Week 4: Abdominal Assessment & Bowl Care

Question 1

What body organs are examined in an abdominal assessment?

Answer 1

Lower GI tract, liver, stomach, uterus, ovaries, kidneys, and bladder.

Question 2

What landmark is used to palpate the kidneys and the liver?

Answer 2

Below the lowest rib. Liver anteriorly on the R upper quadrant and kidney’s posteriorly on the opposite side of the spine beneath each last rib.

Question 3

What does the inspection component of abdominal assessment include?

Answer 3

Checking:

Skin
Umbilicus
Contour and Symmetry
Enlarged organs or masses
Movement or Pulsations

Question 4

When inspecting the skin during the abdominal assessment, what does bruising indicate?

Answer 4

Accidental injury, physical abuse, or a type of bleeding disorder

Question 5

When inspecting the skin during the abdominal assessment, what are examples of unexpected findings?

Answer 5

Generalized color change such as in jaundice or cyanosis

Question 6

When inspecting the skin during the abdominal assessment, should we ask about injections and why?

Answer 6

Yes. Ask pt’s about self-administered injections (e.g LMWH or insulin) as they could lead to mild bruising

Question 7

What does a glistening, taut (tight) appearance to the abdomen indicate when inspecting the skin during the abdominal assessment?

Answer 7

Indicates ASCITES which is an abnormal buildup of fluid in the abdomen

Question 8

During an abdominal skin inspection, what are you primarily checking for?

Answer 8

Check for color, scars, venous patterns, lesions, striae (stretch marks)

Question 9

During an abdominal umbilicus inspection, what are you primarily checking for?

Answer 9

Check for position, shape, color, signs of inflammation, discharge, or protruding masses.

Question 10

During an abdominal contour and symmetry inspection, what are you primarily checking for?

Answer 10

Contour, symmetry, and surface motion of the abdomen, noting any masses, bulging, or distention (can be caused by gas, tumour, or fluid)

If distension if present, a measurement of the abdomen can be done at the umbilicus and recorded periodically to track changes.

Question 11

During an abdominal organ inspection, what are you primarily checking for?

Answer 11

Smoothness and symmetry of the abdomen. Ask pt to take a deep breath and hold. If any bulges are suspected, get pt to lift the head off the bed, so that they become more apparent.

Question 12

During an abdominal ‘movement or pulsation’ inspection, what are you primarily checking for?

Answer 12

Movement of the abdomen during respiration.

Those in severe pain have diminished respiratory movement and tighten abdominal muscles to guard against the pain.

Question 13

What increases bowel motility (hyperactive sounds during auscultation)?

Answer 13

inflammation of the bowel
anxiety
diarrhea
bleeding
excessive ingestion of laxatives
reaction to certain foods

Question 14

What are you auscultating for during an abdominal assessment?

Answer 14

Bowel sounds (w/ diaphragm of a stethoscope)
Vascular sounds (w/bell of a stethoscope)

Question 15

What is a bowel sound?

Answer 15

The audible sound heard with a stethoscope due to passage of air or fluid from peristalsis.

Question 16

How are bowel sounds described as?

Answer 16

Normal
Audible
Absent
Hypoactive (paralytic ileus - intestinal blockage caused by damaged nerves/muscles)
Hyperactive (borborygmi - a rumbling or gurgling noise made by the movement of fluid and gas in the intestines)

Question 17

How long is auscultation performed for?

Answer 17

5-20 seconds in each of the four quadrants.

For at least 5 mins if determining absent bowel sounds.

Always warm the stethoscope diaphragm.

Question 18

What is the purpose of palpitation in the abdominal assessment?

Answer 18

To detect areas of tenderness, distension, or mass

Question 19

How do you palpate the abdomen?

Answer 19

• light palpitation with pal and fingers extended on all 4 quadrants.
• to determine if the abdomen is soft and non-tender or abdomen is firm/rigid with discomfort

Question 20

Good to know:

Important steps to remember forr rectal suppositories administration:

Answer 20

• compare label of med 2x with MAR during med preparation
• identify pt using at least 2 identifiers
• Sims position
• check for rectal bleeding
• check for the presence of feces
• lubricate the rounded end of suppositories + index finger of the dominant hand
• ask pt to take slow deep breaths through the mouth and relax the anal sphincter
• insert into anus 10 cm deep
• remove finger/clean anal area
• pt to remain in sims position for 5 mins
• if suppository is a laxative or fecal softener than place call bell within reach of pt
• document

Question 21

Good to know:

In order to determine a health history of a patient’s bowel elimination, what factors should be considered?

Answer 21

• determine pt’s usual bowel patterns
• pt’s description of usual stool
• identify routines followed to promote normal bowel elimination
• assessment of the use of laxatives, suppositories, or enemas
• assessment of cognitive abilities
• changes in appetite
• diet history
• description of daily fluid intake
• hx of surgery/illness to GI tract
• medication hx
• emotional state
• exercise hx
• hx of pain/discomfort
• environment and adaptive aids
• mobility and dexterity
• presence and status of bowel diversions (i.e ostomy bag)

Question 22

What medical factors alter patterns of bowel elimination?

Answer 22

• age-related changes
• infectious disease (i.e rotavirus (viral) - vomiting/watery stools; c. diff (bacterial) - diarrhea)
• irritable bowel syndrome
• inflammatory bowel disease (2 types - Ulcerative Colitis and Crohn’s Disease)
• DM
• pain
• pelvic floor trauma (caused to women by pregnancy, labor/delivery, aging)
• surgery/anesthesia
• enteral feeding
• meds
• acute illness

Question 23

What are some personal factors that could contribute to changes in bowel movement?

Answer 23

• dietary patterns
• fluid intake
• personal habits
• activity and exercise
• emotions
• Tenemos (repetitive feelings to defecate)
• use of laxatives
• hemorrhoids
• belching, bloating, and flatulence
• nausea/vomiting

Question 24

Abdominal assessment
Bowel habits
Last bowel movement
Frequency
Color and consistency
pain before, during, or after defecation
Sense of incomplete emptying of bowel movements 
Use of laxatives
Hemorrhoids
Belching, bloating, and flatulence
Nausea/vomiting

These are all part of what?

Answer 24

Assessment and Data Gathering on pt for bowel elimination

Question 25

What are the 6 common bowel elimination conditions?

Answer 25

• constipation
• fecal impaction
• diarrhea
• incontinence
• flatulence
• hemorrhoids

Question 26

What is the purpose of an enema?

Answer 26

Instillation of a solution into the rectum and sigmoid colon to promote defecation by stimulating peristalsis..