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NUR 502 > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

Three abdominal regions

A

Epigastric
umbilical
Hypogastric/Supragastric

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2
Q

RUQ Structures

A
  • Liver
  • Gallbladder
  • Duodenum
  • Head of pancreas
  • Right Kidney and adrena
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3
Q

LUQ Structures

A

*Stomach
* Spleen
* Left lobe of liver
* Pancreas
* Left kidney and adrenal
* Splenic flexure of colon
* Part of transverse and
descending colon

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4
Q

RLQ Structures

A
  • Cecum
  • Appendix
  • Right Ovary and tube
  • Right Ureter
  • Right Spermatic cord
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5
Q

LLQ Structures

A

Part of descending colon
* Sigmoid colon
* Left ovary and tube
* Left ureter
* Left spermatic cord

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6
Q

Midline Structures

A

*Aorta
* Uterus
* Bladder

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7
Q

4 Steps of abdominal assessment
(overview)

A

-Inspection
- Auscultation
- Percussion
- Palpation

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8
Q

Patient prep for abdominal assessment

A
  • Supine position, pillow under the head, arms at the
    sides
  • Draping the patient
  • — Raise the gown to just below the nipple line above the xiphoid process
  • Level of the symphysis pubis
  • Empty bladder
  • Warm hands and stethoscope
  • Nails short
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9
Q

Abdomen Development
**Infant and children

A

Umbilicus is prominent
* Liver takes up more space at birth, may be palpable
* Urinary bladder located higher in abdomen
* Less muscular-organs more easily palpated

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10
Q

Abdominal development
**Pregnant

A

Enlarged uterus
* Intestines displaced upwards and to right
* Bowel sounds diminished
* Motility may cause constipation
* Skin changes-striae, Linea nigra

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11
Q

Inspection

(What am I looking for in the abdomen?)

A

Temp- diaphoretic?
Color- bruises, erythema, jaundice, rashes
Scars
Striae-stretch marks
Dilated veins
Symmetry/umbilicus- Inverted?
Pulsations/movement
Visible organs/masses
Hair distribution

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12
Q

Auscultation sounds (what does it sound like?)
**Diaphragm

A

(high pitched sounds)

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13
Q

Auscultation sound-
Assessment

How do I do it? Frequency of bowel sounds?

A

Bowel sounds:
-Start in RLQ at ileocecal valve area-bowel …….sounds are normally always present here.
- Auscultate all 4 quadrants
- Note frequency and character
usually 5 - 30 per minute
- Occur every 5-20 seconds.

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14
Q

Auscultation sounds (what does it sound like?)
**Bowel

A

high pitched, gurgling, and irregular

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15
Q

Types of bowel sounds

A
  • Present (positive bowel sounds)
  • Hyperactive
  • Hypoactive
  • Absent: established after 5 minutes of
    continuous listening
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16
Q

Borborygmus
(Bowel sound)

A

stomach
growling-hyperperistalsis

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17
Q

Abdominal: Auscultate for Vascular sounds
(Types of sounds)

A
  • Bruits in the aortic, renal, iliac, and
    femoral arteries (not normally heard)
  • Check especially in people
    with HTN
  • Occurs with stenosis or
    occlusion of an artery
  • Pulsatile blowing sounds
  • Abdominal Aortic Aneurysm (AAA)
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18
Q

Abdominal inspection (shape)

A

Contour
Flat
Rounded: slightly distended
Scaphoid: concave, Sunken
Protuberant: distended

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19
Q

Developmental Considerations:
Children

A

Potbelly, flat while supine
Liver palpable

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20
Q

Developmental Considerations:
Adult after middle age

A

Females with fat accumulation
Males w fat deposits
Gallstones
Gastric acid secretion
Decreased salivation/taste
Esophageal emptying delayed
Liver-size decreases
Constipation

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21
Q
A
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22
Q

Vascular sounds
(what is it?)

A

Turbulent blood flow
(not normal)

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23
Q

Why do we percuss the abdomen?

A

Looking for solids
Organs like the Liver/spleen
Fluid collection
Masses
Distinguish the tympany vs dullness

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24
Q

What is tympany

A

it’s heard over abdominal areas that may be filled with abdominal air/gas (stomach for example)

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25
Q

What is dullness?

A

it’s heard over solid organs, fluid collection, or areas of consolidations (such as tumor or mass)

26
Q

What does dullness help indicate?

A

helps estimate liver size; can indicate ovarian tumor, distended bladder, ascites, fluid, mass, or adipose tissue

27
Q

What is hyperresonance?

A

Distended abdomen

28
Q

Costovertebral Angle Tenderness (CVA)

A

used for indirect percussion to assess kidneys

done over 12th rib and CVA on back

  • place palm of one hand on patient back, thump with fisted hand
    – pain with inflammation of kidney
    – causes: renal colic, pyelonephritis
29
Q

What is palpation and what is it used for? (in this class instance - light palpation)

A

to assess surface characteristics

feel for organs, enlarged organs, masses, tenderness, fluid and ascites

30
Q

What are the two types of palpation

A

light: abdominal tenderness, muscular resistance, superficial organs and masses

deep: advanced

30
Q

Characteristics of light palpation

A

How to: use the finger pads and gently press down about 1cm or 1/2 inch

gently press down and use light circular motions to palpate for:
- texture
- masses
- moisture
- pulsations
- temperature
- tenderness

31
Q

Deep Palpation characteristics (advanced assessment - do we need to know this?)

