Download PALPATION WHY?

Abdomen
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
Right Upper Quadrant
(RUQ)

Left Upper Quadrant
(LUQ)
• Liver
• Stomach
• Gallbladder
• Spleen
• Duodenum
• Left lobe of liver
• Head of pancreas
• Body of pancreas
• Right kidney and adrenal
• Left kidney and adrenal
gland
• Hepatic flexure of colon
• Part of ascending and
transverse colon
gland
• Splenic flexure of colon
• Part of transverse and
descending colon
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 Right
lower quadrant
(RLQ)
• Cecum
• Appendix
 Left
lower
quadrant
(LLQ)
• Part of descending
• Right ovary and tube
• Right ureter
•
• Right spermatic cord
•
•
•
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colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
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Aorta
 Uterus, if enlarged
 Bladder, if distended

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 The
peritoneum,
a serous membrane,
lines the cavity and forms
a protective cover for
many of the abdominal
structures.
 Peritonitis:
gradual/sudden
onset;pain generalized or
localized; dull/severe;
guarding;
pain on deep inspiration
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The mesentery
a fan-shaped fold
of the peritoneum,
covers most of the
small intestine and
anchors it to the
posterior abdominal
wall.
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A
27-foot tube
from mouth to anus
 Parts
• Esophagus: 10”long
(posterior to trachea)
• Stomach
• Small intestine: 21’ long
• Large intestine (colon):
to 5 feet long
4.5
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Slide 12
 Functions
• Ingest and digest food
• Absorb nutrients, electrolytes, and water
• Excrete wastes
 Peristalsis
moves food along tract under
autonomic nervous system control.
http://video.search.yahoo.com/video/play;_ylt=A2KLqIR_8BlVnSAAKcA0nIlQ;_ylu=X
3oDMTByZjF2ZHFmBHNlYwNzcgRzbGsDdmlkBHZ0aWQDBGdwb3MDNw-?p=peristalsis&vid=3e6d71e1d30e8badbeb252d72faee6fa&l=00%3A57&turl=http%3A
%2F%2Fts2.mm.bing.net%2Fth%3Fid%3DVN.608052195787997517%26pid%3D15.1
&rurl=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Do18UycWRsaA&tit=
Peristaltic+Wave+in+the+Gastric+Antrum&c=2&sigr=11bdaf8tm&sigt=116kg5o2q&sig
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
What are
they?
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 Appetite
 Dysphagia
 Food
intolerance
 Abdominal pain
 Nausea and vomiting
 Bowel habits
 Past abdominal history
 Medications
 Nutritional assessment
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Any
additional
history
specific to
the older
adult?
16







Good Lighting
Expose abdomen so that it is fully visible; drape genitalia and
female breasts
Position for comfort to enhance abdominal wall relaxation
Empty bladder prior to examination with specimen saved if
needed
Warm stethoscope and examine areas identified as painful last
so as to prevent guarding
Order of Physical: Inspection, Auscultation, Percussion,
Palpation
Use distraction to keep patient relaxed and facilitate muscle
relaxation
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Stethoscope
 Alcohol wipe to clean endpiece
 penlight

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
Contour
Stand
on person’s right side and look down on
abdomen
Then stoop or sit to gaze across abdomen
Your head should be slightly higher than abdomen
Determine profile from rib margin to pubic bone;
contour describes nutritional state and normally
ranges from flat to rounded

Symmetry/Swelling or bulges
Shine a
light across abdomen lengthwise across the
person; look for swelling or bulges
Abdomen should be symmetric bilaterally
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What is it?
7F’S:
FAT
FETUS
FECES
FLUID
FLATUS
FIBROID
FATAL GROWTH
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B
U
L
G
E
S
?
Abdominal hernia
Epigastric hernia
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
Umbilicus
 Normally
it is midline
and inverted, with no
sign of discoloration,
inflammation, or
hernia
 Becomes everted and
pushed upward with
pregnancy
 Umbilicus is common
site for piercings in
young women; site
should not be red or
crusted
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
Skin
color/scars
Surface
smooth and
even, with
homogeneou
s color; good
area to judge
pigment
because
often
protected
from sun
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
Skin color/scars

