abdominal assessment cathy gibbs bsn, rn. competencies assess the health status of a patient with a...

Abdominal AssessmentAbdominal AssessmentCathy Gibbs BSN, RNCathy Gibbs BSN, RN

CompetenciesCompetencies

Assess the health status of a patient with a gastrointestinal complaint

Demonstrate the techniques of a gastrointestinal assessment

Relate abnormal physical gastro-intestinal findings to pathological processes

Outline the gastrointestinal variations associated with the aging process

Assess the health status of a patient with a gastrointestinal complaint

Demonstrate the techniques of a gastrointestinal assessment

Relate abnormal physical gastro-intestinal findings to pathological processes

Outline the gastrointestinal variations associated with the aging process

Gastrointestinal System Assessment


Patient’s historyCurrent signs & symptomsVital signsLevel of consciousnessAge & genderBowel habits or alterations in

elimination

Patient’s historyCurrent signs & symptomsVital signsLevel of consciousnessAge & genderBowel habits or alterations in

elimination

Common Chief ComplaintsCommon Chief Complaints

Nausea and vomitingAnorexiaDysphagiaDiarrhea or constipation

Nausea and vomitingAnorexiaDysphagiaDiarrhea or constipation

Common Chief ComplaintsCommon Chief Complaints

Abdominal distensionAbdominal pain Increased eructation or flatulenceDysuriaNocturia

Abdominal distensionAbdominal pain Increased eructation or flatulenceDysuriaNocturia

Characteristics of Chief Complaint

Characteristics of Chief Complaint

QualityAssociated manifestationsAggravating factorsAlleviating factorsTiming

QualityAssociated manifestationsAggravating factorsAlleviating factorsTiming

Past Health HistoryPast Health History

MedicalAbdomen specificNonabdomen specific

SurgicalGI procedures

MedicalAbdomen specificNonabdomen specific

SurgicalGI procedures

Past Health HistoryPast Health History

Allergies Injuries/accidentsSocial historyHealth maintenance activitiesCommunicable diseasesFamily health history

Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis

Allergies Injuries/accidentsSocial historyHealth maintenance activitiesCommunicable diseasesFamily health history

Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis

Common MedicationsCommon Medications

Histamine: two antagonists Antibiotics Antacids Antiemetics Anti-diarrheals Laxatives or stool softeners Steroids Chemotherapeutics Anti-flatulents

Histamine: two antagonists Antibiotics Antacids Antiemetics Anti-diarrheals Laxatives or stool softeners Steroids Chemotherapeutics Anti-flatulents

Social HistorySocial History

Alcohol useDrug useTravel historyWork environmentHobbies/leisure activitiesStressEconomic status

Alcohol useDrug useTravel historyWork environmentHobbies/leisure activitiesStressEconomic status

Health Maintenance Activities

Health Maintenance Activities

SleepDietExerciseStress managementUse of safety devicesHealth checkups

SleepDietExerciseStress managementUse of safety devicesHealth checkups



Stool sampleEvaluate for consistency, color, &

odorOccult bloodStetorrhea

Stool sampleEvaluate for consistency, color, &

odorOccult bloodStetorrhea



Evaluate dietary programType of food, amount

Assess urineAmount, color, odorFluid intake

Evaluate dietary programType of food, amount

Assess urineAmount, color, odorFluid intake



Signs of dehydrationDry mucous membranesPoor skin turgorDecreased urine outputIncrease in pulse

Signs of dehydrationDry mucous membranesPoor skin turgorDecreased urine outputIncrease in pulse



Evaluate laboratory testsPresence of hemorrhoidsSkin color

Yellow, pallor, flushingSphincter control

Reports of control of bowel movements

Incontinence

Evaluate laboratory testsPresence of hemorrhoidsSkin color

Yellow, pallor, flushingSphincter control

Reports of control of bowel movements

Incontinence



Presence of painNonverbal signs

Flinching & grimacingOnset, location, intensity, duration, &

aggravating factorsPalpate for rebound tenderness

Presence of painNonverbal signs

Flinching & grimacingOnset, location, intensity, duration, &

aggravating factorsPalpate for rebound tenderness



Signs of shock following traumaPatient’s knowledge of diagnostic

test & procedures

Signs of shock following traumaPatient’s knowledge of diagnostic

test & procedures

Assessment of the Abdomen

Assessment of the Abdomen

EquipmentOrder

InspectionAuscultationPercussionPalpation

EquipmentOrder

InspectionAuscultationPercussionPalpation

Anatomy and PhysiologyAnatomy and Physiology

Abdominal quadrantsRight upperRight lowerLeft upperLeft lower

Abdominal quadrantsRight upperRight lowerLeft upperLeft lower


StomachSmall intestineLarge intestineLiverGallbladder

StomachSmall intestineLarge intestineLiverGallbladder


PancreasSpleenVeriform appendixKidneys, ureters, and bladderLymph nodes

PancreasSpleenVeriform appendixKidneys, ureters, and bladderLymph nodes

InspectionInspection

ContourSymmetryRectus abdominis musclesPigmentation and colorScarsAscites

ContourSymmetryRectus abdominis musclesPigmentation and colorScarsAscites


StriaeRespiratory movementMasses or nodulesVisible peristalsisPulsationUmbilicus

StriaeRespiratory movementMasses or nodulesVisible peristalsisPulsationUmbilicus

Abdominal StriaeAbdominal Striae


Normal findingsAbdomen is flat or round, symmetricalUniform in color and pigmentationNo scars or striae presentNo respiratory retractionsNo masses or nodulesRipples of peristalsis may be visibleNon-exaggerated pulsation of the

