
posterior thorax. client. I-measure and distansiya
ng dalawang marka. Gawin ang
“Ma’am, please exhale technique na ito sa parehong
forcefully. And then, hold your side ng posterior thorax.
breath for now. I will be
percussing your intercostal “Ma’am, hinga po ulit kayo ng
spaces of the right posterior malalim at hold it po for a
chest wall. Now, I am just while. I-pepercuss ko lang po
writing a mark in here. Okay, ang ilang parte ng inyong likod.
Ma’am, you may now breathe At ngayon, nilalagyan ko lang
again. Now, I want you to po ng marka dito. Okay,
inhale deeply and hold it once Ma’am, pwede na po kayo ulit
again. I am percussing your huminga. Ngayon naman po,
back once again. Alright, you inhale po kayo at hold it again
may now breathe again, po ng ilang mga segundo. Mag-
Ma’am. Please stay still for a pepercuss po ulit ako sa inyong
while because I will be likod. Maaari na po kayo ulit
measuring the distance huminga, Ma’am. Upo lang po
between the two marks, kayo ng maayos at i-
Ma’am.” memeasure ko po yung distance
ng dalawang marka para po
ma-assess ko ang inyong
diaphragmatic excursion.
11. Auscultate for breath To begin, place the diaphragm I-place ang diaphragm ng
sounds of the stethoscope firmly and stethoscope sa posterior chest
directly on the posterior chest wall o sa apex ng lung (C7).
wall at the apex of the lung at Pahingahin ng malalim ang
C7. Ask the client to breathe client sa kaniyang mouth sa
deeply through the mouth for bawat parte ng likod na i-
each area of auscultation (each auscultate. Maging alerto sa
placement of the stethoscope) nararamdaman o comfort ng
in the auscultation sequence so client at mag-offer din ng rest o
that you can best hear break para sa normal breathing
inspiratory and expiratory kung nakakaranas ng fatigue
sounds. Be alert to the client’s ang client.
comfort and offer times for rest
and normal breathing if fatigue “Ma’am, ang susunod kong
is becoming a problem. gagawin ay ang pag-auscultate
ng inyong posterior thorax para
“Ma’am, the next thing that I marinig ko po ang breath
will do is to auscultate your sounds. Kasabay nito, okay lang
posterior thorax for breath po ba na I will place yung
sounds and this includes placing diaphragm ng stethoscope sa
the diaphragm of the inyong likuran? Hinga lang po
stethoscope on your back. Is kayo nang malalim sa bawat
that okay? Breathe deeply parte o area ng likod po ninyo
through your mouth in each na i-auscultate ko. Sabihin niyo
area that I auscultate. Will that rin po sa akin, Ma’am, kung
be okay with you? Just tell me, mayroon kayong
Ma’am, if you feel any signs of nararamdamang pananakit o
discomfort, so we can take a discomfort para we can take a
short break or rest. Alright, I will short rest and ma-normalize po
now begin. Breathe deeply, natin ang iyong breathing if
Ma’am. Again, deep breath, nahihirapan na po kayo dahil sa
Ma’am.” fatigue. Hinga po ng malalim,
Ma’am. Isa pa po, deep breath
po, Ma’am.”
12. Auscultate for voice Bronchophony: Ask the client to Bronchophony: Ipaulit sa client
sounds repeat the phrase “ninety-nine” ang mga salitang “ninety-nine”
while you auscultate the chest habang inau-auscultate ang
wall. chest wall.

Egophony: Ask the client to Egophony: Ipaulit sa client ang

repeat the letter “E” while you letrang “E” habang inau-
listen over the chest wall. auscultate ang chest wall.

Whispered pectoriloquy: Ask Whispered pectoriloquy: Ipaulit

the client to whisper the phrase sa client nang pabulong ang
“one–two–three” while you mga salitang “one-two-three”
auscultate the chest wall. habang inau-auscultate ang
chest wall.
“Ma’am, now I will be
auscultating your voice sounds. “Ma’am, ngayon po ay i-
First assessment is the auscultate ko po ang inyong
bronchophony. Repeat the voice sounds. Para po sa
words ninety-nine whenever I bronchophony, ulitin lang po
auscultate a new portion or ninyo ang salitang ninety-nine
area of your chest wall, Ma’am. sa bawat parte na ma-
Next is the egophony auscultate ko po. Ngayon ay i-
assessment. Repeat the letter E assess po natin ang egophony.
whenever I auscultate a new Ulitin lang po ninyo, Ma’am,
part or area of your chest wall, ang letter E sa bawat area na i-
Ma’am. Now for the whispered auscultate ko. Ok lang po ba
pectoriloquy, please whisper iyon? Ngayon ay ang whispered
one-two-three as I auscultate pectoriloquy naman, sa bawat
different parts of your chest pag-auscultate ko ng inyong
wall, Ma’am.” likod, ibulong po ninyo ang one-
two-three.”
ANTERIOR THORAX “Ma’am, we are done assessing “Ma’am, yun lamang po yung
the posterior thorax. I’ll be now mga kailangan kong i-assess sa
assessing first your anterior inyong posterior thorax. I-
thorax. Is it okay with you?” aassess na po ako ng inyong
anterior thorax. Okay lang po
ba yun sa inyo, Ma’am?”

13. Inspect for shape and Have the client sit with arms at Habang ang client ay nakaupo
configuration the sides. Stand in front of the ng maayos at ang kamay ay
client and assess shape and nasa tagiliran, tumayo sa
configuration. unahan niya. At tingnan shape
at configuration ng dibdib.
“Ma’am, please sit-up straight
with your arms at the side as I “Ma’am, umupo po kayo ng
observe the configuration and maayos at oobserbahan ko po
shape of your anterior thorax.” ang inyong dibdib.”
14. Inspect position of the Observe the sternum from an Obserbahan ang sternum mula
sternum anterior and lateral viewpoint. sa anterior at lateral na
posisyon.
“Ma’am, please sit-up straight
with your arms at the side as I “Ma’am, umupo po kayo ng
observe the position of the maayos upang ma-obserb ko
sternum in an anterior and ang posisyon ng sternum
lateral viewpoint.” ninyo.”
15. Watch for sternal “Ma’am, please sit up straight “Ma’am, umupo po kayo ng
retractions as I watch if there is a presence maayos upang ma-obserb ko
of sternal retractions.” kung mayroonng sternal
retractions.”
16. Inspect slope of the ribs Assess the ribs from an anterior I-assess ang ribs ng client mula
and lateral viewpoint. sa anterior at lateral na
viewpoint.
“Ma’am, just sit-up straight as I
inspect the slop of the ribs “Ma’am, umupo po kayo ng
anteriorly and laterally.” maayos upang ma-inspect ko
ang slope ng inyong ribs.”
17. Observe quality and Note breathing characteristics I-note ang mga breathing
pattern of respirations as well as rate, rhythm, and characteristics ng client at pati
depth. na rin ang rate, rhythm, at
depth nito.
“Ma’am, now I am observing
the quality and pattern of “Ma’am, ngayon po ay
respirations and breathing inoobserb ko po ang kalidad at
characteristics.” ang pattern ng inyong
paghinga.”
18. Inspect intercostal Ask the client to breathe Pahingahin ang client nang
spaces normally and observe the normal at i-obserb ang
intercostal spaces. intercostal spaces.

