Assignment: Abdominal Assessment Paper

NURS 6512 Midterm Exam Review (Week 1-6)

Building A Complete Health History

· Communication techniques used to obtain a patient’s health history

· Recording and documenting patient information

· SOAP note documentation

· Subjective vs objective information when documenting

· Ethical decision making and beneficence

 

Diversity and Health Assessments

· Cultural awareness and diversity

· Socioeconomic, spiritual, and lifestyle factors affecting diverse populations

· Functional assessments

 

Assessment Tools and Diagnostic Tests in Adults and Children

· Growth, Development, and Measurements in children and adults

· Nutritional assessment to include recommended water intake and energy requirements

· Macronutrients vs Micronutrients

· Significance of a food diary

· BMI measurements for normal, overweight, obesity, morbid obesity

· Pernicious Anemia

· Examination techniques and equipment

· Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope. Assignment: Abdominal Assessment Paper

 

Assessment of the Skin, Hair, and Nails

· Skin lesion characteristics

· Documenting skin lesions using “ABCD” rule

· Anatomy and physiology of skin layers

· Abnormal nail findings in older adults

· Psoriatic skin lesions

· Vesicular skin characteristics

· Normal vs abnormal hair distribution during aging

· Characteristics of hair distribution

Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

· Cranial Nerves associated with the HEENT system

· Normal assessment findings of an adolescent’s nose and throat

· Normal examination findings of an infant’s fontanelles

· Examination findings of a patient with hypothyroid and hyperthyroid

· Techniques for examining the HEENT systems

· Examination findings for a patient with sinus symptoms

· Appropriate tuning fork frequencies to approximate vocal frequencies

· Examining the oral mucosa

· Hearing loss findings when examining the elderly patient

· Examination techniques used to examine the trachea and thyroid

 

Assessment of the Abdomen and Gastrointestinal System

· Organs involved in the alimentary tract

· Correct assessment order for examining the abdomen

· Examination technique and findings of the liver

· Examination findings associated with appendicitis

· Examining McBurney’s sign

· Assessment of abdominal pain in women

· Landmarks for abdominal examination

· Characteristics of bowel sounds heard during auscultation

 

© 2019 Walden University Page 2 of 2

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Student Checklist

 

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

 

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Ball: Seidel’s Guide to Physical Examination, 8th Edition

 

Chapter 17: Abdomen

 

Student Checklist

 

 

Assessed A ppropriately by S tudent?

 

 

Yes

No

Comments

I. Inspection of the abdomen (patient supine, pillow under head, arms at sides)

 

 

 

A. Skin characteristics, venous return patterns, symmetry, surface motion

 

 

 

B. Abdominal muscles (as patient raises head) for masses, hernia, or separation

 

 

 

II. Auscultation of all quadrants

 

 

 

A. Bowel sounds and frequency

 

 

 

B. Arteries (bruits)

 

 

 

III. Percussion of all quadrants

 

 

 

A. Tone

 

 

 

B. Estimation of liver size

 

 

 

C. Splenic dullness

 

 

 

D. Gastric air bubble

 

 

 

IV. Light palpation of all quadrants for muscle resistance, tenderness, masses

 

 

 

V. Deep palpation of all quadrants

 

 

 

A. Umbilicus and umbilical ring (bulges, masses)

 

 

 

B. Liver border

 

 

 

C. Gallbladder

 

 

 

D. Spleen

 

 

 

E. Kidneys

 

 

 

F. Aortic pulsations

 

 

 

G. Other masses

 

 

 

VI. With patient seated, percuss the costovertebral angles for kidney tenderness

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Key Points

 

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

 

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Ball: Seidel’s Guide to Physical Examination, 8th Edition

 

Chapter 17: Abdomen

 

Key Points

 

This review discusses examination of the abdomen.

Before the exam, gather the necessary equipment: stethoscope, centimeter ruler, non-stretch tape measure, and marking pen.

 

To inspect the abdomen, perform the following.

Using tangential lighting, inspect the abdomen for four surface characteristics.

• First, observe the skin color. It may vary greatly but should have no jaundice, cyanosis, redness, bruises, or discoloration.

Second, check for nodules and other lesions, which should not be present.

Third, note any scars and draw their location, configuration, and relative size on an illustration of the abdomen. Assignment: Abdominal Assessment Paper

Fourth, assess the venous return. Above the umbilicus, venous return should be toward the head. Below the umbilicus, it should be toward the feet.

• Next, inspect the abdominal contour and symmetry.

• The contour is the abdominal profile from the rib margin to the pubis. It normally may be flat, rounded, or scaphoid. The umbilicus should be centrally located and may be inverted or may protrude slightly.

Contralateral areas of the abdomen should be symmetrical in appearance and contour and should have no distention or bulges. Assignment: Abdominal Assessment Paper

• To elicit hidden masses or bulges, have the patient take a deep breath and hold it. The abdomen should remain smooth and symmetrical. Next, have the supine patient raise their head from the table as you inspect the abdomen. Note any masses, hernia, or muscle separation.
• With the patient’s head at rest, observe for three types of abdominal movement.

• First, inspect for smooth, even movement with respiration.

Second, assess for surface motion from peristalsis. In a thin patient, it normally may be visible. Otherwise, it may signal an intestinal obstruction.

Third, note any aortic pulsation in the upper midline. Although pulsations may be visible in a thin patient, marked pulsations suggest a disorder.

