When Documenting Findings Of An Abdominal Assessment, Which Of The Methods Below Are Best?

Department: Topics in Progressive Care

Marjaana Mehta is an adult nurse practitioner in adult medical oncology at Hackensack (Due north.J.) University Medical Center.

Assessing your patient's belly can provide critical information about his internal organs. Always follow this sequence: inspection, auscultation, percussion, and palpation. Irresolute the order of these assessment techniques could alter the frequency of bowel sounds and brand your findings less authentic.

Have your patient empty his bladder, and then lie supine with a pillow nether his head. Betrayal his abdomen from in a higher place the xiphoid procedure to the symphysis pubis.

Figure. Inspection

1. Picture show your patient's abdomen in four quadrants. Standing at his correct side, look at the abdomen from the side and from above, from the xiphoid procedure to the symphysis pubis, to determine whether it'southward flat, scaphoid, rounded, or protuberant. If it's protuberant, enquire whether this is normal for him. If information technology isn't, yous'll assess for distension or ascites during percussion and palpation.
Next, assess for whatever visible mass, bulging, or asymmetry. Expect for unusual coloring, scars, striae, lesions, petechiae, ecchymoses, spider angiomas, and suspicious-looking moles. Inspect the umbilicus and note any hernias. Look for pulsations. You lot won't see any on most patients, only in a thin patient you may run across pulsation of the aorta in his epigastric surface area and possibly peristaltic waves.




Figure. Auscultation

2. Place the diaphragm of your stethoscope lightly over the right lower quadrant and listen for bowel sounds. If you don't hear any, keep listening for v minutes within that quadrant. Then, listen to the right upper quadrant, the left upper quadrant, and the left lower quadrant. Describe bowel sounds as absent, normoactive, hypoactive, or hyperactive. Absent bowel sounds may indicate ileus or peritonitis. Hyperactive bowel sounds may occur with an early abdominal obstruction or gastrointestinal hypermotility.
3. With the bell of your stethoscope, listen over the aorta, as shown, and the renal, iliac, and femoral arteries. If the patient has hypertension, you may hear a bruit—a vascular sound similar to a heart murmur—caused by turbulent blood menstruum through a narrowed artery. Occasionally, you may hear a bruit limited to systole in the epigastric region of a good for you person.



Figure. Percussion

4. Lightly percuss all iv quadrants of your patient'southward belly. You'll hear irksome sounds over solid structures (such as the liver) and fluid-filled structures (such as a full bladder). Air-filled areas (such every bit the stomach) produce tympany. Dullness is a normal finding over the liver, but a large, dull surface area elsewhere may indicate a tumor or mass.



Figure. Palpation

5. Place the palmar aspect of the fingers on your dominant mitt flat and together on your patient's abdomen. Using a light, gentle, dipping movement, palpate for abnormalities, such every bit muscle guarding, rigidity, or superficial masses. Palpate clockwise, lifting your fingers equally yous motion from one location to another. After light palpation of the entire abdomen, identify your nondominant hand on your dominant paw to perform deeper palpation (1½ to ii inches [three.8 to 5 cm]). Notwithstanding, avert deep palpation if your patient may have a problem such every bit splenomegaly, appendicitis, or aneurysm or if palpation is painful for any reason.
6. To palpate the liver, place your left hand nether your patient, parallel to and supporting the right 11th and 12th ribs and your right hand lateral to the rectus muscle with your fingertips below the liver edge (as identified by dullness during percussion). As shown, press gently in and upwards as your patient takes a deep breath.



Figure

Another approach is to stand by his right shoulder, hook the fingers of both hands (side by side) below the liver border, press in and up toward the costal margin, and ask him to inhale. You lot may be able to feel the soft, polish, sharp border of the liver descending during inspiration. The liver is considered enlarged if the edge extends more than 1.2 inch (3 cm) below the correct costal margin. Document your assessment findings in the medical record.

SELECTED REFERENCES

Bickley L. Bates Guide to Physical Examination and History Taking, 10th ed. Philadelphia, Pa., Lippincott Williams & Wilkins, 2009.

Jarvis C. Physical Examination and Wellness Assessment, 5th ed. Philadelphia, Pa., W.B. Saunders Co., 2007.

© 2010 Lippincott Williams & Wilkins, Inc.

Source: https://journals.lww.com/nursingcriticalcare/fulltext/2010/01000/assessing_the_abdomen.11.aspx

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