Nursing Assessment of the Abdomen

00:00 So now let's talk about abdominal cavities. So, if you remember and go back to your GI system, there are lots of content here in the abdominal cavity. You've got your stomach, your liver, your pancreas, your spleen, your gallbladder, kidneys, intestines, bladder, reproductive organs. There are so many things to consider in regard to your abdominal cavity. So here's a really important point when we're talking about all these organs and consideration and also on examination that the order of examination is really important with this particular region. So if you remember when we just normally assess anything like chest maybe, for example, we can inspect, we can palpate, we can percuss, and then listen. But the abdominal order of assessment and luckily this is the only system like this, the abdominal order of assessment is different. So when we're assessing the abdominal cavity, we can look and inspect, we have to take our ears and listen and auscultate first, then we can percuss, then we can palpate. Now the reason why this is, as you can imagine with the stomach and I know if I've gone too long without eating all those bowel sounds and everything you can hear but we don't want to agitate or palpate or move around the abdominal cavity, we want to listen first to get the truest bowel sounds for that patient. So again, we want to look, visually inspect, we want to listen, then we can percuss and palpate. So this is particularly important with your abdominal assessment. Now starting with the order of the abdominal assessment, the first thing that we will do is inspection. So it's really important when we're talking about assessing the abdominal cavity that we check each quadrant.

01:56 Now we're looking for shape, any odd scheme or abnormalities like bruising, any masses like hernias, movement with respiration or any weird pulsations that we assess. Now when we're assessing the abdominal cavity, we are dividing it into literally 4 quadrants. This makes it really important for documentation. So really we just split this on the right side and the left side and we assess the right upper, right lower, the left upper, and the left lower. And we're going to do this with inspection as well as auscultation, palpation and the rest of our abdominal assessment.

02:34 Now if you recall after inspection with a particular abdominal assessment, we're going to move from inspection to auscultation. Now here are some important points to note when we're talking about auscultating the abdomen. So we're going to listen for bowel sounds and the vascular system. We should hear some blood flowing and pulsating from you aorta. And that is completely normal. So next, we're going to talk about the frequency when we auscultate. You've got to classify are they active bowel sounds, meaning just normal rumbling that you should hear. Now, sometimes you will hear what we call hypoactive bowel sounds, meaning we place our stethoscope to a quadrant and it takes us quite a bit to hear any sort of bowel sounds or movement or gurgling. And it's kind of low and not very loud. That's called a hypoactive bowel sounds. Or you can hear the complete opposite of the hyperactive of like you're sitting here, you place a stethoscope, you can hear that tummy rumbling and those loud bowel sounds kind of when you're hungry and you waited too long to eat, you may hear those as well and we classify that as hyperactive bowel sounds. Now, here's a really important point to note. As you see on the region for auscultation, we listen to every single quadrant. So note, we don't just listen to the right upper quadrant. It's important on auscultation you listen to all 4 quadrants of the patient's abdominal cavity. Now we're to the area of abdominal percussion. So we're going to percuss the abdomen by gently tapping with our hands over different areas of the stomach. Really, we're just noting areas of dullness and tympany. So we may expect to hear a little bit of dullness over about the right upper quadrant of the patient's abdomen because of course this is where our liver is located. Now when we're percussing the rest of the abdomen, we really should be expecting to hear more tympany sounds because this is where there is a loud hollow sound heard over our gas-field organs. Now, if we're percussing over the rest of the abdomen and maybe we hear a little bit of dullness, this could mean that there is a back-up of stool and we want to note this to our provider. Now let's talk about some abnormalities you may see with the patient's abdominal cavity. One of these is called ascites. This is a build-up of fluid on the abdomen. Almost like the patient and this could be a male patient, for example, looks almost pregnant. Lots of fluid build-up and this can vary from several liters of fluid sometimes in a patient's abdomen. Next, you may see what they call caput medusae. So these veins are gorging out and they're snakelike and you can see these distended and enlarged on the surface of the abdomen. Now, both of these are very much abnormal because these are associated with liver issues of your patients. So a further assessment when we're talking about assessing the abdominal cavity. Now internal bleeding is something we should always, always be looking for. So sometimes it will show up on different parts of the abdomen.

05:44 So one way to identify if there's an internal bleeding, so you can look around periumbilical bleeding which is called the coenzyme that you see here. So this is when bruising starts to develop, it's around the belly button or the navel.

06:00 The coenzyme is abnormal and a sign of internal bleeding. Or, very commonly, you may see what they call Gray Turner sign and you see that type of bruising and it's really unlike the flanks or the sides of the patient's abdomen. So this is important after surgery or certain procedures to assess the patient's scan of their abdomen, look underneath their gown and promote as much privacy as possible and also turn your patient to make sure you're assessing flanks for internal bleeding as well. So now we can move on to the palpation part of our abdominal assessment. Now palpation is last when assessing the abdomen. So you want to assess each quadrant for crepitus, any sort of tenderness. So when you push on the patient they're not guarding or grimacing. We're going to check for any masses or pulsation. Now, one keynote if you see a mass, this could be a hernia, it could be something else especially depending on the population you're a patient.

07:01 So if you see a particular mass and you don't know what it is, it's a good idea not to palpate it and make sure you report this to the healthcare provider.