Abdomen Assessment Final
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Transcript of Abdomen Assessment Final
Abdomen
Surface Anatomy
4
locates and describes abdominal findings using two common methods of subdividing the abdomen: quadrants and regions.
4 Quadrants
Regions of the Abdomen
Epigastric: area between costal margins Umbilical: area around umbilicus Suprapubic or hypogastric: area above pubic
bone. or
RUQ LUQRLQ LLQ
Assessment of the abdomen
inspection, auscultation, palpation, and percussion.
Inspection first, followed by auscultation, Auscultation is done before palpation and percussion because palpation and percussion cause movement or
stimulation of the bowel, which can increase bowel motility and thus heighten
bowel sounds, creating false results. Ask the patient to breathe slowly and deeply through
the mouth during the examination to promote relaxation.
painful areas of the abdomen -assess at the end of the examination.
Use a warm stethoscope lighting - adequate hands - warm fingernails are trimmed short. supine position with the head slightly elevated and
arms at the sides. Place small pillows under the head and knees for
comfort.
Ask the client to urinate since an empty bladder makes the assessment more comfortable.
Ensure that the room is warm since the client will be exposed.
Health history
History of abdominal pain History of indigestion, nausea or vomiting,
constipation or diarrhea History of food allergies Appetite and usual food and fluid intake Usual bowel and bladder elimination patterns
History of gastrointestinal disorders, such aspeptic ulcer disease, bowel disease, gallbladder disease, liver disease,appendicitis
History of urinary tract disorders such as infections, kidney stones, or kidney disease
History of abdominal surgery or trauma Type and amount of prescribed and over-the-
counter medications used Amount and type of alcohol ingestion For women, menstrual history
Equipment
■ Examining light
■ Tape measure (metal or unstretchable cloth)
■ Skin-marking pen
■ Stethoscope
introduce self verify the client’s identity Explain to the client Perform hand hygiene Provide for client privacy.
Inquire about the following:
incidence of abdominal pain;
its location,
onset,
sequence, and
chronology;
its quality(description);
its frequency; associated symptoms (e.g., nausea, vomiting, diarrhea);
INSPECTION
INSPECTING THE ABDOMEN
Skin color and surface characteristics, umbilicus, contour, symmetry, peristalsis, pulsations, and visible masses.
The skin color may be slightly lighter than exposed areas.
Fine white or silver lines (striae) -weight gain or pregnancy.
The umbilicus should be centrally located and may be flat, rounded, or concave.
Observe the abdominal contour (line from the rib margin to the pubic bone)
Flat, rounded (convex), or scaphoid (concave)
Distended
Ask the client to take a deep breath and to hold it.
No evidence of enlargement of liver or spleen
Evidence of enlargement of liver or spleen
symmetry of contour - abdominal girth Asymmetric contour, e.g., Localized protrusions around umbilicus, hernia or tumor
The abdomen should be evenly rounded or symmetric, without visible peristalsis.
pulsation may normally be visible.
Observe the vascular pattern. No visible vascular pattern dilated veins is associated with liver disease, ascites,
and venocaval obstruction
Abnormal findings
swelling of the abdomen (ascites) and abdominal masses or unusual pulsations. Presence of rash or other lesions Tense, glistening skin (may indicate ascites,
edema) Purple striae (associated with Cushing’s disease
or rapid weight gain and loss)
AUSCULTATING BOWEL SOUNDS
ANDVASCULAR SOUNDS
Warm the hands and the stethoscope diaphragms.
Rationale: may cause the client to contract the abdominal muscles, and these contractions may be heard during auscultation
Audible bowel sounds
DEVIATIONS FROM NORMAL
Hypoactive, i.e., extremely soft andinfrequent (e.g., one per minute).
indicate decreased motility (surgery, inflammation, paralytic ileus, or late bowel obstruction.)
Hyperactive/increased, i.e., highpitched, loud, rushing sounds that occur frequently (e.g., every 3 seconds) also known as borborygmi.
indicate increasednintestinal motility (diarrhea, an early bowel obstruction, or the use of laxatives.)
True absence of sounds (none heard in 3 to 5 minutes)
indicates a cessation of intestinal motility.
For Bowel Sounds
Use the diaphragm. Place diaphragm of the stethoscope in each of the
four quadrants Listen for active bowel sounds—irregular gurgling
noises occurring about every 5 to 20 seconds.