“Ma’am, please breathe “Ma’am, breathe normally po

normally as I observe and kayo habang inoobserb at
inspect your intercostal spaces.” inspect ko ang iyong intercostal
spaces.”
19. Observe for use of Ask the client to breathe Obserbahan ang paghinga ng
accessory muscles normally and observe for use of client at tingnan ang kanyang
accessory muscles. accessory muscles
(sternocleidomastoid and rectus
“Ma’am, kindly breathe just like abdominis).
how you would normally do it
so I will be able to observe your “Ma’am, hinga po kayo para po
accessory muscles.” ma-obserbahan ko po ang
inyong accessory muscles.”
20. Palpate for tenderness, Use your fingers to palpate for Gamitin ang mga daliri sa pag-
sensation, and surface tenderness and sensation. Start palpate ng tenderness at
masses with your hand sensation. Magsimula gamit ang
positioned over the left clavicle iyong kamay nan aka-posisyon
(over the apex of the left lung) sa kaliwang clavicle and i-move
and move your hand left to ang iyong kamay left to right.
right, comparing findings Ikompara ang resulta bilaterally.
bilaterally.
“Ma’am, okay lang po ba na
“Ma’am, will it be okay to touch hawakan ko kayo at i-palpate
your chest and palpate for ang iyong chest for any signs of
tenderness and sensation?” tenderness, sensation at
masses?
21. Palpate for tenderness “Ma’am, will it be okay to touch “Ma’am, okay lang po ba na
at costochondral your anterior thorax and hawakan ko kayo at i-palpate
junctions of ribs palpate for tenderness at ang iyong chest for any signs of
costochondral junctions of tenderness sa inyong
ribs?” costochondral junctions ng
inyong ribs?
22. Palpate for crepitus Palpation may be performed Ang palpation ay maaaring
with one or both hands, but the gawin gamit ang isa o parehong
sequence of palpation is dalawang kamay. Ngunit
established. Use your fingers to kailangang sundin ang naaayong
palpate crepitus. Start toward sequence ng palpation. Gamitin
the midline at the level of the ang mga daliri sa pag-palpate ng
left scapula (over the apex of crepitus. Magsimula sa gitna sa
the left lung) and move your may bandang parte ng kaliwang
hand left to right, comparing scapula (over the apex of the
findings bilaterally. Move left lung) at galawin ang kamay
systematically downward and mula kaliwa papuntang kanan.
out to cover the lateral portions Ihambing ang findings
of the lungs at the bases. bilaterally. Pagkatapos nito ay
galawin ang kamay pababa at
“Ma’am, is it okay with you that palabas para maabot ang lateral
I will touch and palpate your portion ng lungs at bases.
chest for a few minutes? Please
just relax as I palpate for “Ma’am, okay lang po ba sa
crepitus in your anterior thorax. inyo na hahawakan ko po ang
Tell me if you feel any pain or likod ninyo ng ilang minuto? I-
unusual sensation. Will that be papalpate ko lang po ang
okay with you?” inyong anterior thorax for any
signs of crepitus. Relax lang po
kayo, Ma’am. Kung maaari po
ay sabihin niyo sa akin kung
meron po kayong naramdaman
na pananakit o unusual
sensation. Okay lang po ba iyon
sa inyo?”
23. Palpate for fremitus Following the sequence Sundin ang parehong sequence
described previously for ng pag-palpate sa anterior
palpation, use the ball or ulnar thorax, subalit ngayon ay
edge of one hand to assess for gagamitin ang ulnar edge ng
fremitus (vibrations of air in the kamay para i-assess ang
bronchial tubes transmitted to fremitus ng client. Sa paggalaw
the chest wall). ng kamay mula sa isang parte ng
As you move your hand to each likod ng client, itanong sa client
area, ask the client to say kung maaari niyang sabihin ang
“ninetynine.” Assess all areas ninety-nine.
for symmetry and intensity of
vibration. “Ma’am, i-papalpate ko po ang
inyong anterior thorax at kung
“Ma’am, I will be palpating your okay lang po sa inyo ay
anterior thorax using the ulnar banggitin niyo po ang salitang
edge of my hand to assess ninety-nine kapag minove ko o
fremitus and areas of symmetry yung kamay ko from one area
and intensity of vibration. If it is to another. Okay lang po ba
alright with you, can you say iyon? I-aassess ko lamang po
the word ninety-nine as I move ang symmetry at intensity ng
my hand to each area of your vibration.”
back?”

24. Palpate anterior chest Place your hands on the client’s Ilagay ang dalawang kamay sa
expansion anterolateral wall with your anterolateral wall ng client
thumbs along the costal habang ang thumbs ay nasa
margins and pointing toward costal margins at nakaturo sa
the xiphoid process. As the xiphoid process. Habang ang
client takes a deep breath, client ay humihinga ng malalim,
observe the movement of your obserbahan ang galaw ng
thumbs. inyong thumbs.

