Chapter 5 – Gastrointestinal System Show
Inspection of the abdomen provides information about the client’s GI system, particularly the intestines, as well as the liver and the abdominal cavity overall. Refer to Figure 5.3 for the quadrants and regions: a horizontal and a vertical imaginary line bisects the umbilicus to help you visualize the four quadrants. Note any abnormalities of the abdomen using these quadrants and regions. Figure 5.3: Abdominal quadrants Inspecting the abdomen involves the following steps: 1. Before inspecting the abdomen, note the client’s level of consciousness, facial expression, and assess for the presence of jaundice.
2. Ask the client to expose their abdomen so you can observe from the epigastric (inferior to xiphoid process) down to the hypogastric region (superior to the pubic bone). 3. Note any stoma bags, tubes, drains, incisions, scarring, dressings, or medical equipment (e.g., monitors). NOTE: If you observe discharge/bleeding on a dressing, outline it with a marker/pen and observe whether it increases in size. However, if it is significant quantity, you should investigate the cause and perform a primary survey. 4. Use tangential lighting and observe all four quadrants.
5. Note any potential signs of observable pain. (Remember: if you suspect pain, always ask the client.)
6. Note the abdominal shape.
7. Note skin colour, discolouration, integrity, and swelling.
8. Note the presence of peristaltic movement. 9. Note the findings.
Signs associated with an intestinal blockage is a priority of care because it may indicate the need for surgical intervention. Pain, constipation, vomiting, and abdominal distention are possible signs of a blockage. If any are present, notify the physician/nurse practitioner after performing a primary survey with a complete set of vital signs and a full abdominal assessment. It is especially important to auscultate and palpate the abdomen, because absent bowel sounds or a distended/firm and painful abdomen are associated with blockages. All abnormal signs observed upon inspection require a full abdominal assessment. If you observe signs of pain, begin with a subjective assessment. Any asymmetry, bulging, abnormal contour, swelling, and lesions should be reported to the physician/nurse practitioner. Activity: Check Your UnderstandingWhy does auscultation precedes percussion and palpation on assessing the abdomen?Auscultating before the percussion and palpation of the abdomen ensures that the examiner is listening to undisturbed bowel sounds. In addition, if the patient is complaining of pain, leaving the palpation until last allows the examiner to gather other data before potentially causing the patient more discomfort.
When the nurse conducts physical assessment of the abdomen auscultation should precede palpation to?Question 7 Explanation: With an abdominal assessment, auscultation always is performed before percussion and palpation because any abdominal manipulation, such as from palpation or percussion, can alter bowel sounds.
Which organ would the nurse expect to hear dullness upon percussion during the abdominal assessment?You'll hear dull sounds over solid structures (such as the liver) and fluid-filled structures (such as a full bladder). Air-filled areas (such as the stomach) produce tympany. Dullness is a normal finding over the liver, but a large, dull area elsewhere may indicate a tumor or mass.
What types of percussion notes can be heard during abdominal assessment?Percussion notes normally heard during the abdominal assessment may include tympany, which should predominate because air in the intestines rises to the surface when the person is supine; hyperresonance, which may be present with gaseous distention; and dullness, which may be found over a distended bladder, adipose ...
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