Assessment of the Abdomen

Liz Mathewson

PN 2 Health Assessment

Summer 2007

What are we talking about?

• We are talking about the abdomen

• It is not a body system but the largest cavity of the body with many organs and structures

• These organs belong to a variety of systems of the body

• We will cover the pelvis in the reproductive system assessment

Alimentary Canal

Begins at Pharynx; Ends at Anus

Urinary Tract

What influences a healthy abdomen?

• Age, Developmental level

• Race, Ethnicity, Culture

• Work history

• Living conditions

• Socioeconomics

• Emotional well-being

Age and Developmental Stage

Infants & Newborn• Abdomen is round• Umbilical cord (2 A’s, 1 V) is ligated at delivery

Toddler: • Has “pot belly”; resps are abdominal

Children: • Swallow more air = great sounds• Larger liver in children

The Pregnant Female

• Uterus enlarges and moves into abdominal cavity

• By 14th week the fundus is above the pubic bone and palpable

• By 36th week fundus is high in abd, close to diaphragm and compresses many abd structures

The older adult

• Abdomen more rounded or produberant due to increased adipose tissue, decreased muscle tone and reduced connective tissue

• Soft and relaxed• Decrease in saliva and digestive enzymes,

peristalsis, intestinal absorption and intestinal activity

• Loss of teeth or ill fitting dentures

Psychosocial Considerations

• Stress

• Self-perception in all age groups

Cultural Considerations• Chronic Hep C in African Americans and

Hispanics

• Liver disease from alcohol and drugs more frequent in Native and African Americans

• Gallstones and GB cancer more frequent in Mexican and Native Americans

• African Americans have more colon cancer than Caucasians

Cultural Considerations

• H pylori occurs more frequently in African Americans and Hispanics

• Obesity: 54% of adults; 25% children

• Japanese greater chance of gastric ca

• Lactose intolerance greater in non-Caucasians

Nursing Consideration related to culture

• Language and cultural factors must be considered to avoid miscommunication and misinterpretation of info re: dx

• Nurse must be sensitive to cultural issues regarding disrobing for abd assessment

• Females may require presence of another female when examiner is male

Interview questions

• Describe your appetite and weight;

• Describe your bowel habits; what does stool look like

• History of abd disease or infection

• Do you have N, difficulty swallowing or chewing

• Pain (PQRSTU)

• Travel?

Questions re: Infants

• Is the baby breast-fed or bottle fed?

• Does the baby tolerate the feeding? Is the baby colicky? What do you do to relieve the colic?

• How much water does the baby drink?

Questions re: pregnant mum

• Are you experiencing any N, V, heart burn or flatulence?

• Are you experiencing any elimination problems such as consitipation?

The Abdominal Assessment

As with all assessment we use:• Inspection

• Auscultation

• Percussion

• Palpation

Inspection

• Determine the contour of the abdomen

• Observe the position of the umbilicus

• Observe skin colour

• Observe location and characteristics of lesions, scars, and abd markings

• Observe for symmetry, bulging or masses

• Observe for abdominal wall movement

Auscultate

• Auscultate for bowel sounds

• Auscultate for vascular sounds

• Auscultate for friction rubs

• Begin in RLQ and then proceed through each of the remaining quadrants

• Count the sounds for 60 seconds

Percussion

• Used to determine the size of solid organs

• Used to detect presence of masses, fluid or air

• Estimate the size of the liver and spleen

• Usually performed by physician or advanced practice nurse

• Sound is called tympanic or dull

Palpation

• Determines the size and

location of abd organs and to assess for the presence of masses or tenderness

• Consists of light and deep palpation

• Only physicians or AP nurses do deep

• Will not be tested on registration exams any more.

Abnormalities

• Abnormal abdominal sounds

• Abdominal pain

• Abdominal hernias

Referred Pain

Additional Tests

• Blood Work

• Urine tests

• Stool tests

• Diagnostic Imaging– Upper GI and SB series– Ba Enema

Urinary Tract Assessment

Developmental Assessment Considerations

Infants and Children:

• Increased risk of fluid and electrolyte imbalances at this stage

• Assess for hygiene issues…excessive diaper rash etc

• Undescended testacies, non-central meatus

• Bedwetting;

The Pregnant Female

• 1st trimester enlarged uterus pushes on bladder = increased urination

• Frequency in 2nd and 3rd trimesters as fetus descends into pelvis

• Amount of urine produced increases and often + for sugar

The Older Adult

• Kidneys loose wt• Blood flow to kidneys decreases• Loss of filtration; creatinine clearance decreases• Decreased ability to concentrate and dilute urine• Decreased sensation of thirst affects urine• Nocturia• Overall decrease in kidney function: BP

regulation; elimination of waste; hydration

Psychosocial Considerations

• Social isolation from incontinence

• Stress my lead to UTI’s

• UTI’s in females from sexual trauma; intercourse with new partner; coital frequency;

• Assess sexual abuse in recurrent UTI’s in children

Cultural and Environmental

• Privacy and modesty during eval

• Some cultures do not want body fluid examined by stranger

• Female present for female exam

• African and Asian American’s prone to renal calculi

• African American prone to hypertension

Questions to Ask

• Normal patterns; changes in pattern• Do you feel you empty your bladder?• Do you have control? Do you need to get up at

night? Do you have difficulty starting the stream? • Are you embarrassed by your urinary problem?• History of urinary disease or infection?• Smoker? Second hand smoker?• Work place exposure• Sexual practices?

Questions re: symptoms• Appearance of urine• Discharge from urethra• Skin changes• Short of breath • Chills• Change in cognition• Pain• Lifestyle

Specific Tests

• Blood tests– Creatinine– BUN– BUN creatinine ratio

• Urine tests– Colour, odour, turbidity, specific gravity, pH,

glucose, ketone bodies– C & S– Creatinine

Scopes