“Ma’am, is it okay with you “Ma’am, okay lang po ba na

that I place my hands on your hawakan ang inyong anterior
anterior chest wall? In this chest wall? Sa pag-assess ng
assessment of chest expansion, chest expansion, i-press
I will now be pressing together together ko lang po Ma’am ang
a small skin fold along the inyong skin to create a small
costal margins as I point toward skin fold. Hinga po kayo,
the your xiphoid process. I want Ma’am, nang malalim.”
you take a deep breath,
Ma’am.”
25. Percuss the tone Percuss the apices above the Simulan ang pag-percuss sa
clavicles. Then percuss the apices abve ng clavicles at
intercostal spaces across and kasunod nito ay ang pag-
down, comparing sides. percuss ng intercostal spaces
pababa habang ikinokompara
“Ma’am, the next thing that I ang bawat side.
will assess is to percuss for tone
in your anterior thorax. In order “Ma’am, ang susunod ko po na
to do this, I will lightly and gagawin ang pag-percuss for
gently tap the apices above tone sa inyong anterior thorax.
your clavicles. I will also percuss Upang magawa ko ito, dahan-
the intercostal spaces and dahan ko po na i-tatap ang
compare both sides. Will that apices above your clavicles at i-
be okay with you, Ma’am?” percuss ang inyong intercostal
spaces. Okay lang po ba iyon?
26. Auscultate for breath Place the diaphragm of the I-place ang diaphragm ng
sounds stethoscope firmly and directly stethoscope sa anterior chest
on the anterior chest wall. wall. I-auscultate ang apices ng
Auscultate from the apices of lungs above ng clavicle to the
the lungs slightly above the bases of the lungs sa sixth rib.
clavicles to the bases of the Pahingahin ng malalim ang
lungs at the sixth rib. Ask the client sa kaniyang mouth para
client to breathe deeply maiwasan ang transmission ng
through the mouth in an effort sound na mag-occur sa nose.
to avoid transmission of sounds Pakinggan ang bawat parte o
that may occur with nasal site for one complete
breathing. Listen at each site for respiratory cycle.
at least one complete
respiratory cycle. “Ma’am, ang susunod kong
gagawin ay ang pag-auscultate
“Ma’am, the next thing that I ng inyong anterior thorax para
will do is to auscultate your marinig ko po ang breath
anterior thorax for breath sounds. Kasabay nito, okay lang
sounds and this includes placing po ba na I will place yung
the diaphragm of the diaphragm ng stethoscope sa
stethoscope on your front chest. inyong dibdib? Hinga lang po
Is that okay? Breathe deeply kayo ng malalim sa bawat parte
through your mouth in each o area ng likod po ninyo na i-
area that I auscultate. Will that auscultate ko. Sabihin niyo rin
be okay with you? Just tell me, po sa akin, Ma’am, kung
Ma’am, if you feel any signs of mayroon kayong
discomfort, so we can take a nararamdamang pananakit o
short break or rest. Alright, I will discomfort para we can take a
now begin. Breathe deeply, short rest and ma-normalize po
Ma’am. Again, deep breath, natin ang iyong breathing if
Ma’am.” nahihirapan na po kayo dahil sa
fatigue. Hinga po ng malalim,
Ma’am. Isa pa po, deep breath
po, Ma’am.”
BREASTS & LYMPHATIC “That wraps up our assessment “Tapos na po tayo Ma’am sa
SYSTEM for the anterior thorax. Let’s pag-assess ng anterior thorax.
move on in assessing the Dumako naman po tayo sa pag-
breasts and lymphatic system. assess ng breasts at lymphatic
Will that be okay with you, system. Okay lang po ba sa
Ma’am?” inyo, Ma’am?”
27. Inspect size and Have the client disrobe and sit Tanggalin ang hospital gown ng
symmetry with arms hanging freely. client. Habang ang client ay
Explain what you are observing nakaupo ng maayos at ang
to help ease client anxiety. kamay ay hanging freely,
ipaliwanag sa client kung ano
“Ma’am, will it be okay to ang inoobserbahan para
remove the draping so I will be mabawasan ang pag-aalala o
able to properly assess and anxiety ng client.
inspect the size and symmetry?
Please sit-up straight and just “Ma’am, okay lang po ba na
leave your arms on the side as I tanggalin po natin ang iyong
do an inspection and draping para po ma-assess ko
observation.” po ng maayos ang size at
symmetry. Ok lang po ba iyon?
Upo po kayo ng maayos,
Ma’am, at yung arms niyo po
place them po on your side.”
28. Inspect color and Be sure to note client’s overall Obserbahan ang kabuoang skin
texture skin tone when inspecting the tone sa pag-inspect ng breast
breast skin. Note any lesions. skin at tingnan kung mayroong
lesions.
“Ma’am, please sit-up straight
and just leave your arms on the “Ma’am, upo po kayo ng
side so I will be able to note the maayos para po ma-inspect ko
overall skin tone and observe if po ng maigi ang skin tone ng
there is any presence of breast skin at ma-obserbahan
lesions.” ko kung mayroong lesions.”
29. Inspect superficial Observe visibility and pattern of Obserbahan ang visibility at
venous pattern breast veins. pattern ng breast veins.

“Ma’am, what I would be doing “Ma’am, ang susunod ko po na

next is inspecting visibility and gagawin ay i-inspect ko po ang
pattern of superficial venous visibility at pattern ng
pattern. Please sit-up straight, superficial venous pattern. Upo
Ma’am.” po kayo Ma’am ng maayos.”
30. Inspect areolas Note the color, size, shape, and Obserbahan ang kulay, sukat,
texture of the areolas of both hugis at texture ng areolas ng
breasts. parehong dibdib.

“Ma’am, now I will be noting “Ma’am, o-obserb ko lang po

the color, size, shape, and ang kulay, hugis, sukat at
texture of the areolas. Will that texture ng areolas. Okay lang po
be okay with you?” ba iyon?”
31. Inspect nipples Note the size and direction of Obserbahan ang sukat at
the nipples of both breasts. Also direksiyon ng nipples ng
note any dryness, lesions, parehong dibdib. I-note ang
bleeding, or discharge. dryness, lesions, bleeding o
discharge.
“Ma’am, I will be now
inspecting the size and direction “Ma’am, ngayon naman po ay
of the nipples of your breasts. I i-inspect ko po ang size at
will also be observing signs of direction ng nipples. I-note ko
dryness, lesions, bleeding or rin po kung may presence of
discharge. Will that be okay dryness, lesions, bleeding at
with you? Please sit-up discharge. Ok lang po ba yun sa
straight.” inyo? Upo po kayo ng maayos,
Ma’am.”
32. Inspect for retraction To inspect the breasts Para i-inspect ang dibdib nang
and dimpling accurately for retraction and wasto for retraction and
dimpling, ask the client to dimpling, dapat ay naka-upo
remain seated while performing ang client habang isinasagawa
several different maneuvers. ang iba’t-ibang positions. Itaas
Ask the client to raise her arms ang braso ng client overhead.
overhead; then press her hands Sunod, i-press ang kamay
against her hips. Next ask her to against sa hips ng client. Sunod,
press her hands together. These i-press together ang kamay ng
actions contract the pectoral client. Ang mga actions na ito ay
muscles. para i-contract ang pectoral
muscles.
“Ma’am, the next assessment is
inspecting for retraction and “Ma’am, ang susunod po na
dimpling. To do this, I want you assessment ay ang pag-inspect
to remain seated while you for retraction at dimpling. Para
perform these different gawin ito, umupo po kayo ng
maneuvers. I will be giving you maayos habang ipineperform
instructions to follow. Is that niyo po ang iba’t-ibang
okay with you? First, raise your maneuvers na ito. Bibigyan po
arms overhead. Then, place kita ng instructions na susundin
now your hands against your niyo po. Okay lang po ba iyon sa
hips. Next, press your hands inyo? Una, i-raise niyo po ang
together with fingers of one arms ninyo overhead. Then,
hand pointing opposite to the ngayon place your hands
fingers of the other hand.” naman po against your hips.
Now, press your hands po
together.”
33. Palpate texture and Ask client to lie down and to Pahigain ang client at place
elasticity place overhead the arm on the overhead ang arm sa parehong
same side as the breast being side ng breast na pinapalpate.
palpated. Place a small pillow or Maglagay ng maliit na unan o
rolled towel under breast being rolled towel sa ilalim ng breast
palpated. Use flat pads of 3 ng pinapalpate. Gamitin ang
fingers to palpate client’s tatlong daliri sa pag-palpate ng
breasts. breast ng client.

