Unit 2- abdomen
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in what order do you assess the abdomen?
inspection, auscultation, percussion and palpation
how should you prepare and position the client for and abdominal assessment?
have client void prior
position lying supine w/ arms at sids and knees slightly bent
when doing an abdoninal assessment what would dialated veins indicate? is it an expected finding?
associated w/ cirrhosis or inferior vena cava obstruction
what are the appropriate ways to describe the shape or contour of the abdomen?
what does flatus mean?
protusion is mainly midline, and the flanks are unchanged
what are expected sounds of the abdomen and how often should these sounds be heard?
high pitched clicks and gurgles
5 to 30 times/min
what do you do if bowel sounds seem to be absent?
listen for a full 5 mins
2 mins LRQ and then a min in the other quadrants
if still no sounds call physician!
what is the expected sound of the abdomen during percusion?
dullness-liver or distended bladder
how is the liver span determined?
establish lower boarder of the liver by percussing upward from bellow the umbilicus at the right midclavicular line until tympany turns to dullness --> mark
establish the upper border by percussing downward, starting at the right midclavicular line over the lung until resonance turns to dulllness --> mark
measure the distance between the 2 markings
expected size is 6-12 cm
when should a tender area be assessed?
how do you assess for inflammation or irritation in the abdominal cavity? and what is this test called?
Rebound tenderness (clumberg's sign)
apply firm pressure w/ the hand at 90 degree angle w/ fingers extended, release the pressure, was pain elicited.
this test should be performed in all 4 quadrants
Unit 2- abdomen