Assessment of the Abdomen for nursing students .pptx

Discussion of Abdominal Assessment

1. ASSESSMENT OF THE ABDOMEN JOAN EVASCO,RN,RM ,MAN

2. Learning outcomes Comprehensively describe and discuss the importance of health assessment of the abdomen. Obtain baseline data about client’s functional abilities Develop clinical judgment about a client’s health status

3. REVIEW OF ANATOMY AND PHYSIOLOGY OF THE ABDOMEN

4. When assessing abdomen the nurse must divide the abdomen into four quadrants .

5. REGIONS OF THE ABDOMEN

6. four basic components of Assessing the Abdomen inspection, palpation, percussion, and auscultation . It is important to begin with the general examination of the abdomen with the patient in a completely supine position

7. NURSE’S NOTES Assessing your patient's abdomen can provide critical information about his internal organs. Always follow this sequence: I nspection, Auscultation, Percussion, and Palpation . Have your patient empty his bladder , then lie supine with a pillow under his head . Expose his abdomen from above the xiphoid process to the symphysis pubis .

8. INSPECTION

9. Procedure for Inspection: 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. A ssess 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.

10. Auscultation

11. Procedure for 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, L isten 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 hypermotility.

12. 3. With the bell  of your stethoscope, listen over the aorta, 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.

13. ABNORMAL BOWEL SOUNDS

14. PALPATION

15. Part of hand to use when palpating HAND PART SENSITIVE TO FINGERPADS Fine discriminations, pulses, texture, size, consistency, shape, crepitus Ulnar or palmar surface Vibrations, thrills, fremitus Dorsal (Back) surface temperature

16. palpation Consists of using parts of the hand to touch and feel for the following characteristics: Texture (rough/smooth) Temperature (warm/cold) Moisture (dry/wet) Mobility (fixed/movable/still/vibrating)

17. Consistency (soft/hard/fluid filled) Strength of pulses (strong/weak/thready/ bounding) Size (small, medium, large) S hape (well-defined, irregular) Degree of tenderness

18. Light (superficial)palpation two types of palpation: Light Deep or bimanual

19. deep or bimanual palpation deep palpation- the use of both hands to hold and feel a body structure

20. PERCUSSION

21. The act of striking the body surface to elicit sounds that can be heard or vibrations that can be felt.

22. PERCUSSION Percussion is done to determine t he size, consistency, and borders of body organs .  The presence or absence of fluid in body areas.

23. direct percussion Nurse strikes the area to be percussed with the pads of two, three or four fingers or with the pad of the middle finger two types of percussion

24. indirect percussion Striking of an object ( eg. Finger) Pleximeter Plexor

25. Flatness Dullness Resonance Hyperresonance Tympany Five types of sounds elicited

26. REFERENCES: Bickley, Lynn S., Bates Guide to Physical Examination and History Taking , 10 th ed., Lippincott Williams and Wilkins, Co. 2009, ISBN 978-1-6054-7400-7 Jarvis, Carolyn., Physical Examination & Health Assessment ., 6 th ., Elsevier Saunders., Pocket Companion.., Co. 2012 Missouri, ISBN 978-1-4377-1442-5. Jarvis.C . Physical Examination and Heath Assessment ., 3 rd ., Edition ,W.B. Saunders company, Co. 2000., Philadelphia – ISBN 0- 7216 -8424- 6 Marieb , Elaine N., Essentials of Human Anatomy and Physiology , 10 th ed., Pearson Benjamin Cummings, Co., 2012 Weber, Janer R. Health Assessment in Nursing, 4 th ed ., Lippincott Williams and Wilkins, Co. 2014., ISBN- 978-1-6083- 1608-3 Weber, Janer R. Health Assessment in Nursing, 5 th ed ., Lippincott Williams and Wilkins, Co. 2014., ISBN- 978-1-4511-4280-8

27. Kozier, Barbara et al., Fundamentals of Nursing : Concepts, Process and Practices, 5 th ed, Addison Wesley Nursing, Co., Clinical Methods, The History, Physical and Laboratory Examinations, 3 rd ed., Boston: Butterworths, 1990 https://emedicine.medscape.com/article/1909183-overview https://www.verywellhealth.com/what-is-palpate-430300