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Assessment of Abdomen CHAPTER 9 Examination •Inspection •Auscultation •Percussion •Palpation CHAPTER 9 Abdominal Structure and Function Abdominal quadrants • Upper right quadrant • Upper left quadrant • Lower right quadrant • Lower left quadrant CHAPTER 9 Abdominal Structure and Function Abdominal quadrants CHAPTER 9 Equipment needed The only equipment needed are: • Stethoscope • cloth or plastic ruler • Pencil • Examination table • Light • Small pillow • Drapes to cover the patient CHAPTER 9 • • • • • • Subjective History Appetite Dysphagia Food intolerance Nausea /Vomiting Bowel habits Past abdominal history • Medications • Nutritional Abdominal pain •Onset •Location •Duration •Characteristics •Associated findings •Relieving factors •Tx attempted CHAPTER 9 The Examination • Client – Empty bladder, disrobe & gown, supine, head on pillow, knees bent, arms at side or across chest, have pt ID any area of pain • Nurse – Warm hands & stethoscope, warm environment, good lighting, approach slowly, monitor pt’s face during exam, tender areas last • Inspect, Auscultate, Percuss, Palpate- light & deep CHAPTER 9 Inspection Contour - flat, rounded. SymmetryUmbilicus Skin - texture, color, lesions, veins, turgor Surface motion - pulsations or peristalsis Respiratory movement Hair distribution Demeanor CHAPTER 9 Abdomen - Hernia CHAPTER 9 Auscultation •Use diaphragm high pitched •hold lightly against skin •Begin RLQ (ileocecal valve area) •Bowel sounds •character & frequency •originate from air & fluid movement thru small intestines •hi pitched, gurgling, cascading, irregular, •5-30 times/min, depends on last time pt ate CHAPTER 9 Auscultation cont. • Findings – Normal – hypoactive - absent, slow ie) surgery, inflammation – hyperactive - loud, rushing, tinkling – hyper peristalsis, ”stomach growling” • Listen for 5 minutes before deciding absent CHAPTER 9 Auscultation cont. • Vascular sounds – Bruits- pulsatile blowing sound with artery occlusion (use firmer pressure) –aorta –renal –iliac –femoral – Venous hum- periumbilical region – Peritoneal friction rub CHAPTER 9 • Liver • Spleen • Kidney • Aorta Palpation--Specific Organs CHAPTER 9 Special Procedures • Blumberg sign (Appendix test) –Rebound tenderness • Murphy’s sign (Gallbladder test) • Hernias
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