Assessment of the abdomen

Assessment of the abdomen

1. JHONEE F. BALMEO HEALTH ASSESSMENT ASSESSMENT OF THE ABDOMEN

2. Abdomen The nurse locates and describes abdominal findings using two common methods of subdividing the abdomen: quadrants and regions .

3. Abdomen The nurse locates and describes abdominal findings using two common methods of subdividing the abdomen: quadrants and regions .

4. Assessment of the abdomen involves all four methods of examination ( inspection, auscultation, palpation, and percussion).

5. Specific organs or parts of or g ans lie in each abdominal quadrants and regions

6. Specific organs or parts of or g ans lie in each abdominal quadrants and regions

7. Tips for Examining the Abdomen ◗ Check if the patient has an empty bladder. ◗ Make the patient comfortable in the supine position, with a pillow under the head and perhaps another under the knees. ◗ Ask the patient to keep the arms at the sides or folded across the chest . ◗ Before you begin palpation, ask the patient to point to any areas of pain so that you can examine these areas last. ◗ Warm your hands and stethoscope. ◗ Approach the patient calmly and avoid quick, unexpected movements. Watch the patient’s face for any signs of pain or discomfort . ◗ Distract the patient, if necessary, with conversation or questions .

8. WHAT TO FIND? INSPECTION 01 AUSCULTATION 02 PERCUSSION 03 PALPATION 04

9. Inspection Starting from your usual standing position at the right side of the bed, inspect the abdomen. As you look at the contour of the abdomen, watch for peristalsis. It is helpful to sit or bend down so that you can view the abdomen tangentially. ● The skin. Note : Scars . Describe or diagram their location. Striae . Old silver striae or stretch marks are normal. Dilated veins. A few small veins may be visible normally. Rashes or ecchymoses

10. ● The umbilicus. Observe its contour and location and any inflammation or bulges suggesting a ventral hernia. ● The contour of the abdomen Is it flat, rounded, protuberant, or scaphoid Do the flanks bulge, or are there any local bulges? Also survey the inguinal and femoral areas. Is the abdomen symmetric? Are there visible organs or masses? Look for an enlarged liver or spleen that has descended below the rib cage.

11. ● Peristalsis. Observe for several minutes if you suspect intestinal obstruction . Normally, peristalsis may be visible in very thin people. ● Pulsations. The normal aortic pulsation is frequently visible in the epigastrium .

12. Case Analysis? What do you see in the Abdomen of this client?

13. Auscultation Auscultation provides important information about bowel motility. Listen to the abdomen before performing percussion or palpation because these maneuvers may alter the frequency of bowel sounds. Practice auscultation until you are thoroughly familiar with variations in normal bowel sounds and can detect changes suggestive of inflammation or obstruction. Auscultation may also reveal bruits , or vascular sounds resembling heart murmurs , over the aorta or other arteries in the abdomen

14. Auscultation Occasionally you may hear borborygmi , prolonged gurgles of hyperperistalsis , the familiar “stomach growling.” Because bowel sounds are widely transmitted through the abdomen, listening in one spot, such as the right lower quadrant, is usually sufficient

15. Abdominal Bruits and Friction Rub. If the patient has high blood pressure, listen in the epigastrium and in each upper quadrant for bruits. Later in the examination. Epigastric bruits confined to systole are normal.

16. Percussion Percussion helps you to assess the amount and distribution of gas in the abdomen, possible masses that are solid or fluid-filled, and the size of the liver and spleen. Percuss the abdomen lightly in all four quadrants to assess the distribution of tympany and dullness. Tympany usually predominates because of gas in the gastrointestinal tract, but scattered areas of dullness from fluid and feces are also typical.

17. ● Note any large dull areas suggesting an underlying mass or enlarged organ. This observation will guide your palpation. ● On each side of a protuberant abdomen, note where abdominal tympany changes to the dullness of solid posterior structures.

18. Palpation Light Palpation. Identify any superficial organs or masses and any area of tenderness or increased resistance to your hand. If resistance is present, try to distinguish voluntary guarding from involuntary muscular spasm. To do this:

19. Your client suddenly ask you where the sigmoid colon is located in this area of the abdomen: the best answer is A.  Left upper quadrant B.  Left lower quadrant C. Right lower quadrant

20. The same client ask you again what is the primary function of the gallbladder? Your answer is? A.  Store and excrete bile B.  Aid in the digestion of protein C.  Produce alkaline hormones D.  Produce hormones AWESOME S LIDE

21. The same client suddently complain of pain located in the RLQ (PS of 8/10) and according to the doctor, the client might have appendicitis. To palpate tenderness of an adult's appendix, where should you begin? A.  Left lower quadrant B.  Left upper quadrant C.  Right lower quadrant D.  Right upper quadrant

22. You are a student nurse and was assigned in the Surgical Ward. You are preparing to assess the abdomen of a hospitalized client 2 days after abdominal surgery.  You should first do what? A.  Palpate the incision site B.  Auscultate for bowel sounds C.  Percuss for tympany D.  Inspect the abdominal area

23. Thank You

24. References Audrey Berman . . . [et al.]. – 9th ed. (2012) KOZIER & ERB’S Fundamentals of NURSING Concepts, Process, and Practice. Bickley, Lynn S. -11 TH ED. (2013) Bates’ guide to physical examination and history-taking.