Assessing the Abdomen Two common methods of subdividing the abdomen: A.

quadrants- an imaginary vertical line drawn from the xiphoid process to the pubic symphysis and a horizontal line across the umbilicus - labeled right upper quadrant, left upper quadrant, right lower quadrant and left lower quadrant . regions- imaginary two vertical lines that extend superiorly from the midpoints of the inguinal ligaments, and two horizontal lines, one at the level of the ribs and the other at the level of the iliac crests. Preparations: let the client to urinate !empty bladder ma"es the assessment more comfortable# ensure that the room is warm since the client will be exposed Equipments: - $en light - tape measure watersoluble s"in-mar"ing pencil - stethoscope Steps: %. &ntroduce self and verify client's identity. (xplain the procedure to be done to the client. - )hat is your name* +. $erform hand hygiene ,. $rovide for client privacy -. &nquire client's health history - .ave you felt any abdominal pain* )here* &s it occurring in regular intervals* - /id you vomit or have diarrhea* &f you did vomit or have diarrhea have you noticed presence of blood in your stool or vomitious* - )hat did you eat within the last +- hours* - /id you have any previous surgeries on your abdominal area or problems associated with the said area* 0. Assist client in supine position with arms placed at the sides. 1mall pillows are placed beneath the head in "nees to reduce tension of the abdominal muscles. (xpose only the abdominal area. INSPECTION: 2. &nspect the abdomen for s"in integrity, contour and symmetry. 3As" the client to ta"e a deep breath and hold it so that enlarged liver or spleen will be made visible. 3&f distention is present then measure the abdominal girth using a tape measure placed around the umbilicus. Abnormal 4 rash5other lesions, tense, glistening s"in !ascites, edema#, purple striae !cushing's disease or rapid weight gain and loss# 6. 7bserve for abdominal movements associated with respiration, peristalsis or aortic pulsations and also for vascular pattern. Abnormal AUSCULTATION: 3/one before palpation and percussion because the palpation and percussion cause movement5stimulation of the bowel motility thus heightening bowel sounds creating false results 8. Auscultate the abdomen for bowel sounds, vascular sounds and peritoneal friction rubs. 3)arm the hands and stethoscope diaphragm A. owel 1ounds 9 &rregular gurgling noises occurring every 0 9 +: seconds. The duration of a single sound may range from less than a second to more than several seconds. 3;se the flat-disc diaphragm- &ntestinal sounds are relatively high pitched and best accentuated by the diaphragm. 3As" when the client last ate- bowel sounds normally increase shortly after or long after eating. They are loudest when a meal is long overdue. 3- 9 6 hours after a meal bowel sounds may be heard continuously over the ileocecal valve area while the

digestive contents from the small intestine empty through the valve into the large intestine. 3$lace the diaphragm of the stethoscope in each of the four quadrants of the abdomen. . <ascular sounds- bruits sound 3;se the bell of the stethoscope over the aorta, renal arteries, iliac arteries, and femoral arteries. =. $eritoneal >riction ?ubs 9 rough, grating sounds li"e two pieces of leather rubbing together. 3Auscultating the spleenic site- place stethoscope over the left lower rib cage in the anterior axilliary line and as" the client to ta"e a deep breath. 3 Auscultating the liver site- place stethoscope over the right lower rib cage. PERCUSSION: @. $ercuss several areas of the four quadrants to determine presence of tympany !gas in the stomach and intestines# and dullness !decrease, absence or flatness of resonance over solid masses or fluids#. A. Aiver- percuss to determine size 3 egin in the right midclavicular line below the level of the umbilicus then percuss upward over the tympanic areas until a dull percussion sound indicates the lower liver border. 3Then percuss downward at the right midclavicular line, beginning from an area of lung resonance and progressing downward until a dull percussion sound indicates the upper liver border !usually the 0th 9 6th interspace#. 3Beasure the distance between the two mar"s !upper and lower liver border: in cm. to establish liver span size. 3?epeat steps % 9 , at the midsternal line. PALPATION: %:. Aight palpation - detect areas of tenderness and5or muscle guarding. 3 .old palm of hand parallel to the client's s"in surface and depress about % cm or to the depth of the subcutaneous tissue with the pads of the fingers moving in a slightly circular motion. 3Cote presence of superficial pain, masses, and muscle guarding. 3&f client is excessively tic"lish 4 begin by pressing your hand on top of the client's hand while pressing lightly. Then slide your hand off the client's and onto the abdomen to continue examination. %%. /eep palpation 3;se either the bimanual method or Dust press the distal finger of the palmar surface of the fingers of one hand into the abdominal wall 3/epress the abdominal wall about - 9 0 cm !% E - + in#. 3 Cote the mass !size, location, mobility, consistency, tenderness# and structure of underlying contents. 3=hec" for rebound tenderness in areas where client complains of pain. - )ith one hand press slowly and deeply over the area indicted then lift the hand quic"ly. 3&f client has no complains of pain during deep pressure but indicates pain at the release of pressure 4 rebound tenderness A. Aiver 9 detect enlargement and tenderness Two bimanual approaches used: i. $lace one hand along the anterior rib cage and the other on the posterior rib cage. 31tand on client's right side and place left hand on the posterior thorax at about the%%th or %+th rib !push upward and provide support of underlying structures for the anterior palpation#. 3$lace right hand along the rib cage !-0 # to the right of the rectus muscle with the fingers pointing toward the rib cage. 3Aet the client exhale then exert a gradual and gentle pressure beneath the costal margin for a - 9 0 cm

depth. 9 /uring expiration, the abdominal wall relaxes, facilitating deep, palpation. 3Baintain hand position and as" client to breath deeply. This ma"es the liver border descend and moves the liver into a palpable position. The liver should feel firm and have a regular contour. 3&f the liver is enlarged 4 measure the number of cms. &t extends below the costal region. ii. ;se of bimanual method 9 one hand is superimposed on the other . ladder 3&f client's history indicates possible urinary retention 4 palpate the area above the symphysis pubis. 3/ocument findings in the client's record using forms or chec"list supplemented by narrative notes when appropriate