Before documenting bowel sounds as absent, the nurse must listen for 2 minutes or longer in each abdominal quadrant.
For Vascular Sounds
Use the bell of the stethoscope over the aorta, renal arteries, iliac arteries, and femoral arteries.
Listen for bruits.
Absence of arterial bruits
Loud bruit over aortic area (possiblen aneurysm) Bruit over renal or iliac arteries
Peritoneal Friction Rubs
Friction rubs may be caused by inflammation, infection, or abnormal growths.
Absence of friction rub
Friction rub
Percussion of the Abdomen
Percuss several areas in each of the four quadrants to determine presence of tympany (gas in stomach
and intestines) and Dullness (decrease, absence, or flatness of
resonance over solid masses or fluid).
Use a systematic pattern:
Begin in the lower right quadrant, proceed to the upper right quadrant, the upper left quadrant, and the lower left quadrant.
NORMAL FINDINGS
Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a
full bladder
DEVIATIONS FROM NORMAL
Large dull areas (associated with presence of fluid or a tumor)
Palpation of the Abdomen
Watch the patient’s face for nonverbal signs of pain during palpation.
Palpate each quadrant in a systematic manner, noting muscular resistance, tenderness, enlargement of the organs, or masses.
If the patient complains of abdominal pain, palpate the area of pain last.
The abdomen should normally be soft, relaxed, and free of tenderness.
Abnormal findings include involuntary rigidity, spasm, and pain
may indicate trauma, peritonitis, infection, tumors, or enlarged or diseased abdominal organs.
PALPATING THE LIVER Palpate the liver by placing the left hand under
the patients lower right rib cage
Palpate gently inward & upward with fingertips while patient takes a deep breath
The normal liver edge should feel firm and smooth and may be mildly tender.
Abnormal findings include Hard and firm liver edge (found in cancer of the liver), Nodularity (found with tumor, metastatic cancer,
cirrhosis of the liver), and pain (from vascular engorgement as in congestive heart
failure, hepatitis, or abscess).
Spleen: Left hand – left lower rib cage Press right hand below the left costal margin-
while patient takes deep breath
Not palpable
KIDNEY: Usually felt in people with very relaxed abdominal
muscles Solid, firm, smooth elastic mass
Palpation of the Bladder Palpate the area above the pubic symphysis if the
client’s history indicates possible urinary retention.
Not palpable
Distended and palpable as smooth, round, tense mass (indicates urinary retention)
Aorta: With thumb and index finger Press deeply in the epigastric region
Soft & pulsatile
Normal Age-Related Variations
INFANTS Internal organs of newborns and infants are
proportionately larger than those of older children and adults
The infant’s liver may be palpable Umbilical hernias may be present at birth.
CHILDREN Toddlers -“pot belly” appearance, Late preschool and school-age -leaner and have a
flat abdomen. Peristaltic waves may be more visible than in
adults. The liver is relatively larger than in adults.
OLDER ADULTS Decreased bowel sounds Decreased abdominal tone Liver border palpated more easily The rounded abdomens -increase in adipose tissue
and a decrease in muscle tone. Stool passes through the intestines at a slower rate
GI Variations with pregnancy
Decrease in gastric motility High incidence of N, V (r/t pregnancy hormones)
and “heartburn” or acid reflux Bowel sounds diminished r/t enlarged uterus
displacing intestines Linea nigra- increased pigmentation of abd midline Striae Gravidarum
Sample Documentation
Normal Exam-
Abdomen soft, rounded and symmetric without distention; no lesions or scars, or visible peristalsis. Aorta midline without bruit or visible pulsation; umbilicus inverted and midline without herniation; bowel sounds present in all 4 quadrants. Liver, kidney and spleen non-palpable; no tenderness on palpation. Reports good appetite; no constipation, nausea or diarrhea. Voiding well and denies laxative use.
Normal Examination findings…
I examined this elderly gentleman’s abdomen. On general inspection from the end of the bed he appeared comfortable at rest. There were no peripheral signs of abdominal or liver disease. His abdomen was soft and non-tender with no distension. There were no palpable masses or organomegaly. Bowel sounds were present.
In summary, this is an elderly gentleman with normal abdominal examination.