Assessment of Abdomen

CHAPTER Examination InspectionInspection AuscultationAuscultation PercussionPercussion PalpationPalpation 9

CHAPTER Abdominal quadrants Upper right quadrantUpper right quadrant Upper left quadrantUpper left quadrant Lower right quadrantLower right quadrant Lower left quadrantLower left quadrant 9 Abdominal Structure and Function

CHAPTER 9 Abdominal quadrants

CHAPTER Equipment needed The only equipment needed are: StethoscopeStethoscope cloth or plastic ruler cloth or plastic ruler PencilPencil Examination tableExamination table LightLight Small pillowSmall pillow Drapes to cover the patientDrapes to cover the patient 9

CHAPTER Subjective History AppetiteAppetite DysphagiaDysphagia Food intoleranceFood intolerance Nausea /VomitingNausea /Vomiting Bowel habitsBowel habits Past abdominal historyPast abdominal history MedicationsMedications Nutritional assessmentNutritional assessment Abdominal pain OnsetOnset LocationLocation DurationDuration CharacteristicsCharacteristics Associated findingsAssociated findings Relieving factorsRelieving factors Tx attemptedTx attempted 9

CHAPTER The Examination ClientClient –Empty bladder, disrobe & gown, supine, head on pillow, knees bent, arms at side or across chest, have pt ID any area of pain NurseNurse –Warm hands & stethoscope, warm environment, good lighting, approach slowly, monitor pt’s face during exam, tender areas last Inspect, Auscultate, Percuss, Palpate- light & deepInspect, Auscultate, Percuss, Palpate- light & deep 9

CHAPTERInspection Contour - flat, rounded. Symmetry-Umbilicus Skin - texture, color, lesions, veins, turgor Surface motion - pulsations or peristalsis Respiratory movement Hair distribution Demeanor 9

CHAPTER Abdomen - Hernia 9

CHAPTER Auscultation Use diaphragm high pitchedUse diaphragm high pitched hold lightly against skinhold lightly against skin Begin RLQ (ileocecal valve area)Begin RLQ (ileocecal valve area) Bowel soundsBowel sounds character & frequencycharacter & frequency originate from air & fluid movement thru small intestinesoriginate from air & fluid movement thru small intestines hi pitched, gurgling, cascading, irregular,hi pitched, gurgling, cascading, irregular, 5-30 times/min, depends on last time pt ate5-30 times/min, depends on last time pt ate 9

CHAPTER Auscultation cont. FindingsFindings –Normal –hypoactive - absent, slow ie) surgery, inflammation –hyperactive - loud, rushing, tinkling – hyper peristalsis, ”stomach growling” Listen for 5 minutes before deciding absentListen for 5 minutes before deciding absent 9

CHAPTER Auscultation cont. Vascular soundsVascular sounds –Bruits- pulsatile blowing sound with artery occlusion (use firmer pressure) –aorta –renal –iliac –femoral –Venous hum- periumbilical region –Peritoneal friction rub 9

CHAPTER Palpation--Specific Organs LiverLiver SpleenSpleen KidneyKidney AortaAorta 9

CHAPTER Special Procedures Blumberg sign (Appendix test)Blumberg sign (Appendix test) –Rebound tenderness Murphy’s sign (Gallbladder test)Murphy’s sign (Gallbladder test) HerniasHernias 9