A

assess and feel for the location and size of internal organs, masses, and tenderness

may be done using one or two hands – 5-6cm or 2-3 inches

if pain reported in an area - gently palpate last

32
Q

Advanced assessment - deep palpation: bimanual technique

A

one hand over the other, push down

obese patient uses bimanual

33
Q

Abdominal masses may be characterized by:

Different types of masses…

Physiological, inflammatory, vascular, neoplasitc,obstructive

A

physiological: pregnant uterus
inflammatory: diverticulitis
vascular: AAA
neoplastic: colon cancer
obstructive: distended bladder or dilated loop of bowel

34
Q

Abnormal findings in palpation

A

guarding, rigidity, rebound tenderness (when pain is felt when moving hand away), peritonitis

35
Q

Peritonitis indications

A

positive cough test, involuntary guarding, rigidity, rebound tenderness and percussion tenderness

36
Q

Palpation of the liver

A

place left hand posteriorly parallel to and supporting 11th and 12th ribs on right

place right hand in upper quadrant below area of liver dullness

have patient take a deep breath, feel liver margin for smoothness, firm sharp edge

37
Q

Hooking technique - advanced assessment

A

alternative to liver palpation

hook hands under costal margin as patient takes a deep breath

38
Q

Palpation of the kidneys - advanced

A

usually not palpable unless enlarged!

right kidney: usually inferior pole of the right kidney
- place left hand underneath patient’s back
- have patient take a deep breath
- palpate with right hand on anterior abdominal wall
- feel for lower pole of kidney
- have patient release breath
- slowly release kidney

left kidney is rarely palpable

39
Q

Palpation of the spleen

A

spleen is not normally palpable; is palpable when enlarged

an enlarged spleen expands anteriorly, downward and medially
- it replaces tympany of stomach and colon with dullness

have patient take a deep breath, feel the edge of spleen with fingertips

40
Q

Abnormal assessment finding - appendicitis

A

localized tenderness in RLQ, right flank
rebound tenderness
inflamed peritoneum
Rovsing sign - indirect tenderness
Psoas sign - irritation to the iliopsoas muscles

41
Q

What is the Rovsing sign

A

when you palpate the LLQ and the patient has pain on the RLQ

42
Q

Abnormal assessment findings - umbilical hernia

A

protrusion of intestine through weakness in umbilical ring

43
Q

Abnormal assessment findings - incisional hernia

A

bulge near operative scar

44
Q

Abnormal assessment findings - epigastric hernia

A

protrusion of abdominal structures through epigastrium

45
Q

Abnormal assessment findings - hepatomegaly

A

enlarged liver

causes: hepatitis, cirrhosis, portal obstruction/HTN

46
Q

Abnormal assessment findings - cholecystitis

A

RUQ pain, Murphy sign

Murphy sign - pain on inspiration from palpation of gallbladder

47
Q

Abnormal assessment findings - splenomegaly

A

Enlarged spleen

causes: inflammation, HIV, splenic infarct, Mono, trauma, malaria

48
Q

Abnormal assessment findings - pancreatitis

A

LUQ pain, radiates to back, mid-epigastrium, left scapula

aggravated by eating, severe nausea and vomiting

49
Q

Abnormal assessment findings - gastric ulcer

A

ask if they take anything to help?

stomach

pain is dull, brought on by food; radiates to back

50
Q

Abnormal assessment findings - gastritis

A

inflammation of stomach lining

gnawing or burning feeling in the upper abdomen; LUQ

51
Q

Abnormal assessment findings - gastroenteritis

A

Small intestine

Diffuse abdominal pain; ask for pain rating on pain scale

caused by Norovirus

nausea and vomiting

52
Q

Abnormal assessment findings - ascites

A

fluid accumulation
rigid/taut
increased girth
fluid shift

can be very hard depending on amount of fluid and tightness
measure to see if abdomen is growing in size
can trigger other conditions in patient

ask: are you in pain? how long? have you sought help for this before?

53
Q

Abnormal assessment findings - distended abdomen

A

can be caused by: obesity, pregnancy, ovarian cyst, ascites, tumor, stool, gas/air

54
Q

Abnormal assessment findings - distended abdomen - the F’s (she listed in class)

A

Fluid
Feces
Full bladder
Flatulence
Fetus
Fatal tumor
Fatal feces
Fat

55
Q

Abnormal assessment findings - intestinal obstruction

A

fever, vomiting
absent stool/gas passage
pain above obstruction
hyperactive bowel sounds initially, then hypoactive or absent
abdomen tender to touch
distended abdomen

abdominal surgery

56
Q

Abnormal assessment findings - large bowel obstruction

A

bloating, gradual onset of pain
can rupture internally – feces in abdominal cavity
vomiting
hypoactive bowel sounds

57
Q

5 questions to ask patient beginning of abdominal assessment

A
  1. Have you recently had any nausea or vomiting?
  2. Have you had any abdominal surgery?
  3. What is your dietary pattern like? How often do you eat meals?
  4. Are you currently having any abdominal pain/tenderness?
  5. When was your last bowel movement? Color/form
58
Q

Describe Bruits and the cause

A

Turbulent sounding caused by stenosis of the Aorta

59
Q

Palpation- expected findings

A

Nontender with relaxed muscles

NUR 502 (3 decks)

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