 

To auscultate the abdomen, perform the following.

Remember to auscultate before you percuss or palpate because these techniques can alter bowel sounds. Using the diaphragm of a warmed stethoscope, listen for bowel sounds and note their frequency and character.

• Expect to hear clicks and gurgles at a rate of 5 to 35 per minute.
• Note unexpected findings, such as increased or decreased bowel sounds or high-pitched tinkling sounds.

• Auscultate for three additional sounds.

• First, use the stethoscope diaphragm to detect high-pitched friction rubs over the liver and spleen.

Second, use the stethoscope bell to check for bruits over the aortic, renal, iliac, and femoral arteries.

Third, use the stethoscope bell to assess for a soft, continuous, low-pitched venous hum in the epigastric area and around the umbilicus.

 

To percuss the abdomen, perform the following.

Systematically percuss for tone in all abdominal quadrants.

• Tympany is heard over the stomach and intestines.
• Dullness is heard over organs and solid masses.

• Percuss to estimate the liver span, using three steps.

• First, determine the lower border of the liver by percussing up from an area of tympany along the right midclavicular line. Mark the point where tympany changes to dullness, which usually occurs at or slightly below the costal margin.

Second, determine the upper border of the liver by percussing down from an area of resonance along the right midclavicular line. Mark the point where resonance changes to dullness, which usually is in the fifth intercostal space. Assignment: Abdominal Assessment Paper

Third, measure the distance between the marks. The vertical liver span usually ranges from 6 to 12 cm.

• To assess liver descent, ask the patient to take a deep breath and hold it while you percuss the lower border again. With this maneuver, the area of dullness at the lower border should shift down 2 to 3 cm.
• Percuss the spleen just posterior to the midaxillary line on the left side, beginning in areas of lung resonance and moving in several directions. You normally may hear a small area of splenic dullness from the sixth to ninth rib. Percuss the lowest intercostal space in the left anterior axillary line before and after the patient takes a deep breath. Tympany should remain in this area.
• Percuss for the gastric air bubble in the left lower anterior rib cage and left epigastric region. Gastric bubble tympany is lower in pitch than intestinal tympany.

With the patient seated, percuss the kidneys, following two steps.

• First, place the palm of your hand over the right costovertebral angle and strike it with the side of the fist of your other hand.

Second, repeat this action on the left costovertebral angle. In both locations, the patient should feel a thud but no pain.

 

To palpate the abdomen, perform the following.

Using light palpation, systematically assess all quadrants. But first, try to relax the abdominal muscles. For example, place a small pillow under the patient’s head and slightly flexed knees, warm your hands, take a slow and gentle approach, and save any tender areas for last. For light palpation, press in no more than 1 cm with the palmar surface of your fingers.

• Expect the abdomen to feel smooth and soft.

Note any resistance or tenderness. And watch for guarding, which should alert you to proceed with caution.

Using moderate palpation, systematically assess all quadrants in two ways.

• First, palpate with the palmar surface of your fingers. This may elicit tenderness that was not produced by light palpation.

Second, palpate with the side of your hand throughout the respiratory cycle. As the patient inhales, you may feel the liver and spleen bump gently against your hand.

• Using deep palpation, systematically assess all quadrants with the palmar surface of your fingers. If a patient’s obesity or muscular resistance makes deep palpation difficult, try bimanual palpation with one hand on top of the other. With either technique, feel for the rectus abdominis muscles, aorta, and portions of the colon. Note any tenderness.

If you detect a mass, evaluate its location, size, shape, consistency, tenderness, pulsation, mobility, and movement with respiration. To see if the mass is superficial or intraabdominal, palpate as the patient lifts his or her head off the table. A superficial mass will remain palpable; an intraabdominal mass will not.

Palpate the umbilical ring and periumbilical area. The umbilical ring should feel round and regular. The area should have no bulges, nodules, or granulation.

• Palpate for specific abdominal structures.
• For the liver, press in and feel for its edge at the right costal margin as the patient takes a deep breath. If palpable, the liver should feel firm, smooth, even, and nontender.

For the gallbladder, palpate below the liver margin at the lateral border of the rectus abdominus muscle. A healthy gallbladder is not palpable.

For the spleen, press in over the left costal margin as the patient takes a deep breath. The spleen is not usually palpable.

For the kidneys, assess the right and left organs separately, placing one hand on the flank and the other hand on the costal margin. As the patient inhales deeply, lift the flank and palpate deeply. The right kidney is more commonly palpable than the left kidney.

For the aorta, palpate deeply for the aortic pulsation slightly left of the midline. If the pulsation is prominent, try to determine its direction.

For the bladder, palpate above the symphysis pubis. If the bladder is distended with urine, it feels like a smooth, round, tense mass. Assignment: Abdominal Assessment Paper

 

To assess the abdomen further, perform the following.

If you suspect ascites, percuss the supine patient’s abdomen for dullness in the dependent parts and tympany in the upper parts. Also assess for shifting dullness or fluid wave.

• If the patient reports abdominal pain, assess it thoroughly, especially its quality and location. When examining the abdomen, be sure to watch the patient’s face for clues to pain. If needed, assess for rebound tenderness and perform the iliopsoas muscle and obturator muscle tests.

If you suspect a freely movable abdominal mass, perform ballottement.