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Questions and Answers
What is the expected outcome of performing an abdominal examination?
What should be completed before starting the physical assessment?
Why is hand hygiene and PPE important in the abdominal examination?
Why is it important to identify the patient?
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Why is it important to explain the purpose of the abdominal examination?
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What should be done to ensure patient privacy during the abdominal examination?
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During palpation, which organs are normally not palpable?
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What is the purpose of assessing for rebound tenderness?
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What is the purpose of using a bath blanket during an abdominal assessment?
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Why is rebound tenderness assessed last?
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Why is it necessary to inspect the abdomen for skin color and contour?
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What is the significance of Castell's sign?
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What is the purpose of McBurney's Point?
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Why is it important to examine the painful area last during an abdominal assessment?
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What should the nurse do before starting the abdominal assessment?
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What is the technique called when palpating the kidneys?
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Why is it necessary to use a systematic method when auscultating the abdomen?
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Why must percussion and palpation techniques be performed after auscultation?
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What is the primary purpose of auscultating the abdomen for vascular sounds?
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What is the significance of tympany over more air-filled regions of the abdomen?
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What is the purpose of percussing the abdomen on the right side?
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When should you palpate an area of the abdomen where the patient complains of pain or discomfort?
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What is the difference between light and deep palpation techniques?
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What is the purpose of the fluid wave test in percussing the abdomen?
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Study Notes
Abdominal Assessment
- The objective of an abdominal assessment is to complete the examination without causing the patient anxiety or discomfort, documenting the findings, and making appropriate referrals to other healthcare professionals as needed.
Pre-Assessment
- Complete a health history, focusing on the abdomen, by asking questions such as:
- Are you having any stomach issues?
- When was your last bowel movement?
- Can you describe it?
- How are you urinating?
- Do you have any pain while urinating?
- Or difficulty starting a stream?
- Any discharge?
- (If female) When was your last menstrual period?
Preparation
- Perform hand hygiene and put on PPE, if indicated, to prevent the spread of microorganisms.
- Identify the patient to ensure the right patient receives the intervention and to prevent errors.
- Close curtains around the bed and close the door to the room, if possible, to ensure the patient's privacy.
- Explain the purpose of the examination and what you are going to do, and answer any questions, to relieve anxiety and facilitate cooperation.
Abdominal Inspection
- Inspect the abdomen for:
- Skin color
- Contour
- Pulsations
- Umbilicus
- Other surface characteristics (rashes, lesions, masses, scars)
- The umbilicus should be centrally located and may be flat, rounded, or concave.
- The abdomen should be evenly rounded or symmetric, without visible peristalsis.
- In thin people, an upper midline pulsation may normally be visible.
Abdominal Auscultation
- Auscultate all four quadrants of the abdomen for:
- Bowel sounds using the diaphragm of the stethoscope
- Vascular sounds using the bell of the stethoscope
- Listen for 2-3 minutes before determining that bowel sounds are absent.
- A bruit on auscultation suggests an aneurysm or arterial stenosis.
Abdominal Percussion
- Percuss the abdomen for:
- Tones
- Density of the abdominal contents, organs, or possible masses
- Tympany over more air-filled regions (e.g., stomach and intestines) and dullness over a solid organ (e.g., liver) are the predominant tones elicited.
- Percussion on the right side helps evaluate the size of the liver; on the left side, it helps to evaluate the spleen; percussion over the symphysis pubis helps to evaluate the bladder for fullness.
Abdominal Palpation
- Palpate the abdomen lightly in all four quadrants and then palpate using deep palpation technique.
- If the patient complains of pain or discomfort in a particular area of the abdomen, palpate that area last.
- Palpation provides information about the location, size, tenderness, and condition of the underlying structures.
- Light palpation is ½ inch deep, and deep palpation is 5-8cm or >1/2 inch deep.
Specialized Techniques
- Castell's sign: enlarged spleen upon percussion
- Hook method: liver palpation
- Bimanual technique: kidneys palpation
- McBurney's point: determines location of appendix
- Rovsing's sign: pain in the right lower quadrant upon palpation of the left lower quadrant
- Psoas sign: pain in the lower back and abdominal area upon palpation of the psoas muscle
- Obturator sign: pain in the hip and abdominal area upon palpation of the obturator muscle
- Blumberg's sign (rebound tenderness): pain upon removal of pressure rather than application of pressure to the abdomen, indicating peritoneal irritation.
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Description
Test your knowledge on the abdominal assessment process, including the expected outcomes, necessary preparations, and documentation of findings. This quiz covers the importance of a health history, physical examination, and referral to other healthcare professionals.
