Abdominal Assessment Flashcards
abdominal structures (7)
1) gastrointestinal system (GI)
2) urinary tract
3) reproductive tract
4) part of cardiovasc
5) parts of nervous ex/ spinal cord
6) blood forming organs ex/ spleen
7) immune system
abdominal landmarks
1) right upper quad
2) left upper quad
3) right lower quad
4) left lower quad
right upper quad contains what (5)
1) liver & gallbladder
2) duodenum
3) head of pancreas
4) right adrenal gland & right kidney
5) ascending & transverse colon (portions)
left upper quad contains (6)
1) liver (left lobe)
2) stomach*
3) spleen*
4) body of pancreas
5) transverse & descending colon (portions)
6) left adrenal & kidney
right lower quad (6)
-what complication can occur here
1) appendix*
2) cecum
3) right kidney (portion)
4) ovary (right) & fallopian tube
5) ascending colon
6) ureter (right)
- APPENDICITUS
left lower quad (5)
-what complication can occur here
1) left kidney
2) descending colon*
3) sigmoid colon*
4) ovary (left) & fallopian tube
5) ureter (left)
- DIVERTICULITIS: inflammed pocket of colon
abdominal history
- appetite and weight
- difficulty swallowing/chewing
- pain/tenderness (OLDCART)
- nausea & vom
- food intolerance
- alcohol
- health care occupation
- hep b exposure
abdominal history cont
- usual bowel habits “how often”
- rectal probs
- past abdominal history (surgeries, trauma, diagnostic tests)
- current meds: NSAIDS (ibuprofen, motrin, aspirin), steroids, antibiotics
- current nutrition “can you recall what you ate in the last 24 hours”
bowel elimination
- natural laxatives
- characteristics of stool
- patterns vary widely 1-2 x’s a day to 2-3 x’s a week
- natural laxatives: prune juice, bran & fiber
- characteristics of stool: consistency (amount, color, shape, odor & presence of unusual matter ex/ blood)
color of stool
black: iron or upper GI bleed
red: low GI bleed or hemorrhoids
black tarry-melena: blood in GI tract
white or clay-color: lack of bile
factors affecting bowel function (9)
- age
- life-style
- diet (fiber intake)
- exercise
- meds, anesthesia (slows down GI motility, increase constipation)
- pain
- tissue inquiry
- hydration
- habits
alterations in bowel functions (6)
1) constipation
2) diarrhea
- liquid watery stool; electrolyte loss
3) incontinence
- loss of bowel control
4) flatulence
5) fecal impaction
6) distention
- acidic fluid collected in belly (bloating)
urinary elimination
-5 x’s day while awake
-look at color, odor, amount
if <30 cc/hr, CALL DOC
factors affecting urinary elimination (4)
1) fluid intake
2) age
3) health status ex/ diabetes
4) emotional state
alterations in urinary elimination (lots)
-incontinence (loss of urine / bowel)
enuresis
bed wetting
nocturia
increase urination at night
oliguria
urinary output of <420 ml in 24 hours
polyuria
increase urination
retention
can get UTI’s; when you pee do you have to go soon after
dysuria
difficulty / pain w/ peeing
pyuria
puss in urine
anuria
no urine output
stress incontinence
cough / sneeze -> pee a little
nutritional disorders (4)
1) kwashiokor
2) marasmus
3) cachexia
4) anorexia nervosa / bulimia
cachexia
malnutrition/wasting; most often secondary to cancer
-muscle wasting = human skeletons
kwashiokor
malnutrition that develops when babies are weaned form breast milk w/ out proper protein intake
maramus
secondary to protein & calorie deficiency
- gradual starvation
- may be secondary to acute illness
order done on a physical exam
1) inspect
2) auscultate
3) percuss
4) palpate
- if push then listen = produce false bowel sounds
inspection
-skin
- scars
- striae: stretch marks d/t weight loss, prego, ect.; purple color)
- rashes, lesion, or masses
inspection
-contour
normal: slightly convex or flat
obese: rounded
abnormal: swollen, distended, bulging
(bulging can indicate hernia; when cough can see)
inspection
-muscle tone & symmetry
- color
- contour
- location
- visible peristalis
- pulsations (super thin ppl)
- signs of pain: GUARDING always indicated sever probs
auscultation
- diaphragm assesses what
- bell assesses what
always auscultate BEFORE palpate for abdominal
diaphragm: bowel soudsn
bell: vascular sounds over aorta
in abdominal assessment; where do you being?
RIGHT LOWER QUAD
bowel sounds
- active
- absent
active: gurgling, high-pitched occur about 5-35 times/min
absent: may be secondary to bowel obstruction, abdominal surgery, paralytic ileum (dont move efficiently as should) or peritonitis (inflammation of perotilic cavity; very tender stomach)
how long should you listen in each quad
min of 1 minute each if absent bowel sounds
hypoactive bowel sounds
decreased, diminished bowel sounds may be due to:
-surgery, NPO status, inflammation or fluid imbalance
hyperactive bowel sounds
increased bowel sounds, often w/
-diarrhea, could be early sign of obstruction
borborygmi
stomach growling (outloud) -increase frequency/intensity of bowel sounds w/ diaherra, hunger, inflammation, bleeding, anxiety
palpation
- note size, position, mobility, consistency, tension of major organs
- tenderness (leave most tender for last)*
light palpation
-purpose
- press gently 1/2 inch
purpose: localize pain, mases, or tender organs
deep palpation
-purpose
- press firmly 1-3 inches
- when can feel organs*
- use 1-2 hands, for pressure & palp
purpose: to indicate abdominal organs, enlarged organs, locate abdominal masses
