nursing evaluation of the abdomen matheny medical and educational center the abdominal evaluation
TRANSCRIPT
NURSING EVALUATION OF THE ABDOMEN
MATHENY MEDICAL AND EDUCATIONAL CENTER
The Abdominal Evaluation
Abdominal Anatomy
GLASS Gallbladder Liver Aorta Stomach Spleen
Pancreas Bowel Appendix Urinary
Bladder Reproductive
Ovaries Uterus
Quadrants
RUQHepatitisGallstonesCholecystisisPancreatitisPNARLQAppendicitisDiverticulitisSBOOvariesHernia
LUQSpleenUlcersGastritis PNA
LLQDiverticulitisConstipationSBOOvarianHernia
Abdominal Exam Sequence
ObserveAuscultatePalpatePercuss
Observation
Shape Flat, Scaphoid Distended
Appliances Gtube, Baclofen pump,
OstomiesScars
Adhesions Obstruction Surgeries
Discolorations/Bruises
Distension Flatus Obstruction Gastroparesis Constipation Ascites
Auscultate
Present or Absent Listen for 2 – 3 minutes Listen in all 4 quadrants
Freqency Normoactive
1 sound q 2-5 secs Hyperactive
Intestinal Inflammation Gastroentritis Obstruction
Hypoactive Serosal Inflammation
Peritonitis Appendicitis
Ileus SBO
Quality High Pitched - Obstruction
Palpation
Use both handsPalpate all four quadrants
Feel for tenderness, masses, organomegaly Start in quadrant opposite of location of pain and save
quadrant with pain till last First do superficial palpation then do deep
Flex hips and knees to relax abdomen if neededWait for expiration for abdomen to relax in
neededRed Flags
Stiff or Rigid abdomen – peritonitis Pain localized to particular quadrant/area
Percussion
Differentiates solid mass or ascites vs air filled space Solid tissue and ascites sounds dull Air filled space sounds tympanic
Used to measure liver
Differential Diagnosis
ConstipationGastroparesisPneumoniaUlcersIrritable Bowel DiseaseSmall Bowel ObstructionVolvulusAppendicitisGallstones/cholecystitisUrinary RetentionOvarian cystsMenstrual pain
Notify Physician
Bilious, bloody, or intractable vomitingBloody stool – bright red or melenaRigid abdomenPoint tenderness in abdomenSignificant/acute abdominal distention
What to Report to MD
VITAL SIGNS!!!Exam findings Distention, Quality of bowel sounds, Location of tendernessHistory should include
Recent GI history Vomiting – bilious, bloody, content Diarrhea – bloody, particularly foul smelling Constipation – know when was last bm
Pertinent GI history if unknown to MD Recent weight Any measures already taken
Venting of gtube, residuals, suppositories given, bowel rest, etc…
THANK YOU!THE END
QUESTIONS????