“Ma’am, will it be okay that I “Ma’am, okay lang po ba na

touch and palpate some parts hahawakan ko po kayo at i-
of your breast to know its papalpate ko ang ibang parte
texture and elasticity? Please lie
ng inyong dibdib para ma-
down and place your right arm assess ko ang texture at
overhead as I palpate the right elasticity? Higa po kayo dito,
side of your breast. Now, place Ma’am at please place your
the left arm overhead as I right arm overhead habang
palpate the left side of your pinapalpate ko ang right side ng
breast.” inyong dibdib. Ngayon naman
ay place your left arm overhead
habang i-palpate ko ang inyong
kaliwang parte ng inyong
dibdib.”
34. Palpate for tenderness “Ma’am, will it be okay with “Ma’am, okay lang po ba sa
and temperature you that I palpate your breasts inyo na i-palpate kop o ang
for tenderness and inyong dibdib para ma-assess
temperature? Please sit-up ko ang tenderness at
staright.” temperature nito? Upo po kayo,
Ma’am, nang maayos.”
35. Palpate for masses Note location, size in I-note ang lokasyon, sukat,
centimeters, shape, mobility, sentimetro, hugis, galaw,
consistency, and tenderness. consistency at tenderness. I-
Also note the condition of the note din ang kondisyon ng
skin over the mass. bukol.

“Ma’am, what I will do next is “Ma’am, ang gagawin po natin

to palpate your breasts for ngayon ay palpation for
masses. Will it be okay with you masses. Okay lang po ba na
that I touch some parts of your hahawakan ko po ang ibang
breast so I will be able to do parte po ng iyong dibdib para
palpation and note for the ma-palpate ko po if there is any
location, size, centimeter, presence of masses at i-note ko
shape, mobility, consistency, po ang location, size, mobility,
and tenderness?” centimeter, shape, consistency
at tenderness nito?”
36. Palpate the nipples Wear gloves to compress the Magsuot ng gloves at i-
nipple gently with your thumb compress ang nipple gently
and index finger. Note any gamit ang thumb at index
discharge. finger. I-note kung mayroong
discharge.
“Ma’am, the next thing that I
have to assess is palpating your “Ma’am, ang susunod na
nipples. Will that be okay with kailangang i-assess ay ang pag-
you? It is important that you do palpate ng nipples. Okay lang
not feel self-conscious because po ba yun sa inyo? Importante
this assessment will help us po, Ma’am, na hindi po kayo
health professionals attain ma-conscious dahil ang
accurate results and findings. assessment na ito ay
Ma’am, please also do not feel makakatulong sa aming mga
tensed and anxious because this health professionals na
will not hurt and you do not mahanap ang tama at wastong
have to worry because I will be resulta. Ma’am, huwag din po
gentle. Okay, I will be now kayong gaanong ma-tense at
palpating the nipple with my mag-alala dahil hindi po ito
thumb and index finger. Please masakit. Okay, mag-papalpate
relax and don’t worry, Ma’am.” na po ako gamit mo ang aking
thumb at index finger. Relax
lang po kayo, Ma’am.”
37. Inspect and palpate Ask the client to sit up. Inspect Paupuin nang maayos ang
axillae the axillary skin for rashes or client. I-inspect ang axillary skin
infection. kung mayroong rashes or
Hold the client’s elbow with one infection.
hand, and use the three Hawakan ang siko ng client
fingerpads of your other hand gamit ang isang kamay at
to palpate firmly the axillary gamitin ang tatlong daliri ng
lymph nodes. kabilang kamay sa pag-palpate
“Ma’am, please sit up straight ng axillary lymph nodes.
so I will be able to inspect the
axillary skin for infection or “Ma’am, upo po kayo ng
rashes. Will it be okay that I will maayos para po ma-inspect ko
hold your elbow, Ma’am? Now, po ng maigi ang iyong axillary
using my other hand I’ll be skin at makita kung mayroong
palpating your axillary lymph infection o rashes. Okay lang po
nodes.” ba na hawakan ko po ang
inyong elbow, Ma’am? Ngayon,
i-palpate ko naman po gamit
ang kabila kung kamay ang
iyong axillary lymph nodes.”
38. Demonstrate how to “Ma’am, are you interested in “Ma’am, interesado po ba kayo
perform Breast Self- learning how to do the breasts na matutunan ang breasts self-
Exam self-examination? But if not, no examination? Pero kung hindi
need to worry. The choice is up po, okay lang po. Ang choice po
to you. But if you are, I am more ay nasa sainyo. Pero if kayo po
than willing to teach you how to interesado, pwede ko po
and give you instructions on kayong bigyan ng instructions
how to perform the for you to follow and perform
examination. Do you also want the examination on your own?
me to give you feedback on Okay lang po ba sa inyo na
your technique and method?” magbigay po ako ng feedback
or hindi na po?

“In doing this examination, you “Sa pagsasagawa ng

have to lie down and place your examination na ito, kailangan
arm overhead on the same side po, Ma’am, ay kayo ay
as the breast being palpated. nakahiga. And you also have to
You ca place a small pillow if place your arm overhead on the
you want. It is best if you use same side ng inyong breast na
flat pads of three fingers to pinapalpate. Kung gusto niyo po
palpate the breasts. You can ay you can place a small pillow
palpate in a circular or overhead. Mas inaadvise rin po,
clockwise or wedged or vertical Ma’am, to use flat pads of three
strip pattern. Ma’am, you also fingers sa pag-palpate. Ang
have to make sure that you are pag-palpate ay maaaring
able to palpate every square rotation, wedged, o vertical
inch of the breast from the strip na pattern. Ma’am, it is
nipple and areola to the also advised na ma-palpate po
periphery of breast tissue up to ang bawat parte ng breast.”
the tail of the Spence.”

