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Abdominal Assessment
The document outlines objectives and techniques for conducting an abdominal assessment in nursing, including anatomy, assessment techniques, and documentation of findings. It covers inspection, auscultation, percussion, and palpation, detailing normal and abnormal abdominal findings. Additionally, it emphasizes the importance of patient preparation and communication during the assessment process.
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Abdominal Assessment
- 1. Charmaine Kei .Palomar RN ASSESSMENT OF ABDOMEN
- 2. OBJECTIVES 2 At the endof this class, the student will be able to: 1. Review the Anatomy and Physiology of the abdomen. 2.Identify quadrants, regions and landmarks for the abdominal assessment. 3. Correctly perform techniques of inspection, auscultation, percussion and palpation. 4. Differentiate normal from abnormal findings. 5. Document findings.
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- 4. Process of Digestionand Elimination 1. Mouth 2. Esophagus 3. Stomach 4. Small intestines 5. Large intestines 6. Rectum 7. Anus 4
- 5. Associated organs 1. liver 2.gall bladder 3. pancreas 5
- 6. Regions of theAbdomen Epigastric Umbilical Suprapubic or hypogastric: 6
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- 12. ❖ Inspection ❖ Auscultation ❖Palpation ❖ percussion 12 ASSESSMENT TECHNIQUES FOR ABDOMENS
- 13. 13 SITES OF REFERREDABDOMINAL PAINAbdominal Pain Sites of Referred Abdominal Pain
- 14. 14 Subjective Data: (Healthhistory questions) • Change in appetite • Usual weight; Changes in usual weight Difficulty swallowing • Are there any foods you have difficulty tolerating? • Have you felt nauseated? • Have you vomited (emesis)? • Experience indigestion? • Heart burn (pyrosis) or Belching (eructation) Use antacids, if so, how often? • Abdomen feel bloated after eating (distension) Abdominal pain? Associated with eating? • Alcohol use? • Medications?
- 15. 15 Bowel habits Usual colorand consistency Any diarrhea/constipation/ excessive flatulence Any recent change Use of laxatives…
- 16. Past abdominal history •GI problems: ulcer, hepatitis, jaundice, appendicitis, colitis, hernia • Surgical history of abdomen Surgical problems in the past • Abdominal x-rays, sonograms, CT results, colonoscopy results, etc..
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- 18. 18 PERFORMANCE 1. PREPARATION 1. Priorto performing the procedure, check the doctor's order for the need to perform the assessment. 2. Perform hand hygiene, Apply gloves, and observes other appropriate infection prevention procedures. Prepare equipment needed for the assessment. 3. Introduce self and verifies the client's identity using agency protocol. Explain the procedure to the client, and how he or she can participate, especially about the need to assume several positions for this examination.
- 19. 19 4. Ask theclient to empty the bladder before beginning the examination. Ensure that the room is warm. Instruct the client to remove clothes and to put on a gown. 5. Help the client to lie supine with the arms folded across the chest or sides. Place a flat pillow under the client's head for comfort. Slightly flex the client's legs by placing a pillow or rolled blanket under the client's knees. 6. Drape the client with sheets so that the abdomen is visible from the lower rib cage to the pubic area.
- 20. 20 7. Instruct theclient to breathe through the mouth . Advise to take slow, deep breaths 8. Provide privacy
- 21. 21 ASSESSING THE ABDOMEN Askif the client has any history of the following: • Incidence of abdominal pain • Tender areas • Location • Onset • Sequence • Quality • Frequency • Associated symptoms • Constipation or diarrhea • Change in appetite, • Food intolerances, and foods ingested in past 24 hours.
- 22. 22 10. Assist theclient to a supine position, with the arms placed comfortably at the sides. Place small pillows beneath the knees.
