ABDOMINAL ASSESSMENT - PowerPoint by fjwuxn

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									ABDOMINAL ASSESSMENT
Abdominal Assessment
   Patient needs to be exposed from above the
    xiphoid process to the symphysis pubis.
   Also, make sure your patient does not have a
    full bladder.
   Place patient in a supine position: pillow under
    the head and knees.
   Helps to relax abdominal muscles.
Abdominal Assessment
   Have patient point out any areas of pain or
    tenderness.
   Examine these last.
   During exam continue to monitor your patient’s
    facial expression for pain and discomfort.
   Use inspection, auscultation, percussion, and
    palpation to perform the exam.
Abdominal Assessment
   Always auscultate before percussing or
    palpating.
   These manipulations may alter your patient’s
    bowel motility and resulting bowel sounds.
Abdominal Assessment
    Inspect the skin of the abdomen and flank’s
     for:
1.   Scars
2.   Dilated veins
3.   Stretch marks
4.   Rashes
5.   Lesions
6.   Pigmentation changes
Abdominal Assessment
    Look for discoloration over the umbilicus:
1.   Cullen’s Sign: discoloration over the umbilicus
2.   Grey Turner’s Sign: discoloration over the flanks
    These are both late signs suggesting intra-
     abdominal bleeding
Abdominal Assessment
    Assess the size and shape of your patient’s
     abdomen to determine:
1.   Scaphoid (concave)
2.   Flat
3.   Round
4.   Distended
    Ask the patient if it is its usual size and shape
Abdominal Assessment
    Check for:
1.   Bulges
2.   Hernias
3.   Distended Flanks
    Ascites appears as bulges in the flanks and
     across the abdomen and indicates edema
     caused by CHF, or liver failure.
Abdominal Assessment
    Look at your patient’s umbilicus
    Note location and contour and observe for any
     signs of herniation or inflammation.
    Check for:
1.   Visible pulsation
2.   Visible peristalsis (wavelike motion of organs moving
     their contents through the digestive tract). May
     indicate bowel obstruction.
3.   Visible masses
Abdominal Assessment
   Next auscultate for bowel sounds and other
    sounds such as bruits throughout the abdomen.
   Gently place the diaphragm on your patient’s
    abdomen and proceed systematically, listening
    for bowel sounds in each quadrant.
   Note location, frequency, and character
   Normal bowel sounds consist of a variety of
    high-pitched gurgles and clicks that occur every
    5-15 seconds.
Abdominal Assessment
   More frequent sounds indicate increased bowel
    motility in conditions such as diarrhea or an
    early intestinal obstruction.
   You may hear loud, prolonged, gurgling sounds
    known as borborygmi.
   These indicate hyperperistalsis.
   Decreased or absent sounds suggest a paralytic
    ileus or peritonitis
Abdominal Assessment
                 Bruits are swishing
                  sounds that indicate
                  turbulent blood flow.
                 Listen in areas over
                  abdominal blood vessels
                  such as the aorta and
                  renal arteries
                 Presence indicates
                  abdominal aortic
                  aneurysm or renal artery
                  stenosis
Abdominal Assessment
   Percussing the abdomen produces different
    sounds based on the underlying tissues.
   Sounds help you detect excessive gas and solid
    or fluid-filled masses
   Also help you determine the size and position of
    solid organs such as the liver and spleen
   Percuss the abdomen in the same sequence
    you used for auscultation
Abdominal Assessment
   Note the distribution of tympany and dullness
   Expect to hear tympany in most of the abdomen
   Expect dullness over the solid abdominal organs
    such as the liver and spleen
Abdominal Assessment
    Palpate the abdomen last to detect:
1.   Tenderness
2.   Muscular rigidity
3.   Superficial organs and masses
    Before you begin palpation, ask your patient if
     he has any pain or tenderness
    Palpate that area last, using gentle pressure
     with a single finger
Abdominal Assessment
   Ask him to cough and tell you if and where he
    experiences any pain
   This is typical for peritoneal inflammation
Abdominal Assessment
                 Light palpation by moving
                  your hand slowly and just
                  lifting it off the skin.
                 Use same sequence as
                  for auscultation and
                  percussion
                 Watch for patient’s face
                  for signs of discomfort
Abdominal Assessment
                  Identify any masses and
                   note:
              1.   Size
              2.   Location
              3.   Contour
              4.   Tenderness
              5.   Pulsations
              6.   Mobility
Abdominal Assessment
                 Abdominal pain upon
                  light palpation suggests
                  peritoneal irritation or
                  inflammation
                 If rigidity or guarding
                  while palpating,
                  determine whether it is
                  voluntary (patient
                  anticipates the pain) or
                  involuntary (peritoneal
                  inflammation)
Abdominal Assessment
                 Next palpate deeply to
                  detect large masses or
                  tenderness
                 Use one hand on top of
                  another and push down
                  slowly.
                 Assess for rebound
                  tenderness by pushing
                  slowly and then releasing
                  your hand quickly off the
                  tender area.
Abdominal Assessment
   If you note a protruding abdomen with bulging
    flanks and dull percussion sounds in dependent
    areas, you might perform two tests for ascites.
Ascites/Test 1
   Assess for areas of tympany and dullness while
    your patient is supine
   Lie him on one side
   Percuss again, noting once more any areas of
    tympany and dullness
   If your patient has ascites, the area of dullness
    will shift down to the dependent side and the
    area of tympany will shift up.
Ascites/Test 2
                    Test for fluid wave, ask an
                     assistant to press the edge of
                     his hand firmly down the
                     midline of your patient’s
                     abdomen
                    With your fingertips, tap one
                     flank and feel for the impulse’s
                     transmission to the other flank
                     through excess fluid
                    If you detect the impulse
                     easily, suspect ascites

								
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