HEART & NECK VESSELS “Ma’am, those are basically the “Ma’am, yun lamang po ang
procedures that I have to mga procedures na kailangang
perform in order to assess the i-perform para ma-assess ang
breast and lymphatic system. breast at lymphatic system.
Let us now start the assessment Ngayon ay pwede na po tayo
for the heart and neck vessels. magsimula sa assessemt ng
Will that be okay?” heart at neck vessels. Okay lang
po ba iyon sa inyo?”
39. Observe the jugular Inspect the jugular venous pulse Sa pag-inspect ang jugular
venous pulse by standing on the right side of venous pulse, tumayo sa kanang
the client. The client should be banda ng client. Ang client ay
in a supine position with head kailangang nasa supine position
and torso is on the same plane. kung saan ang kanyang ulo at
Ask the client to turn the head torso ay dapat nasa isang plane
slightly to the left. Shine a lamang. I-turn ang head ng
tangential light source onto the client slightly sa kaliwa.
neck to increase visualization of Gumamit ng tangential light
pulsations as well as shadows. source para mas makita ang
Next, inspect the suprasternal pulsations at shadows.
notch or the area around the
clavicles for pulsations of the “Ma’am, ang una po na
internal jugular veins. procedure sa pag-assess ng
heart at lymphatic system ay
“Ma’am, the first procedure in ang pag-obserb ng juular
assessing the heart and venous pulse. Higa po kayo dito,
lymphatic system is to observe Ma’am, in a supine position.
jugular venous pulse. To do this, Turn your head po, Ma’am, to
please lie down in a supine the left. Gagamit din po ako ng
position. Please turn your head penlight para po mas makita ko
slightly to the left. I’ll shine a po ang pulsations at shadows.”
light so I will be able to see
much better the pulsations and
shadows.”
40. Evaluate jugular venous Evaluate jugular venous I-evaluate ang jugular venous
pressure pressure by watching for pressure sa pamamagitan ng
distention of the jugular vein. It pag-obserb sa distention ng
is normal for the jugular veins jugular vein. Normal lamang na
to be visible when the client is makita ang jugular veins kung
supine. To evaluate jugular vein ang client ay naka supine na
distention, position the client in posisyon. I-posisyon ang client
a supine position with the head ng supine at i-elevate ang kama
of the bed elevated 30, 45, 60, sa 30, 45, 60, at 90 degrees. Sa
and 90°. At each increase of the bawat pagtaas nito, turn slightly
elevation, have the client’s head away ang ulo ng client. Sa
turned slightly away from the paggamit ng tangential lighting,
side being evaluated. Using obserbahan ang distention,
tangential lighting, observe for protrusion o bulging.
distention, protrusion, or
bulging. “Ma’am, ang susunod ko po na
gagawin ay ang pag-evaluate
“Ma’am, what I am about to do ng jugular venous pressure.
is evaluate your jugular venous Higa po kayo dito, Ma’am, in a
pressure. I want you to lie down supine position. Okay, i-elevate
in the bed in a supine position. ko poi tong kama sa 30 degrees
Okay, I will elevate the bed first hanggang 90 degrees. Sa bawat
at 30 degrees and increase it pag-elevate, turn your head
until 90 degrees. Each time I slightly away po sa side na
elevate the bed, please turn ineevaluate po. Okay lang po ba
your head slightly away from yun?”
the side I am evaluating it at.
Will that be alright with you?”
41. Auscultate carotid If the client is middle-aged or Kung ang client ay may
arteries older or if you suspect katandaan na o sa tingin mo ay
cardiovascular disease. Place mayroon siyang sakit sa puso, i-
the bell of the stethoscope over place ang bell ng stethoscope sa
the carotid artery and ask the carotid artery at ipa-hold ang
client to hold his or her breath breath ng client para hindi ma-
for a moment so that breath conceal ng breath sounds ang
sounds do not conceal any vascular sounds.
vascular sounds.
“Ma’am, ilalagay ko lamang po
“Ma’am, I’ll be placing the bell ang bell ng stethoscope para
of the stetoscope to auscultate ma-auscultate ang carotid
carotid arteries. Please hold arteries. Hold your breath po
your breath for a moment, muna, Ma’am.”
Ma’am.”
42. Palpate carotid arteries Palpate each carotid artery I-palpate ang carotid artery
alternately by placing the pads alternately sa pamamagitan ng
of the index and middle fingers pag-place ng index at middle na
medial to the daliri sa sternocleidomastoid
sternocleidomastoid muscle on muscle ng leeg ng client. I-note
the neck. Note amplitude and ang amplitude at contour ng
contour of the pulse, elasticity pulso, elasticity ng artery, at
of the artery, and any thrills thrills.
(which feel similar to a purring
cat). “Ma’am, ang susunod na
procedure ay palpation ng
“Ma’am, next procedure is to carotid arteires. Tingin po kayo
palpate carotid arteries. Look sa taas, Ma’am, sa ceiling po
above, Ma’am, in the ceiling so para po ma-palpate ko ang
I’ll be able to palpate carotid carotid arteries. Huwag po
arteries. Please stay still as you kayong gaanong gagalaw at
remain in lying position.” higa lang po kayo.”
43. Inspect pulsations The client in supine position Pahigain ang client (supine
with the head of the bed position) at i-elevate ang
elevated between 30° and 45° kanyang ulo 30° and 45°.
stand on the client’s right side Tumayo sa right side ng client at
and look for the apical impulse i-obserb kung mayroong
and any abnormal pulsations. abnormal pulsations.

