it is an brief description about abdominal assessment ,mainly expalins about the bowel sounds.. it is useful more for nurses , paramedics

1. ABDOMINAL ASSESSMENT= 03
ASSESSMENT, AUSCULTATION,
PERCUSION & PALPATION OF
ABDOMEN FOR NURSES…..
PRESENTED BY
MURUGESH HJ RN
ICU 02 ( IMSC)
KFCH JIZAN SAUDI ARABIA

2. ABDOMEN ASSESSMENT….
 ASSESSMENT….
 ASSESSING PATIENT'S ABDOMEN CAN PROVIDE CRITICAL INFORMATION ABOUT HIS
INTERNAL ORGANS (inside the peritoneum) . ALWAYS FOLLOW THIS SEQUENCE:
ASSESSMENT OR INSPECTION, AUSCULTATION, PERCUSSION, AND PALPATION. CHANGING
THE ORDER OF THESE ASSESSMENT TECHNIQUES COULD. ALTER THE FREQUENCY OF
BOWEL SOUNDS AND MAKE YOUR FINDINGS LESS ACCURATE..
POSITION-
ASK patient TO empty his bladder( if consious), then lie supine with a pillow under his head.
Expose his abdomen from above the xiphoid process to the symphysis pubis.

3. ASSESSMENT……..
 ASSESSMENT-
 Picture your patient's abdomen in four quadrants. Standing at his right side, look at the
abdomen from the side and from above, from the xiphoid process to the symphysis
pubis, to determine whether it's flat, scaphoid, rounded, or protuberant. If it's
protuberant, ask whether this is normal for him. If it isn't, you'll assess for distension or
ascites during percussion and palpation.
 Next, assess for any visible mass, bulging, or asymmetry. Look for unusual coloring,
scars, striae, lesions, petechiae, ecchymoses, spider angiomas, and suspicious-looking
moles. Inspect the umbilicus and note any hernias. Look for pulsations. You won't see
any on most patients, but in a thin patient you may see pulsation of the aorta in his
epigastric area and possibly peristaltic waves.

4. AUSCULTATION….
 AUSCULTATION-
 Place the diaphragm of your stethoscope lightly over the right lower
quadrant and listen for bowel sounds. If you don't hear any, continue
listening for 5 minutes within that quadrant. Then, listen to the right upper
quadrant, the left upper quadrant, and the left lower quadrant. Describe
bowel sounds as absent, normoactive, hypoactive, or hyperactive. Absent
bowel sounds may indicate ileus or peritonitis. Hyperactive bowel sounds
may occur with an early intestinal obstruction or gastrointestinal hyper
motility… IF ABSENT BOWEL SOUNDS INDICATES THERE IS BLOCKAGE IN UPPER GI
TRACT ……

5. BOWEL SOUNDS ASSESSMENT….
 Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push
food through. The intestines are hollow, so bowel sounds echo through the abdomen much
like the sounds heard from water pipes. Most bowel sounds are normal.
 Auscultate for bowel sounds. Begin in the right lower quadrant (RLQ), and move in
sequence up to the right upper quadrant (RUQ), left upper quadrant (LUQ), and
finally the left lower quadrant (LLQ). Auscultate for bruits over the aorta, renal arteries,
iliac arteries, and femoral arteries.
 Abdominal sounds may either be classified as normal, hypoactive, or hyperactive. Hypoactive,
or reduced, bowel sounds often indicate that intestinal activity has slowed down. On the other
hand, hyperactive bowel sounds are louder sounds related to increased intestinal activity.

6. AUSCULTATION….
 AUSCULTATION -
 With the bell of your stethoscope, listen over the aorta, as shown, and the
renal, iliac, and femoral arteries. If the patient has hypertension, you may hear
a bruit—a vascular sound similar to a heart murmur—caused by turbulent
blood flow through a narrowed artery. Occasionally, you may hear a bruit
limited to systole in the epigastric region of a healthy person.

7. PERCUSSION…..
 Lightly percuss all four quadrants of your patient's abdomen. You'll hear
dull sounds over solid structures (such as the liver) and fluid-filled
structures (such as a full bladder). Air-filled areas (such as the stomach)
produce tympany. Dullness is a normal finding over the liver, but a large,
dull area elsewhere may indicate a tumor or mass.

8. PALPATION ……
 PALPATION ……
 Place the palmar aspect of the fingers on your dominant hand flat and together on your
patient's abdomen. Using a light, gentle, dipping motion, palpate for abnormalities, such
as muscle guarding, rigidity, or superficial masses. Palpate clockwise, lifting your fingers as
you move from one location to another. After light palpation of the entire abdomen, place
your non dominant hand on your dominant hand to perform deeper palpation (1½ to 2
inches [3.8 to 5 cm]). However, avoid deep palpation if your patient may have a problem
such as splenomegaly, appendicitis, or aneurysm or if palpation is painful for any reason.

9. PALPATION OF LIVER…..
 PALPATION OF LIVER…..
 To palpate the liver, place your left hand under your patient,
parallel to and supporting the right 11th and 12th ribs and your
right hand lateral to the rectus muscle with your fingertips
below the liver border (as identified by dullness during
percussion). As shown, press gently in and up as your patient
takes a deep breath

10. PALPATION …Contd…
 Another approach is to stand by his right shoulder, hook the fingers of
both hands (side by side) below the liver border, press in and up toward
the costal margin, and ask him to inhale. You may be able to feel the
soft, smooth, sharp edge of the liver descending during inspiration. The
liver is considered enlarged if the edge extends more than 1.2 inch (3
cm) below the right costal margin. Document your assessment
findings in the medical record…….

11. NURSING RESPONSIBILITIES..
 ***EXPLAIN THE PROCEDURE IN DETAIL TO THE PATIENT
 ***THOROUGH HISTORY COLLECTION- ASK PATIENT IS THERE ANY HISTORY
OF ABDOMINAL BLEEDING INJURIES,ORGAN PROTRUSION , ANY ABDOMINAL
ENLARGEMENT …
 ***RESPECT PATIENT PRIVACY –CLOSE CURTAINS ALWAYS..
 ***INFORM TO DOCTOR IF PATIENT IS OMPLAINING SEVERE AFTER
EXAMINATION
 ***DOCUMENT THE FINDINGS & PROCEDURE , INFORM ANY ABNORMALITIES
…

12. Referances…..
 REFERENCES
 Bickley L. Bates Guide to Physical Examination and History Taking, 10th ed.
Philadelphia, Pa., Lippincott Williams & Wilkins, 2009.
 Jarvis C. Physical Examination and Health Assessment, 5th ed. Philadelphia, Pa.,
W.B. Saunders Co., 2007.
 © 2010 Lippincott Williams & Wilkins, Inc.

13. THANK U ALL