abdominal assessment
DESCRIPTION
ABDOMINAL ASSESSMENT. Abdominal Assessment. Patient needs to be exposed from above the xiphoid process to the symphysis pubis. Also, make sure your patient does not have a full bladder. Place patient in a supine position: pillow under the head and knees. Helps to relax abdominal muscles. - PowerPoint PPT PresentationTRANSCRIPT
Abdominal Assessment
Patient needs to be exposed from above the xiphoid process to the symphysis pubis.
Also, make sure your patient does not have a full bladder.
Place patient in a supine position: pillow under the head and knees.
Helps to relax abdominal muscles.
Abdominal Assessment
Have patient point out any areas of pain or tenderness.
Examine these last. During exam continue to monitor your patient’s
facial expression for pain and discomfort. Use inspection, auscultation, percussion, and
palpation to perform the exam.
Abdominal Assessment
Always auscultate before percussing or palpating.
These manipulations may alter your patient’s bowel motility and resulting bowel sounds.
Abdominal Assessment
Inspect the skin of the abdomen and flank’s for:
1. Scars
2. Dilated veins
3. Stretch marks
4. Rashes
5. Lesions
6. Pigmentation changes
Abdominal Assessment
Look for discoloration over the umbilicus:1. Cullen’s Sign: discoloration over the umbilicus
2. Grey Turner’s Sign: discoloration over the flanks These are both late signs suggesting intra-
abdominal bleeding
Abdominal Assessment
Assess the size and shape of your patient’s abdomen to determine:
1. Scaphoid (concave)
2. Flat
3. Round
4. Distended Ask the patient if it is its usual size and shape
Abdominal Assessment
Check for:1. Bulges
2. Hernias
3. Distended Flanks Ascites appears as bulges in the flanks and
across the abdomen and indicates edema caused by CHF, or liver failure.
Abdominal Assessment
Look at your patient’s umbilicus Note location and contour and observe for any
signs of herniation or inflammation. Check for:1. Visible pulsation
2. Visible peristalsis (wavelike motion of organs moving their contents through the digestive tract). May indicate bowel obstruction.
3. Visible masses
Abdominal Assessment
Next auscultate for bowel sounds and other sounds such as bruits throughout the abdomen.
Gently place the diaphragm on your patient’s abdomen and proceed systematically, listening for bowel sounds in each quadrant.
Note location, frequency, and character Normal bowel sounds consist of a variety of
high-pitched gurgles and clicks that occur every 5-15 seconds.
Abdominal Assessment
More frequent sounds indicate increased bowel motility in conditions such as diarrhea or an early intestinal obstruction.
You may hear loud, prolonged, gurgling sounds known as borborygmi.
These indicate hyperperistalsis. Decreased or absent sounds suggest a paralytic
ileus or peritonitis
Abdominal Assessment
Bruits are swishing sounds that indicate turbulent blood flow.
Listen in areas over abdominal blood vessels such as the aorta and renal arteries
Presence indicates abdominal aortic aneurysm or renal artery stenosis
Abdominal Assessment
Percussing the abdomen produces different sounds based on the underlying tissues.
Sounds help you detect excessive gas and solid or fluid-filled masses
Also help you determine the size and position of solid organs such as the liver and spleen
Percuss the abdomen in the same sequence you used for auscultation
Abdominal Assessment
Note the distribution of tympany and dullness Expect to hear tympany in most of the abdomen Expect dullness over the solid abdominal organs
such as the liver and spleen
Abdominal Assessment
Palpate the abdomen last to detect:1. Tenderness
2. Muscular rigidity
3. Superficial organs and masses Before you begin palpation, ask your patient if
he has any pain or tenderness Palpate that area last, using gentle pressure
with a single finger
Abdominal Assessment
Ask him to cough and tell you if and where he experiences any pain
This is typical for peritoneal inflammation
Abdominal Assessment
Light palpation by moving your hand slowly and just lifting it off the skin.
Use same sequence as for auscultation and percussion
Watch for patient’s face for signs of discomfort
Abdominal Assessment
Identify any masses and note:
1. Size
2. Location
3. Contour
4. Tenderness
5. Pulsations
6. Mobility
Abdominal Assessment
Abdominal pain upon light palpation suggests peritoneal irritation or inflammation
If rigidity or guarding while palpating, determine whether it is voluntary (patient anticipates the pain) or involuntary (peritoneal inflammation)
Abdominal Assessment
Next palpate deeply to detect large masses or tenderness
Use one hand on top of another and push down slowly.
Assess for rebound tenderness by pushing slowly and then releasing your hand quickly off the tender area.
Abdominal Assessment
If you note a protruding abdomen with bulging flanks and dull percussion sounds in dependent areas, you might perform two tests for ascites.
Ascites/Test 1
Assess for areas of tympany and dullness while your patient is supine
Lie him on one side Percuss again, noting once more any areas of
tympany and dullness If your patient has ascites, the area of dullness
will shift down to the dependent side and the area of tympany will shift up.