Assessing the abdomen

Assessing the abdomen
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The nurse locates and describes abdominal findings using two common method Subdividing the abdomen into quadrants and regions

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In addition, practitioners often use certain landmarks to locate abdominal signs and symptoms

planning
Ask the client to urinate since as empty bladder makes the assessment more comfortable € Ensure that the room is warm
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Equipment
Examining light € Tape measure € Water soluble skin marking pencil € stethoscope
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performance
Explain the procedure € Observe appropriate infection control procedure € Provide client privacy € Health history taking € Assist in supine position
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Inspection of abdomen

Inspect the abdomen for skin integrity
Normal findings Deviation from normal

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Unblemished skin; Uniform color; Silver-white striae (stretch marks) or surgical scars

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Presence of rash or other lesions; Tense, glistening skin (may indicate ascites, edema) Purple striae (associated with Cushing¶s diseases)

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 it. € Assess the symmetry of contour while standing at the foot of the bed. € If distention is present, measure the abdominal girth by placing a tape around the abdomen at the level of the umbilicus.

Normal Findings

Deviation from normal

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Flat, rounded (convex), or scaphoid (concave) No visible enlargement of spleen and liver Symmetric contour

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Distended

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Evidence of enlargement of spleen and liver Asymmetric contour (localized protrusion)

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Observe abdominal movements associated with respiration, peristalsis, or aortic pulsations
Normal findings
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Deviation from normal
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Symmetric movements caused by respiration; Visible peristalsis in very lean people; Aortic pulsation in thin persons at epigastric area

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Limited movement due to pain or disease process; Visible peristalsis in non lean-client (bowel obstruction); Marked aortic pulsation

Observe the vascular pattern.
Normal Findings
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Deviation from Normal
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No visible vascular pattern

Visible venous pattern (dilated veins) is associated with liver disease, ascites and venocaval obstruction

Auscultation of the abdomen

Auscultate the abdomen for bowel sounds, vascular sounds, and peritoneal friction rubs
Normal Findings
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Deviation from normal
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Audible bowel sounds; Absence of arterial bruits; Absence of friction rub

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Absent, hypoactive, or hyperactive bowel sounds; Loud bruit over aortic area (possible aneurysm); Bruit over renal or iliac arteries

PERCUSSION OF THE ABDOMEN

Percuss several areas in each of the four quadrants to determine presence of tympany(gas in stomach and instestines) and dullness . € Use a systematic pattern: Begin in the lower left quadrant, then proceed to the lower right quadrant, the upper right quadrant, and the upper left quadrant.
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Normal findings
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Deviation from normal
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Tympany over the stomach and gasfilled bowels; dullness specially over the liver and spleen, or a full bladder

Large dull areas (associated with presence of fluid or tumor)

Percuss the liver to determine its size.
Normal Finding
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Deviation from normal
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6 to 12 cm in the midclavicular line; 4 to 8 cm at the midsternal line

Enlarged size

Perform light palpation first to detect areas of tenderness and/or muscle guarding.
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Systematically explore all four quadrants.

Normal findings
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Deviation from Normal
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No tenderness; relaxed abdomen with smooth, consistent tension

Tenderness and hypersensitivity; Superficial masses; Localized areas of increased tension

Perform deep palpation over all four quadrants
Normal findings
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Deviation from normal
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Tenderness may be present near xiphoid process, over cecum, and over sigmoid colon

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Generalized or localized areas of tenderness Mobile or fixed masses

Palpate the liver to detect enlargement and tenderness.
Normal Findings
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Deviation from Normal
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May not be palpable Border feels smooth

Enlarged Smooth but tender

Palpate the area above the pubic symphysis if the client·s history indicates possible urinary retention.
Normal findings
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Deviation from normal
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Not palpable

Distended and palpable as smooth, round, tense mass

Assess for Rebound Tenderness and Rovsing·s Sign (Appendicitis)
Normal
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No rebound tenderness is present

Deviation from N € Client perceives sharp, stabbing pain as the examiner releases pressure from the abdomen ( Blomberg¶s sign). It suggest peritoneal irritation. € Referred rebound tenderness- pain in the RLQ during pressure in the LLQ is a positive Rovsing¶s sign.

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Cholecystitis- assess RUQ pain or tenderness which may signal inflammation of the gallbladder. Press your finger tips under the liver border at the right costal margin and ask the client to inhale deeply.

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Normal No increase in pain is present

Deviation from Normal € Accentuated sharp pain that causes the client to hold his or her breath (inspiration arrest) is a positive sign called Murphy¶s sign and is associated with acute cholecystitis.

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