Plate AT-M

Muscles

Injection sites and why the others are refused, breathing muscles, reflexes, and mobility.

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TEXT ONLY — NOT A SEPARATE PART OF THIS MODEL: Masseter and temporalis · Muscles of facial expression · Abdominal wall and rectus abdominis · Pelvic floor (levator ani) · Skeletal muscle as tissue

Abdomen and pelvis

3 structures

Abdomen and pelvisHigh yield

Abdominal wall and rectus abdominis

The front of the belly is a layer of fat over the rectus abdominis, a strap muscle on each side of the midline that runs from the pubic bone up to the bottom tip of the breastbone and the cartilages of ribs 5 to 7, with three flat muscle sheets wrapping the sides.

Why the exam cares

The fat over this wall is where the nurse gives most subcutaneous insulin, heparin, and enoxaparin, and where the nurse catches a client who does not rotate sites. After abdominal surgery, the nurse helps the patient brace this wall to cough and must act at once if the incision opens.

How to find it

The umbilicus is the reference point: inject at least 2 inches (5 cm) away from it in every direction.
The usable zone runs from below the rib margin to above the belt line, avoiding the waistband and any scar, bruise, or hardened spot.
The linea alba is the firm seam down the midline between the two rectus muscles; a midline abdominal incision runs along it.
Ask the patient to lift the head off the pillow; the rectus muscles tighten and show their edges.

Injection site

Subcutaneous insulin

The nurse pinches a fold of fat at least 2 inches from the umbilicus and injects at 90 degrees if 2 inches of tissue can be grasped, or 45 degrees if only 1 inch can. Insulin absorbs fastest and most evenly from the abdomen, and the client rotates spots within it so the tissue does not harden. A client who always injects in the same spot needs more teaching.

Injection site

Heparin and enoxaparin technique

The nurse does not aspirate and does not massage the site, because both increase bruising. For a prefilled enoxaparin syringe, the nurse leaves the air bubble in, inserts the whole needle at 90 degrees into a pinched fold held throughout the injection, and alternates the left and right sides of the abdomen.

Procedure

Splinting the incision

The nurse has the patient hold a pillow or folded blanket firmly over the incision while coughing and deep breathing. Bracing the wall eases pain and takes strain off the sutures, so the patient breathes deeply instead of taking shallow, guarded breaths that raise the risk of atelectasis and pneumonia.

Emergency

Dehiscence and evisceration

Critical

A sudden gush of pink, watery drainage or a patient saying something gave way after coughing means the wound may have opened. The nurse stays with the patient, has another staff member call the surgeon, places the patient in low Fowler's with knees bent, and covers the wound with sterile gauze soaked in sterile normal saline. If organs show, the nurse keeps the patient NPO for surgery, watches for shock, and never pushes the organs back in.

Pharmacological and Parenteral TherapiesReduction of Risk PotentialPhysiological Adaptation

Abdomen and pelvis

Iliopsoas

The deep hip flexor that runs from the lower spine and the inside of the pelvis to the top of the thigh bone.

Why the exam cares

On the right side the cecum sits in front of it, so an inflamed appendix can press on it and make hip movement hurt; the nurse who finds this keeps the patient NPO with no heat, enemas, or laxatives. It also stays shortened when the hip is held bent for long periods, and the exam tests this after an above-the-knee amputation, where the nurse positions the patient prone so the hip stays straight enough for a prosthesis.

How to find it

Not felt directly; it passes under the groin crease just to the outside of the femoral pulse.
Test it by having the patient lift the thigh against the nurse's hand, or by extending the hip backward while the patient lies on the other side.
In the abdomen it runs along both sides of the lower spine; on the right the cecum sits in front of it, and an appendix that lies behind the cecum rests directly on it.

Assessment

Psoas sign in appendicitis

Critical

With the patient on the left side, the nurse gently extends the right hip backward, or asks the supine patient to raise the right thigh against resistance; pain in the right lower abdomen suggests an inflamed appendix touching the muscle. The nurse keeps the patient NPO and gives no enemas, laxatives, or heat to the abdomen, because these can raise pressure in the appendix and cause rupture. Sudden relief of pain can mean it has already ruptured, so the nurse reports it right away instead of charting improvement.

Assessment

Hip flexion contracture after above-the-knee amputation

Watch

After an above-the-knee amputation the residual limb tends to rest bent at the hip, and a hip that cannot fully straighten makes fitting and walking with a prosthesis hard. As the surgeon allows, the nurse places the patient prone several times a day, stops propping the residual limb on a pillow after the early post-op period, and limits long stretches of sitting in a chair. For any patient who sits or lies with the hips bent for long periods, the nurse also lowers the head of the bed at intervals and moves the hip into full extension during range-of-motion exercises.

Physiological AdaptationReduction of Risk PotentialBasic Care and Comfort

Abdomen and pelvisHigh yield

Pelvic floor (levator ani)

The levator ani is the sling of muscle across the floor of the pelvis that holds up the bladder, rectum, and in women the uterus.

Why the exam cares

Childbirth stretches it and age weakens it, and after a radical prostatectomy removes the prostate and the sphincter at the bladder neck, men rely on the pelvic floor and external sphincter to stay dry. The muscle can be retrained, so the nurse must teach pelvic floor (Kegel) exercises correctly and tell stress leakage apart from urge leakage.

How to find it

It lies too deep to feel through the skin. A correct squeeze lifts the perineum, and the provider or nurse can feel it during a vaginal or rectal exam.
The urethra, vagina, and anus pass through a gap in it, so tightening it feels like holding back urine and gas at the same time.
Its two halves join in the midline in two places. In front of the anus they attach to the perineal body, which lies in the perineum between the vaginal opening (or scrotum) and the anus. Behind the anus they join in a midline seam that runs back to the tailbone (coccyx).

Procedure

Kegel exercises

The nurse teaches the patient to empty the bladder, then squeeze as if holding back urine and gas, hold about 3 seconds, relax for the same time, and repeat about 10 times, three times a day, with the buttocks, thighs, and belly relaxed and breathing normal. The patient may stop the urine stream once to find the muscle but must not practice while voiding, because that can leave urine in the bladder and raise infection risk. Results take weeks to months of daily practice, so the nurse encourages the patient to keep going.

Assessment

Stress vs. urge incontinence

Leaking a small amount with a cough, sneeze, laugh, or lift is stress incontinence, and pelvic floor training is its first-line treatment. A sudden, strong urge followed by leaking is urge incontinence, managed mainly with bladder training, timed voiding, and cutting bladder irritants such as caffeine. The nurse asks when the leaking happens, because the teaching plan depends on the answer.

Assessment

Postpartum perineum

After a vaginal birth the nurse inspects the perineum for redness, swelling, bruising, and drainage, and checks how well the edges of any tear or episiotomy stay together. Once the patient is comfortable, the nurse teaches pelvic floor contractions to help restore muscle tone and lower the risk of later incontinence.

Health Promotion and MaintenanceBasic Care and Comfort

Sources

Source	License
BodyParts3D, © The Database Center for Life Science licensed under CC Attribution 4.0 InternationalThe 3D plates. Modified: element meshes merged per structure, simplified, compressed, and recoloured for the web.	CC-BY-4.0
OpenStax Anatomy and Physiology 2e (CC BY 4.0)Informed the anatomical facts. The prose is original to this portal.	CC-BY-4.0
MedlinePlus / NIH	Public Domain (US Gov)
Nursing Nerds editorialEvery sentence in the atlas entries, each passed through independent clinical review.	Original