ABDOMINAL ASSESSMENT

spring 2012 1

History - Subjective Data• Abdominal pain• Appetite• Food intolerances• Dietary problems• Weight change• Dysphagia• Flatulence, belching • Bloody emesis (hematemesis)• Black tarry stools (melena),• Heartburn, diarrhea, constipation • Cramping

spring 2012 2

History - Subjective Data• Bowel habits, stool character• Medication Hx including OTC • Nausea and Vomiting• Changes in micturation:

– Amount and color of urine– Obstruction of the urinary tract– Urinary Incontinence– Urinary tract pain

• Female: ask about pregnancy• Past hx (surgery, trauma, kidney dx, alcoholism, HTN, heart dx• Review History and evaluate Hepatitis risk

spring 2012 3

Common Conditions Producing Abdominal Pain

• Appendicitis• Cholecystitis• Pancreatitis• Perforated gastric or

duodenal ulcer• Intestinal obstruction• Leaking abdominal aneurysm• Ectopic pregnancy• Pelvic inflammatory disease• Renal stones

spring 2012 4

Common collaborative problems • Peritonitis• Ileus• Intestinal bleeding• Bowel obstruction• Urinary obstruction• Hepatic failure• Peptic Ulcer Disease• GERD

Sequence for Abdominal Exam

• Inspection• Auscultation• Percussion• Light Palpation• Deep Palpation ?

spring 2012 5

Physical Exam-INSPECTION• INSPECTION

– Observe client’s movement and position– Have the client supine– Ask the client to locate tender areas– Inspect for distension– Inspect for normal respiratory movements– Note presence of peristaltic movement or

aortic pulsation by looking across the abd

spring 2012 6

Physical Exam -AUSCULTATION• AUSCULTATION

– Start @ _______– listen for ______ amount of time– Listen in _________– Note frequency and character– Auscultate for vascular sounds– If bruits are heard, DO NOT PALPATE the

abdomen

spring 2012 7

Normal Findings: Percussion

• Tympany over stomach and intestines

• Dullness over liver, spleen, pancreas, kidneys and distended bladder

• Liver border

spring 2012 8

Physical Exam - PALPATION• PALPATION

– Light palpation ½ inch -1 (1-2 cm)

• Palpate the abdomen lightly in all 4 quadrants

• Observe for any signs of discomfort

• Get the client to relax

• Avoid quick jars during palpation

- Deep Palpation

spring 2012 9

Common Abnormalities• Multiple Abdominal Bruises• Engorged Prominent Veins• Generalized Symmetric Distension• Bluish Discoloration around the umbilicus

(Cullen’s sign- intra peritoneal hemmorhage)

• Protruding Umbilicus• Absent or hyperactive bowel sounds• Palpable liver

spring 2012 10

Special Procedures

• Eliciting Abdominal Pain:

– Rebound Tenderness– Iliopsoas Sign– Obturator Sign– Murphy’s Sign

spring 2012 11

Developmental Considerations:Geriatric/Older Adult

• Increased fat deposit over abdominal area• Muscle tone more lax• Reduced GI peristalsis• Constipation common• Thinner abdominal wall• Abdominal contour is often rounded• Impaired digestion and food intolerances• Liver size decreases after age 50

spring 2012 12

Health Promotion

• Nutrition• Immunization• Food poisoning• Lead poisoning• OTC Drugs• Excessive laxative or enemas

spring 2012 13

Nursing Diagnoses

• Constipation• Diarrhea• Urinary retention• Altered tissue perfusion (renal, GI)• Altered nutrition (less or more than body

requirements)

spring 2012 14