abdominal assessment cathy gibbs bsn, rn. competencies assess the health status of a patient with a...
TRANSCRIPT
CompetenciesCompetencies
Assess the health status of a patient with a gastrointestinal complaint
Demonstrate the techniques of a gastrointestinal assessment
Relate abnormal physical gastro-intestinal findings to pathological processes
Outline the gastrointestinal variations associated with the aging process
Assess the health status of a patient with a gastrointestinal complaint
Demonstrate the techniques of a gastrointestinal assessment
Relate abnormal physical gastro-intestinal findings to pathological processes
Outline the gastrointestinal variations associated with the aging process
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Patient’s historyCurrent signs & symptomsVital signsLevel of consciousnessAge & genderBowel habits or alterations in
elimination
Patient’s historyCurrent signs & symptomsVital signsLevel of consciousnessAge & genderBowel habits or alterations in
elimination
Common Chief ComplaintsCommon Chief Complaints
Nausea and vomitingAnorexiaDysphagiaDiarrhea or constipation
Nausea and vomitingAnorexiaDysphagiaDiarrhea or constipation
Common Chief ComplaintsCommon Chief Complaints
Abdominal distensionAbdominal pain Increased eructation or flatulenceDysuriaNocturia
Abdominal distensionAbdominal pain Increased eructation or flatulenceDysuriaNocturia
Characteristics of Chief Complaint
Characteristics of Chief Complaint
QualityAssociated manifestationsAggravating factorsAlleviating factorsTiming
QualityAssociated manifestationsAggravating factorsAlleviating factorsTiming
Past Health HistoryPast Health History
MedicalAbdomen specificNonabdomen specific
SurgicalGI procedures
MedicalAbdomen specificNonabdomen specific
SurgicalGI procedures
Past Health HistoryPast Health History
Allergies Injuries/accidentsSocial historyHealth maintenance activitiesCommunicable diseasesFamily health history
Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis
Allergies Injuries/accidentsSocial historyHealth maintenance activitiesCommunicable diseasesFamily health history
Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis
Common MedicationsCommon Medications
Histamine: two antagonists Antibiotics Antacids Antiemetics Anti-diarrheals Laxatives or stool softeners Steroids Chemotherapeutics Anti-flatulents
Histamine: two antagonists Antibiotics Antacids Antiemetics Anti-diarrheals Laxatives or stool softeners Steroids Chemotherapeutics Anti-flatulents
Social HistorySocial History
Alcohol useDrug useTravel historyWork environmentHobbies/leisure activitiesStressEconomic status
Alcohol useDrug useTravel historyWork environmentHobbies/leisure activitiesStressEconomic status
Health Maintenance Activities
Health Maintenance Activities
SleepDietExerciseStress managementUse of safety devicesHealth checkups
SleepDietExerciseStress managementUse of safety devicesHealth checkups
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Stool sampleEvaluate for consistency, color, &
odorOccult bloodStetorrhea
Stool sampleEvaluate for consistency, color, &
odorOccult bloodStetorrhea
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Evaluate dietary programType of food, amount
Assess urineAmount, color, odorFluid intake
Evaluate dietary programType of food, amount
Assess urineAmount, color, odorFluid intake
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Signs of dehydrationDry mucous membranesPoor skin turgorDecreased urine outputIncrease in pulse
Signs of dehydrationDry mucous membranesPoor skin turgorDecreased urine outputIncrease in pulse
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Evaluate laboratory testsPresence of hemorrhoidsSkin color
Yellow, pallor, flushingSphincter control
Reports of control of bowel movements
Incontinence
Evaluate laboratory testsPresence of hemorrhoidsSkin color
Yellow, pallor, flushingSphincter control
Reports of control of bowel movements
Incontinence
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Presence of painNonverbal signs
Flinching & grimacingOnset, location, intensity, duration, &
aggravating factorsPalpate for rebound tenderness
Presence of painNonverbal signs
Flinching & grimacingOnset, location, intensity, duration, &
aggravating factorsPalpate for rebound tenderness
Gastrointestinal System Assessment
Gastrointestinal System Assessment
Signs of shock following traumaPatient’s knowledge of diagnostic
test & procedures
Signs of shock following traumaPatient’s knowledge of diagnostic
test & procedures
Assessment of the Abdomen
Assessment of the Abdomen
EquipmentOrder
InspectionAuscultationPercussionPalpation
EquipmentOrder
InspectionAuscultationPercussionPalpation
Anatomy and PhysiologyAnatomy and Physiology
Abdominal quadrantsRight upperRight lowerLeft upperLeft lower
Abdominal quadrantsRight upperRight lowerLeft upperLeft lower
Anatomy and PhysiologyAnatomy and Physiology
StomachSmall intestineLarge intestineLiverGallbladder
StomachSmall intestineLarge intestineLiverGallbladder
Anatomy and PhysiologyAnatomy and Physiology
PancreasSpleenVeriform appendixKidneys, ureters, and bladderLymph nodes
PancreasSpleenVeriform appendixKidneys, ureters, and bladderLymph nodes
InspectionInspection
ContourSymmetryRectus abdominis musclesPigmentation and colorScarsAscites
ContourSymmetryRectus abdominis musclesPigmentation and colorScarsAscites
InspectionInspection
StriaeRespiratory movementMasses or nodulesVisible peristalsisPulsationUmbilicus
