Abdominal Assessment PDF - NCMB 316 RLE

Abdominal Assessment J.A.K.E NCMB 316 RLE ABDOMINAL ASSESSMENT Hepatic flexure of colon Health History...

Abdominal Assessment J.A.K.E NCMB 316 RLE ABDOMINAL ASSESSMENT Hepatic flexure of colon Health History Part of ascending and transverse colon Inquire about a history of abdominal disease. 2) Left Upper Quadrant Is there a family history of abdominal disease? Stomach Ask the client to describe the usual bowel pattern and Spleen characteristics. Left lobe of liver Are there problems with weight loss or gain, a change in Body of pancreas appetite or taste, food intolerance, belching, nausea or Left kidney and adrenal vomiting, hematemesis (blood in emesis), pain or Splenic flexure of colon indigestion with eating, difficulty swallowing, diarrhea or Parts of transverse and descending colon constipation, bowel incontinence, flatulence (excess gas), 3) Right Lower Quadrant changes in bowel habits or stool characteristics (e.g., clay- Cecum colored or blood in stool, ribbon-like stools), hemorrhoids Appendix (is there any pain or bleeding especially with defecation), Right ovary and fallopian tube rectal pain or itching, pain in the abdomen, ascites Right ureter (swelling of the abdomen) or jaundice? Right spermatic cord Terms to remember: 4) Left Lower Quadrant Defecation – bowel movements (BM) Part of descending colon Constipation – passage of hard stool, no passage of stool Sigmoid colon for a period of time Left ovary and fallopian tube Obstipation-collection of hardened feces in the colon Left ureter Diarrhea-frequent passage of watery stools Left spermatic cord Flatulence-presence of excess gas (tympanites) Nine Abdominal Regions Fecal impaction – collection of hardened feces in the folds of the rectum Pyrosis – heart burn Fecal incontinence – involuntary elimination of bowel movements (Encopresis) Feces – waste products of digestion in the colon Stool – waste products of digestion expelled into the external environment Acholic stool (clay-colored stool) – absence of bile pigment stercobilin in biliary obstruction Melena - black, tarry stool due to Upper GI bleeding. Hematochezia – passage of stool with bright red blood due to lower GI bleeding Steatorrhea – greasy, fatty foul smelling stool due to presence of undigested fats Emesis – vomiting Hematemesis – vomiting of blood Dysphagia – difficulty swallowing Odynophagia – painful swallowing Satiety – feeling of having had eaten enough Subdivision of Abdomen Four Quadrants Nine Regions Abdominal Quadrants 1) Right Upper Quadrant Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal ABD 1 of 4 J.A.K.E Abdominal Assessment NCMB 316 RLE Preparation Abdominal Flat Protruberant or Equipment - stethoscope, marking pen, ruler contour Rounded Distended, scaphoid Empty bladder –to promote comfort during procedure (measure or concave Short fingernails abdominal Warm and comfortable environment – hands and girth) – diaphragm should be warm to prevent discomfort describes the Patient lie on back, hands on the side or the chest, pillow nutritional under head, knees slightly flexed or with rolled towel under state the knees (dorsal recumbent position) – to relax the abdomen and make palpation easier Symmetry Symmetric Asymmetric Movement Respiratory Diminished Sequence of Assessment movement abdominal respiration Pulsations Slight pulsation Vigorous, exaggerated pulsations Peristaltic Not visible Visible waves Patient Behavior: Normal findings: A comfortable person is relaxed and Assessment Findings quiet on the examining table, has a relaxed facial expressions and normal respirations. Inspection Normal Abnormal Abnormal findings: Restlessness and constant turning to Color Lighter than the Purple find comfort, resisting any movements, knees flexed up, general skin tone Yellow facial grimacing and rapid uneven respirations may Pale indicate pain. Redness Bruises Vascularity Scattered fine Dilated veins veins Striae Old, silvery, Red Striae white striae Skin Pale, smooth, Non-healing scars, characteristic minimally raised redness, over