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D. Tanner, RN, MSN NUR 211 Fall Semester

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Presentation on theme: "D. Tanner, RN, MSN NUR 211 Fall Semester"— Presentation transcript:

1 D. Tanner, RN, MSN NUR 211 Fall Semester
Abdomen Assessment D. Tanner, RN, MSN NUR 211 Fall Semester

2 Anatomy of the Abdomen 4 Quadrants RUQ, RLQ, LUQ, LLQ Midline
9 Regions- epigastric, umbilical, suprapubic The word "abdomen" has a curious story behind it. It comes from the Latin "abdodere", to hide. The idea was that whatever was eaten was hidden in the abdomen.

3 4 Quadrants

4 9 Regions


6 Location! Location! Location!
RUQ liver gallbladder duodenum (small intestine) pancreas head right kidney and adrenal

7 Location! Location! Location!
RLQ cecum appendix right ovary and tube

8 Location! Location! Location!
LLQ sigmoid colon left ovary and tube LUQ stomach spleen pancreas left kidney and adrenal

9 GI Variations Due to Age
Aging- should not affect GI function unless associated with a disease process Decreased: salivation, sense of taste, gastric acid secretion, esophageal emptying, liver size, bacterial flora Increased: constipation!

10 GI Variations with pregnancy
Decrease in gastric motility High incidence of N, V (r/t pregnancy hormones) and “heartburn” or acid reflux Bowel sounds diminished r/t enlarged uterus displacing intestines Linea nigra- increased pigmentation of abd midline Striae Gravidarum

11 Nursing History - Abdomen
Subjective Data: Ask about: Appetite Wt gain or loss Dysphagia Intolerance to certain foods Any Abdominal Pain of Nausea and Vomiting Bowel movements Any past abdominal problems

12 Nursing History Infants and Children –
Ask: bottle or breast fed, any table foods, how often & how well & how much the baby eat, any problems with constipation, c/o of any abdominal pain Teenagers- Ask: nutritional assessment, activity & exercise patterns, recent wt. loss or gain

13 Nursing History Older Adults Ask: how do you get your groceries?
prepare your meals? do you have any trouble swallowing? how often do your bowels move? how often do you take anything for constipation? Rx / OTC/ herbs what meds do you take?

14 Nursing Assessment Objective Data: General Observation Inspect
Auscultate Percuss Palpate (always last)

15 Focused Health History
Nutrition Allergies Medications Cigarette/tobacco ETOH intake Recreational drug use Stool characteristics Urine characteristics Exposure to infectious dz. Recent stressful life events Possibility of Pregnancy

16 Techniques for Exam Provide privacy
Good lighting/appropriate temp in rm Expose the abdomen Empty bladder Position pt supine, arms by side & head on pillow with knees slightly bent or on a pillow Warm stethoscope & hands Painful areas last Distraction techniques

17 Inspection Overall observation
Abd contour- flat, scaphoid, round, protuberant Abd symmetry and skin color - note any masses, striae, scars, veins, pigmentation Pulsations

18 Auscultation Always done before percussion & palpation
Use diaphragm of stethoscope Listen lightly Start with RLQ

19 Auscultation What makes a bowel sound?
Note character & frequency of bowel sounds (5-30 times/minute) Sounds like….. Listen for 5 minutes before documenting absent bowel sounds Listen for bruits- aortic, renal, iliac, femoral Hyper- gastroenteritis, obstruction, hungry Hypo- pregnancy, peritonitis

20 Percussion Gently tapping on the skin to create a vibration
Detect fluid, gaseous distention and masses Tympany- gas (dominant sound because of air in sm intestine) Dullness- solid masses, distended bladder Percuss liver, spleen ,kidneys

21 Palpation of Abdomen Light palpation- depress about 1 cm. Assess skin pulsations. Always done first- clockwise Deep palpation- depress skin about 5-8 cm. Always assess tender areas last. Watch pt’s expression during palpation

22 Inspection Abnormal Findings
Visible or distended veins- ascites Visible peristalsis- obstruction Spider nevi (cutaneous angiomas)- cirrhosis Asymmetry/ Distention- mass or intestinal obsruction Color changes- jaundice, bluish/cyanotic

23 Abnormal Auscultation
Absence/Hyperactive bowel sounds- “borborygmi” Bruits- “swoosh” Peritoneal Friction Rub- rough, grating heard over liver & spleen- inflammation of peritoneal surface from tumor, infection, etc.

24 Percussion Abnormal Findings
Enlarged organs, palpable masses, distention, ascites Marked tenderness

25 Palpation Abnormal Findings
Tenderness- rebound- done away from painful area- done at end of exam Masses- document location, size, shape, mobile, pulsating, smooth, nodular, firm Firmness or muscle guarding/rigidity- intraabdominal bleeding- DO NOT CONTINUE TO PALPATE!!!!!!

26 Special Procedures Fluid Wave- need 3 hands- feel for impulse of the wave of fluid across the abdomen= ascites Rebound Tenderness- Blumberg’s Sign Iliopsoas Muscle Test- thigh muscle lift R leg and push down on R thigh= appendicitis Obturator Test- lift R leg and rotate at 90 degrees= muscle is irritated by appendicitis Murphy’s Sign- “inspiratory arrest” palpate the liver should be painless= cholecystitis

27 Special Procedures McBurney’s Point- RLQ midclavicular= appendicitis
Referred pain- location of pain is not necessarily where the involved organ is! May be felt where the organ was located in fetal development ex: spleen= L shoulder pain/ kidney= groin pain Hooking technique- palpate the liver- feeling for the liver edge

28 Special Procedures Cullen’s Sign- bluish discoloration around the umbilicus EMERGENCY!!! Kehr’s Sign- abd pain radiating to R shoulder= spleen or pancreatitis

29 Sample Documentation Normal Exam-
Abdomen soft, rounded and symmetric without distention; no lesions or scars, or visible peristalsis. Aorta midline without bruit or visible pulsation; umbilicus inverted and midline without herniation; bowel sounds present in all 4 quadrants. Liver, kidney and spleen non-palpable; no tenderness on palpation. Reports good appetite; no constipation, nausea or diarrhea. Voiding well and denies laxative use.

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