abdominal aorta may be presentUmbilicus is depressed

Normal findingsAbdomen is flat or round, symmetricalUniform in color and pigmentationNo scars or striae presentNo respiratory retractionsNo masses or nodulesRipples of peristalsis may be visibleNon-exaggerated pulsation of the

abdominal aorta may be presentUmbilicus is depressed

AuscultationAuscultation

Assess all four quadrantsListen for at least 5 minutes

before concluding bowel sounds are absent

Assess all four quadrantsListen for at least 5 minutes

before concluding bowel sounds are absent

Stethoscope placement for Auscultating Abdominal Vasculature

Stethoscope placement for Auscultating Abdominal Vasculature

Abdominal Assessment Landmarks

Abdominal Assessment Landmarks

1. Xiphoid process2. Costal margin3. Abdominal

midline4. Umbilicus5. Rectus Abdominis

Muscle6. Anterior Superior

Iliac Spine7. Inguinal Ligament8. Symphysis Pubis

1. Xiphoid process2. Costal margin3. Abdominal

midline4. Umbilicus5. Rectus Abdominis

Muscle6. Anterior Superior

Iliac Spine7. Inguinal Ligament8. Symphysis Pubis


Normal findings Bowel sounds are heard in all

quadrantsUsually sounds are high pitchedOccur 5 to 30 times per minute

Normal findings Bowel sounds are heard in all

quadrantsUsually sounds are high pitchedOccur 5 to 30 times per minute


Abnormal findings: absent, hypoactive or hyperactive bowel sounds

Pathophysiological indicationsAbsent and hypoactive bowel

sounds may indicate decreased motility and possible obstruction

Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

Abnormal findings: absent, hypoactive or hyperactive bowel sounds

Pathophysiological indicationsAbsent and hypoactive bowel

sounds may indicate decreased motility and possible obstruction

Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

PercussionPercussion

Percuss all four quadrantsAssess liver span, liver descent,

margins of spleen, stomach, kidneys, bladder

Sounds heard: tympany or dullness

Percuss all four quadrantsAssess liver span, liver descent,

margins of spleen, stomach, kidneys, bladder

Sounds heard: tympany or dullness

Normal FindingsNormal 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

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

Abnormal FindingsAbnormal Findings

Dullness over areas where tympany is normally heardThis finding may indicate a mass

or tumor, ascites, full intestine, pregnancy

Liver span > 12 cm or < 6 cmThis finding may indicate

hepatomegaly or cirrhosis

Dullness over areas where tympany is normally heardThis finding may indicate a mass

or tumor, ascites, full intestine, pregnancy

Liver span > 12 cm or < 6 cmThis finding may indicate

hepatomegaly or cirrhosis


Costovertebral angle tenderness May indicate pyelonephritis

Ability to percuss a recently emptied bladder May indicate urinary retention

Costovertebral angle tenderness May indicate pyelonephritis

Ability to percuss a recently emptied bladder May indicate urinary retention

PalpationPalpation

Light vs. DeepPalpate all quadrantsNormal findings

No tendernessAbdomen feels softNo muscle guarding

Light vs. DeepPalpate all quadrantsNormal findings

No tendernessAbdomen feels softNo muscle guarding

Light palpation of the abdomen

Light palpation of the abdomen

Palpitation for Ascites;Fluid Wave

Palpitation for Ascites;Fluid Wave


Tenderness on palpationMay indicate inflammation, masses,

or enlarged organsMuscle guarding on expiration

May indicate peritonitisPresence of masses, bulges, or

swellingMay indicate enlarged organs,

tumors, cholecystitis, hepatitis, cirrhosis

Tenderness on palpationMay indicate inflammation, masses,

or enlarged organsMuscle guarding on expiration

May indicate peritonitisPresence of masses, bulges, or

swellingMay indicate enlarged organs,

tumors, cholecystitis, hepatitis, cirrhosis


Liver is palpable below the costal marginMay indicate CHF, hepatitis, cirrhosis,

encephalopathy, cancerSpleen is palpable

May indicate inflammation, CHF, cirrhosis, mononucleosis

Kidneys are palpableMay indicate hydronephrosis,

neoplasms, polycystic kidney disease

Liver is palpable below the costal marginMay indicate CHF, hepatitis, cirrhosis,

encephalopathy, cancerSpleen is palpable

May indicate inflammation, CHF, cirrhosis, mononucleosis

Kidneys are palpableMay indicate hydronephrosis,

neoplasms, polycystic kidney disease


Aorta width > 4 cmMay indicate abdominal aortic aneurysm

Able to palpate recently emptied bladderMay indicate urinary retention

Palpable inguinal lymph nodes > 1 cm in diameter or tender nodesMay indicate systemic infections, cancer

Aorta width > 4 cmMay indicate abdominal aortic aneurysm

Able to palpate recently emptied bladderMay indicate urinary retention

Palpable inguinal lymph nodes > 1 cm in diameter or tender nodesMay indicate systemic infections, cancer

abdominal assessment cathy gibbs bsn, rn. competencies assess the health status of a patient with a...

Documents

health status

elimination slide

constipation slide

colitis slide

gastrointestinal assessment

rn slide

factors timing slide

gastrointestinal complaint