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Abdominal Assessment

Abdominal Assessment

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Published by dbryant0101
Nursing Sample Chapter...Looks like a good textbook
Nursing Sample Chapter...Looks like a good textbook

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Published by: dbryant0101 on Dec 08, 2008
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367
 Abdominal  Assessment 
18
PART ONE
STRUCTURE AND FUNCTION
ABDOMINAL QUADRANTSABDOMINAL WALL MUSCLESINTERNAL ANATOMY
Solid VisceraHollow VisceraVascular Structures
PART TWO
NURSING ASSESSMENT
COLLECTING SUBJECTIVE DATANURSING HISTORY
Current SymptomsPast HistoryFamily HistoryLifestyle and Health Practices
COLLECTING OBJECTIVE DATA
Client PreparationEquipment and SuppliesKey Assessment Points
PHYSICAL ASSESSMENTVALIDATION AND DOCUMENTATIONOF FINDINGS
Example of Subjective DataExample of Objective Data
PART THREE
ANALYSIS OF DATA
DIAGNOSTIC REASONING:POSSIBLE CONCLUSIONS
Selected Nursing DiagnosesSelected Collaborative ProblemsMedical Problems
DIAGNOSTIC REASONING: CASE STUDY
Subjective DataObjective Data
 
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Structure and Function
The abdomen is bordered superiorly by the costal margins,inferiorly by the symphysis pubis and inguinal canals, and lat-erally by the flanks (Fig. 18-1). To perform an adequate as-sessment of the abdomen, the nurse needs to understand theanatomic divisions known as the abdominal quadrants, theabdominal wall muscles, and the internal anatomy of the ab-dominal cavity.
Abdominal Quadrants
The abdomen is divided into four quadrants for purposesof physical examination. These are termed the right upperquadrant (RUQ), right lower quadrant (RLQ), left lowerquadrant (LLQ), and left upper quadrant (LUQ). The quad-rants are determined by an imaginary vertical line (mid-line) extending from the tip of the sternum (xiphoid),through the umbilicus to the symphysis pubis. This line isbisected perpendicularly by the lateral line, which runsthrough the umbilicus across the abdomen. Familiarization with the organs and structures in each quadrant is essen-tial to accurate data collection, interpretation, and do-cumentation of findings (Display 18-1). Another, oldermethod divides the abdomen into nine regions. Three of these regions are still commonly used to describe abdom-inal findings—epigastric, umbilical, and hypogastric orsuprapubic.
Abdominal Wall Muscles
The abdominal contents are enclosed externally by the ab-dominal wall musculature, which includes three layers of muscle extending from the back, around the flanks, to thefront. The outermost layer is the external abdominal oblique;the middle layer is the internal abdominal oblique; and theinnermost layer is the transverse abdominis. Connective tis-sue from these muscles extends forward to encase a verticalmuscle of the anterior abdominal wall called the rectusabdominis. The fibers and connective tissue extensionsof these muscles (aponeuroses) diverge in a characteristicplywood-like pattern (several thin layers arranged at rightangles to each other), which provides strength to the ab-dominal wall. The joining of these muscle fibers andaponeuroses at the midline of the abdomen forms a whiteline called the linea alba, which extends vertically from thexiphoid process of the sternum to the symphysis pubis(Fig. 18-2). The abdominal wall muscles protect the inter-nal organs and allow normal compression during functionalactivities such as coughing, sneezing, urination, defecation,and childbirth.
Internal Anatomy
 A thin, shiny, serous membrane called the peritoneumlines the abdominal cavity (parietal peritoneum) and alsoprovides a protective covering for most of the internalabdominal organs (visceral peritoneum). Within the ab-dominal cavity are structures of several different body systems—gastrointestinal, reproductive (female), lymphatic,and urinary. These structures are typically referred to as theabdominal viscera and can be divided into two types—solid viscera and hollow viscera. Solid viscera are those organsthat maintain their shape consistently—the liver, pancreas,spleen, adrenal glands, kidneys, ovaries, and uterus. Thehollow viscera consist of structures that change shape de-pending on their contents. These include the stomach, gall-bladder, small intestine, colon, and bladder. Palpation of theabdominal viscera depends on location, structural consis-tency, and size.
SOLID VISCERA
The liver is the largest solid organ in the body. It is lo-cated below the diaphragm in the RUQ of the abdomen.It is composed of four lobes that fill most of the RUQ andextend to the left midclavicular line. In many people, theliver extends just below the right costal margin, where itmay be palpated. If palpable, the liver has a soft consis-tency. The liver functions as an accessory digestive organand has a variety of metabolic and regulatory functions as well (Fig. 18-3).The pancreas, located mostly behind the stomach, deepin the upper abdomen, is normally not palpable. It is a longgland, extending across the abdomen from the RUQ to theLUQ. The pancreas has two functions. It is an accessory organ of digestion and an endocrine gland.The spleen is approximately 7 cm wide and is locatedabove the left kidney, just below the diaphragm at the levelof the ninth, tenth, and eleventh ribs. It is posterior to theleft midaxillary line and posterior and lateral to the stomach.
PARTONE
 
