Download abdominal assessment

ASSESSING THE
ABDOMEN
Outcomes



Identify pertinent abdominal history
questions.
Obtain an abdominal history.
Perform an abdominal physical
assessment.
(Continued)
Outcomes
Document pertinent abdominal
assessment findings.
 Identify actual/potential health
problems stated as nursing
diagnosis.
 Differentiate between normal and
abnormal findings.

Structure



Stomach
Small intestines
Large intestines






Urinary tract
Bladder
Kidneys
Liver
Pancreas
Gall bladder
Function
What are the functions of…
Stomach:
Churns food; intrinsic factor for
B12, hydrochloric acid begins
digestion
Small intestines:
Primary site for digestion
Large intestines:
Absorbs sodium and water
(Continued)
Function
What are the functions of…
Liver:
Metabolism; produces bile,
clotting factors; detoxifies drugs
& alcohol; converts glucose to
glycogen; stores vitamins
Pancreas:
Produces insulin and glucagon,
pancreatic enzymes
(Continued)
Function
What are the functions of…
Gall bladder:
Stores and concentrates bile
Spleen:
Stores RBCs, produces RBCs and
macrophages
(Continued)
Function
What are the functions of…
Bladder:
Stores urine
Kidneys:
Remove wastes, help control
B/P, produce erythropoietin
Relationship to Other
Systems

Integumentary

Respiratory

Musculoskeletal

Neurological
Lymphatic

Reproductive
Cardiovascular

Urinary

Endocrine


Developmental
Variations - Children

Proportionately Larger Abdomen



“Protuberance”
Diminishes to Adult Proportion during
Adolescence.
Abdominal Respirations Common


Abdominal Muscles are Underdeveloped
Organs are more easily palpated
Developmental
Variations - Pregnancy

Abdominal Muscles Relax

Later Stage: Uterus pushes Stomach up
& impinges on Diaphragm

Bowel Sounds are Diminished

Due to Pressure and Iron Ingestion



Increased Venous Pressure—Hemorrhoids,
Constipation
Appendix displaced upward and laterally R
Linea Nigra and Stria develop on skin
Developmental
Variations, Con’t.

Older adults






General Slowing of Entire System
Chewing: Dentition problems
Reduction of Saliva, Stomach Acid, Gastric
Motility, Peristalsis
Swallowing, Absorption, Digestion
compromised
Reduction in Muscle Mass & Tone
Diminished response to painful stimuli

May mask abdominal health problems.
Cultural Variations
- African Americans

Sickle Cell Anemia




Obesity


Splenomegaly & Jaundice
Acute Abdominal Pain
Vomiting
Weight > 20% ideal weight
Lactose Intolerance

Abdominal Cramping, Diarrhea
Cultural Variations
- Asian Americans

GI Cancer




Anorexia
Bowel and Digestive Problems
Pain, Problems with weight loss
Lactose Intolerance


Abdominal Cramping
Diarrhea
Cultural Variations
- Jews

Crohn’s Disease



Ulcerative Colitis




Abdominal Pain
Diarrhea
Abdominal Pain
Diarrhea
Rectal Bleeding
Colon Cancer

Changes in Bowel Habits, Blood in Stool,
Constipation
Cultural Variations
- Native Americans

Alcoholism


Diabetes


Liver Disease/Pancreatitis (Jaundice,
anorexia, ascites, pain, steatorrhea)
Polyuria, thirst, weakness, weight loss,
itching
Gallbladder Disease

Pain
Cultural Variations
- European Americans

Lactose intolerance (Mediterranean)


Abdominal Cramping, Diarrhea
Thalassemia (Greek/Italian)

Anemia, Jaundice, Splenomegaly
Case Study


Ann Robichaud,
56-year-old,
divorced, mother
of 2 grown
children, mill
worker
C/O “I’m
constipated all
the time.”
History






Biographical data
Current health status
Past health history
Family history
Review of systems
Psychosocial history
Symptoms
What symptoms would signal an abdominal
problem?





Pain
Change in weight
Change in bowel habits
Indigestion
Nausea and vomiting
Pertinent History Findings



No bowel movement for 4 days
Dull, intermittent, lower
abdominal pain 2/10, walking
makes it worse
“Feels bloated”
(Continued)
Pertinent History Findings




Problem with constipation for past
few years; uses laxatives
Cholecystectomy and
appendectomy
Diet: junk food, high fat
No exercise
Physical Assessment
Anatomical landmarks: abdomen
divided into 4 quadrants (or
nine) or anatomical structures
Approach: inspection,
auscultation, percussion,
palpation
Position: Supine
(Continued)
Inspection
Abdomen:
 Size, shape, symmetry
 Condition of skin: color, lesions,
veins, hair distribution,
hernias
 Movements: respirations,
pulsations, and peristalsis
(Continued)
Inspection
Umbilicus:
 Position, color, contour, and
herniation
Pg 576 in new text; 490 in old text
Auscultating sites for vascular sounds
Auscultation
Bowel sounds (all 4 quadrants):
 Note frequency and pitch
Vascular sounds:
 Bruits over arteries
 Venous hum over liver
(Continued)
Auscultation
Friction rubs:
 Over inflamed organs or tumors
Scratch test:
 Locate lower edge of liver
Percussion
Always percuss before palpating!
Review Assessing
Liver/Spleen Size
(Pg 592 new text; 499
old text; on website for video)
for Lab on Wed.
Percussion
Indirect (mediate): note tympany or
dullness
 All 4 quadrants
 Liver size at right MCL
 Splenic dullness
Fist or blunt:
 Organ tenderness and CVA
tenderness
Palpation
Light:
 Surface characteristics, tenderness,
guarding, turgor
Deep:
 Masses, organs
Organs:
 Liver
 Kidneys
 Spleen
 Aorta
(Continued)
Palpation
Inguinal lymph nodes:
 Horizontal and vertical
Test abdominal reflexes
Additional tests:
 Peritoneal irritation: obturator,
Iliopsoas pg 601, rebound
 Fluid: fluid wave tests, shifting
dullness
Pertinent Physical
Findings




Obese, 5’2”, 175#
Abdomen slightly distended in
lower quadrants
Hypoactive bowel sounds
Tenderness in lower quadrants
Nursing Diagnosis
What actual or
potential
problems can
you identify for
Mrs. Robichaud?