N112

•Inspection

• •Auscultation (performed second
• because palpation and percussion can alter bowel sounds).

•Percussion

•Palpation

old, silvery, white stretch marks from past pregnancies or weight gain

occurs with malnourishment or dehydration

Protrusion of abdominal viscera through abnormal opening in muscle wall

Engorged superficial capillaries of abdomen

• •Look across abdomen at eye level. Abdomen is flat, rounded,
• or scaphoid. Should be evenly rounded.

Scaphoid abdomen, protuberant abdomen, abdominal distention

• a slight pulsation may be visible in the epigastrium and extends full length in thin
• people.

normally not seen, although may be seen in very thin people as slight ripples.

RLQ

5 min in an abdominal quadrant

•Move diaphragm to RUQ, LUQ, LLQ.

a series of intermittent, soft clicks and gurgles heard at a rate of 5 to 30/min.

loud, prolonged gurgles, high pitched

*increased mobility, diarrhea

•indicate decreased motility of bowels.

The sound that gas makes as it moves through the intestines. It can occur when you're hungry, but it can also happen after meals. It's often called "stomach growling" or "stomach rumbling." Borborygmi is normal and happens to everyone from time to time.

abdominal aorta and renal, iliac, and femoral arteries to listen for bruits. Especially important if client has HTN or if arterial insufficiency is suspected.

NO

aneurysm or arterial stenosis.

in the epigastric and umbilical areas using the bell of the stethoscope

NOT NORMALLY heard

obstructed portal circulation.

•liver and spleen by listening over the right and left lower rib cage with the diaphragm of stethoscope.

•Normal: no friction rub auscultated.

abnormal, high-pitched, rough, grating sounds produced when the large surface area of the liver or spleen rubs the peritoneum.

**Heard in association with respiration. Indicate inflammation or tumors.

is predominant sound heard because air is present in stomach and intestines.

is normally heard over organs such as the liver or a distended bladder. Note when tympany changes to dullness.

fatty liver, liver fibrosis, Cirrhosis

Fluid in the abdomen

•to assess for tenderness in difficult-to-palpate structures.

•Position client in sitting position with back to examiner.

•Place left hand flat against costovertebral angle (CVA) over the twelfth rib. Use ulnar side of right fist to strike left hand.

no tenderness is elicited. The examiner may sense only a dull thud.

**Pain or tenderness over CVA may suggest kidney infection or renal calculi (stones).

•If client ticklish, have client perform self-palpation with your hand over client’s hand. Gradually remove the client’s hand when ticklishness is gone.

Observe client’s face while performing palpation for changes in expression indicating pain or discomfort

to identify areas of tenderness, masses and muscular resistance.

•With hands and forearm on a horizontal plane, use the pads of the approximated fingers to depress the abdominal wall 1 cm.

• **Avoid short, quick jabs. Lightly palpate all four quadrants in a systematic manner by gently
• lifting fingers and moving to next area.

•Normal: no guarding; abdomen is soft

•Abnormal: involuntary guarding indicates peritoneal irritation.

to assess for organ enlargement, masses, bulges, or swelling

•Use palmar surface of fingers, compress to a maximum depth of 5 to 6 cm in RLQ.

Perform bimanual palpation if resistance is encountered, client is obese, or to assess deeper structures.

Identify any masses and note location, size, shape, consistency, tenderness, pulsation, and degree of mobility. Continue palpation of other quadrants.

•Normal: only aorta and edge of liver are palpable.

**No palpable organ enlargement, nor masses, bulges, or swelling.

One-Hand Method

Bimanual Method

to note consistency and tenderness.

•Bimanual: stand at client’s right side and place left hand under client’s back at the level of 11th to 12th ribs.

• *Lay right hand parallel to right costal margin
• (fingertips should point toward client’s head). Ask client to inhale, then compress upward and inward with your fingers.

• liver is usually not palpable, although it may be felt in some thin clients. If lower edge is felt, it should be firm, smooth, and even. Mild tenderness may be
• normal.

hard, firm liver may indicate cancer. Nodularity may occur with tumors, cancer, late cirrhosis, or syphilis. Tenderness may be from vascular engorgement (CHF) or hepatitis

spleen is seldom palpable at left costal margin; rarely, the tip is palpable in the presence of a low, flat diaphragm as in emphysema.

palpable spleen suggests enlargement.

Palpate spleen gently as an enlarged spleen may rupture.

to palpate for a distended bladder

Using deep palpation, begin at symphysis pubis, and move upward and outward to estimate bladder borders

empty bladder not palpable

distended bladder is palpated as a smooth, round, and somewhat firm mass. Moderately full bladder is palpable above symphysis pubis. Full bladder is palpated above symphysis pubis and may be close to umbilicus.

•Place client in supine position, with knees slightly flexed.

• *Using finger pads of 2nd, 3rd, & 4th fingers, apply firm pressure and palpate with a rotary
• motion in the right inguinal area.

• Palpate for lymph nodes in left inguinal
• area.

• •Normal: small, movable, nontender nodes less than
• 1 cm in diameter

•Abnormal: greater than 1 cm in diameter nonmovable, tender lymph nodes. Localized or systemic infections, cancer or lymphomas.

•Client is supine. Apply several seconds of firm pressure to the abdomen, with hand at a 90 degree angle (perpendicular to abdomen) and the fingers extended. Quickly release the pressure.

pain is not elicited

as abdominal wall returns to its normal position, client complains of pain at pressure site (direct rebound tenderness) or at another site (referred rebound tenderness). May indicate peritoneal irritation--> sharp pain in area of inflammation.

pain in RLQ at McBurney’s point

- 1/3 the distance of the interior superior spine to the umbilicus

•measure abdominal girth in all clients with abdominal distention.

•Measure abdominal girth at same time each day. Ideally in morning just after voiding.

• •Ideal position for client is standing; otherwise client should be in supine position. Head may be
• slightly elevated for orthopneic clients. Client should be in same position for all measurements.

•Use a disposable or easily cleaned tape measure.

•Place tape measure behind client and measure at umbilicus.

•Record measurement in inches or centimeters.

Take all future measurements as same location. Mark site with a ballpoint pen

•Esophageal emptying is delayed increasing risk for aspiration

•Abdominal musculature loses much of its tone.

•Increased fat deposition in abdominal area.

•Gastric acid decreases which may interfere with vitamin B 12 absorption

•Increased complaints of gas or constipation.

•Increased incidence of gastrointestinal malignancy.

•Intestines subject to ischemia related to atherosclerosis.

less elastic, and changes in gastric motility result in alterations in digestion and absorption.

55 % which can impair drug metabolism