1. Week 7 Abdominal Assessment: Bowel Elimination

2. Learning Objectives 1. Describe and list factors that affect elimination. 2. Explain common physical assessment procedures used to evaluate elimination health of patients across the lifespan. 3. Identify priority elimination assessment findings. 4. Differentiate normal elimination assessment from abnormal findings. 5. Explain the process for assessment of the abdomen and bowel/bladder elimination.

3. Assessment Related to Elimination

4. Elimination: The process of and ability to rid the body of waste.

5. Q. How is waste excreted from the body? A. Feces, sweat, and urine

6. Abdominal Assessment Inspect Auscultate Percuss Palpate

7. Abdominal Assessment Inspect- What might you expect to see normally – what might you see that could mean a problem?

8. Hematoma or bruising

9. Striae (stretch marks)are seen when a person grows or gains weight rapidly or has certain diseases or conditions.

10. Note piercings/foreign objects…

11. Especially areas which may be infected

12. Observe for surgical scars, or scars resulting from traumatic injury.

13. Inspect for bulges or masses

14. Massive Abdominal Hernia

15. Abdominal/Pelvic Mass

16. Abdominal Mass

18. Hernias

19. Scrotal Hernia Large indirect inguinal hernias pass through the internal inguinal ring, down the inguinal canal as far as the external ring, and into the neck of the scrotum. In this example a huge inguinal hernia has become incarcerated within the scrotal compartment. A para- umbilical hernia is also present in this man with ascites.

20. Auscultate for bowel sounds in all for quadrants

22. Percuss- Tympany is heard over the stomach and gas filled bowels. Dullness is heard over solid organs or a mass, tumor or fecal

23. Palpate- Gently palpate all four quadrants. Abdomen should be soft and non-tender (no pain)

24. Guarding- Abdominal pain

25. Bowel Habits Color Consistency Frequency When was your last Bowel Movement? How often do you move your bowels? What is your normal pattern?

27. The Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the form of human feces into seven categories. The form of the stool depends on the time it spends in the colon. Type 1: Separate hard lumps, like nuts (hard to pass) Type 2: Sausage-shaped, but lumpy Type 3: Like a sausage but with cracks on its surface Type 4: Like a sausage or snake, smooth and soft Type 5: Soft blobs with clear cut edges (passed easily) Type 6: Fluffy pieces with ragged edges, a mushy stool Type 7: Watery, no solid pieces. Entirely liquid Types 1 and 2 indicate constipation, with 3 and 4 being the "ideal stools" especially the latter, as they are the easiest to pass, and 5–7 being further tending towards diarrhea or urgency. However there are drawbacks to the type 4 stool, as multiple wipes are often required to shift its stubborn presence from the anus.

28. The Bristol Stool Scale or Bristol Stool Chart is sometimes referred to in the UK as the "Meyers Scale", it was developed by Heaton at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997.

29. End of Week 7