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Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
The ABDOMENThe ABDOMENThe ABDOMENThe ABDOMEN
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Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
The AbdomenThe nurse locates and describes abdominal findings using 2 common methods of subdividing the abdomen:Quadrants
Regions
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Abdominal LandmarksPractitioners often use certain landmarks to locate abdominal signs and symptoms
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Organs in the 4 Quadrants (Box 30-7)
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Methods of Abdominal Examination
Involves all 4 methods of examination:
Inspection
Auscultation
Palpation
Percussion
Cause movement or stimulation of the bowel, w/c can ���� bowel motility and thus heighten bowel sounds = false results
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
AssessmentInspection of the abdomen
Skin integrity
Contour and symmetry
Observe the abdominal contour (profile line from
the rib margin to the pubic bone) while standing
at the client’s side when the client is supine
Ask the client to take a deep breath and to hold it
(makes an enlarged liver or spleen more obvious)
If distention is present – measure abdominal girth
Place tape measure around the abdomen @ the
level of the umbilicus
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Measuring abdominal girth
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Inspection of the AbdomenObserve abdominal movements associated w/ respiration, peristalsis, or aortic pulsationsSymmetric movements (respi); visible peristalsis (very lean); aortic pulsations @ epigastric area (thin persons)
Limited movement (pain, dse); visible peristalsis (bowel obstruction); marked aortic pulsations
Observe the vascular patternDilated veins = liver dse, ascites, venocaval obstruction
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Ascites
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Auscultation of the AbdomenFor bowel sounds, vascular sounds, peritoneal friction rubs
Warm hands and stethoscope
Cold hands and stethoscope = client will contract abdl muscles, w/c may be heard during auscultation
N: audible bowel sounds; (-) arterial bruits and friction rub
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Deviations:Hypoactive bowel sounds
Extremely soft and infrequent (1/min)
Indicate ����ed motility associated w/ manipulation of bowel during surgery, inflammation, paralytic ileus, or late bowel obstruction
Hyperactive (����ed) bowel sounds
High-pitched, loud, frequent, rushing sounds (q3 sec.) = borborygmi
����ed intestinal motility = diarrhea, early bowel obstruction, use of laxative
True absence of sounds (none heard in 3 –5 min) = cessation of intestinal motility
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Auscultating bowel sounds
Use the flat-disc diaphragm
Ask when the client last ate
Shortly after or shortly before = normally ����ed
Loudest when meal is long overdue
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Auscultating bowel soundsPlace diaphragm in each of the 4 quadrants over all of the auscultatory sites
Listen for active bowel sounds
Irregular gurgling noises occurring about q5 – 20 secs.
May range from < 1 sec – more than several secs.
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
For Vascular soundsUse bell of the stethoscope over aorta, renal arteries, iliac arteries, and femoral arteries
Listen for bruitsLoud bruit over aortic area = possible aneurysm
Over renal or iliac arteries
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Abdominal aneurysm
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Peritoneal Friction Rubs
Rough, grating sounds like 2 pcs of leather rubbing together
May be caused by inflammation, infection, or abnormal growths
Auscultate splenic site – stethoscope over LL rib cage, ant. axillary line
Ask to deep breathe = accentuate sound of friction rub
Liver site
over LR rib cage
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Percussion of the abdomen
Percuss different areas in each of the 4 quadrants – to det. presence of:
Tympany = gas in stomach and intestines
Dullness = ����, absence, or flatness of resonance over solid masses or fluid
Use systematic pattern:
Begin in RLQ ���� RUQ ���� LUQ ���� LLQ
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Percussion of the abdomen
Normal:
Tympany over stomach and gas-filled bowels
Dullness = over liver or spleen, or full bladder
Deviation:
Large dull areas = associated w/ presence of fluid or a tumor
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Percussion of the liver
To det. its size – begin in the rt. midclavicular line below the level of the umbilicus
Measure distance between lower liver border and upper liver border in centimeters (cm) = liver size
6 – 12 cm (2 ½ - 3 ½ in.) = midclavicularline
4 – 8 cm (1 ½ - 3 in.) = midsternal line
Enlarged size: liver dse.
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Palpation of the AbdomenLight palpation 1st –to detect areas of tenderness and/or muscle guardingSystematically explore all 4 quadrants
N: no tenderness; relaxed w/ smooth consistent tension
D: tenderness, hypersensitivity; superficial masses; localized areas of ����ed tension
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Palpation of the Abdomen
Deep palpation over all 4 quadrants
Sensitive areas last
Depress about 4 – 5 cm (1 ½ - 2 in.)
Note masses and structure of underlying contents
If mass present – size, location, mobility, contour, consistency, tenderness
Check for rebound tenderness – in areas where client complains of pain
(+) rebound tenderness – pain upon release of pressure = peritoneal inflammation
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Bimanual deep palpation
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Palpation of the liverPalpate liver to detect enlargement and tenderness
Normal: not palpable; border feels smooth
Deviation: enlarged; smooth but tender; nodular or hard
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Palpation of the Bladder
Palpate area over symphysis pubis if client’s history indicates possible urinary retention
Normal: bladder not palpable
Deviation: distended; and palpable as smooth, round, tense mass = urinary retention
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Lifespan considerationsInfantsInternal organs proportionately larger than older children and adults = abdomen rounded and tend to protrude
Liver palpable – 1 – 2 cm below rt. intercostal margin
Umbilical hernias – may be present @ birth
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Umbilical hernia
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Children Toddlers – characteristic “pot belly” appearance until 3 – 4 years Late pre-school and school-age – leaner and have flat abdomenVisible peristaltic waves than in adultsMay not be able to pinpoint areas of tenderness Observe facial expressions to det. Areas of maximum tenderness
If ticklish, guarding, or fearful – use task that requires concentration to distract, or have child place hands on examiners hands = “helping” do exam”
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
“Potbelly”
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
Elders Rounded abdomens = due to ���� adipose tissue, ���� muscle tone
Abdominal wall slacker and thinner
Palpation easier and more accurate
Pain threshold higher
Major abdominal problems such as appendicitis or other acute emergencies – may go undetected
GI pain (chest or abdomen) needs to be differentiated from cardiac pain (chest)
GI pain: relieved by food, antacid, upright position
Cardiac pain: aggravated by activity, stress; relieved by rest or nitroglycerine
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
EldersFecal incontinence in confused or neurologically impaired older adults
Colon cancer higher incidence
Change in bowel fxn, rectal bleeding, weight loss
����ed absorption of oral meds
Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN
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