Assessment of the Abdomen Liz Mathewson PN 2 Health Assessment Summer 2007

What are we talking about? We are talking about the abdomen It is not a body system but the largest cavity of the body with many organs and structures These organs belong to a variety of systems of the body We will cover the pelvis in the reproductive system assessment

Alimentary Canal Begins at Pharynx; Ends at Anus

Urinary Tract

What influences a healthy abdomen? Age, Developmental level Race, Ethnicity, Culture Work history Living conditions Socioeconomics Emotional well-being

Age and Developmental Stage Infants & Newborn Abdomen is round Umbilical cord (2 A’s, 1 V) is ligated at delivery Toddler: Has “pot belly”; resps are abdominal Children: Swallow more air = great sounds Larger liver in children

The Pregnant Female Uterus enlarges and moves into abdominal cavity By 14 th week the fundus is above the pubic bone and palpable By 36 th week fundus is high in abd, close to diaphragm and compresses many abd structures

The older adult Abdomen more rounded or produberant due to increased adipose tissue, decreased muscle tone and reduced connective tissue Soft and relaxed Decrease in saliva and digestive enzymes, peristalsis, intestinal absorption and intestinal activity Loss of teeth or ill fitting dentures

Psychosocial Considerations Stress Self-perception in all age groups

Cultural Considerations Chronic Hep C in African Americans and Hispanics Liver disease from alcohol and drugs more frequent in Native and African Americans Gallstones and GB cancer more frequent in Mexican and Native Americans African Americans have more colon cancer than Caucasians

Cultural Considerations H pylori occurs more frequently in African Americans and Hispanics Obesity: 54% of adults; 25% children Japanese greater chance of gastric ca Lactose intolerance greater in non- Caucasians

Nursing Consideration related to culture Language and cultural factors must be considered to avoid miscommunication and misinterpretation of info re: dx Nurse must be sensitive to cultural issues regarding disrobing for abd assessment Females may require presence of another female when examiner is male

Interview questions Describe your appetite and weight; Describe your bowel habits; what does stool look like History of abd disease or infection Do you have N, difficulty swallowing or chewing Pain (PQRSTU) Travel?

Questions re: Infants Is the baby breast-fed or bottle fed? Does the baby tolerate the feeding? Is the baby colicky? What do you do to relieve the colic? How much water does the baby drink?

Questions re: pregnant mum Are you experiencing any N, V, heart burn or flatulence? Are you experiencing any elimination problems such as consitipation?

The Abdominal Assessment As with all assessment we use: Inspection Auscultation Percussion Palpation

Inspection Determine the contour of the abdomen Observe the position of the umbilicus Observe skin colour Observe location and characteristics of lesions, scars, and abd markings Observe for symmetry, bulging or masses Observe for abdominal wall movement

Auscultate Auscultate for bowel sounds Auscultate for vascular sounds Auscultate for friction rubs Begin in RLQ and then proceed through each of the remaining quadrants Count the sounds for 60 seconds

Percussion Used to determine the size of solid organs Used to detect presence of masses, fluid or air Estimate the size of the liver and spleen Usually performed by physician or advanced practice nurse Sound is called tympanic or dull

Palpation Determines the size and location of abd organs and to assess for the presence of masses or tenderness Consists of light and deep palpation Only physicians or AP nurses do deep Will not be tested on registration exams any more.

Abnormalities Abnormal abdominal sounds Abdominal pain Abdominal hernias

Referred Pain

Additional Tests Blood Work Urine tests Stool tests Diagnostic Imaging –Upper GI and SB series –Ba Enema

Urinary Tract Assessment

Developmental Assessment Considerations Infants and Children: Increased risk of fluid and electrolyte imbalances at this stage Assess for hygiene issues…excessive diaper rash etc Undescended testacies, non-central meatus Bedwetting;

The Pregnant Female 1 st trimester enlarged uterus pushes on bladder = increased urination Frequency in 2 nd and 3 rd trimesters as fetus descends into pelvis Amount of urine produced increases and often + for sugar

The Older Adult Kidneys loose wt Blood flow to kidneys decreases Loss of filtration; creatinine clearance decreases Decreased ability to concentrate and dilute urine Decreased sensation of thirst affects urine Nocturia Overall decrease in kidney function: BP regulation; elimination of waste; hydration

Psychosocial Considerations Social isolation from incontinence Stress my lead to UTI’s UTI’s in females from sexual trauma; intercourse with new partner; coital frequency; Assess sexual abuse in recurrent UTI’s in children

Cultural and Environmental Privacy and modesty during eval Some cultures do not want body fluid examined by stranger Female present for female exam African and Asian American’s prone to renal calculi African American prone to hypertension

Questions to Ask Normal patterns; changes in pattern Do you feel you empty your bladder? Do you have control? Do you need to get up at night? Do you have difficulty starting the stream? Are you embarrassed by your urinary problem? History of urinary disease or infection? Smoker? Second hand smoker? Work place exposure Sexual practices?

Questions re: symptoms Appearance of urine Discharge from urethra Skin changes Short of breath Chills Change in cognition Pain Lifestyle

Specific Tests Blood tests –Creatinine –BUN –BUN creatinine ratio Urine tests –Colour, odour, turbidity, specific gravity, pH, glucose, ketone bodies –C & S –Creatinine

Scopes