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- 24. 24 11. Inspect theabdomen for skin integrity, coloration of the skin, vascularity of the abdominal skin, any striae, scars, lesions and rashes. NORMAL FINDINGS: *Unblemished skin *Uniform color *Silver-white striae (stretch marks) or surgical scars 11. Inspect the abdomen for skin integrity, coloration of the skin, vascularity of the abdominal skin, any striae, scars, lesions and rashes. NORMAL FINDINGS: *Unblemished skin *Uniform color *Silver-white striae (stretch marks) or surgical scars
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- 26. 26 • Presence ofrash or other lesions Tense, glistening skin (may indicate ascites, edema) • Purple striae (associated with Cushing’s disease or rapid weight gain and loss) DEVIATIONS FROM NORMAL:
- 27. 27 12. Inspect theabdomen for contour and symmetry:
- 28. 28 NORMAL: Flat, rounded (convex),or scaphoid (concave) DEVIATION FROM NORMAL: - Distended 14. Ask the client to take a deep breath and to hold it. Normal findings: No evidence of enlargement of liver or spleen Deviation from normal: Evidence of enlargement of liver (Hepatomegaly) or spleen (Splenomegaly)
- 29. 29 15. Assess thesymmetry of contour while standing at the foot of the bed. Normal: Symmetric contour Deviations from normal:Asymmetric contour e.g., localized protrusions around umbilicus, inguinal ligaments, or scars (possible hernia or tumor) 16. If distention is present, measure the abdominal girth by placing a tape around the abdomen at the level of the umbilicus.
- 30. 30 17. Inspect abdominalmovement when the client breathes in (respiratory movements), observe aortic pulsations, and observe for peristaltic waves. Normal findings: - Symmetric movements caused by respiration - Visible peristalsis in very lean people Aortic pulsations in thin people at epigastric area. Deviation from Normal: - Limited movement due to pain or disease process - No Visible peristalsis (possible bowel obstruction) - Marked aortic pulsations
- 31. 31 18. Observes thevascular pattern. Normal findings: - No visible vascular pattern Deviation from Normal: - Visible venous pattern (dilated veins) is associated with liver disease, ascites, and venocaval obstruction
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- 33. 33 19. Auscultate theabdomen for bowel sounds, vascular sounds, and peritoneal friction rubs. Warm the hands and the stethoscope diaphragms.
- 34. 34 • Normal finding: -Audible bowel sounds • Deviations from Nomal: ❑ Hypoactive, ❑ Hyperactive ❑ Decreased or absent
- 35. 35 FOR BOWEL SOUNDS -Usethe flat-disk diaphragm. • Intestinal sounds are relatively high pitched and best accentuated by the diaphragm. Light pressure with the stethoscope is adequate. - Ask when the client the last time he/she ate.
- 36. 36 21. Place diaphragmof the stethoscope in each of the four quadrants of the abdomen.
- 37. 37 22. Listen foractive bowel sounds. irregular gurgling noises occurring about every 5 to 20 seconds.
- 38. 38 23. Use thebell of the stethoscope over the aorta, renal arteries, iliac arteries, and femoral arteries. FOR VASCULAR SOUNDS
- 39. 39 24. Listen forbruits Normal: - Absence of arterial bruits Deviations from Normal: -Loud bruit over aortic area (possible aneurysm)
- 40. 4 0 25. Peritoneal FrictionRubs 26. Peritoneal friction rubs are rough, grating sounds like two pieces of leather rubbing together. Normal finding: - Absence of friction rub Deviation from normal: - Friction rub
- 41. 41 26. Percuss several areasin each of the four quadrants to determine presence of tympany and dullness. Use a systematic pattern. PERCUSSION OF THE ABDOMEN
- 42. 42 Normal: - Tympany overthe stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a full bladder Deviation from normal: -Large dull areas (associated with presence of fluid or a tumor)
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- 44. 44 27. Percuss theliver, begin in the RLQ at the mid-clavicular line (MCL) and percuss upward. Note the change from tympany to dullness.
- 45. 45 29. Perform bluntpercussion on the liver. Percuss the liver by placing the left hand flat against the lower right anterior rib cage. Use the ulnar side of the right fist to strike the left hand.
