ASSESSING THE ABDOMEN

Outcomes Identify pertinent abdominal history questions. Obtain an abdominal history. Perform an abdominal physical assessment. (Continued)

Outcomes Document pertinent abdominal assessment findings. Identify actual/potential health problems stated as nursing diagnosis. Differentiate between normal and abnormal findings.

Structure Stomach Small intestines Large intestines Urinary tract Bladder Kidneys Liver Pancreas Gall bladder

Function What are the functions of… Stomach: Churns food; intrinsic factor for B12, hydrochloric acid begins digestion Small intestines: Primary site for digestion Large intestines: Absorbs sodium and water (Continued)

Function What are the functions of… Liver: Metabolism; produces bile, clotting factors; detoxifies drugs & alcohol; converts glucose to glycogen; stores vitamins Pancreas: Produces insulin and glucagon, pancreatic enzymes (Continued)

Function What are the functions of… Gall bladder: Stores and concentrates bile Spleen: Stores RBCs, produces RBCs and macrophages (Continued)

Function What are the functions of… Bladder: Stores urine Kidneys: Remove wastes, help control B/P, produce erythropoietin

Relationship to Other Systems Integumentary Musculoskeletal Lymphatic Cardiovascular Respiratory Neurological Reproductive Urinary Endocrine

Developmental Variations - Children Proportionately Larger Abdomen “Protuberance” Diminishes to Adult Proportion during Adolescence. Abdominal Respirations Common Abdominal Muscles are Underdeveloped Organs are more easily palpated

Developmental Variations - Pregnancy Abdominal Muscles Relax Later Stage: Uterus pushes Stomach up & impinges on Diaphragm Bowel Sounds are Diminished Due to Pressure and Iron Ingestion Increased Venous Pressure—Hemorrhoids, Constipation Appendix displaced upward and laterally R Linea Nigra and Stria develop on skin

Developmental Variations, Con’t. Older adults General Slowing of Entire System Chewing: Dentition problems Reduction of Saliva, Stomach Acid, Gastric Motility, Peristalsis Swallowing, Absorption, Digestion compromised Reduction in Muscle Mass & Tone Diminished response to painful stimuli May mask abdominal health problems.

Cultural Variations - African Americans Sickle Cell Anemia Splenomegaly & Jaundice Acute Abdominal Pain Vomiting Obesity Weight > 20% ideal weight Lactose Intolerance Abdominal Cramping, Diarrhea

Cultural Variations - Asian Americans GI Cancer Anorexia Bowel and Digestive Problems Pain, Problems with weight loss Lactose Intolerance Abdominal Cramping Diarrhea

Cultural Variations - Jews Crohn’s Disease Abdominal Pain Diarrhea Ulcerative Colitis Rectal Bleeding Colon Cancer Changes in Bowel Habits, Blood in Stool, Constipation

Cultural Variations - Native Americans Alcoholism Liver Disease/Pancreatitis (Jaundice, anorexia, ascites, pain, steatorrhea) Diabetes Polyuria, thirst, weakness, weight loss, itching Gallbladder Disease Pain

Cultural Variations - European Americans Lactose intolerance (Mediterranean) Abdominal Cramping, Diarrhea Thalassemia (Greek/Italian) Anemia, Jaundice, Splenomegaly

Case Study Ann Robichaud, 56-year-old, divorced, mother of 2 grown children, mill worker C/O “I’m constipated all the time.”

History Biographical data Current health status Past health history Family history Review of systems Psychosocial history

Symptoms What symptoms would signal an abdominal problem? Pain Change in weight Change in bowel habits Indigestion Nausea and vomiting

Pertinent History Findings No bowel movement for 4 days Dull, intermittent, lower abdominal pain 2/10, walking makes it worse “Feels bloated” (Continued)

Pertinent History Findings Problem with constipation for past few years; uses laxatives Cholecystectomy and appendectomy Diet: junk food, high fat No exercise

Physical Assessment Anatomical landmarks: abdomen divided into 4 quadrants (or nine) or anatomical structures Approach: inspection, auscultation, percussion, palpation Position: Supine (Continued)

Inspection Abdomen: Size, shape, symmetry Condition of skin: color, lesions, veins, hair distribution, hernias Movements: respirations, pulsations, and peristalsis (Continued)

Inspection Umbilicus: Position, color, contour, and herniation

Pg 576 in new text; 490 in old text Auscultating sites for vascular sounds

Auscultation Bowel sounds (all 4 quadrants): Note frequency and pitch Vascular sounds: Bruits over arteries Venous hum over liver (Continued)

Auscultation Friction rubs: Over inflamed organs or tumors Scratch test: Locate lower edge of liver

Percussion Always percuss before palpating! Review Assessing Liver/Spleen Size (Pg 592 & website)

Percussion Indirect (mediate): note tympany or dullness All 4 quadrants Liver size at right MCL Splenic dullness Fist or blunt: Organ tenderness and CVA tenderness

Palpation Light: Surface characteristics, tenderness, guarding, turgor Deep: Masses, organs Organs: Liver Kidneys Spleen Aorta (Continued)

Palpation Inguinal lymph nodes: Horizontal and vertical Test abdominal reflexes Additional tests: Peritoneal irritation: obturator, Iliopsoas pg 601, rebound Fluid: fluid wave tests, shifting dullness

Pertinent Physical Findings Obese, 5’2”, 175# Abdomen slightly distended in lower quadrants Hypoactive bowel sounds Tenderness in lower quadrants

Nursing Diagnosis What actual or potential problems can you identify for Mrs. Robichaud?