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Abdomen AssessmentAbdomen Assessment

D. Tanner, RN, MSND. Tanner, RN, MSN

NUR 211NUR 211Fall SemesterFall Semester

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Anatomy of the AbdomenAnatomy of the Abdomen

4 Quadrants RUQ, RLQ, LUQ,4 Quadrants RUQ, RLQ, LUQ,LLQLLQ

MidlineMidline

9 Regions9 Regions-- epigastric,epigastric,umbilical, suprapubicumbilical, suprapubic

The word "abdomen" has aThe word "abdomen" has acurious story behind it. Itcurious story behind it. Itcomes from the Latincomes from the Latin"abdodere", to hide. The idea"abdodere", to hide. The ideawas that whatever was eatenwas that whatever was eatenwas hidden in the abdomen.was hidden in the abdomen.

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4 Quadrants4 Quadrants

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9 Regions9 Regions

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Location! Location! Location!Location! Location! Location!

RUQRUQ

liverliver

gallbladdergallbladderduodenum (smallduodenum (smallintestine)intestine)

pancreas headpancreas head

right kidney and adrenalright kidney and adrenal

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Location! Location! Location!Location! Location! Location!

RLQRLQ

cecumcecum

appendixappendix

right ovary and tuberight ovary and tube

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Location! Location! Location!Location! Location! Location!

LLQLLQ

sigmoid colonsigmoid colonleft ovary and tubeleft ovary and tube

LUQLUQ

stomachstomachspleenspleenpancreaspancreasleft kidney and adrenalleft kidney and adrenal

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GI Variations Due to AgeGI Variations Due to Age

AgingAging-- should not affectshould not affectGI function unlessGI function unlessassociated with a diseaseassociated with a disease

processprocess

Decreased: salivation,Decreased: salivation,sense of taste, gastricsense of taste, gastric

acid

secretion,acid

secretion,esophageal emptying,esophageal emptying,liver size, bacterial floraliver size, bacterial flora

Increased: constipation!Increased: constipation!

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GI Variations with pregnancyGI Variations with pregnancy

Decrease in gastricDecrease in gastricmotilitymotility

High incidence of N, VHigh incidence of N, V

(r/t pregnancy hormones)(r/t pregnancy hormones)and heartburn or acidand heartburn or acidrefluxreflux

Bowel sounds diminishedBowel sounds diminishedr/t enlarged uterusr/t enlarged uterusdisplacing intestines

displacing intestines

Linea nigraLinea nigra-- increasedincreasedpigmentation of abdpigmentation of abdmidlinemidline

Striae GravidarumStriae Gravidarum

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Nursing HistoryNursing History -- AbdomenAbdomen

Subjective DataSubjective Data::Ask about:Ask about:AppetiteAppetiteWt gain or lossWt gain or lossDysphagiaDysphagiaIntolerance to certainIntolerance to certainfoodsfoodsA

nyAbd

ominal Pain ofA

nyAbd

ominal Pain ofNausea and VomitingNausea and VomitingBowel movementsBowel movementsAny past abdominalAny past abdominalproblemsproblems

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Nursing HistoryNursing History

Infants and ChildrenInfants and Children

Ask:bottle or breast fed, any table foods,Ask:bottle or breast fed, any table foods,how often & how well & how much thehow often & how well & how much thebaby eat, any problems with constipation,baby eat, any problems with constipation,c/o of any abdominal painc/o of any abdominal pain

TeenagersTeenagers--

Ask: nutritional assessment, activity &Ask: nutritional assessment, activity &exercise patterns, recent wt. loss or gainexercise patterns, recent wt. loss or gain

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Nursing HistoryNursing History

Older AdultsOlder Adults

Ask: how do you get your groceries?Ask: how do you get your groceries?

prepare your meals?prepare your meals?

do you have any trouble swallowing?do you have any trouble swallowing?

how often do your bowels move?how often do your bowels move?

how often do you take anything forhow often do you take anything forconstipation? Rx / OTC/ herbsconstipation? Rx / OTC/ herbs

what meds do you take?what meds do you take?

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Nursing AssessmentNursing Assessment

Objective DataObjective Data::

General ObservationGeneral Observation

InspectInspect

AuscultateAuscultate

PercussPercussPalpate (always last)Palpate (always last)

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Focused Health HistoryFocused Health History

NutritionNutrition AllergiesAllergies MedicationsMedications Cigarette/tobaccoCigarette/tobacco ETOH intakeETOH intake Recreational drug useRecreational drug use Stool characteristicsStool characteristics

Urine characteristicsUrine characteristics Exposure to infectious dz.Exposure to infectious dz. Recent stressful lifeRecent stressful life

eventsevents Possibility of PregnancyPossibility of Pregnancy

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Techniques for ExamTechniques for Exam

Provide privacyProvide privacy

Good lighting/appropriate temp in rmGood lighting/appropriate temp in rm

Expose the abdomenExpose the abdomen Empty bladderEmpty bladder

Position pt supine, arms by side & head onPosition pt supine, arms by side & head onpillow with knees slightly bent or on a pillowpillow with knees slightly bent or on a pillow

Warm stethoscope & handsWarm stethoscope & hands

Painful areas lastPainful areas last

Distraction techniquesDistraction techniques

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InspectionInspection

Overall observationOverall observation

Abdcontour

Abdcontour-- flat,flat,scaphoid, round,scaphoid, round,

protuberantprotuberant

Abd symmetry and skinAbd symmetry and skin

colorcolor -- note any masses,note any masses,striae, scars, veins,striae, scars, veins,pigmentationpigmentation

PulsationsPulsations

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AuscultationAuscultation

Always done beforeAlways done beforepercussion &percussion &

palpationpalpation

Use diaphragm ofUse diaphragm ofstethoscopestethoscope

Listen lightlyListen lightly

Start with RLQStart with RLQ

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AuscultationAuscultation

What makes a bowel sound?What makes a bowel sound?

