Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen....

29

Transcript of Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen....

Page 1: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,
Page 2: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Physical Assessment: Physical Assessment: The Abdomen The Abdomen

Purposes• Identifies the anatomical

boundaries of the abdomen.

• Identifies the functions of abdomen auscultation, palpation, and percussion.

• Performs complete physical examination of the abdomen,

• Documenting findings in an approved format.

Page 3: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

The AbdomenThe Abdomen

The abdomen extends from The abdomen extends from the diaphragm inferiorly to the the diaphragm inferiorly to the inlet of the true pelvis. Its inlet of the true pelvis. Its contents are partially contents are partially protected:protected:

• Superiorly by the lower ribs.

• Posterior by the lumbar vertebra.

• Laterally by the iliac bones.

Page 4: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Abdomen RegionsAbdomen Regions

Divisions of the abdomenDivisions of the abdomen

• Four Quadrants.

• Nine regions.

Page 5: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Four QuadrantsFour Quadrants

The four quadrants are The four quadrants are formed by two imaginary formed by two imaginary perpendicular lines:perpendicular lines:

• One line laterally across the midline at the umbilicus.

• One line vertically fro xiphoid process to the symphysis pubis.

Page 6: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Nine RegionsNine Regions

The nine regions are referred The nine regions are referred to as :to as :

• Right hypochondriac.• Epigastric.• Left hypochondriac.• Right lumbar.• Umbilical.• Left lumbar.• Hypogastric• Left inguinal.

Page 7: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Assessment ProceduresAssessment Procedures

Beginning the Beginning the ExaminationExamination

• Gather data.

• Prepare the Environment.

• Prepare client.

Page 8: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

InspectionInspection

The first step, inspection, The first step, inspection, focuses on abdominal wallfocuses on abdominal wall

• Contour.• Appearance.• Movement.

Note for any :Note for any :

• Bulging along the midline.• Bulging above the inguinal

ligament.• Not for the position of the

umbilicus.

Page 9: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

ExaminationExamination

• Look for scars, striae, hernias, vascular changes, lesions, or rashes.

• Look for movement associated with peristalsis or pulsations.

Page 10: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

AuscultationAuscultation

• Auscultation precedes percussion and palpation to improves the reliability of auscultation by preventing a disruption or distortion of bowel sounds.

Page 11: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

AuscultationAuscultation

• Place the diaphragm of the stethoscope lightly on the abdomen.

• Listen for bowel sounds. Are they normal, increased, decreased, or absent ? In all four quadrants.

• Listen for bruits over the renal arteries, iliac arteries, and aorta.

Page 12: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

BruitsBruits

• In addition to bowel sounds, abdominal bruits are sometimes heard. Listen over the aorta, renal, and iliac arteries. Bruits confined to systole do not necessarily indicate disease. Don't be fooled by a heart murmur transmitted to the abdomen.

Page 13: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

PercussionPercussion

This technique allow you to This technique allow you to evaluate the size of some of evaluate the size of some of the organs and to detect the the organs and to detect the presence of excess fluid or air.presence of excess fluid or air.

• Remember to ask whether there are any sites that are tender of painful, This area should percussed last.

• Remember to warm your hands before beginning.

Page 14: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

PercussionPercussion

• Percuss in all four quadrants using a clockwise sequence beginning with the right upper quadrant unless contraindicated by pain.

• Categorize what you hear as tympanitic or dull. Tympany is normally present over most of the abdomen in the supine position. Unusual dullness may be a clue to an underlying abdominal mass.

Page 15: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Liver SpanLiver Span

                                   

                                   

Measure the liver span by percussing hepatic dullness from above (lung) and below (bowel). A normal liver span is 6 to 12 cm in the midclavicular line.

Page 16: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Liver Span Liver Span

• Percuss downward from the chest in the right midclavicular line until you detect the top edge of liver dullness.

• Percuss upward from the abdomen in the same line until you detect the bottom edge of liver dullness.

Page 17: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Splenic DullnessSplenic Dullness

• Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanitic.

• Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.

Page 18: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

PalpationPalpationGeneral PalpationGeneral Palpation

Begin with light palpationBegin with light palpation

• At this point you are mostly looking for areas of tenderness. The most sensitive indicator of tenderness is the patients facial expression . Voluntary or involuntary guarding may also be present.

Proceed to deep palpation Proceed to deep palpation

• After surveying the abdomen lightly. Try to identify abdominal masses or area of deep tenderness

Page 19: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Palpation of the LiverPalpation of the LiverStandard MethodStandard Method

• Place your fingers just below the right costal margin and press firmly.

• Ask the patient to take deep breath.

• You may feel the edge of the liver press against your finger. Or it may slide under your hand as the patient exhales . A normal liver is not tender.

Page 20: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Alternate MethodAlternate MethodThis method is useful when the This method is useful when the patient is obese or when the patient is obese or when the examiner is small compared to examiner is small compared to the patient. the patient.

• Stand by the patients chest.

• “Hook’’ your fingers just below the coastal margin and press firmly.

• Ask the patient to take a deep breath.

• You may feel the edge of the liver press against your fingers .

Page 21: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Palpation of the AortaPalpation of the Aorta

• Press down deeply in the midline above the umbilicus.

• The aortic pulsation is easily felt on most individuals.

• A well defined, pulsatile mass, greater than 3 cm across, suggests an aortic aneurysm.

Page 22: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Palpation of the SpleenPalpation of the Spleen

• Use your left hand to lift the lower rib cage and flank.

• Press down just below the left costal margin with your right hand.

• Ask the patient to take a deep breath.

• The spleen is notnot normally palpable on most individuals.

Page 23: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Special Testes Special Testes

Rebound TendernessRebound Tenderness

This is a test for peritoneal irritation:This is a test for peritoneal irritation:

• Warn the patient what you about to do

• Press deeply on the abdomen with your hand

• After a moment, quickly release pressure.

• If it hurts more when you release, the patient has rebound tenderness

Page 24: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Special TestsSpecial Tests

Costovertebral tenderness Costovertebral tenderness

CVA tenderness is often CVA tenderness is often associated with renal disease:associated with renal disease:

• Warn the patient what you are about to do.

• Have the patient sit up on the exam table.

• Use the heel of your closed fist to strike the patient firmly over the costovertebral angles.

• Compare the left and the right sides

Page 25: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Shifting DullnessShifting Dullness

This is a test for peritoneal fluid This is a test for peritoneal fluid (ascites)(ascites) : :

• Percuss the patients abdomen to outline areas of dullness and tympany

• Have the patient roll away from you.

• Percuss and again outline areas of dullness and tympany. If the dullness has shifted to areas of prior tympany. The patient may have excess peritoneal fluid.

Page 26: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Psoas SignPsoas Sign

This is a test for appendicitis:This is a test for appendicitis:

• Place your hand above the patients right knee:

• Ask the patient to flex the right hip against resistance.

• Increased abdominal pain indicates a positive psoas sign

Page 27: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

ObturatorObturator Sign Sign

This is a test for appendicitis:This is a test for appendicitis:

• Raise the patients right leg with the knee flexed .

• Rotate the leg internally at the hip.

• Increased abdominal pain indicates a positive obturator sign .

Page 28: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

ConclusionConclusion

• By Completion of the abdominal examination you:

• Compare findings with the patients baseline and expected findings.

• Identify Unexpected outcomes

• And nursing intervention’

Page 29: Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation,

Record and ReportRecord and Report

• Assessment findings

• Description of abnormalities

• Abnormal findings (report to physician)