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NSG2317 - health assessment > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

Solid Viscera

A

viscera that maintains a characteristic shape regardless of their contents

liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus

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2
Q

Hollow Viscera

A

the shape of the viscera depends on their contends
- typically not palpable unless distended with
contents (feces, urine, etc)

stomach, gallbladder, small intestine colon bladder

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3
Q

Abdominal Quadrants in Anatomical Position

A

RLQ - right lower quadrant
RUQ - right upper quadrant
LUQ - left upper quadrant
LLQ - left lower quadrant

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4
Q

Health History Points (9)

A
  1. Changes in Appetite - eating, weight
  2. Difficulty Swallowing
  3. Food Intolerance - to what? what happens?
  4. Abdominal Pain - OPQRSTU
  5. Nausea/ Vomiting -
  6. Bowel Habits - frequency, quality, recent changes
  7. Previous Abdominal History
  8. Medications - laxatives
  9. Alcohol and Tobacco - risk for cancers
  10. Nutrition - assess for nutritional deficits and
    malnutrition
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5
Q

Anorexia

A

loss of appetite
- occurs with gastro-intestinal disease, as an
adverse effect of medication, pregnancy, or with
psychological disorders

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6
Q

Dysphagia

A

Difficulty swallowing
- occurs with disorders of the throat or esophagus

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7
Q

Pyrosis

A

heartburn caused by reflux of gastric acid

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8
Q

Belching

A

excessive burping
- can occur with food intolerance
- can be indicative of a hiatal hernia

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9
Q

Hematemesis

A

blood in the vomit
- occurs with stomach or duodenal ulcers

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10
Q

Melena

A

black and tarry feces due to gastrointestinal bleeding
- if taking iron supplements, black feces might
occur without the tarry texture

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11
Q

Inspection Points

A
  1. Demeanor
  2. Contour, Symmetry of the abdomen
  3. Umbilicus
  4. Skin
  5. Pulsations or Movement
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12
Q

Inspection: Demeanor

A

observe the patient for signs of pain, discomfort or distress:
- flexion of the knees
- grimacing
- involuntary rigidity
- voluntary guarding

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13
Q

Voluntary Guarding

A

voluntary contraction of the abdominal musculature to avoid unpleasant sensation (cold, pain, tickles)
- occurs bilaterally
- muscles relax during exhalation
- often involves pushing examiner away

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14
Q

Involuntary Rigidity

A

involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation
- constant
- unilateral
- same area experiencing rigidity often becomes
painful when the patient increases intra-
abdominal pressure

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15
Q

Inspection: Contour, Symmetry

A

Positioning - standing on the patient’s right side, look at the abdomen from above, and from the side to note the contour
a. flat or rounded –> normal
b. scaphoid - associated with extreme weight
loss, malnutrition
c. perturbant - associated with obesity, ascites,
pregnancy

Notes:
- the abdomen should be symmetrical
bilaterally
- no bulging, pulsations, visible masses, or
asymmetrical shapes should be present

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16
Q

Inspection: Umbilicus

A

the umbilicus should be midline and inverted
- if everted, note whether or not this is normal
for the patient –> can become everted with
ascites, hernias, or masses
- inspect for signs of discoloration,
inflammation or hernia

17
Q

Inspection: Skin

A
  1. Colour - should be uniform, consistent with ethnicity
    • note any redness, rashes, bruises, etc
  2. Striae - stretch marks
    • normal finding if consistent with rapid or
      prolonged skin stretching, otherwise
      abnormal
  3. Lesions - not usually present
  4. Presence of veins - not usually present
  5. Turgor - good skin elasticity reflects healthy nutrition, hydration
  6. Temperature - should be warm

Skin is normally warm, dry and intact with colour consistent with ethinicity, and no presence of lesions, masses, rashes, or bruising

18
Q

Auscultation Points

A

a. Bowel Sounds
b. Vascular Sounds

19
Q

Auscultation of Bowel Sounds

A

start in the LRQ and continue clockwise unless pain or tenderness is expressed –> then start in the next quadrant and do painful one last
- uses the diaphragm of the stethoscpe

20
Q

Types of Bowel Sounds (4)

A

a. Normal - 5-30 sounds per minute
b. Hyperactive - increased motility (30+)
- often occurs when digesting food, or in early
bowel obstruction (when consistent with
other signs)
c. Hypoactive - decreased motility (<5)
- often occurs following abdominal surgery,
when the patient has not eaten for a while
d. Absent - listen for 5 minutes to distinguish hypoactive and absent sounds

21
Q

Auscultation of Vascular Sounds

A

assess the presence of vascular sounds in the abdomen prior to palpation
- Normal: no sounds
- use the bell end of the stethoscope to listen
over the aorta, left and right renal artery, iliac
a artery and femoral artery

