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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