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This soft, flat structure is normally not palpable. In somehealthy clients, the lower tip can be felt below the leftcostal margin. When the spleen enlarges, the lower tip ex-tends down and toward the midline. The spleen functionsprimarily to filter the blood of cellular debris, to digest mi-croorganisms, and to return the breakdown products tothe liver.The kidneys are located high and deep under the di-aphragm. These glandular, bean-shaped organs, measur-ing approximately 10
×
5
×
2.5 cm, are consideredposterior organs and approximate with the level of theT12 to L3 vertebrae. The tops of both kidneys are pro-tected by the posterior rib cage. Kidney tenderness is bestassessed at the costovertebral angle (Fig. 18-4). The rightkidney is positioned slightly lower because of the positionof the liver. Therefore, in some thin clients, the bot-tom portion of the right kidney may be palpated anteri-orly. The primary function of the kidneys is filtration andelimination of metabolic waste products. However, thekidneys also play a role in blood pressure control andmaintenance of water, salt, and electrolyte balance. Inaddition, they function as endocrine glands by secretinghormones.The pregnant uterus may be palpated above the level of the symphysis pubis in the midline. The ovaries are locatedin the RLQ and LLQ and are normally palpated only dur-ing a bimanual examination of the internal genitalia (seeChapter 20).
HOLLOW VISCERA
The abdominal cavity begins with the stomach. It is a dis-tensible, flasklike organ located in the LUQ, just below thediaphragm and in between the liver and spleen. The stom-ach is not usually palpable. The stomach’s main function isto store, churn, and digest food.The gallbladder, a muscular sac approximately 10 cmlong, functions primarily to concentrate and store the bileneeded to digest fat. It is located near the posterior surfaceof the liver lateral to the midclavicular line. It is not nor-mally palpated because it is difficult to distinguish betweenthe gallbladder and the liver.The small intestine is actually the longest portion of thedigestive tract (approximately 7.0 m long) but is named forits small diameter (approximately 2.5 cm). Two major func-tions of the small intestine are digestion and absorption of nutrients through millions of mucosal projections lining its walls. The small intestine, which lies coiled in all four quad-rants of the abdomen, is not normally palpated.The colon, or large intestine, has a wider diameter thanthe small intestine (approximately 6.0 cm) and is approxi-mately 1.4 m long. It originates in the RLQ, where it at-taches to the small intestine at the ileocecal valve. The colonis composed of three major sections: ascending, transverse,and descending. The ascending colon extends up along theright side of the abdomen. At the junction of the liver in theRUQ, it flexes at a right angle and becomes the transversecolon. The transverse colon runs across the upper abdomen.In the LUQ near the spleen, the colon forms another rightangle and then extends downward along the left side of theabdomen as the descending colon. At this point, it curves intoward the midline to form the sigmoid colon in the LLQ.The sigmoid colon is often felt as a firm structure on palpa-tion, whereas the cecum and ascending colon may feelsofter. The transverse and descending colon may also be felton palpation.The colon functions primarily to secrete large amountsof alkaline mucus to lubricate the intestine and neutralizeacids formed by the intestinal bacteria. Water is also ab-sorbed through the large intestine, leaving waste productsto be eliminated in stool.The urinary bladder, a distensible muscular sac locatedbehind the pubic bone in the midline of the abdomen,functions as a temporary receptacle for urine. A bladderfilled with urine may be palpated in the abdomen above thesymphysis pubis.
VASCULAR STRUCTURES
The abdominal organs are supplied with arterial blood by theabdominal aorta and its major branches. Pulsations of theaorta are frequently visible and palpable midline in the upperabdomen. The aorta branches into the right and left iliac ar-teries just below the umbilicus. Pulsations of the right and leftiliac arteries may be felt in the RLQ and LLQ (Fig. 18-5).
CHAPTER 18
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ABDOMINAL ASSESSMENT
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Right costalmarginLeft costalmarginRight flankLeft flankUmbilicusXyphoidprocessAnteriorsuperioriliac spineInguinalcanalInguinalligamentSymphysispubisFemoral nerveFemoral arteryFemoral veinEmpty spaceInguinal ligament(Poupart's)
FIGURE 18-1.
Landmarks of the abdomen.

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