Health and Physical Assessment

Health and PhysicalAssessment

Abdominal Assessment

Workshop 7by

Melissa HinnawiMarielis Hidalgo

Adriana Yaffe

Organs that Form the Abdomen

The abdomen contains the organs of the digestive system, the spleen, the urinary tract including the bladder, kidneys, and ureters; and ureters; the uterus and ovaries; the aorta; and the iliac renal, and femoral arteries.

The Abdominal CavityThe abdominal cavity has a serous membrane called the peritoneum which covers the organs and holds them in place.

The peritoneum contains a parietal layer that lines the walls of the abdomen and the visceral pleura, which coats the outer surface of the organs.https://youtu.be/IMCNo1Hbooc

Division of Abdomen

The Abdominal AssessmentThe abdominal assessment provides information about a variety of system because every system, with the exception of the respiratory system, is found within the abdomen.Not only does assessment of the abdomen enable you to obtain valuable information about the functioning of the gastrointestinal, cardiovascular, reproductive, neuromuscular, and genitourinary system: it can also provide vital information about the health status of every other system.https://www.youtube.com/watch?v=44N8NL8SNx4

The Abdominal AssessmentAssessment of the abdomen Questions:

Medications, allergies and food intolerances, tobacco and alcohol use

Menstrual cycle, pregnancies, sexual transmitted diseases Surgeries, appetite (weight loss or gain), psychologic concerns

(anorexia, bulimia) Pain Location, onset, duration, quality, and radiation Is pain associated with meals? Are precipitating factors (urination, intercourse) present? What makes it better? Does any swelling occur with pain? Is nausea associated with pain? Does the pain wake the patient at

night?

Assessment Steps

Assessment Questions Eating

Does coughing occur with eating (dysphagia)? Does food get stuck?

Does reflux or burning occur before, after or during meals?

Does coughing occur at night? Has a change in taste occurred?

Nausea

Does nausea develop with or without emesis? Is it associated with eating or smells? Is nausea associated with pain?

Do sudden movements cause nausea? Describe emesis color and consistency

What is the timing of nausea and vomiting? What makes the nausea better or worse?

Inspect and AuscultateNormal range of findings

InspectionUse tangential lighting-note any asymmetry and contours (scaphoid, flat, rounded) while standing straight on and from the side. Are pulsations or movements noted? Are scars,

lesions, moles, or striae in evidence? Is the patient’s demeanor guarded? Is he or she

lying in the fetal position? Are tubes (peritoneal dialysis) or appliances

(colostomy or urostomy) present? Is the skin free of redness, inflammation and

jaundice?

Inspect and Auscultate Auscultation

Pick a pattern and stick to it (RUQ, LUQ, LLQ, RLQ-clockwise)

Listen in each area. (Between 5 and 30 bowel sounds should be heard per minute)

Use the diaphragm for bowel sounds. Asses he aorta and renal arteries with the

bell to identify any bruits.

Inspect and AuscultateAbnormal Findings Inspection Note areas of swelling and asymmetry, Are protruding masses (hernia, everted umbilicus)

notes? Are reddened, jaundiced, or ascetic areas of the skin

found? Are cutaneous angiomas present? (high pressure form

portal hypertension causes abnormal vasculature to become more visible-spider nevi)

A pulsating mass may indicate an aortic aneurysm or intestinal obstructions.

Inspect and AuscultateAuscultation Tinkling sound may indicate

an obstruction. A hyperactive high pitched

sound may also indicate an obstruction.

Are sounds hypoactive to absent? (absent sounds can be an emergency)

Are bruits heard? (Reassess the heart sounds to ensure bruits are not a murmur echo)

Assessment of the abdomenPercuss and palpate

Stress and tension could make percussion and palpation not only uncomfortable for the patient but also change the assessment findings (tense abdominal muscles). Encourage the patient to voice concerns.Preparation: Empty the bladder (request urine sample, if needed); ensure warm hands and room. Patient assumes supine position, head on pillow, and knees elevated (less tension in the

abdominal wall)

