Abdominal Assessment Video

State name, course number (NU 518), focused abdominal assessment, obtain verbal
consent from patient
Scan the room prior to starting the assessment.
Have patient empty bladder prior to starting.
Correct preparation and positioning: good light source, full exposure of abdomen, empty
nbladder. *Supine, arms beside body, legs slightly flexed. Small pillow under the head is
ok and another under slightly flexed knees. Drape a towel or sheet over the patients
chest.

Follows correct sequence of exam: inspections, auscultation, percussion, palpation

Maintain privacy

Inspection:
Describe skin (color, scars, lesions, etc.) and umbilical characteristics. Inspect for bruises
and localized discoloration. Note any areas of redness. A bluish periumbilical
discoloration indicates abdominal bleeding. Note any striae. Inspect for lesions,
particularly nodules. Note any scars and obtain history as to where scar is from.
Describe contour and surgace movements (profiles, masses, distention, pulsations, hernia,
or peristalsis). Inspect abdomen for contour, symmetry, surface motion. Is the contour
flat, rounded, or scaphoid. Flat contour is common in well-muscled, athletic adults. The
rounded or convex contour is characteristic of young children, but in adults it is because
of subcutaneous fat or poor muscle tone. Abdomen should be evenly rounded with
maximum height of convexity at umbilicus. Scaphoid or concave contour is seen in thin
adults. Umbilicus should be centrally located without displacement upward, downward,
or laterally. May be inverted or protrude slightly but should be free of inflammation,
swelling, or bulge that may indicate hernia. Symmetry from a seated position at patients
side then to a standing position behind patients head if possible. Look for any distention
or bulges. Ask patient to take deep breath and hold it. Contour should remain smooth and
symmetric. Ask patient to raise head from the table, which contracts rectus abdominis
 muscles, which produces muscle prominence in thin or athletic adults. Superficial
abdominal walls may be visible; if hernia present, may protrude. Movement inspect from
supine position. Smooth, even movement should occur with respiration. Surface motion
from peristalisis, seen as rippling movement across abdomen, may be seen in thin
individuals but may also indicate intestinal obstruction. Abdominal aortic pulsations seen
in the upper midline are often visible in thin adults. Marked pulsations may occur as
result of increased pulse pressure or AAA.

Ausculation:
Listen with diaphragm, describe bowel sounds-how long would you listen before you
stated bowel sounds absent? Bowel sounds heard as clicks and gurgles occurring
irregularly, ranging from 5-35 per minute. Most often can be assessed adequately by
listening in one place. If bowel sounds not heard within 5 minutes, would be
considered absent
Listen with the bell in the four areas, describe arterial and venous sounds. Listen in the
epigastric region, andi n the arotic, renal, iliac, and femoral arteries. Auscultate in
the epigastric region and around the umbilicus for a venous hum.

Percussion:
Percuss all quadrants or regions of the abdomen for a sense of overall tympany and
dullness. Tympany is the predominant sound. Dullness is heard over organs and solid
masses.
Estimate liver size. Begin liver percussion at right midclavicular line over an area of
tympany. Always begin with area of tympany and proceed to an area of dullness because
that sound change is easiest to detect. Percuss upward along the midclavicular line to
determine lower border of liver. Liver dullness usually heard at costal margin or slightly
below it. Mark with marking pen. Determine upper border of liver by starting percussion
on the right midclavicular line at an area of lung resonance around third intercostal space.
Continue downward until percussion changes to one of dullness, marking upper border of
 liver. Mark location with marking pen. The upper border is usually in the fifth intercostal
space. Measure span of liver; normal is 6 to 12 centimeters or 2.5 to 4.5 inches.
Spleen: percuss spleen just posterior to midaxillary line on the left side. Percuss in
several directions beginning at area of lung resonance. May hear small area of splenic
dullness from the sixth to ninth rib.
Kidney: DONE LAST: ask patient to assume sitting position. Place palm of hand over
right costovertebral angle and strike your hand with the ulnar surface of the fist of your
other hand. Repeat over the left costovertebral angle. Should not cause pain.

Palpation:
Demonstrate light palpation; verbalize reason. Begin with light, systematic palpation of
all four quadrants, avoiding areas that have been identified as problem spots. Lay the
palm of your hand lightly on the abdomen, with fingers extended and held together. With
palmar surface of your fingers, depress the abdominal wall no more than 1 centimeter,
using a light and even pressing circular potion. Abdomen should feel smooth, with
consistent softness. Light palpation useful in identifying muscular resistance and areas of
tenderness.
Demonstrate deep palpation; verbalize reason for deep palpation of abdomen. Deep
palpation necessary to thoroughly delineate abdominal organs and to detect less obvious
masses. Use the palmar surface of your extended fingers, pressing deeply and evenly into
the abdominal wall. Palpate all four quadrants moving fingers back and forth over the
abdominal contents. Often you are able to feel the borders of the rectus abdominis
muscles, the aorta, and portions of the colon. Tenderness not elicited with light or
moderate palpation may become evident.
Palpation of liver: place left hand under the patient at the 11th and 12th ribs, pressing
upward to elevate the liver toward the abdominal wall. Place your right hand on the
abdomen, fingers pointing toward the head and extended so the tips rest on the right
midclavicular line below the level of liver dullness. Press your right hand gently but
deeply, in and up. Have the patient breathe regularly a few times and then take a deep
breath. Try to feel the liver edge as the diaphragm pushes it down to meet your fingertips.
 Ordinarily the liver is not palpable. If felt, it should be smooth, firm, even, and nontender.
Feel for nodules, tenderness, and irregularity.
Palpation of spleen: while standing on patients right side, reach across with your left
hand and place it beneath the patient over the left costovertebral angle. Press upward with
that hand to lift the spleen anteriorly toward the abdominal wall. Place the palmar surgace
of your right hand with fingers extended on the patients abdomen below the left costal
margin. Press your fingertips inward toward the spleen as you ask the patient to take a
deep breath. Try to feel the edge of the spleen moving downward toward your fingers.
The spleen is usually not palpable in an adult.
Temperature of abdominal skin compared to other body areas:

Scan room again.