Mr. Arun presents with severe abdominal pain and vomiting. The nurse demonstrates abdominal assessment techniques including inspection, auscultation, percussion and palpation. During inspection, the nurse observes for distention, asymmetry, scars and pulsations. Auscultation involves listening for bowel and vascular sounds. Percussion identifies areas of dullness or tympany. Palpation includes light palpation of each quadrant and deep palpation of the liver and assessment for rebound tenderness, which may indicate appendicitis. The nurse documents findings and refers the patient to a higher facility if indicated based on the assessment results.

1. Institute of Nursing Education, Bambolim
Community Health Nursing-MLHP –OSPE
Skill Station : Abdominal Assessment
Articles required: Stethoscope, wrist watch with second hand, pen
Situation- Mr Arun comes to the Health and Wellness Centre with complains of severe pain in
abdomen. She had one bout of vomiting. Demonstrate the assessment technique and tell the
findings that need to be recorded.
Instructions: Observe if the participant is performing the following steps in their correct
sequence (as necessary) and technique. Score “1” for each point conducted correctly or mark “0”
if the task is not done or incorrectly done and calculate the core.
Sr
No
Task to be performed
1 Greets patient, Observe his body alignment and facial
expression for objective indicators of discomfort, such as grimacing
or flexing the legs (occurs in acute appendicitis or peritonitis)
2 Make patient comfortable, maintained eye contact, listened
attentively and collected chief complains
3 Take health history- Onset of symptoms, duration, precipitating
factor, associated factors, previous episode, etc
4 Inspection of mouth-
Explain procedure to patient . Ask patient to remove dentures if
present.
Observe for-
a) Mouth- Drooping of mouth/ presence of drooling
b) Lips- Assess colour and lubrication. Note – bleeding, cracks,
lesions
c) Teeth- Inspect teeth for looseness, cracks, gross caries
d) Gums- Assess for inflammation and bleeding( occurs in
gingivitis or periodontitis)
e) Buccal cavity- to visualize buccal cavity retract the cheeks
with a tongue depressor. Use penlight to examine the
membranes of both sides of cheek (observe for cancer sores,
inflammation, stomatitis , halitosis
f) Tongue and pharynx- depress tongue, note colour, coating of
tongue, presence of oedema.
g) Tonsils- Assess for inflammation or exudates
h) Uvula- Should rise with soft palate when patient says “aah”. If
yellow, it is indicative of Jaundice.
i) Gag reflex- Stimulate gag reflex by pressing tongue depressor
on back of tongue.( Normal- involuntary contraction at the
oropharynx
j) Tongue- ask patient to move from side to side. ( inability to
move tongue suggests 12th cranial nerve damage)

2. Assessment of Abdomen- To locate the organs and make
documentation more specific, the abdomen is divided into four
quadrants- right upper, right lower, left upper and left lower. Clock
wise examination of quadrants is done. The epigastric, Umblical
and hypogastric areas are further delineated.
Sequence of assessment is inspection, auscultation, percussion and
palpation. ( percussion and palpation stimulate bowel sounds and
thus are done after auscultation of the abdomen)
-Ask patient to breath slowly and deeply through the mouth during
the examination to promote relaxation
-Ask patient to identify painful areas of the abdomen and explain
that you will assess these at the time of examination
Ask patient to empty bladder before the abdominal assessment
Maintain privacy and expose the Abdomen. Provide patient
warm towel.
5 Inspection of abdomen-
Inspect abdomen from sternum to pubis.
a) Note contour of abdomen – round/ flat/ concave
b) Observe for distention and asymmetry, which could indicate
presence of Mass
c) Look for peristaltic waves – indicative of intestinal obstruction
in adult or pyloric stenosis in infant
d) Observe for scars / pigmentation eg in pregnancy striae or
loose folds in weight loss
e) Observe for venous network on the abdomen in hepatic
obstruction, portal hypertension or ascitis
f) Assess umbilicus for inversion (normal) or eversion in clients
with umbilical hernia or extreme ascitis presence of
redness/discharges, masses, flat, weeping
g) Observe for –Mild pulsationsin very thin patients, vigorous
pulsations in patients with right ventricular hypertrophy. Or
with Mass anterior to aorta.
h) If presence of an Ostomy - observe colour, character ,
appearance of peri stomal skin , amount and character of the
effluent in the pouch.
6 Ausculatation of abdomen-
Listen to bowel sounds and vascualar sounds for 4 to 5 min.
a) Warm diaphragm and place it lightly in the centre of all four
quadrants. Follow a pattern of assessment ie- clockwise
examination of quadrants.
b) Count frequency and character of bowel sounds for one full
minute. ( move the stethoscope to various areas within the in
quadrant if you are unable to elicit sounds in the centre
Normal bowel sounds- 5 to 34 bowel sounds per minute