Assessment of the abdomenPercuss and palpate

Normal range of findings: Percussion Generalized tympani with dullness over the liver and spleen. Dull sounds with fatty tissue, fluids, masses Hyper-resonance with bloating Palpation-Normal liver span 6 to 12 cm (adult) Should include light and deep palpation. (Remember to watch the patient’s face for signs of

discomfort) Palpate 1 inch for light massaging action. Palpate 2 to 3 inches for deep action. (May need both hands) Asses painful areas last. If the patient is ticklish, place his or her hand under yours. Liver PalpationPatient takes a deep breath; as he or she is exhaling, press in with the nurse’s right hand. Area in non-tender and usually not palpable.https://www.youtube.com/watch?v=Psr-i8duhZU

Assessment of the abdomenPercuss and palpate

Abnormal Findings Percussion Dullness or hyper-resonance can indicate a pathologic condition. Palpation Note masses or pockets of fluid. Liver border is very prominent. Patient is guarded and does not allow the nurses to assess a certain area. Rebound tenderness could indicate peritonitis or appendicitis.

Some Abdominal Disease’sHirschsprung's disease is a blockage of the large intestine due to improper muscle movement in the bowel ribbon like stool-failure of innervation of gi tract around 5-12 weeks gestation

Acid reflux or gastroesophageal reflux disease (GERD) is a condition in which acid in the stomach rises up into the esophagus. Acid reflux can cause heartburn and other symptoms. Acid reflux generally occurs because the lower esophageal sphincter relaxes and allows harsh stomach juices flow into the esophagus. Acid reflux Below you will find some of the foods you can't eat with acid reflux.

Some Abdominal Disease’sPrune belly syndrome is a rare, genetic, birth defect affecting about 1 in 40,000 births. About 97% of those affected are male. Prune belly syndrome is a congenital disorder of the urinary system, characterized by a triad of symptoms(A partial or complete lack of abdominal muscles, Undescended testicles in males, Urinary tract abnormality such as unusually large ureters, distended bladder).

Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. There are several causes of abdominal aortic aneurysm, but the most common results from atherosclerotic disease. As the aorta gets progressively larger over time there is increased chance of rupture.

Some Abdominal Disease’sCeliac disease is an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.

Fatty liver disease is characterized by increased accumulation of fat, especially triglycerides, in the liver cells. It is normal for the liver to contain some fat and by itself, this causes no symptoms. In some patients, the excess fat can cause inflammation called steatohepatitis (steato=fat+hepar=liver +itis=inflammation), although there is no relationship between the amount of fat present and the potential for inflammation.

Some Abdominal Disease’sIrritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long term.

Sometimes tiny, bulging pouches (called diverticula) form in the colon. This condition is called diverticulosis. If the pouches become inflamed or infected, this is diverticulitis.

References• Abdomen Anatomy and Physiology. (n.d.). Retrieved from

http://intranet.tdmu.edu.ua/data/kafedra/internal/distance/classes_stud/English/1course/Heath%20Assessment%20Practicum/Health%20Assessment%20Practicum/26.%20Abdomen%20Anatomy%20and%20Physiology.htm

• Zerwekh, J. A., Gaglione, T., & Miller, C. J. (2011). Mosby's assessment memory notecards: Visual, mnemonic and memory aids for nurses (2nd ed.). St. Louis, MO: Mosby Elsevier.

• Google. (2015). La presentación "HISTORIA CLINIC. google.com. Recuperado de:• https://www.google.com/search?

q=abdomen+data+subjetiva+apetito&rlz=1C1TSNP_enUS615US615&espv=2&biw=1093&bih=498&source

• ALEJANDRO D. (2015). Dolor abdominal. LinkedIn Corporation. Recuperado de: • http://es.slideshare.net/ANALISIS/dolor-abdominal-7718256

References• Hospital San Vicente de Paul. (2010). Patologías abdominales quirúrgicas más comunes.

slideshare.net. Recuperado de:• http://www.slideshare.net/PRINCESSANITA/patologias-abdominales-quirurgicas-mas-comunes• http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-200

24578• https://www.nlm.nih.gov/medlineplus/ency/article/000257.htm• http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages

/facts.aspx• http://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-diseas

e.aspx• http://emedicine.medscape.com/article/175472-overview• http://www.vascularweb.org/vascularhealth/pages/abdominal-aortic-aneurysm.aspx