The abdomen is bordered superiorly by the costal margins, inferiorly by the symphysis pubis and inguinal canals, and

lat- erally by the anks (Fig. 18-1). To perform an adequate as- sessment of the abdomen, the nurse needs to understand the anatomic divisions known as the abdominal quadrants, the abdominal wall muscles, and the internal anatomy of the abdominal cavity.

Abdominal Quadrants

Abdominal Wall Muscles

Three layers: - The outermost layer is the external abdominal oblique; - The middle layer is the internal abdominal oblique; - The innermost layer is the transverse abdominis.

Collecting Subjective Data

Subjective data concerning the abdomen are collected as part of a clients overall health history interview or as a fo- cused history for a current abdominal complaint. The data focus on symptoms of particular abdominal organs and the function of the digestive system, along with aspects of nutrition, usual bowel habits, and lifestyle. The nurse aims to assure the client that all the questions are important tools for detecting and treating a possible disorder or disease.

Current Symptoms
Abdominal Pain

Indigestion

Nausea and Vomiting

Bowel Elimination

PAST HISTORY

FAMILY HISTORY

CLIENT PREPARATION - Ask client to empty bladder

- insctruct client to remove clothes and put on gown if desired - Help the client to lie supine with the arms folded across the chest or resting by the sides - Slightly ex the clients legs by placing a pillow or rolled blanket under the clients knees - Drape the client with sheets so the abdomen is visible from the lower rib cage to the pubic area. - Instruct the client to breathe through the mouth and to take slow, deep breaths - ask the client about painful or ten- der areas - Approach the client with slow, gentle, and uid movements.

Small pillow or rolled blanket Centimeter ruler Stethoscope (with a warm diaphragm and bell) Marking pen

EQUIPMENT and SUPPLIES

KEY ASSESSMENT POINTS

Observe and inspect abdominal skin and overall contour and symmetry. Auscultate after inspection and before percussion, and, nally, palpate. Assessment examination evaluates the following abdominal structures in the abdominal quadrants: skin, stomach, bowel, spleen, liver, kidneys, aorta, and bladder. Common abnormal ndings include abdominal edema, or swelling, signifying ascites; abdominal masses signifying abnormal growths or constipation; unusual pulsations, such as those seen with an aneurysm of the abdominal aorta; and pain associated with appendicitis.

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