3. Abnormal bowel sounds - Hyper peristalsis ( more frequent,
high pitched gurgling sounds eg in diarrhea, gastroenteritis or
intestinal haemorrhage.
- Paralytic ileus- Absence of bowel sounds seen In
peritonitis / in intestinal obstruction, the bowel sounds
may be absent in the quadrant in which the obstruction
occurs.
c) Auscultation using firmer pressure with diaphragm over the
aortic, renal, iliac and femoral arteries for presence of bruits
(swishing sounds)
d) Listen for friction rub – heard over diseased liver, spleen or
gall bladder.
7 Percussion of abdomen -
Place your middle finger or index finger on patients skin and then
strike that finger with the same finger on your opposite hand to
elicit sounds to elicit sounds.
-All four quadrants are percussed in a systematic, clockwise
manner to identify fluid, masses or air.
Normal- (a) Tympany over abdomen
b) dullness or flat sound over liver and full bladder
Abnormal- Decreased tympany and increased dullness caused due
to presence of fluid or Mass.
8 Palpation of abdomen - Stand to right side of patient.
I) Light palpation- Roll hand over abdominal area starting with
heel of the hand, progressing to the palm, and finishing at finger
tips, palpate with flattened finger tips each quadrant in
systematic manner, noting muscular resistance, tenderness,
pulsations, enlargement of organs, presence of mass.
If patient complains of abdominal pain, palpate the area of pain last.
Normal- Abdomen will feel soft and supple, relaxed and free of
tenderness
Abnormal- If you feel resistance with a distended abdomen,
- Board like tenderness, pain on light palpation.
II) Deeppalpation- Is used to assess enlarged organs and presence
of Masses.
a) Palpation of Liver- Bimanual palpation-
Liver is not normally palpable.
i) Ask patient to inhale.
ii) Stand at side of patient , place your left hand under the rib cage
and use the palmar surface of the fingers of right hand to palpate
liver just below the right costal margin .
Normal- Liver edge feels firm, smooth
Abnormal- Liver edge will feel hard, firm (in cancer liver), pain in
case of vascular engorgement as congestive heart failure, hepatitis
or abscess.

4. -If liver border is more than 1 to 3 cm, then liver is considered to be
enlarged.
b) Rebound tenderness is seen in patients with peritonitis.
( patient feels pain when you release hand quickly after slow
palpation)
To Assess for appendicitis/ peritoneal inflammation,
Gently press your flattened finger tips approximately 6-8cm into
the quadrant opposite that in which you elicited pain, and then
quickly release the pressure. The patient will feel a sudden, sharp
pain over the original area of discomfort if rebound tenderness is
present.
Contraindication- Never deeply palpate the right lower quadrant
if appendicitis is suspected
Deeppalpation to be avoided in clients with rigid abdomens or
those who have pancrestitis or ectopic pregnancy because the
procedure can be very painful and can cause serious injury to the
patient.
9 Assess forAscitis-
a) With patient in supine position place palm of hand against
the lateral abdominal wall. With the other hand , tap the
opposite wall of the abdomen and check for fluid wave.
b) Identify areas of greatest abdominal girth and using
‘measuring tape’ measure the abdominal girth
10 Make the patient comfortable, replace the articles and document
findings, Refer patient to FRU if required.
Name and signature of evaluator: