Transcript Abdominal Assessment

Abdominal Assessment
Cathy Gibbs BSN, RN
Competencies
Assess the health status of a patient
with a gastrointestinal complaint
 Demonstrate the techniques of a
gastrointestinal assessment
 Relate abnormal physical gastrointestinal findings to pathological
processes
 Outline the gastrointestinal variations
associated with the aging process
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Gastrointestinal System
Assessment
Patient’s history
 Current signs & symptoms
 Vital signs
 Level of consciousness
 Age & gender
 Bowel habits or alterations in
elimination
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Common Chief Complaints
Nausea and vomiting
 Anorexia
 Dysphagia
 Diarrhea or constipation
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Common Chief Complaints
Abdominal distension
 Abdominal pain
 Increased eructation or flatulence
 Dysuria
 Nocturia
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Characteristics of
Chief Complaint
Quality
 Associated manifestations
 Aggravating factors
 Alleviating factors
 Timing
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Past Health History
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Medical
Abdomen specific
 Nonabdomen specific
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Surgical
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GI procedures
Past Health History
Allergies
 Injuries/accidents
 Social history
 Health maintenance activities
 Communicable diseases
 Family health history
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Malignancies of stomach, liver, pancreas;
peptic ulcer disease, DM, irritable bowel
syndrome, colitis
Common Medications
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Histamine: two antagonists
Antibiotics
Antacids
Antiemetics
Anti-diarrheals
Laxatives or stool softeners
Steroids
Chemotherapeutics
Anti-flatulents
Social History
Alcohol use
 Drug use
 Travel history
 Work environment
 Hobbies/leisure activities
 Stress
 Economic status
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Health Maintenance Activities
Sleep
 Diet
 Exercise
 Stress management
 Use of safety devices
 Health checkups
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Gastrointestinal System
Assessment
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Stool sample
Evaluate for consistency, color, & odor
 Occult blood
 Stetorrhea
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Gastrointestinal System
Assessment
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Evaluate dietary program
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Type of food, amount
Assess urine
Amount, color, odor
 Fluid intake
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Gastrointestinal System
Assessment
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Signs of dehydration
Dry mucous membranes
 Poor skin turgor
 Decreased urine output
 Increase in pulse
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Gastrointestinal System
Assessment
Evaluate laboratory tests
 Presence of hemorrhoids
 Skin color
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Yellow, pallor, flushing
Sphincter control
Reports of control of bowel movements
 Incontinence
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Gastrointestinal System
Assessment
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Presence of pain
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Nonverbal signs
 Flinching
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& grimacing
Onset, location, intensity, duration, &
aggravating factors
Palpate for rebound tenderness
Gastrointestinal System
Assessment
Signs of shock following trauma
 Patient’s knowledge of diagnostic test &
procedures
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Assessment of the Abdomen
Equipment
 Order
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Inspection
 Auscultation
 Percussion
 Palpation
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Anatomy and Physiology
Abdominal quadrants
Right upper
 Right lower
 Left upper
 Left lower
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Anatomy and Physiology
Stomach
 Small intestine
 Large intestine
 Liver
 Gallbladder
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Anatomy and Physiology
Pancreas
 Spleen
 Veriform appendix
 Kidneys, ureters, and bladder
 Lymph nodes
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Inspection
Contour
 Symmetry
 Rectus abdominis muscles
 Pigmentation and color
 Scars
 Ascites
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Inspection
Striae
 Respiratory movement
 Masses or nodules
 Visible peristalsis
 Pulsation
 Umbilicus
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Abdominal Striae
Inspection
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Normal findings
Abdomen is flat or round, symmetrical
 Uniform in color and pigmentation
 No scars or striae present
 No respiratory retractions
 No masses or nodules
 Ripples of peristalsis may be visible
 Non-exaggerated pulsation of the
abdominal aorta may be present
 Umbilicus is depressed
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Auscultation
Assess all four quadrants
 Listen for at least 5 minutes before
concluding bowel sounds are absent
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Stethoscope
placement for
Auscultating
Abdominal
Vasculature
Abdominal Assessment
Landmarks
1.
2.
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7.
8.
Xiphoid process
Costal margin
Abdominal midline
Umbilicus
Rectus Abdominis
Muscle
Anterior Superior
Iliac Spine
Inguinal Ligament
Symphysis Pubis
Auscultation
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Normal findings
Bowel sounds are heard in all quadrants
 Usually sounds are high pitched
 Occur 5 to 30 times per minute
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Auscultation
Abnormal findings: absent,
hypoactive or hyperactive bowel
sounds
 Pathophysiological indications
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Absent and hypoactive bowel sounds
may indicate decreased motility and
possible obstruction
 Hyperactive bowel sounds indicate
increased motility and possible
diarrhea, gastroenteritis
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Percussion
Percuss all four quadrants
 Assess liver span, liver descent,
margins of spleen, stomach, kidneys,
bladder
 Sounds heard: tympany or dullness
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Normal Findings
Tympany heard over air-filled
areas, such as stomach and
intestines
 Dullness heard over solid areas,
such as liver, spleen, or a distended
bladder
 No tenderness elicited over kidneys
and liver
 Empty bladder is not percussable
above the symphysis pubis
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Abnormal Findings
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Dullness over areas where tympany
is normally heard
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This finding may indicate a mass or
tumor, ascites, full intestine, pregnancy
Liver span > 12 cm or < 6 cm
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This finding may indicate hepatomegaly
or cirrhosis
Abnormal Findings
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Costovertebral angle tenderness
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May indicate pyelonephritis
Ability to percuss a recently
emptied bladder
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May indicate urinary retention
Palpation
Light vs. Deep
 Palpate all quadrants
 Normal findings
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No tenderness
 Abdomen feels soft
 No muscle guarding
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Light palpation of the abdomen
Palpitation for Ascites;
Fluid Wave
Abnormal Findings
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Tenderness on palpation
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Muscle guarding on expiration
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May indicate inflammation, masses, or
enlarged organs
May indicate peritonitis
Presence of masses, bulges, or swelling
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May indicate enlarged organs, tumors,
cholecystitis, hepatitis, cirrhosis
Abnormal Findings
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Liver is palpable below the costal margin
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Spleen is palpable
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May indicate CHF, hepatitis, cirrhosis,
encephalopathy, cancer
May indicate inflammation, CHF, cirrhosis,
mononucleosis
Kidneys are palpable
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May indicate hydronephrosis, neoplasms,
polycystic kidney disease
Abnormal Findings
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Aorta width > 4 cm
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Able to palpate recently emptied
bladder
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May indicate abdominal aortic
aneurysm
May indicate urinary retention
Palpable inguinal lymph nodes > 1
cm in diameter or tender nodes
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May indicate systemic infections, cancer