Striae, moles (nevi),
lesions, surgical scars,
papules If a scar is
present, draw its
location in person’s
record, indicating
length in
centimeters.
 Surgical scar alerts
you to possible
presence of
underlying
adhesions and
excess fibrous tissue.
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
Pulsation or movement
Normally
you may see pulsations from aorta beneath
skin in epigastric area, particularly in thin persons
with good muscle wall relaxation
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NORMAL...created by the normal waves of peristalsis and
segmentation
HYPOACTIVE...reflects diminshed motility....“ileus“, often
follows surgery, viral illness, severe trauma or
overwhelming generalized sepsis, such as with peritonitis
HYPERACTIVE...Increased bowel sounds may occur with
gastroenteritis, early intestinal obstruction, or hunger.
High-pitched tinkling sounds, with rushes and tinkles.
Suggest intestinal fluid and air under pressure, as in
early obstruction or phase of ileus resolution.
ABSENT ...referring to an inability to hear any bowel sounds
after 5 minutes of continuous listening, are typically
associated with abdominal pain and rigidity...severe ileus
or bowel exhaustion with prolonged bowel
obstruction...(indicators of a surgical emergency).
Slide 28
As you listen to
abdomen, note
presence of any
vascular sounds or
bruits.
 Using firmer
pressure, check over
aorta, renal arteries,
especially in people
with hypertension.
 Usually no such
sound is present.

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Percuss for general
 Tympany




Or
Possible dullness
WHY?
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To properly percuss, lay
only the finger of your nondominant hand on the site
to be percussed. Then
using the tip of your
dominant long finger, rap
on the dorsal surface of you
non-dominant long finger
at the joint.
Or, can use either pointer
finger.
Which is
direct and
which is
indirect
percussion?
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32
PALPATION
WHY?
assess for organ enlargement, masses, or bulges, or assess
for pain
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




Place your left hand under person’s
back parallel to 11th and 12th ribs
and lift up to support abdominal
contents
Place your right hand on RUQ, with
fingers parallel to midline
Push deeply down and under right
costal margin
Ask person to take a deep breath; it
is normal to feel edge of liver bump
your fingertips as diaphragm
pushes it down during inhalation
It feels like a firm regular ridge;
often liver is not palpable
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 Umbilical
hernia
 Epigastric hernia
 Incisional hernia
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36
 Hypoactive
bowel sounds
 Hyperactive bowel sounds
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37
 Arterial
bruit: aortic or renal
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 Enlarged
liver
 Enlarged nodular liver
 Enlarged gallbladder
 Enlarged spleen
 Enlarged kidney
 Aortic aneurysm
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 Inspection
• Contour, symmetry, umbilicus, skin, pulsation or
movement
 Auscultation
• Bowel sounds; note any vascular sounds
 Percussion
• All four quadrants, and kidneys
 Palpation
• Light and deep palpation in all four quadrants,
and palpate for liver
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The nurse suspects appendicitis. How should
the nurse proceed with the assessment of the
patient’s abdomen?
1. The nurse should ask the patient to point to
where the pain is located and palpate that
region first.
2. The nurse should not palpate the patient’s
abdomen because this will illicit pain.
3. The nurse should listen for a bruit at
McBurney’s point.
4. The nurse should palpate last and note
rebound tenderness at McBurney’s point.
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The nurse is assessing a patient’s abdomen
and notices a thrill in the right upper
quadrant. The nurse should suspect which
of the following?
1. This is a normal finding and should be
documented as such.
2. Possible abdominal aortic aneurysm
3. Possible appendicitis
4. Possible gallstones
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