N 295 lecture 11   abdominal student copy
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  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams 5 to 32 normal frequency
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams
  • N252 Abdominal Assessment Prof. Adams

Transcript

  • 1. ABDOMINAL ASSESSMENT spring 2012
  • 2. History - Subjective Data
    • Abdominal pain
    • Appetite
    • Food intolerances
    • Dietary problems
    • Weight change
    • Dysphagia
    • Flatulence, belching
    • Bloody emesis (hematemesis)
    • Black tarry stools (melena),
    • Heartburn, diarrhea, constipation
    • Cramping
    spring 2012
  • 3. History - Subjective Data
    • Bowel habits, stool character
    • Medication Hx including OTC
    • Nausea and Vomiting
    • Changes in micturation:
      • Amount and color of urine
      • Obstruction of the urinary tract
      • Urinary Incontinence
      • Urinary tract pain
    • Female: ask about pregnancy
    • Past hx (surgery, trauma, kidney dx, alcoholism, HTN, heart dx
    • Review History and evaluate Hepatitis risk
    spring 2012
  • 4. Common Conditions Producing Abdominal Pain
    • Appendicitis
    • Cholecystitis
    • Pancreatitis
    • Perforated gastric or duodenal ulcer
    • Intestinal obstruction
    • Leaking abdominal aneurysm
    • Ectopic pregnancy
    • Pelvic inflammatory disease
    • Renal stones
    • Common collaborative problems
    • Peritonitis
    • Ileus
    • Intestinal bleeding
    • Bowel obstruction
    • Urinary obstruction
    • Hepatic failure
    • Peptic Ulcer Disease
    • GERD
    spring 2012
  • 5. Sequence for Abdominal Exam
    • Inspection
    • Auscultation
    • Percussion
    • Light Palpation
    • Deep Palpation ?
    spring 2012
  • 6. Physical Exam-INSPECTION
    • INSPECTION
      • Observe client’s movement and position
      • Have the client supine
      • Ask the client to locate tender areas
      • Inspect for distension
      • Inspect for normal respiratory movements
      • Note presence of peristaltic movement or aortic pulsation by looking across the abd
    spring 2012
  • 7. Physical Exam -AUSCULTATION
    • AUSCULTATION
      • Start @ _______
      • listen for ______ amount of time
      • Listen in _________
      • Note frequency and character
      • Auscultate for vascular sounds
      • If bruits are heard, DO NOT PALPATE the abdomen
    spring 2012
  • 8. Normal Findings: Percussion
    • Tympany over stomach and intestines
    • Dullness over liver, spleen, pancreas, kidneys and distended bladder
    • Liver border
    spring 2012
  • 9. Physical Exam - PALPATION
    • PALPATION
      • Light palpation ½ inch -1 (1-2 cm)
        • Palpate the abdomen lightly in all 4 quadrants
        • Observe for any signs of discomfort
        • Get the client to relax
        • Avoid quick jars during palpation
        • - Deep Palpation
    spring 2012
  • 10. Common Abnormalities
    • Multiple Abdominal Bruises
    • Engorged Prominent Veins
    • Generalized Symmetric Distension
    • Bluish Discoloration around the umbilicus (Cullen’s sign- intra peritoneal hemmorhage)
    • Protruding Umbilicus
    • Absent or hyperactive bowel sounds
    • Palpable liver
    spring 2012
  • 11. Special Procedures
    • Eliciting Abdominal Pain:
      • Rebound Tenderness
      • Iliopsoas Sign
      • Obturator Sign
      • Murphy’s Sign
    spring 2012
  • 12. Developmental Considerations: Geriatric/Older Adult
    • Increased fat deposit over abdominal area
    • Muscle tone more lax
    • Reduced GI peristalsis
    • Constipation common
    • Thinner abdominal wall
    • Abdominal contour is often rounded
    • Impaired digestion and food intolerances
    • Liver size decreases after age 50
    spring 2012
  • 13. Health Promotion
    • Nutrition
    • Immunization
    • Food poisoning
    • Lead poisoning
    • OTC Drugs
    • Excessive laxative or enemas
    spring 2012
  • 14. Nursing Diagnoses
    • Constipation
    • Diarrhea
    • Urinary retention
    • Altered tissue perfusion (renal, GI)
    • Altered nutrition (less or more than body requirements)
    spring 2012