1. ASSESSING THE ABDOMEN

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

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

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

5. 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)

6. 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)

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

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

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

12. 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

13. 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

14. 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.

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

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

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

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

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

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

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

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

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

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

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

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

27. Inspection
Umbilicus:
Position, color, contour, and herniation

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

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

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

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

32. 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

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

34. 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

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

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