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02.08 Abdomen (Abdominal) Assessment

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Overview

  1. Remember the order of assessment is different!
    1. Inspect
    2. Auscultate
    3. Percuss
    4. Palpate

Nursing Points

General

  1. Supplies needed
    1. Stethoscope
    2. Pen light (optional)

Assessment

  1. Inspect
    1. Shape and contour
      1. Look across abdomen left to right
      2. Can use pen light to look for visible bulging or masses
      3. Look for distention
    2. Umbilicus – discoloration, inflammation, or hernia
    3. Skin texture and color
    4. Lesions or scars
      1. Note details – length, color, drainage, etc.
    5. Visible pulsations
    6. Respiratory movements (belly breather)
  2. Auscultate
    1. Start in RLQ → RUQ → LUQ → LLQ
      1. This follows the large intestine
    2. Use diaphragm of stethoscope to listen for 1 full minute per quadrant
      1. Active – Should hear 5-30 clicks per minute
      2. Hypoactive
      3. Hyperactive
      4. Absent – must listen for 5 minutes per quadrant to confirm this
    3. Use bell of stethoscope to listen for bruits
      1. Aorta – over the epigastrium
      2. Iliac and femoral arteries – Inguinal are
      3. Renal arteries – A few cm above and to the side of the umbilicus
        1. Press firmly
      4. The presence of a bruit could indicate narrowing of the arteries – if this is a new finding, report to provider
  3. Percuss
    1. Percuss x 4 quadrants, starting in RLQ as with auscultation
    2. Expect to hear tympany
    3. Dullness could indicate a mass, fluid-filled bladder, blood in the belly, or significant adipose tissue
      1. Exception – dullness over the liver is expected
    4. CVA tenderness
      1. Place nondominant hand flat over the costovertebral angle (flank).
      2. Strike your hand with the ulnar surface of your dominant hand
      3. Should be nontender
      4. Repeat bilaterally
  4. Palpate
    1. Light palpation – small circles in all 4 quadrants
      1. Can do 4 small areas in each quadrant to be thorough
    2. Deep palpation – deeper circles in all areas
    3. Palpating for masses – make note of size, location, consistency, tenderness, and mobility
    4. Make note of any guarding or tenderness
    5. Assess for rebound tenderness
      1. Press down slowly and deeply
      2. Release quickly
      3. Ask patient which hurt most (down or up)
      4. Rebound tenderness over RLQ could indicate appendicitis
    6. If distended, perform Fluid-Wave test to look for ascites:
      1. Place patient’s hand over umbilicus
      2. Place your hand on right flank, then tap or push on the left flank with your other hand
      3. If you feel the tap/push on the opposite hand, that’s a Positive Fluid-Wave test
        1. Indicates Ascites
      4. You may also see the patient’s hand ‘wave’ with the fluid

Nursing Concepts

  1. Ask patient if they have had any difficulty with bowel movements
    1. Frequency
    2. Consistency
    3. Color
      1. Bleeding?
  2. If a bowel movement is available, asses the stool for color, consistency, character

Patient Education

  1. Purpose for assessments and what you will be looking at/for

Reference Links

Study Tools

Video Transcript

In this video we’re going to review an abdominal assessment. Now, you may remember from the intro to health assessment video that the order of assessment is a little different with abdominal assessments, so you’ll see that here as well.

One thing that is the same is we always start with inspection. So make sure you lift your patient’s gown and look at their abdomen. You’re looking for the shape and contour, looking for any bulges, masses, or distention – you can even shine a pen light across it if you need to.
You are also looking around the umbilicus for any redness or swelling, any drainage, or any obvious herniations. If you have the patient cough or bear down, that will make hernias more apparent.
Also make note of any wounds, lesions, or scars – and the details of those – size, shape, color, drainage, etc. And, make note of any visible pulsations or respiratory movements – just like we did in the heart and lungs assessments.
Now – we move to auscultation – this is where it’s a little bit different. If we start pressing all over their abdomen, we could change their bowel sounds, so always auscultate first. You’re going to start in the right lower quadrant and work your way up, over, and down, listening for a full minute in each quadrant. You should hear between 5 and 30 clicks a minute. Less is considered hypoactive, more is considered hyperactive. In order to confirm that bowel sounds are actually absent, you have to listen for a full 5 minutes in each quadrant.
While you have your stethoscope on, turn over to the bell of your stethoscope and listen for bruits over the major arteries. You’ll listen over the epigastrium for the aorta, up and to the side of the umbilicus for the renal arteries on both sides, and then to both femoral and iliac arteries. Remember a bruit indicates narrowing of the arteries, which is never good.
Now that you’re done with auscultation you can move on to percussion. You’re going to percuss all 4 quadrants, again starting in the right lower quadrant and working your way around. You should hear tympany. Dullness over the liver or in obese patients is expected, but otherwise dullness could indicate fluid or blood, or a mass.
We’ll also check for CVA tenderness – it could indicate inflammation in the kidneys. Place one hand on the patient’s flank and strike it with the ulnar side of your other hand, then repeat that on the other side. It shouldn’t be painful.
Now we can finish up our abdominal assessment with palpation. Start with light small circles in all 4 quadrants, or even in smaller sections if you want. Then, move to deeper circles in the same areas. You’re feeling for any masses – noting details about any that you find. We also want to note if the patient is guarding or reports any pain with palpation.
If you suspect appendicitis, you can test for rebound tenderness over the right lower quadrant. Press down slowly and gently, then release quickly – ask the patient which hurt more – down or up.
And finally, if you see any distention, you need to test for Ascites. Now, of course, this patient doesn’t have any, but we’ll show you this test anyways. Now, of course, this patient doesn’t have any, but we’ll show you this test anyways. You’ll have the patient put their hand over their umbilicus. Put one of your hands on the flank and tap the other flank with your other hand. If you feel the tap in the opposite hand, that’s positive for ascites.

So that’s the physical portion of the abdominal assessment, make sure you are also asking your patient about their bowel movements or assessing their stool – color, frequency, consistency. It’s super important.
Now, go out and be your best selves today. And, as always, happy nursing!

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