scars inflammation abdomen Free of lesions or changes in moles, rashes skin glistening and Flat moles, taut, petechiae, surgical scars cutaneous angiomas may be present (spider nevi), dilated but record the veins, and poor skin length in cm and turgor location, good skin turgor Umbilicus’ Similar to Everted – ascites and color, surrounding abdominal mass location abdominal skin Enlarged and Everted tones – umbilical hernia Midline Cullen’s sign- Inverted, round bleeding, jaundice ABD 2 of 4 J.A.K.E Abdominal Assessment NCMB 316 RLE Assessment Findings Blunt Inflammation Auscultation Normal Abnormal percussion of No tenderness infection the kidney Bowel sounds (RLQ- RUQ-LUQ- Intermittent, soft LLQ) clicks cascading RLQ – and gurgles Hypoactive ileocecal 5-30/min, do not Hyperactive valve bowel bother to count Absent – auscultate sounds are just judge for 5 minutes before normally “borborygmi” – concluding absent present here stomach Diaphragm of growling steth – high pitch Vascular sounds -for people with No bruits With bruits hypertension -bell – low pitch Percussion sounds Flatness – bone or muscle Dullness – heart, liver, spleen (fluid, feces) Resonance – air filled lungs (hollow) Hyperresonance – emphysematous lung (hyperinflated) Tympany – air filled stomach (drumlike) (gas in stomach or intestine) Assessment Findings Palpation Normal Abnormal Assessment Findings Guarding Abdomen Non-tender, soft Percussion Normal Abnormal Rigid Tympany No palpable Hyper-resonace Masses With mass Dullness over masses Tone Enlarged area of the spleen and 2.5 – 3 cm wide dullness liver with a Wide, bounding LLB: costal Aorta moderately pulse margin (1-4cm) strong and Height of the ULB: right 5th – regular pulse Hepatomegaly liver 7th ICS Liver Not palpable, Enlarged, tender MCL: 6-12 cm mild tenderness MSL: 4-8 cm is normal 7 cm wide near Enlarged Spleen Spleen Seldom palpable the left 10th rib, (posterior - splenomegaly slightly posterior LMAL) Kidneys Not palpable Enlarged to the MAL ABD 3 of 4 J.A.K.E Abdominal Assessment NCMB 316 RLE Inspiratory Arrest (Murphy’s sign) - Normally, palpating the liver causes no pain. - In a patient with inflammation of the gall bladder or cholecystitis, pain occurs on palpation of the liver. - Holding the fingers under the liver border, ask the patient to take a deep breath. - A normal response, patient completes the deep breath without pain. - It is confirmed when the patient feels sharp pain and abruptly stops midway on inspiration. Term to remember: OSCOPY – means visualization of an organ or body cavity with lighted instruments o esophagoscopy o gastroscopy o duodenoscopy o proctosigmoidoscopy o colonoscopy o laparoscopy CENTESIS – means aspiration of fluid from body organ or body cavity o paracentesis – aspiration of fluid from the abdominal cavity OSTOMY – means opening to the outside of the body o colostomy o ileostomy o jejunostomy o gastrostomy ECTOMY – means removal of an body organ or glands o appendix o spleen o gallbladder o stomach RRHAPHY, PEXY, PLASTY – means repair o herniorhaphy o orchidopexy o rhinoplasty ITIS – means inflammation of an body organ or cavity o stomatitis o gastritis o pancreatitis LITHIASIS – formation of stone o cholelithiasis o nephrolithiasis o choledolithiasis o ureterolithiasis Enema – administration of fluid or medication into the colon through a rectal tube Tests for Appendicitis Ageusia – absence of sense of taste Blumberg’s sign (Rebound tenderness) – Sharp, stabbing Cachexia – severe weight loss and severe wasting pain as the examiner releases pressure from the abdomen Gastric gavage – feeding through NGT Rovsing’s sign – Pain in the RLQ during pressure in the LLQ Gastric lavage – irrigation of the stomach through NGT Psoas sign (Iliopsoas muscle test) – Pain in the RLQ Gastrostomy feeding – gastrostomy tube when raising the client’s right leg from the hip while Jejunostomy feeding – jejunostomy tube applying pressure on the lower thigh Obturator sign – Pain in the RLQ when the hip and knee are flexed and when the legs are rotated internally ABD 4 of 4