Deep palpation is used to determine organ size, as well as the presence of abnormal abdominal masses. In deep palpation, the examiner places the flat portion of his or her right hand on the patient's abdomen, and his or her left hand is placed over the right hand. The fingertips of the left hand exert the pressure, while the right hand should appreciate any tactile stimulation. Pressure should be applied to the abdomen gently but steadily. The technique of deep palpation is demonstrated in Figure 17-22.
During deep palpation, the patient should be instructed to breathe quietly through the mouth and to keep arms at the sides. Asking the patient to open the mouth when breathing seems to aid in generalized muscular relaxation. The palpating hands should be warm, because cold hands may produce voluntary muscular spasm called guarding. Engaging the patient in conversation often aids in relaxing the patient's abdominal musculature. Patients with well-developed rectus muscles should be instructed to flex their knees to relax the abdominal muscles. Any tender areas must be identified.
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