Mohammed Kadhim Lecture 9 Objectives At the end the students will be able to 1 Demonstrate the ability to safely amp accurately complete abdominal assessment 2 Demonstrate the ability to accurately document abdominal assessment data in organized manner ID: 1031966
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1. Abdominal Assessment Hassanain Mohammed KadhimLecture -9-
2. Objectives:At the end the students will be able to:1 .Demonstrate the ability to safely & accurately complete abdominal assessment.2.Demonstrate the ability to accurately document abdominal assessment data in organized manner.Equipment NeededI. Stethoscope.2.Measuring tip centimeter.3.Skin-marking pen.4.Alcohol swab (to clean end piece).
3. Preparation1 .Expose the abdomen so that it is visible.2.Drape the genitalia & female breast.3. Ask the client to empty the bladder.4.Keep the room warm.5.Position the client supine, with the head on a pillow, theknees bent or on pillow, & the arm at the sides or cross the chest.6.Warm the stethoscope end piece.7.Warm your hand.8.1nsure about any painful area, examine such area last to avoid any muscle guarding.Note:Assessment of abdomen different from other assessments in that inspection & auscultation precede percussion & palpation.
4. Subjective data:1. Dysphagia (Difficulty in Swallowing) 2. Nausea and vomiting3. Food intolerance 4. Bowel habits5. Past abdominal history6. Medications7. Nutritional assessment8. Appetite9.Abdominal pain
5. Abdominal Assessment 4 technique 1-Inspection 2-Auscultation3-Percussion 4-Palpation M.Sc Hassanain Mohammed Kadhim5
6. Abdomen Landmarks6
7. -7- F CAUSE Abdominal Distension 1- Fat (obese) 2- Fluid ( Ascites)3- Flatus (Gases)4- Fetus (Pregnancy)5- Feces (Constipation) 6- Fatal Growth ( malignancy )7- Fibroid Tumor M.Sc Hassanain Mohammed Kadhim7
8. Inspection: 1- Color ; normal light 2- Contour ( shape): flat or slightly roundedAb: scaphoid & distension3- Symmetry : symmetrical ( when client supine position raise his head)Ab: Asymmetrical caused by organ enlargement , mass , hernia 4- Respiratory movement : can seen clearly in male5-Aortic pulsation : no pulsation seen or slight pulsation in the epigastric region in thin people
9. 6- Peristaltic waves: no waves will be visible may be seen in thin person Ab: ripple form waves may seen in the intestinal obstruction 7- Inspect for lesion and rash: free on lesion and rash Ab: change in mole , petechiae Striae : free of striae , silver to white color striae may seen in obese or multigraveda 8- Vascularity : fine veins may seen located above or blow the umbilical area Ab: @ dilated vein seen in liver cirrhosis , obstruction of inferior vena cava , portal hypertension or ascites @ spider angioma : dilated artery or capilliary in portal hypertension and liver disease
10. 9- Scar : free of scarAb: assess scar according to location , size and color (young scar is pink while old scar is white)Spider Angioma
11. 10- Umbilicus inspect for the following : A- Color : pink skin around it should be evenly as abdomen colorAb: bluish around umbilicus ( cullen’s sign) intra - abdominal bleeding B- shape inverted or protruded not more than 0.5 cmAb: everted in abdominal distension or hernia C- Location : midline at lateral line Ab: deviated umbilicus caused by mass , scar , hernia
12. Auscultation of abdomen for the following:Bowel soundsUse the diaphragm of a warm stethoscopeApply light pressure to auscultation bowel sounds for up to 5 minutes in each quadrant. Begin in the right lower quadrant(RLQ) at the ileocecal valve area Assess for frequency and pitch
13. Normal bowel sound: soft clicks and gargling heard in 5-30 per minute . Loud prolong gurgle of stomach growling – hyperactive sound called ( borborygmi )Ab: Hypoactive bowel sound in diminished motility in surgery , late bowel obstructionHyperactive bowel sound occur by diarrhea gastroenteritis or early bowel obstructionAbsent bowel sound associated with peritonitis or paralytic ileus
14. Vascular sound use the bell to auscultate for vascularSounds normally: No bruits, no venous hums, no friction rubs. Assessed in the following area:Right renal arteryLeft renal arteryRight iliac artery Left iliac arteryRight femoral arteryLeft femoral arteryAortic humUmbilical hum
15. Percussion of the abdomen for the following:1- General percussion 2- Liver span - percuss starting below umbilicus at client's right midclavicular line (MCL). - Percuss upward until you heardullness; mark this point. - Percuss downward from the lung resonance in the right MCL todullness & mark.- Repeat in midsternal line.3- scratch test to assess liver
16. 4- Blunt percussion to assess kidneys
17. 5- Assess spleen
18. 6-Special test ( Ascites )Ascites; Accumulation of Fluid in the Peritoneal Cavity 1- Shifting dullness2- Fluid wave test
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20. 7- Assess Appendicitis 1- Rebound Tenderness2- Rovsing Sign3-Positive Psoas Sign4- Positive Obturator Sign
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