“Ma’am, now I’ll be inspecting “Ma’am, ngayon ay i-inspect ko

for abnormal pulsation. Please po kung mayroong abnormal
stay still as you remain in lying pulsation. Huwag po kayong
position.” gaanong gagalaw at higa lang
po kayo.”
44. Palpate apical impulse Remain on the client’s right side Pahigain ang client at manatili
and ask the client to remain sa kanang banda ng client.
supine. Gamitin ang isa o dalawang
Use one or two finger pads to daliri para ma-palpate ang
palpate the apical impulse in apical impulse sa mitral area.
the mitral area. You may ask the Gamit ang palmar surfaces ng
client to roll to the left side to kamay, let client roll to left side
better feel the impulse using para mas maramdaman ang
the palmar surfaces of your impulse.
hand.
“Ma’am, i-palpate ko na po ang
“Ma’am, I will be palpating now apical impulse. Higa po kayo at
the apical impulse. Please face po sa left side para mas
remain in lying position. maramdaman ko po ang apical
Actually, for me to better feel impulse.”
the apical impulse, can you face
on your left side?”
45. Palpate for abnormal Use your palmar surfaces to Gamitin ang palmar surfaces
pulsations palpate the apex, left sternal para sa pag-palpate ng apex,
border, and base. kaliwang sternal border at base.

“Ma’am, I will now be palpating “Ma’am, mag-papalpate

for abnormal pulsations. I will naman po ako ngayon to know
be using my hands to palpate if if there is abnormal pulsation.
there is any abnormality. Is that Gagamitin ko po ang aking
okay with you?” kamay sa pag-palpate para
malaman kung mayroong
abnormality. Okay lang po ba
iyon?”
46. Auscultate heart rate Place the diaphragm of the Ilagay ang diaphragm g
and rhythm stethoscope at the apex and stethoscope sa apex at
listen closely to the rate and pakinggan ang rate at rhythm
rhythm of the apical impulse. ng apical impulse.

“Ma’am, now I will proceed in “Ma’am, ngayon po ay mag-

auscultating heart rate and proceed na po ako sa pag-
rhythm. I will place the ausculatte ng heart rate at ang
diaphragm of my stethoscope rhythm nito. Ilalagay ko po
so that I will be able to hear and itong diaphragm ng
listen well closely to the rate of stethoscope para marinig ko
the apical impulse. Is that fine?” nang malinaw yung rate ng
apical impulse. Okay lang po
ba?”
47. Auscultate to identify Auscultate the first heart sound I-auscultate ang unang pintig ng
S1 and S2 (S1 or “lub”) and the second puso (S1 or “lub”) at ang
heart sound (S2 or “dubb”). pangalawang pintig (S2 o
“dubb”).
“Ma’am, I will now be
auscultating to identify and “Ma’am, ngayon po ay mag-
listen to heart sounds. Just relax auscultate po ako para ma-
and breathe normal.” identify at marinig kop o ang
heart sounds. Relax lang po at
hinga po ng normal.”
48. Auscultate for extra Use the diaphragm first, then Gamitin muna ang diaphragm
heart sounds the bell to auscultate over the tapos sunod ay ang bell sa
entire heart area. Note bahagi ng heart area. I-note ang
characteristics (e.g., location, mga katangian (lokasyon at
timing) of any extra sound timing) ng extra sounds na
heard. Auscultate during the narinig. I-auscultate tuwing sa
systolic pause (space heard systolic pause (puwang na
between S1 and S2) narinig sa pagitan ng S1 at S2).

“Now, I will be auscultating for “Ngayon ay mag-asucultate ko

extra heart sounds, Ma’am. By for extra heart sounds, Ma’am.
doing this, I will be able to noteSa pagsasagawa nito,
its characteristics. This will just
malalaman ko po ang mga
be done for a few minutes. katangian ng extra sounds na
Please stay still.” narinig. Magtatagal lamang po
ito ng mga ilang minute. Stay
still lang po kayo, Ma’am.”
49. Auscultate for murmurs Use the diaphragm and the bell Gamitin ang diaphragm at bell
of the stethoscope in all areas ng stethoscope sa lahat ng
of auscultation because parte ng auscultation dahil ang
murmurs have a variety of murmurs ay mayroong iba’t
pitches. Auscultate for murmurs ibang klaseng pitches. I-
across the entire heart area. auscultate para marinig ang
murmurs.
“Next, I will now auscultate for
murmurs. I will be placing the “Sunod, ang gagawin ko po ay
diaphragms first then the bell of ang pag-auscultate for
the stethoscope. Is that okay murmurs. Gagamitin ko ang
with you, Ma’am. Alright, diaphragm at bell ng
please stay still and avoid stethoscope. Okay lang po ba
unnecessary movements.” yun, Ma’am? Stay still lang po
kayo at i-avoid po natin ang any
uncecessary movements.”
ABDOMEN “Ma’am, that ends the “Ma’am, yun lamang po yung
assessment for the heart and mga kailangang i-assess
neck vessels. Let’s now move pagdating sa heart at neck
with observing and assessing vessels. Tumungo naman po
the abdomen. Is that alright tayo sa pag-assess at pag-
with you? obserb sa abdomen. Okay lang
po ba iyon?”
50. Observe coloration of “Ma’am, the first procedure in “Ma’am, ang unang procedure
the skin assessing the abdomen is to sa pag-assess sa abdomen ay
observe the coloration of the ang pag-obserb sa kulay nito.
skin. Please avoid unnecessary Kung maaari po ay iwasan po
movements so I will be able to natin, Ma’am, ang unnecessary
clearly inspect.” movements upang makita ko po
nang malinaw iyong abdomen
at maigi ko po itong ma-
inspect.”
51. Note the vascularity of “Ma’am, the next assessment is “Ma’am, ang susunod po na
the abdominal skin noting the vascularity of the assessment ay patungkol sa
abdominal skin.” vascularity ng abdominal skin.”
52. Inspect for scars Ask about the source of a scar, Itanong sa client kung saan
and use a centimeter ruler to nanggaling ang peklat at
measure the scar’s length. gumamit ng ruler para sukatin
Document the location by ang haba nito. I-document ang
quadrant and reference lines, lokasyon ng peklat kung saang
shape, length, and any specific quadrant ito, haba, o iba pang
characteristics. tiyak na katangian ng peklat.

“Ma’am, the next thing that I “Ma’am, ang susunod ko na

would be doing is to inspect for gagawin ay ang pag-inspect ng
scars. May I know where did scars. Ma’am, saan niyo po
you get this scar? Please stay nakuha itong peklat na ‘to?
still as I measure the scar’s Please stay still po, Ma’am,
length and shape.” susukatin ko lang po ang haba
at hugis nito.”
53. Assess for lesions and “Ma’am, the next procedure is “Ma’am, ang susunod po na
rashes assessing for lesions and rashes procedure ay ang pag-assess ng
of the abdominal skin. Will that lesions at rashes ng abdominal
be okay with you?” skin. Okay lang po ba yun?
54. Inspect umbilicus “Ma’am, the next procedure is “Ma’am, ang susunod po na
inspecting your umbilicus. Will procedure ay ang pag-inspect
that be okay with you?” ng umbilicus. Okay lang po ba
yun?
55. Inspect abdominal Sitting at the client’s side, look Habang nakaupo sa gilid ng
contour and symmetry across the abdomen at a level client, i-obserb ang abdomen sa
slightly higher than the client’s lebel na medyo mas mataas sa
abdomen. Inspect the area tiyan ng client. I-inspect ang
between the lower ribs and bahagi o parte sa pagitan ng
pubic bone. Measure abdominal lower ribs at pubic bone.
girth. Sukatin ang abdominal girth.