StriaeRespiratory movementMasses or nodulesVisible peristalsisPulsationUmbilicus
InspectionInspection
Normal findingsAbdomen is flat or round, symmetricalUniform in color and pigmentationNo scars or striae presentNo respiratory retractionsNo masses or nodulesRipples of peristalsis may be visibleNon-exaggerated pulsation of the
abdominal aorta may be presentUmbilicus is depressed
Normal findingsAbdomen is flat or round, symmetricalUniform in color and pigmentationNo scars or striae presentNo respiratory retractionsNo masses or nodulesRipples of peristalsis may be visibleNon-exaggerated pulsation of the
abdominal aorta may be presentUmbilicus is depressed
AuscultationAuscultation
Assess all four quadrantsListen for at least 5 minutes
before concluding bowel sounds are absent
Assess all four quadrantsListen for at least 5 minutes
before concluding bowel sounds are absent
Stethoscope placement for Auscultating Abdominal Vasculature
Stethoscope placement for Auscultating Abdominal Vasculature
Abdominal Assessment Landmarks
Abdominal Assessment Landmarks
1. Xiphoid process2. Costal margin3. Abdominal
midline4. Umbilicus5. Rectus Abdominis
Muscle6. Anterior Superior
Iliac Spine7. Inguinal Ligament8. Symphysis Pubis
1. Xiphoid process2. Costal margin3. Abdominal
midline4. Umbilicus5. Rectus Abdominis
Muscle6. Anterior Superior
Iliac Spine7. Inguinal Ligament8. Symphysis Pubis
AuscultationAuscultation
Normal findings Bowel sounds are heard in all
quadrantsUsually sounds are high pitchedOccur 5 to 30 times per minute
Normal findings Bowel sounds are heard in all
quadrantsUsually sounds are high pitchedOccur 5 to 30 times per minute
AuscultationAuscultation
Abnormal findings: absent, hypoactive or hyperactive bowel sounds
Pathophysiological indicationsAbsent and hypoactive bowel
sounds may indicate decreased motility and possible obstruction
Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis
Abnormal findings: absent, hypoactive or hyperactive bowel sounds
Pathophysiological indicationsAbsent and hypoactive bowel
sounds may indicate decreased motility and possible obstruction
Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis
PercussionPercussion
Percuss all four quadrantsAssess liver span, liver descent,
margins of spleen, stomach, kidneys, bladder
Sounds heard: tympany or dullness
Percuss all four quadrantsAssess liver span, liver descent,
margins of spleen, stomach, kidneys, bladder
Sounds heard: tympany or dullness
Normal FindingsNormal Findings
Tympany heard over air-filled areas, such as stomach and intestines
Dullness heard over solid areas, such as liver, spleen, or a distended bladder
No tenderness elicited over kidneys and liver
Empty bladder is not percussable above the symphysis pubis
Tympany heard over air-filled areas, such as stomach and intestines
Dullness heard over solid areas, such as liver, spleen, or a distended bladder
No tenderness elicited over kidneys and liver
Empty bladder is not percussable above the symphysis pubis
Abnormal FindingsAbnormal Findings
Dullness over areas where tympany is normally heardThis finding may indicate a mass
or tumor, ascites, full intestine, pregnancy
Liver span > 12 cm or < 6 cmThis finding may indicate
hepatomegaly or cirrhosis
Dullness over areas where tympany is normally heardThis finding may indicate a mass
or tumor, ascites, full intestine, pregnancy
Liver span > 12 cm or < 6 cmThis finding may indicate
hepatomegaly or cirrhosis
Abnormal FindingsAbnormal Findings
Costovertebral angle tenderness May indicate pyelonephritis
Ability to percuss a recently emptied bladder May indicate urinary retention
Costovertebral angle tenderness May indicate pyelonephritis
Ability to percuss a recently emptied bladder May indicate urinary retention
PalpationPalpation
Light vs. DeepPalpate all quadrantsNormal findings
No tendernessAbdomen feels softNo muscle guarding
Light vs. DeepPalpate all quadrantsNormal findings
No tendernessAbdomen feels softNo muscle guarding
Abnormal FindingsAbnormal Findings
Tenderness on palpationMay indicate inflammation, masses,
or enlarged organsMuscle guarding on expiration
May indicate peritonitisPresence of masses, bulges, or
swellingMay indicate enlarged organs,
tumors, cholecystitis, hepatitis, cirrhosis
Tenderness on palpationMay indicate inflammation, masses,
or enlarged organsMuscle guarding on expiration
May indicate peritonitisPresence of masses, bulges, or
swellingMay indicate enlarged organs,
tumors, cholecystitis, hepatitis, cirrhosis
Abnormal FindingsAbnormal Findings
Liver is palpable below the costal marginMay indicate CHF, hepatitis, cirrhosis,
encephalopathy, cancerSpleen is palpable
May indicate inflammation, CHF, cirrhosis, mononucleosis
Kidneys are palpableMay indicate hydronephrosis,
neoplasms, polycystic kidney disease
Liver is palpable below the costal marginMay indicate CHF, hepatitis, cirrhosis,
encephalopathy, cancerSpleen is palpable
May indicate inflammation, CHF, cirrhosis, mononucleosis
Kidneys are palpableMay indicate hydronephrosis,
neoplasms, polycystic kidney disease
Abnormal FindingsAbnormal Findings
Aorta width > 4 cmMay indicate abdominal aortic aneurysm
Able to palpate recently emptied bladderMay indicate urinary retention
Palpable inguinal lymph nodes > 1 cm in diameter or tender nodesMay indicate systemic infections, cancer
Aorta width > 4 cmMay indicate abdominal aortic aneurysm
Able to palpate recently emptied bladderMay indicate urinary retention
Palpable inguinal lymph nodes > 1 cm in diameter or tender nodesMay indicate systemic infections, cancer