The ABDOMEN

Page 631 - 639

Dyana M. M. Saplan, RN, MAN

The Abdomen
The nurse locates and describes abdominal findings using 2 common methods of subdividing the abdomen:
Quadrants Regions

Dyana M. M. Saplan, RN, MAN

Abdominal Landmarks
Practitioners often use certain landmarks to locate abdominal signs and symptoms

Dyana M. M. Saplan, RN, MAN

Organs in the 4 Quadrants (Box 30-7)

Dyana M. M. Saplan, RN, MAN

Methods of Abdominal Examination

Involves all 4 methods of examination:
Inspection Auscultation Palpation Percussion
Cause movement or stimulation of the bowel, w/c can bowel motility and thus heighten bowel sounds = false results

Dyana M. M. Saplan, RN, MAN

Assessment
Inspection of the abdomen
Skin integrity Contour and symmetry
Observe the abdominal contour (profile line from the rib margin to the pubic bone) while standing at the clients side when the client is supine Ask the client to take a deep breath and to hold it (makes an enlarged liver or spleen more obvious) If distention is present measure abdominal girth Place tape measure around the abdomen @ the level of the umbilicus

Dyana M. M. Saplan, RN, MAN

Measuring abdominal girth

Dyana M. M. Saplan, RN, MAN

Inspection of the Abdomen

Observe abdominal movements associated w/ respiration, peristalsis, or aortic pulsations
Symmetric movements (respi); visible peristalsis (very lean); aortic pulsations @ epigastric area (thin persons) Limited movement (pain, dse); visible peristalsis (bowel obstruction); marked aortic pulsations

Observe the vascular pattern

Dilated veins = liver dse, ascites, venocaval obstruction
Dyana M. M. Saplan, RN, MAN

Ascites

Dyana M. M. Saplan, RN, MAN

Auscultation of the Abdomen

For bowel sounds, vascular sounds, peritoneal friction rubs Warm hands and stethoscope
Cold hands and stethoscope = client will contract abdl muscles, w/c may be heard during auscultation N: audible bowel sounds; (-) arterial bruits and friction rub

Dyana M. M. Saplan, RN, MAN

Deviations:
Hypoactive bowel sounds
Extremely soft and infrequent (1/min) Indicate ed motility associated w/ manipulation of bowel during surgery, inflammation, paralytic ileus, or late bowel obstruction

Hyperactive ( ed) bowel sounds

High-pitched, loud, frequent, rushing sounds (q3 sec.) = borborygmi ed intestinal motility = diarrhea, early bowel obstruction, use of laxative

True absence of sounds (none heard in 3 5 min) = cessation of intestinal motility

Dyana M. M. Saplan, RN, MAN

Auscultating bowel sounds

Use the flat-disc diaphragm Ask when the client last ate
Shortly after or shortly before = normally ed Loudest when meal is long overdue

Dyana M. M. Saplan, RN, MAN

Auscultating bowel sounds

Place diaphragm in each of the 4 quadrants over all of the auscultatory sites Listen for active bowel sounds
Irregular gurgling noises occurring about q5 20 secs. May range from < 1 sec more than several secs.

Dyana M. M. Saplan, RN, MAN

For Vascular sounds

Use bell of the stethoscope over aorta, renal arteries, iliac arteries, and femoral arteries Listen for bruits
Loud bruit over aortic area = possible aneurysm Over renal or iliac arteries

Dyana M. M. Saplan, RN, MAN

Abdominal aneurysm

Dyana M. M. Saplan, RN, MAN

Peritoneal Friction Rubs

Rough, grating sounds like 2 pcs of leather rubbing together
May be caused by inflammation, infection, or abnormal growths

Auscultate splenic site stethoscope over LL rib cage, ant. axillary line
Ask to deep breathe = accentuate sound of friction rub

Liver site
over LR rib cage
Dyana M. M. Saplan, RN, MAN

Percussion of the abdomen

Percuss different areas in each of the 4 quadrants to det. presence of:
Tympany = gas in stomach and intestines Dullness = , absence, or flatness of resonance over solid masses or fluid

Use systematic pattern:

Begin in RLQ RUQ LUQ LLQ

Dyana M. M. Saplan, RN, MAN

Percussion of the abdomen

Normal:
Tympany over stomach and gas-filled bowels Dullness = over liver or spleen, or full bladder

Deviation:
Large dull areas = associated w/ presence of fluid or a tumor

Dyana M. M. Saplan, RN, MAN

Percussion of the liver

To det. its size begin in the rt. midclavicular line below the level of the umbilicus Measure distance between lower liver border and upper liver border in centimeters (cm) = liver size
6 12 cm (2 - 3 in.) = midclavicular line 4 8 cm (1 - 3 in.) = midsternal line Enlarged size: liver dse.
Dyana M. M. Saplan, RN, MAN

Palpation of the Abdomen

Light palpation 1st to detect areas of tenderness and/or muscle guarding
Systematically explore all 4 quadrants N: no tenderness; relaxed w/ smooth consistent tension D: tenderness, hypersensitivity; superficial masses; localized areas of ed tension
Dyana M. M. Saplan, RN, MAN

Palpation of the Abdomen

Deep palpation over all 4 quadrants
Sensitive areas last Depress about 4 5 cm (1 - 2 in.) Note masses and structure of underlying contents If mass present size, location, mobility, contour, consistency, tenderness Check for rebound tenderness in areas where client complains of pain
(+) rebound tenderness pain upon release of pressure = peritoneal inflammation
Dyana M. M. Saplan, RN, MAN

Bimanual deep palpation

Dyana M. M. Saplan, RN, MAN

Palpation of the liver

Palpate liver to detect enlargement and tenderness
Normal: not palpable; border feels smooth Deviation: enlarged; smooth but tender; nodular or hard

Dyana M. M. Saplan, RN, MAN

Palpation of the Bladder

Palpate area over symphysis pubis if clients history indicates possible urinary retention
Normal: bladder not palpable Deviation: distended; and palpable as smooth, round, tense mass = urinary retention

Dyana M. M. Saplan, RN, MAN

Lifespan considerations
Infants
Internal organs proportionately larger than older children and adults = abdomen rounded and tend to protrude Liver palpable 1 2 cm below rt. intercostal margin Umbilical hernias may be present @ birth

Dyana M. M. Saplan, RN, MAN

Umbilical hernia

Dyana M. M. Saplan, RN, MAN

Children
Toddlers characteristic pot belly appearance until 3 4 years Late pre-school and school-age leaner and have flat abdomen Visible peristaltic waves than in adults May not be able to pinpoint areas of tenderness
Observe facial expressions to det. Areas of maximum tenderness

If ticklish, guarding, or fearful use task that requires concentration to distract, or have child place hands on examiners hands = helping do exam
Dyana M. M. Saplan, RN, MAN

Potbelly

Dyana M. M. Saplan, RN, MAN

Elders
Rounded abdomens = due to adipose tissue, muscle tone Abdominal wall slacker and thinner
Palpation easier and more accurate

Pain threshold higher

Major abdominal problems such as appendicitis or other acute emergencies may go undetected GI pain (chest or abdomen) needs to be differentiated from cardiac pain (chest) GI pain: relieved by food, antacid, upright position Cardiac pain: aggravated by activity, stress; relieved by rest or nitroglycerine
Dyana M. M. Saplan, RN, MAN

Elders
Fecal incontinence in confused or neurologically impaired older adults Colon cancer higher incidence
Change in bowel fxn, rectal bleeding, weight loss

ed absorption of oral meds

Dyana M. M. Saplan, RN, MAN

Video Presentation
Dyana M. M. Saplan, RN, MAN