- 46. 46 28. Percuss the spleen.Begin posterior to the left mid-axillary line (MAL), and percuss downward
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- 48. 4 8 30. Instruct theclient to sit with his or her back to you. Perform blunt percussion on the kidneys by placing the left hand flat at the costovertebral angles (CVA) over the twelfth rib and using the ulnar side of the right fist to strike the left hand.
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- 50. 50 PALPATION OF THEABDOMEN
- 51. 51 31. Place thepatient back to supine position and perform light palpation over the quadrants of the abdomen.
- 52. 52 32. Perform lightpalpation first to detect areas of tenderness and/or muscle guarding. Systematically explore all four quadrants.
- 53. 53 33. Light Palpation a.Holds the palm of your hand slightly above the client’s abdomen, with your fingers parallel to the abdomen b. Depresses the abdominal wall lightly, about 1 cm or to the depth of the subcutaneous tissue, with the pads of your fingers. c. Moves the finger pads in a slight circular motion
- 54. 54 Light Palpation d. Notesareas of tenderness or superficial pain, masses, and muscle guarding. To determine areas of tenderness, ask the client to tell you about them and watch for changes in the client’s facial expressions. e. If the client is excessively ticklish, begin by pressing your hand on top of the client’s hand while pressing lightly. Then slide your hand off the client’s and onto the abdomen to continue the examination
- 55. 55 (a) Stand atthe client's right side, reach over the abdomen with your left arm, and place your hand under the posterior lower ribs. Pull up gently. 34. Palpate the spleen:
- 56. 56 (b) Place yourright hand below the left costal margin with the fingers pointing toward the client's head.
- 57. 57 (c) Asks theclient to inhale and press inward and upward as you provide support with your other hand. Be sure to palpate with your fingers below the costal margin so you do not miss the lower edge of an enlarged spleen.
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- 60. 6 0 (a) To palpatethe right kidney, support the right posterior flank with your left hand and place your right hand in the RUQ just below the costal margin at the MCL. 35. Palpate the kidneys:
- 61. 61 (b) To capturethe kidney, ask the client to inhale. Then compress your fingers deeply during peak inspiration.
- 62. 62 (c) Ask theclient to exhale and hold the breath briefly. Gradually release the pressure of your right hand. If you have captured the kidney, you will feel it slip beneath your fingers. (d) To palpate the left kidney, reverse the procedure.
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- 66. 6 6 Palpate deeply at90 degrees into the abdomen halfway between the umbilicus and the anterior iliac crest. Then suddenly release pressure. 39. Assessing for rebound tenderness:
- 67. 67 Palpate deeply inthe LLQ and quickly release pressure. 40. Test for referred rebound tenderness.
- 68. 6 8 ❑ (a)Asks theclient to lie on the left side. ❑ (b) Hyperextends the client's right leg. Place the patient on a supine position afterwards. 41. Assess for Psoas sign:
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- 70. 70 ❑ (a)Supports theclient's right knee and ankle. (b) Flexes the hip and knee, and rotate the leg internally and externally. 42. Assess for Obturator sign:
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- 73. 73 43. Perform Hypersensitivitytest: After ensuring that the patient is in a supine, neutral position, stroke the abdomen with a sharp object
- 74. 74 TEST FOR CHOLECYSTIT TEST FORCHOLECYSTITIS 44. Press your fingertips under the liver border at the right costal margin and ask the client to inhale deeply. PALPATION OF THE BLADDER 45. Palpate the area above the pubic symphysis if the client’s history indicates possible urinary retention
- 75. 75 46. Inform theclient about the end of assessment. Show gratitude for the participation and cooperation of the patient and ensures the patient is in a stable condition before leaving the patient's room. 47. Perform hand hygiene.
- 76. 76 48. Document findingsin the client record using printed or electronic forms or checklists supplemented by narrative notes when appropriate. Inform Health Care Provider (HCP) for any untoward findings.
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