Assessing the Abdomen

Basic Concept:
Abdominal assessment is a evaluation of the abdomen, liver, and bladder involving four methods of
examination: inspection, auscultation, percussion, and palpation.

Objectives:
1. To obtain an accurate nursing health history of the client’s abdomen and related functions.
2. To determine for any deviations or abnormalities of the abdomen.
3. To be able to formulate nursing diagnosis, collaborative problem, and referral.

Preparation:
1. Assemble equipment:
Examining light – To visually check
Tape Measure (Metal or non-stretchable cloth) – To measure ascites if present
Water-soluble skin-marking pencil – If enlargement of the liver is suspected, mark it
Stethoscope
2. Introduce yourself and verify client’s identity. Explain to the client what you are going to do, why is it
necessary, and how the client can cooperate. – To establish rapport so that the client can cooperate.
3. Perform hand hygiene, and observe appropriate infection control procedures. – To reduce microorganisms
and avoid cross contamination.
4. Provide privacy for the client.

I will now start the assessment. Before I proceed with the procedure, we need to ask the client to empty the bladder
before doing the assessment so that the client can feel comfort to the rest of the examination and to ensure accurate
assessment.

PROCEDURE RATIONALE
1. Determine the client’s history of the following:
Incidence of abdominal pain: its location, onset,
sequence, and chronology; its quality
(description); its frequency; associated and the
symptoms
Bowel habits To acquire past health history and current
Incidence of constipation or diarrhea problems maybe reoccurrence of previous ones.
Change in appetite
Food intolerances
Foods ingested in the last 24 hours
Specific signs and symptoms
Previous problems and treatment
2. Assist the client to a supine position, with the arms
placed comfortably at the sides. Putting a small pillow under the patient’s knees
Place small pillows beneath the knees and the helps relax the abdominal muscles.
head. To avoid chilling and shivering, which can tense
Expose only the client’s abdomen from the chest the abdominal muscles.
line to the pubic area.
INSPECTION OF THE ABDOMEN
To check for any abnormalities or deviation like
3. Inspect the abdomen for skin integrity. skin turgor.
Assess the skin by pinching the abdominal fold.
4. Inspect the abdomen for contour and symmetry.
Observe the abdominal contour while standing
at the client’s side when the client is supine.
Ask the client to take a deep breath and to hold
To check for any abnormalities or deviation
it.
To determine any signs of enlargement of the
Assess the symmetry of contour while standing
liver or spleen.
at the foot of the bed.
If distension is present, measure the abdominal
girth by placing a tape around the abdomen at
the level of the umbilicus.
5. Observe the abdominal movements associated with To detect possible signs of bowel obstruction
respiration, peristalsis, or aortic pulsations. and any limited movements.
6. Observe the vascular pattern. To detect visible venous pattern or dilated veins.
AUSCULTATION OF THE ABDOMEN
Cold hands and a cold stethoscope may cause
the client to contract the abdominal muscles,
and these contractions may be heard during
auscultation.
7. Auscultate the abdomen for bowel sounds, vascular
Warm first the stethoscope by rubbing either the
sounds, and peritoneal friction rubs.
bell or diaphragm so that we can’t startle the
client.
This is to listen for presence of bruits or grating
sounds.
 PERCUSSION OF THE ABDOMEN
8. Percuss several areas in each of the four quadrants.
To determine presence of tympany, dullness, or
Use a systematic pattern: Begin in the lower left
flatness.
quadrant, then proceed to the lower right
You can use either direct and indirect
quadrant, the upper right quadrant, and the
percussion technique
upper left quadrant.
PERCUSSION OF THE LIVER
9. Percuss the liver
Begin percussing the abdomen along the right
midclavicular line, starting below the level of the
umbilicus.
Move upward until the percussion notes change
from tympany to dullness, usually at or slightly
below the costal margin.
Mark the point of change with a felt-tip pen.
To listen for a change of tympany to dullness.
Percuss downward along the right midclavicular
This is called a positive splenic percussion sign.
line, starting above the nipple. Move downward
until percussion notes change from normal lung
resonance to dullness, usually at the fifth to
seventh intercostal space.
Again, mark the point of change with a felt-tip
pen.
Estimate the liver’s size by measuring the
distance between the two marks.
PALPATION OF THE ABDOMEN
10. Perform light palpation first. To determine the size, shape, positions, and
Systematically explore all four quadrants. tenderness of major abdominal organs and to
Perform deep palpation over all four quadrants. detect masses and fluid accumulation.
PALPATION OF THE LIVER
11. Palpate the liver.
A. METHOD 1: STANDARD PALPATION
Place the patient in the supine position.
Stand at the right side of the client, place your
left hand under client’s back at the approximate
location of the liver.
Place your right hand slightly below the mark at
the liver’s upper border that you made during
percussion. To detect areas of tenderness
Point the finger of your right hand toward the
patient’s head just under the costal margin.
As the patient inhales, deeply, gently press in
and up on the abdomen until the liver brushes
under your right hand.
Note any tenderness.
B. METHOD 2: HOOKING THE LIVER
Stand next to the patient’s right shoulder, facing
his feet.
Place hands side by side, and hook your
To detect presence of hepatomegaly or
fingertips over the right costal margin, below the
enlargement of the liver.
lower mark of dullness.
Ask the patient to take a deep breath as you
push your fingertips in and up.
PALPATION OF THE BLADDER
12. Palpate the area above the pubic symphysis, if the To determine if the client has distended bladder,
client’s history indicates possible urinary retention. which results to urinary retention and nocturia.
To take note for what has been assessed for
13. Document findings in the client record.
future reference.