You examine the patient for the hepatojugular reflux by examining for a rise in the jugular venous pressure after
a. applying firm pressure to the left upper quadrant of the abdomen for 30 to 60 seconds.
b. lowering the head of the bed from a 45° angle until the patient is lying flat.
c. palpating the liver for 20 seconds.
d. applying firm pressure to the right upper quadrant of the abdomen for 30 to 60 seconds.
D
Hepatojugular reflux is a test that is very sensitive in detecting right ventricular failure. This procedure is performed if the CVP is normal but right ventricular failure is suspected. Position the patient supine or elevated to a 30° angle if the jugular veins are visible. Instruct the patient to breathe normally. Using single or bimanual deep palpation, press firmly on the right upper quadrant of the abdomen for 30 to 60 seconds. Watch the level of jugular pulsations as you push in with your hand. Normally, this pressure should not elicit any change in the jugular veins.
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