Note character & frequency ofbowel sounds (5Note character & frequency ofbowel sounds (5--

30 times/minute)30 times/minute) Sounds like..Sounds like..

Listen for 5 minutes before documenting absentListen for 5 minutes before documenting absentbowel soundsbowel sounds

Listen for bruitsListen for bruits-- aortic, renal, iliac, femoralaortic, renal, iliac, femoral HyperHyper-- gastroenteritis, obstruction, hungrygastroenteritis, obstruction, hungry

HypoHypo-- pregnancy, peritonitispregnancy, peritonitis

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PercussionPercussion

Gently tapping on the skin to create aGently tapping on the skin to create avibrationvibration

Detect fluid, gaseous distention andDetect fluid, gaseous distention andmassesmasses

TympanyTympany-- gas (dominant soundbecausegas (dominant soundbecause

of air in sm intestine)of air in sm intestine)

DullnessDullness-- solid masses, distendedbladdersolid masses, distendedbladder

Percuss liver, spleen ,kidneysPercuss liver, spleen ,kidneys

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Palpation ofAbdomenPalpation ofAbdomen

Light palpationLight palpation-- depress about 1 cm. Assess skindepress about 1 cm. Assess skinpulsations. Always done firstpulsations. Always done first-- clockwiseclockwise

Deep palpationDeep palpation-- depress skin about 5depress skin about 5--8 cm.8 cm.

Always assess tender areas last.Always assess tender areas last.

Watch pts expression during palpationWatch pts expression during palpation

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Inspection Abnormal FindingsInspection Abnormal Findings

Visible or distended veinsVisible or distended veins-- ascitesascites

Visible peristalsisVisible peristalsis-- obstructionobstruction

Spider nevi (cutaneous angiomas)Spider nevi (cutaneous angiomas)-- cirrhosiscirrhosis

Asymmetry/ DistentionAsymmetry/ Distention-- mass or intestinalmass or intestinalobsructionobsruction

Color changesColor changes-- jaundice,

bluish/cyanoticjaun

dice,

bluish/cyanotic

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Abnormal AuscultationAbnormal Auscultation

Absence/Hyperactive bowel soundsAbsence/Hyperactive bowel sounds--borborygmiborborygmi

BruitsBruits-- swooshswoosh

Peritoneal Friction RubPeritoneal Friction Rub-- rough, grating heardrough, grating heardover liver & spleenover liver & spleen-- inflammation of peritonealinflammation of peritonealsurface from tumor, infection, etc.surface from tumor, infection, etc.

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Percussion Abnormal FindingsPercussion Abnormal Findings

Enlarged organs, palpable masses,Enlarged organs, palpable masses,distention, ascitesdistention, ascites

Marked tendernessMarked tenderness

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Palpation Abnormal FindingsPalpation Abnormal Findings

TendernessTenderness-- reboundrebound-- done away from painfuldone away from painfulareaarea-- done at end of examdone at end of exam

MassesMasses-- document location, size, shape, mobile,document location, size, shape, mobile,pulsating, smooth, nodular, firmpulsating, smooth, nodular, firm

Firmness or muscle guarding/rigidityFirmness or muscle guarding/rigidity--intraabdominal bleedingintraabdominal bleeding-- DO NOT CONTINUEDO NOT CONTINUETO PALPATE!!!!!!TO PALPATE!!!!!!

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Special ProceduresSpecial Procedures

Fluid WaveFluid Wave-- need 3 handsneed 3 hands-- feel for impulse offeel for impulse ofthe wave of fluid across the abdomen= ascitesthe wave of fluid across the abdomen= ascites

Rebound TendernessRebound Tenderness-- Blumbergs SignBlumbergs Sign

Iliopsoas Muscle TestIliopsoas Muscle Test-- thigh muscle lift R leg andthigh muscle lift R leg andpush down on R thigh= appendicitispush down on R thigh= appendicitis

Obturator TestObturator Test-- lift R leg and rotate at 90lift R leg and rotate at 90degrees= muscle is irritatedby appendicitisdegrees= muscle is irritatedby appendicitis

Murphys SignMurphys Sign-- inspiratory arrest palpate theinspiratory arrest palpate the

liver shouldbe painless= cholecystitisliver shouldbe painless= cholecystitis

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Special ProceduresSpecial Procedures

Cullens SignCullens Sign-- bluish discoloration aroundbluish discoloration aroundthe umbilicus EMERGENCY!!!the umbilicus EMERGENCY!!!

Kehrs SignKehrs Sign-- abd pain radiating to Rabd pain radiating to Rshoulder= spleen or pancreatitisshoulder= spleen or pancreatitis

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