NURSING EVALUATION OF THE ABDOMEN

MATHENY MEDICAL AND EDUCATIONAL CENTER

The Abdominal Evaluation

Abdominal Anatomy

GLASS Gallbladder Liver Aorta Stomach Spleen

Pancreas Bowel Appendix Urinary

Bladder Reproductive

Ovaries Uterus

Quadrants

RUQHepatitisGallstonesCholecystisisPancreatitisPNARLQAppendicitisDiverticulitisSBOOvariesHernia

LUQSpleenUlcersGastritis PNA

LLQDiverticulitisConstipationSBOOvarianHernia

Abdominal Exam Sequence

ObserveAuscultatePalpatePercuss

Observation

Shape Flat, Scaphoid Distended

Appliances Gtube, Baclofen pump,

OstomiesScars

Adhesions Obstruction Surgeries

Discolorations/Bruises

Distension Flatus Obstruction Gastroparesis Constipation Ascites

Auscultate

Present or Absent Listen for 2 – 3 minutes Listen in all 4 quadrants

Freqency Normoactive

1 sound q 2-5 secs Hyperactive

Intestinal Inflammation Gastroentritis Obstruction

Hypoactive Serosal Inflammation

Peritonitis Appendicitis

Ileus SBO

Quality High Pitched - Obstruction

Palpation

Use both handsPalpate all four quadrants

Feel for tenderness, masses, organomegaly Start in quadrant opposite of location of pain and save

quadrant with pain till last First do superficial palpation then do deep

Flex hips and knees to relax abdomen if neededWait for expiration for abdomen to relax in

neededRed Flags

Stiff or Rigid abdomen – peritonitis Pain localized to particular quadrant/area

Percussion

Differentiates solid mass or ascites vs air filled space Solid tissue and ascites sounds dull Air filled space sounds tympanic

Used to measure liver

Differential Diagnosis

ConstipationGastroparesisPneumoniaUlcersIrritable Bowel DiseaseSmall Bowel ObstructionVolvulusAppendicitisGallstones/cholecystitisUrinary RetentionOvarian cystsMenstrual pain

Notify Physician

Bilious, bloody, or intractable vomitingBloody stool – bright red or melenaRigid abdomenPoint tenderness in abdomenSignificant/acute abdominal distention

What to Report to MD

VITAL SIGNS!!!Exam findings Distention, Quality of bowel sounds, Location of tendernessHistory should include

Recent GI history Vomiting – bilious, bloody, content Diarrhea – bloody, particularly foul smelling Constipation – know when was last bm

Pertinent GI history if unknown to MD Recent weight Any measures already taken

Venting of gtube, residuals, suppositories given, bowel rest, etc…

THANK YOU!THE END

QUESTIONS????