“Ma’am, I will be now “Ma’am, i-inspect ko na po

inspecting your abdominal ngayon ang inyong abdominal
contour. And I will be observing contour. At i-obserb ko ito sa
that from your side. Will it be inyong gilid. Okay lang po ba sa
okay with you for me to inyo na sukatin ko po ang
measure the abdominal girth?” inyong abdominal girth?

Look at the abdomen as the Obserbahan ang tiyan ng client

client lies in a relaxed supine habang siya ay nakahiga nang
position. supine position.

“Ma’am, in order to inspect the “Ma’am, para po ma-inspect ko

abdominal symmetry, please lie ang iyong abdominal symmetry,
still in a supine position just like okay lang po ba sa inyo na
when you are sleeping. Just humiga parang kapag
relax, Ma’am, I will now be natutulog lang po kayo. Ma’am,
assessing the abdominal relax lang po kayo. Ma’am, i-
symmetry.” aassess ko na po ang iyong
abdominal symmetry.”
56. Inspect abdominal “Ma’am, now I will be “Ma’am, ngayon naman po ay
movement when client inspecting your abdominal i-assess ko ang iyong abdominal
breathes movement.” movement.”
57. Observe aortic “Ma’am, next procedure is to “Ma’am, ang susunod na
pulsations observe your aortic pulsations.” procedure ay oobserbahan ko
ang iyong aortic pulsations.”
58. Observe peristaltic “Ma’am, what I will be doing “Ma’am, ang gagawin ko po
waves next is to observe for peristaltic sunod ay ang pag-obserb ng
waves.” peristaltic waves.”
59. Auscultate for bowel Use the diaphragm of the Gamitin ang diaphragm ng
sounds stethoscope and make sure that stethoscope at siguraduhin na
it is warm before you place it on warm ito bago ilagay sa tiyan ng
the client’s abdomen. Apply client. Mag-apply lamang ng
light pressure or simply rest the light pressure o i-rest lamang
stethoscope on a tender ang stethoscope sa tiyan ng
abdomen. Begin in the RLQ and client. Simulan ito sa RLQ at
proceed clockwise, covering all mag-proceed clockwise para
quadrants. ma-cover lahat ng quadrants.
Listen for at least 5 minutes Makinig nang mga limang
before determining that no minuto bago magpasiya na
bowel sounds are present and walang bowel sounds na
that the bowels are silent. narinig.

“Ma’am, now I will be “Ma’am, ngayon ay mag-

performing an auscultation for perform po ako ng auscultation
bowel movements. Is it okay for bowel movements. Okay
with you that I’ll place the lang po ba sa inyo na ilalagay
diaphragm of my stethoscope in ko ang diaphragm ng
the different parts of your stethoscope sa iba’t ibang
abdomen so I will be able to bahagi ng iyong tiyan para po
listen and cover all the mapakinggan ko ang bowel
quadrants?” sounds mula sa lahat ng
quadrants?”
60. Auscultate for vascular Use the bell of the stethoscope Gamitin ang bell ng stethoscope
sounds to listen for bruits (low-pitched, para mapakinggang kung
murmur-like sound) over the mayroong bruits (low-pitched,
abdominal aorta and renal, iliac, murmur-like sound) sa
and femoral arteries. abdominal aorta at renal, iliac at
femoral arteries.
“Ma’am, now I will be
performing an auscultation for “Ma’am, ngayon ay mag-
vascular sounds. I will now be perform po ako ng auscultation
placing the bell of the for vascular sounds. Ilalagay ko
stethoscope over your po itong bell ng stethoscope sa
abdomen, Ma’am. Is that inyo pong tiyan, Ma’am. Okay
alright with you?” lang po ba iyon?
61. Auscultate for a friction Listen over the right and left Mag-auscultate sa bandang
rub over the liver and lower rib cage with the kanan at kaliwa ng lower rib
spleen diaphragm of the stethoscope. cage gamit ang diaphragm ng
stethoscope.
“Now, I will be auscultating
over the right and left lower rib “Ma’am, i-auscultate ko na po
cage, Ma’am. Is that fine with ang iyong right and left lower
you?” rib cage. Okay lang po ba
iyon?”
62. Percuss for tone Lightly and systematically Dahan-dahang i-tap o i-percuss
percuss all quadrants. ang quadrants.

“Ma’am, the next procedure “Ma’am, ang susunod na

that I will be performing is procedure na i-perform ko ay
percussing for tone. Will it be ang pag-percuss for tone. Okay
alright with you that I will touch lang po ba sa inyo na hawakan
your abdomen and slightly I will ko po kayo at i-tap ko lang po
be tapping some parts of it?” ang ibang parte nito?”
63. Percuss the span or To assess the lower border, Para i-assess ang lower border,
height of the liver by begin in the RLQ at the magsimula sa RLQ ng
determining lower and midclavicular line (MCL) and midclavicular line (MCL) at mag-
upper borders percuss upward. Note the percuss pataas. I-note ang
change from tympany to nakitang pagbabago mula
dullness. Mark this point: It is tympany at naging dullness.
the lower border of liver Markahan ang point: Ito ay ang
dullness. To assess the descent lower border ng liver dullness.
of the liver, ask the client to Para ma-assess and descent ng
take a deep breath and hold; liver, pahingahin nang malalim
then repeat the procedure. ang client at i-hold ito.
Remind the client to exhale Paalalahanan ang client na mag-
after percussing. exhale pagkatapos ng
percussion.
To assess the upper border,
percuss over the upper right Sa pag-assess ng upper border,
chest at the i-percuss ang upper right chest
MCL and percuss downward, sa MCL at mag-percuss pababa
noting the change from lung at i-note ang pagbabagong na-
resonance to liver dullness. obserbahan mula lung
Mark this point: It is the upper resonance at naging liver
border of liver dullness. dullness. Markahan ang point:
Ito ang upper border ng liver
Repeat percussion of the liver at dullness.
the midsternal line (MSL).
Ulitin ang percussion ng liver sa
“Ma’am, now I will be midsternal line (MSL) naman.
percussing the height of the
liver. To do this, please take a “Ma’am, ngayon naman ay
deep breath and hold it for a mag-percuss po ako to know
while until I tell you to do so. the span o height ng liver. Para
Okay, you may now exhale and magawa ito, hinga po kayo ng
breathe normally again, malalim then hold it po for a
Ma’am.” while. Okay, hinga na po kayo,
Ma’am, nang normal ulit.”
64. Perform blunt This is to assess for tenderness Ang blunt percussion ay
percussion on the liver in difficult-to- palpate ginagawa para ma-assess ang
and kidneys structures. Percuss the liver by tenderness sa mga bahaging
placing your left hand flat mahirap na ma-palpate. I-
against the lower right anterior percuss ang liver sa
rib cage. Use the ulnar side of pamamagitan ng pag-place ng
your right fist to strike your left kaliwang kamay sa lower right
hand. anterior rib cage. Gamitin ang
ulnar side ng kanang kamay at i-
Perform blunt percussion on strike ito sa kaliwang kamay.
the kidneys at the I-perform ang blunt percussion
costovertebral angles sa kidneys ng costovertebral
(CVA) over the twelfth rib. angles (CVA) sa 12th rib.

