Health assessment on the abdomen examination

1. PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY, ASELLA, ETHIOPIA,
EAST AFRICA.

2.  The method most commonly used to identify the
location of assessment findings is the four-
quadrant method,

3.  which divides the abdomen into four sections by
“drawing” a line vertically from the xiphoid
process to the symphysis pubis and a horizontal
line at the level of the umbilicus.

6.  For the rarely used nine-region method,
Examination of the abdomen differs in sequence
from all other body systems.

7.  Percussion and palpation stimulate the bowel
and may alter bowel sounds.

8.  Therefore, you should inspect and auscultate
before performing percussion and palpation.

9.  To promote comfort, ask the client to empty his
bladder before the examination.
 Have the client assume a supine position with
flexed knees.

10.  This relaxes the abdominal muscles and is usually
the most comfortable position.

11.  If the client has a painful area, examine that
area last to minimize discomfort during the rest
of the exam.

12.  The skin over the abdomen is usually paler than
that over other parts of the body.

13.  The abdomen should be symmetrical with a
rounded contour and sunken umbilicus.

14.  You may be able to see peristalsis and aortic
pulsations on a very thin client, but in most
clients usually you will see no movement.

15.  In clients with abdominal distention, the skin
appears taut.

17.  Distention may be normal, as with pregnancy, or
it may be due to gas or fluid retention or to
bowel obstruction.

18.  Proceed in an organized manner, listening in
several areas in all four quadrants.

19.  Use the same pattern for every examination so
that it becomes a habit.

20.  First Auscultate Bowel Sounds Bowel sounds are
high-pitched,
 irregular gurgles or clicks lasting one to several
seconds and occurring every 5 to 15 seconds (or
5 to 30 times per minute) in the average adult.

21.  If the client has a nasogastric (NG) tube that is
attached to suction,
 discontinue the suction or clamp off the tube
while listening for bowel sounds.

22.  Otherwise, you may mistake the sound of suction
in the stomach for bowel sounds.

23.  ■ Normal.
Audible, occurring every 5 to 15 sec (or 5– 30
times per min) in a healthy adult.

24.  Hyperactive (hyperperistalsis).
Loud, rushing sounds occurring every 2 or 3 sec (or
more than 30 per min);

25.  may indicate diarrhea,
 early bowel obstruction,
 or gastroenteritis (infection of the GI tract).

26.  Very faint and infrequent (fewer than 5 sounds
per min);
 may occur after abdominal surgery or with bowel
obstruction, infection, or problems of
innervation.

27.  Absent. None after listening for 5 min.

28.  Next Auscultate the Major Arteries Major arterial
vessels lie in the abdomen below the intestines.

29.  Listen over the aorta and the renal, iliac, and
femoral arteries for the presence of bruits.

30.  Use indirect percussion to assess for fluid, air,
organs, or masses.

31.  Normally there is generalized tympany over the
bowels (due to the presence of gas) and the
abdomen is nontender, soft, and without masses.

32.  You will hear dullness when percussing organs,
masses, or fluids.
 Some practitioners include percussion of the
kidney with the abdominal examination.

33.  Begin with light palpation to put the patient at
ease.
 Palpate for tenderness and guarding in all four
quadrants.

34.  Some practitioners include percussion of the
kidney with the abdominal examination.

35.  Begin with light palpation to put the patient at
ease.

36.  Palpate for tenderness and guarding in all four
quadrants.

37.  Palpation of the liver and spleen is an advanced
technique not usually performed by staff nurses,
except perhaps in some specialty areas.