Lecture Notes: Assessing the Abdomen in Health Assessment

Importance of Abdominal Assessment

• Abdomen protects vital organs
• Largest cavity in the body

Sequence of Assessment

1. Inspection
   • Look for abnormalities: stretch marks, distension
2. Auscultation
   • Use stethoscope to listen for abdominal sounds
3. Percussion
   • Tapping motion to detect sounds
4. Palpation
   • Light and deep, using four fingers

Reason for Sequence

• Avoid false bowel sounds from premature pressure

Special Considerations

Pregnant Clients

• Abdominal distension due to pregnancy
• Nausea/vomiting due to rise in HCG levels (common in 1st and 2nd trimesters)
• Diminished bowel sounds because of enlarged uterus
• Possible skin changes: striae, linea nigra

Aging Adults

• Increased abdominal fat accumulation (females - menopause, males - sedentary lifestyle)
• Decreased gastric secretions, constipation, decreased salivation
• Decrease in liver size affecting drug metabolism

Collecting Health History

• Inquire about:
  • Appetite, weight changes, urination, flatulence, indigestion, nausea/vomiting
  • Pain specifics, planned vs. unplanned weight gain, frequency of bowel movements
  • Medication effects, travel history, dietary supplements

Preparing for Assessment

• Ensure patient privacy and comfort
• Warm equipment
• Encourage emptying bladder before assessment
• Explain procedure thoroughly

Detailed Assessment Techniques

Inspection

• Do not touch; visually inspect
• Check symmetry, umbilicus positioning, skin color, hair, abdominal pulsations

Auscultation

• Use diaphragm of stethoscope for bowel sounds
• Start in RLQ; listen for 5 minutes if no sounds
• Document absence, hypoactive (<5/min), or hyperactive (>30/min) sounds

Abdominal Mapping

• Quadrants: RLQ, RUQ, LUQ, LLQ
• Organ locations:
  • RLQ: Appendix, right ovary
  • RUQ: Liver, gallbladder, pancreas head, right kidney
  • LUQ: Stomach, spleen, left kidney
  • LLQ: Colon, left ovary

Auscultating Vascular Sounds

• Use bell of stethoscope for aortic, renal, iliac, femoral arteries
• Listen for vascular sounds (bruit, venous hum)

Percussion

• Tympany expected in quadrants, dullness over organs
• Check for distension, bladder fullness

Palpation

• Light Palpation:
  • Use fingers, 1 cm depth
  • Clockwise motion
• Deep Palpation:
  • 5-8 cm depth, same motion
  • Note any pain or guarding

Palpating Specific Organs

• Liver: Right upper quadrant, use hands to feel edge
• Spleen: Normally not palpable, only if enlarged
• Kidneys: Use "duck-bill" position to palpate right flank

Abnormalities in Abdominal Distension

• Pregnancy: Enlarged abdomen
• Obesity: Uniform roundness
• Ascites: Single curve, everted umbilicus
• Ovarian Cyst: Localized curve, dullness over fluid

Documentation

• Always note any abnormalities observed during the assessment.