“Ma’am, now I will be “Ma’am, mag-perform na po

performing a blunt percussionako ng blunt percussion sa
on the kidneys and liver. Tell me
kidneys at liver. Sabihin niyo
if you feel any pain or unusual
lang po sa akin kung may
sensation, is that okay with nararamdaman kayong
you?” pananakit o kakaibang
pakiramdam, okay lang po ba
iyon?
65. Perform light palpation Using the fingertips, begin Gamit ang iyong mga daliri,
palpation in a nontender simulan ang pag-palpate sa
quadrant, and compress to a nontender quadrant at i-
depth of 1 cm in a dipping compress hanggang 1 cm.
motion. Then gently lift the Dahan-dahang i-lift ang mga
fingers and move to the next daliri.
area.
“Ma’am, now I will be “Ma’am, ngayon ay mag-
performing a light palpation. perform na po ako ng light
And this involves me touching palpation. At sa procedure na
and applying gentle pressure on ito ay kailangan po na hawakan
some areas and parts of your ko kayo at mag-apply po ng
abdomen. Is that okay with gentle pressure sa inyong tiyan.
you?” Okay lang po ba iyon?”
66. Deeply palpate all Using the palmar surface of the Gamit ang palmar surface ng
quadrants to delineate fingers, compress to a mga daliri, i-compress hanggang
abdominal organs and maximum depth (5–6 cm). 5-6 cm. I-perform ito gamit ang
detect subtle masses Perform bimanual palpation if dalawang kamay sa pag-assess
you encounter resistance or to ng mas malalalim na structures
assess deeper structures. o organs.

“Ma’am, now I will be “Ma’am, ngayon po ay mag-

performing a deep palpation to perform na ako ng deep
detect if there is any presence palpation para malaman kung
of masses. And this involves me mayroong bukol. Sa procedure
touching and applying quite a na ito, kailangan po na
deep pressure on some parts of hawakan ko kayo at mag-apply
your abdomen. Tell me if there ako ng medyo deep pressure sa
is any pain. Is that okay with ibang bahagi ng iyong iyan.
you?” Sabihin niyo lang po kung may
nararamdaman kayong sakit.
Okay lang po ba iyon?”
67. Palpate liver Note consistency and I-note ang consistency at
tenderness. To palpate tenderness. Sa pag-palpate
bimanually, stand at the client’s gamit ang dalawang kamay,
right side and place your left tumayo sa kanan ng client at
hand under the client’s back at ilagay ang kaliwang kamay sa
the level of the eleventh to likod ng client sa 11th at 12th
twelfth ribs. Lay your right hand ribs. Ilagay ang kanang kamay sa
parallel to the right costal right costal margin.
margin (your fingertips should Ipa-inhale ang client tapos i-
point toward the client’s head). compress pataas at papasok
Ask the client to inhale, then gamit ang iyong daliri.
compress upward and inward
with your fingers. “Ma’am, ngayon po ay
ipapalpate ko pa ang liver. Okay
“Ma’am, I will now be palpating lang po ba nahawakan ko po
the liver. Will it be okay to kayo ulit para sa palpation?
touch your abdomen and Okay, inhale po kayo, Ma’am.”
palpate? Alright, Ma’am, please
inhale.”
68. Palpate urinary bladder Palpate for a distended bladder I-palpate ang bladder kapag
when the client’s history or kinakailangan lamang.
other findings warrant (e.g. dull Magsimula sa symphysis pubis
percussion noted over the at i-move pataas at palabas sa
symphysis pubis). Begin at the bladder borders.
symphysis pubis and move
upward and outward to “Ma’am, ngayon ay i-papalpate
estimated bladder borders. ko naman po ang urinary
“Now I will be palpating the bladder. Okay lang po ba iyon
urinary bladder. Will that be sa inyo?”
okay with you?”
69. Assess for rebound If the client has abdominal pain Kapag mayroong abdominal
tenderness or tenderness, test for rebound pain ang client, isagawa ang test
tenderness by palpating deeply for rebound tenderness sa
at 90 degrees into the abdomen pamamagitan ng pag-palpate
away from the painful or tender nang malalim 90 degrees sa
area then suddenly release abdomen at malayo dapat sa
pressure. Listen and watch for masakit na parte or bahagi at i-
the client’s expression of pain. release ang pressure.
Ask the client to describe which Pagmasdan at tingnan ang
hurt more – the pressing in or expression ng client. Ipalarawan
the releasing - and where on sa client kung alin ang mas
the abdomen the pain occurred. masakit: ang pag-press in o ang
pag-release at kung saan
“Ma’am, do you feel any naramdaman ang pananakit.
abdominal pain? To test for
rebound tenderness, I will “Ma’am, may nararamdaman
palpating deep your abdomen. po ba kayong pananakit sa
Will that be okay with you? iyong tiyan? Para po sa test for
Which one hurts more: pressing rebound tenderness, i-
in or releasing? Ma’am, can you papalpate ko nang malalim ang
tell me which part or area of iyong tiyan. Okay lang po ba
your abdomen hurts the most?” iyon? Sabihin niyo po sa akin,
Ma’am, kung mas masakit yung
pag-press in ko o pag-release ko
nung pressure. Ma’am, saang
parte po ninyo naramdaman
ang sakit?