22
Q

Types of Vascular Sounds (2)

A
  1. Systolic Bruit - pulsing, blowing sound
    • causes: abdominal aortic aneurysm, partial
      occlusion of the femoral arteries, renal artery
      stenosis –> anything causing partial occlusion of
      blood flow
  2. Venous Hum - soft, continuous humming sound
    • causes: portal hypertension, liver cirrhosis
    • heard between the xiphoid process and
      umbilicus
23
Q

Documenting the Presence of Vascular Sounds (3)

A
  1. Location
  2. Pitch
  3. Timing - during the cardio cycle
24
Q

Percussion of the Abdomen

A

used to:
a. assess the relative density of abdominal
contents
b. to locate organs
c. screen for abdominal fluid or masses

perform while the patient is supine, starting in the RLQ (skip to next if patient expresses pain/tenderness in RLQ) –> move clockwise

25
Q

Sounds associated with Abdominal Percussion

A

a. Tympany - heard over the intestines/ colon (air rises to the surface when supine)

b. Dullness - heard over solid structures, a distended bladder, adipose tissue, fluid or mass
- note whether dullness should be heard over
area examined
- abnormal finding if noted over areas that should
be tympany

c. Hyper-Resonance - is heard with gaseous
distension

26
Q

Palpation of the Abdomen

A

LIGHT palpation is used to:
a. assess surface characteristics - texture,
temperature, moisture, swelling, rigidity,
pulsations
b. presence of pain

perform while the patient is supine, depressing the skin approximately 1cm while making a gentle rotary motion, lifting the fingers from the skin completely before moving to the nest location
- if patient does not express pain/ tenderness,
start in RLQ and move clockwise
- if patient expresses pain/ tenderness in RLQ,
start at next quadrant clockwise

ALWAYS save areas of pain/ tenderness for last

27
Q

Abdominal Palpation: Abnormal Findings (4)

A
  1. Voluntary Guarding - intermittent contraction of
    muscles
  2. Involuntary Rigidity - constant rigidity of the
    muscles
  3. Tenderness - associated with acute and chronic
    pain/ inflammation
    - acute pain extending from the umbilicus to
    the RLQ is indicative of appendicitis
  4. Organomegaly - abnormal enlargement of the organs
28
Q

Ascites

A

fluid accumulation in the peritoneal cavity due to portal hypertension an flow albumin in the blood
Causes: liver cirrhosis, congestive heart failure

Inspection: perturbant abdomen (single curve),
everted umbilicus, bulging flanks in supine
position (gravity pushes to the sides), skin is tight,
glistening, recent weight gain, increase in
abdominal girth

Auscultation: normal over intestines (when supine,
fluid moves to the side), diminished over fluid

Percussion: tympany over intestines (when supine,
fluid moves to the side + intestines “float”), dull
over fluid

Palpation: skin is tight (movement is limited),
glistening/ moist, increased intra-abdominal
pressure

29
Q

Bowel Obstruction

A

Inspection: distended abdomen, vomiting, fever, decreased blood pressure, increased pulse rate, increased breathing rate, dehydration + loss of electrolytes (hypovolemic shock = loss of fluids)

Auscultation: initially hyperactive (to compensate), then hypoactive –> potentially none if severe

Percussion: dull over areas above blockage (accumulation of fluid and gas), tympany over areas distal to blockage

Palpation: skin is tight (pressure from excess fluid and gas leaking into peritoneum), limited movement, potentially feel the blockage

30
Q

Older Adult Considerations: Physiological Changes

A
  1. Changes in accumulation of adipose tissue
    a. women - accumulates in suprapubic areas (dec
    estrogen levels)
    b. men - deposits in abdominal areas
  2. Delayed esophageal emptying - food moves
    slower down the esophagus into the stomach –>
    increases the risk of food/ liquid entering the
    trachea/ lungs (aspiration + pneumonia secondary
    to aspiration)
  3. Decreased:
    a. salivation - dry mouth, decrease in taste
    b. gastric acid secretion - absorption of oral
    medications impaired or delayed
    c. liver size - decreased ability to process and clear
    medication –> risk of accumulation + toxicity
    d. renal functioning - decreased ability to clear
    toxic build up (+ liver size)
31
Q

Older Adult Considerations: Increased Risks

A

a. Dehydration - reduced ability to conserve water,
respond to changes in temperature, acuteness of
thirst
- less likely to drink when thirsty due to decreased ability to perform AODL

b. Gallstones - secondary to dehydration

c. Constipation - poor dietary habits (+ decreased
taste, smell), sedentary lifestyle, decreased ADOL
(ignoring the urge to defecate)

NSG2317 - health assessment (18 decks)

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