1. Assessing the Abdomen

2. Need to know location and function of underlying ( ) Routine after abdominal surgery or after GI procedure/test ( ), auscultate, then ( )

3. Assessment Abdominal or ( ) back pain – Location, onset, frequency, precipitating factors, aggravating factors, type of pain, and severity Movement and ( ) Normal bowel habits – Frequency and character of stools; recent changes; intake; meds related

4. Assessment If patient has had abdominal surgery, trauma, or diagnostic tests of ( ) Recent weight changes or intolerance to diet ( ), belching, flatulence, hematemesis, ( ), heartburn, diarrhea, or constipation Determine if taking anti-inflammatory meds or ( )

5. Assessment Review history for: – health care occupation – ( ) – intravenous drug use – household or sexual contact with HBV carrier – Sexually active heterosexual person – Sexually active homosexual or bisexual man – International traveler in areas of high ( )

6. Steps for Assessment Prepare patient – Ask if needs to empty bladder/bowels – Keep upper chest and legs draped – Warm room – Have patient lie supine with arms at sides and knees slightly bent – Maintain conversation except during ( ) – Ask to point to ( ) areas

7. Steps for Assessment Identify landmarks that divide abdominal regions – Tip of ( ) process to symphysis pubis – Line intersects ( )

8. Steps for Assessment Inspect skin of surface of abdomen for color, scars, venous patterns, rashes, lesions, stretch marks, and ( ) If you note bruising, ask if patient self- administers injections

9. Steps for Assessment Inspect contour, symmetry, and surface motion of abdomen Note any masses, bulging, or ( ) If abdomen is distended, note if it is generalized – Fat – ( )- flanks do not bulge – Feces – Fluids- flanks bulge – ( ) – Full Bladder – False pregnancy – Fatal Tumor – unilateral bulging or distention – ( )- symmetrical bulge in lower abdomen

10. Steps for Assessment If you suspect distention, measure ( ) by placing tape measure around abdomen at level of umbilicus If patient has and ( ) connected to suction, turn off momentarily

11. Steps for Assessment Auscultate bowel sounds – Place diaphragm of the stethoscope lightly over each of ( ) quadrants – Ask patient not to talk – Listen until you hear repeated gurgling or bubbling sounds in each quadrant – Describe as ( ), hyperactive, hypoactive, or ( ) Listen for 5 minutes over each quadrant before deciding they are absent

12. Steps for Assessment Normal- irregularly every ( ) seconds ( )- cessation of gastric motility Hyperactive- diarrhea or early intestinal obstruction Hypoactive- paralytic ileus or peritonitis – May be after ( ) for 24 hours or more

13. Steps for Assessment Place ( ) of stethoscope over the epigastric region of abdomen and each quadrant – Vascular ( ) sound Stop and notify dr. Do not palpate or percuss Lightly palpate over each abdominal quadrant – Painful areas ( ) – Note muscular resistance, distention, tenderness, and superficial masses or organs – Observe face for signs of discomfort – Note if abdomen is firm or soft

14. Steps for Assessment Just below umbilicus and above symphysis pubis, palpate for smooth, rounded mass If masses are palpated note size, location, shape, consistency, tenderness, mobility, and texture If tenderness present, test for ( ) tenderness by pressing slowly and deeply into the involved area and then let go quickly ( )

15. Inflammation of appendix Often lies on back or sides with knees flexed to decrease pain Sharp pain directly over irritated peritoneum 2-12 hours after onset ( ) pain Rebound tenderness Anorexia, N/V

16. ( ) Obstruction of cystic duct causing inflammation or distention of gallbladder Murphy’s sign: Apply gentle pressure to ( ) Sharp pain and increased respiratory rate when patient takes a ( )

17. Constipation Disruption in normal bowel pattern – Opioid use, inadequate fiber and fluid intake Generalized discomfort Distention Palpation of hard mass in ( ) May have N/V

18. ( ) Chronic inflammatory lesion of ileum Steady colicky pain in ( ) Cramping, tenderness, flatulence, nausea, fever, diarrhea Bloody stools, weight loss, weakness, fatigue May have tender mass in ( )

19. ( ) Inflammation of stomach and intestinal tract Generalized abdominal discomfort ( ) Nausea Vomiting Diarrhea Abdominal Cramping

20. ( ) Inflammation of pancreas associated with alcoholism and ( ) disease Steady severe epigastric pain close to umbilicus and radiates to back Abdominal rigidity and ( ) Pain not relieved by vomiting and worse lying ( )

21. ( ) Obstruction of small bowel that occurs after abdominal surgery or use of anticholinergic medications Generalized severe abdominal distention ( ) Decreased or absent bowel sounds

22. Peptic Ulcers Damage of GI mucosa at any area of GI tract May be caused by ( ) or NSAIDs Aggravated by smoking and excessive alcohol use Gastric: dull epigastric pain, early satiety; not usually relieved by food or antacids

23. Peptic Ulcers ( ): pain is episodic, 30 min- 2 h; aching burning or gnawing epigastric pain; pain usually ( ) after meals and at night; often relieved by food/antacid Both: complaints of fullness, epigastric discomfort, nausea, abdominal distention, bloating, ( ), weight loss