Created by: Nicole Anderson MN, NP Presented by: Jennifer Burgess RN, GNC(C)
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Transcript of Created by: Nicole Anderson MN, NP Presented by: Jennifer Burgess RN, GNC(C)
![Page 1: Created by: Nicole Anderson MN, NP Presented by: Jennifer Burgess RN, GNC(C)](https://reader035.fdocuments.us/reader035/viewer/2022062518/56649c9e5503460f9495ebed/html5/thumbnails/1.jpg)
AbdominalAssessment
Created by: Nicole Anderson MN, NP
Presented by: Jennifer Burgess RN, GNC(C)
![Page 2: Created by: Nicole Anderson MN, NP Presented by: Jennifer Burgess RN, GNC(C)](https://reader035.fdocuments.us/reader035/viewer/2022062518/56649c9e5503460f9495ebed/html5/thumbnails/2.jpg)
Objectives
1. Overview of anatomy2. Abdominal assessment technique3. Interpretation of findings4. Constipation, fecal impaction,
and bowel obstruction5. When to report findings
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OverviewOf
Anatomy
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1. Abdominal quadrants2. Landmarks/surface
anatomy3. Abdominal muscles4. Abdominal vasculature5. Internal organs
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Abdominal Quadrants
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•Dividing the abdomen into 4 quadrants will aid during assessment and will allow for appropriate documentation of findings.•Understanding which organs are relevant to each quadrant will help you to determine etiology of signs/symptoms found during assessment.
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Landmarks and Surface
Anatomy
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Understanding landmarks and surface anatomy will
enhance your documentation skills and
will allow for more efficient reporting of symptoms.
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Abdominal Muscles
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• Function to support abdominal cavity and protect organs•Weakness in these muscles may lead to hernias, inability to cough effectively, increased risk of falls, abdominal distension, postural problems, and back pain.
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Abdominal Vasculature
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Internal Organs
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Liver: bile production, controls levels of fats/amino acids/proteins in the blood, immune function, detoxification, metabolizes drugs, blood clotting, store sugars, etc.Gallbladder: aids in fat digestion and concentrates/stores bile produced by the liver.Pancreas: produces digestive enzymes, secretes insulin/glucagon/somatostatin to control blood sugar levelsSpleen: stores and produces lymphocytes
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Small intestine: digestion and absorption of nutrients, approximately 21 feet long.Large intestine: absorption of water, lubrication of contents, neutralization of acids, decomposition by live bacteria, approximately 4.5-5 feet long and 2.5 inches in diameter.
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Organs Per Quadrant
RUQ: liver, gallbladder, duodenum, hepatic flexure of colon, head of pancreas, right kidney/ureter, part of ascending and transverse colon
RLQ: cecum, appendix, small intestine, right ureter, right ovary/fallopian tube, right spermatic cord
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LUQ: stomach, spleen, splenic flexure of colon, tail of pancreas, left kidney/ureter, part of transverse and descending colon
LLQ: sigmoid colon, small intestine, part of descending colon, left ovary/fallopian tube, left spermatic cord
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Abdominal Assessment Technique
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Preparation
1. Resident should be calm and supine
2. Bring a stethoscope3. An understanding of health
history or reported symptoms is useful
4. Obtain relevant history from resident
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Technique
1. Inspection2. Auscultation3. Percussion4. Palpation
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Inspection
1. Observe resident’s abdomen from foot of bed for peristalsis, asymmetry, and abdominal distension
2. Observe umbilicus for deviation3. Assess skin of abdomen4. Measure abdominal girth if
relevant
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Auscultation
1. Start in RLQ and listen to each quadrant for 2-5 minutes for bowel sounds
2. Normal sounds are high-pitched and gurgling in small intestine and low-pitched and rumbling in the colon
3. Normally occur at a rate of 5-35/min
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Percussion
1. Percuss all quadrants for dullness
2. Percuss for tympany3. Percuss for hyperresonance4. Percuss for bladder volume
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Palpation
1. With warm hands lightly palpate all 4 quadrants- palpate any area of pain last
2. Use pads of fingers depressing abdomen 1cm
3. Moderate palpation may be done to assess musculature and deeper structure
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Interpretation of
Findings
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Inspection
Asymmetry: enlarge spleen or liver
Distension: fat, flatus, stool, fluid, tumor
Bruising at umbilicus: acute necrotizing pancreatitis
Flank bruising: intra-abdominal or retroperitoneal hemorrhage, or injury to pancreas
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Periumbilical and flank ecchymosis
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Auscultation
Very loud bowel sounds: hyperperistalsis caused by diarrhea or early intestinal obstruction.
High-pitched tinkles and rushes: bowel obstruction
Absence or decreased: paralytic ileus, peritonitis, or acute abdomen
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Percussion
Dullness: normal over liver and spleen, but abnormal in mid abdomen and may be due to organ distension or mass
Pain: inflammationTympany: high-pitched tympany
suggests distensionHyperresonance: normal at umbilicus,
but anywhere else suggests distended vasculature or aneurysms
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Palpation
Crepitus: subcutaneous emphysema suggests abscess, diverticulitis, or organ perforation.
Pain: many causes such as peritonitis, inflammation, abscess
Mass/Ridge: depending on the area, could mean tumor, aneurysm, abscess.
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Constipation, Fecal Impaction,
and Bowel Obstruction
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Constipation
Infrequent or difficult passage of stool, hard stool, or a feeling of
incomplete evacuation
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Signs and Symptoms
•Difficulty passing stool•Hardened stool•Complaints of rectal fullness•Self disimpaction•hemorrhoids•Symptoms are often un-noticed in the older adult and frequency of stools may not change
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Red Flags
•Distended tympanic abdomen•Vomiting•Blood in stool•Weight loss•Severe constipation of recent onset/worsening in older adults
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Fecal Impaction
A large lump of hard dry stool that remains stuck in the rectum, often due to chronic constipation
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Signs and Symptoms
•Abdominal cramping and bloating• Leakage of liquid from rectum or diarrhea in a resident with chronic constipation•Rectal bleeding•Small, semi-formed stools•Difficulty passing stool and/or straining
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Red Flags
•Nausea and vomiting•Tachypnea•Tachycardia•Abdominal distension with tympanic, absent and/or high-pitched bowel sounds
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Bowel Obstruction
Significant mechanical impairment for complete blockage of contents through the intestine. Mechanical obstruction can effect either the small or large intestine.
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Signs and Symptoms
Small bowel obstruction:•Cramping around umbilicus or epigastrium•Vomiting•Obstipation•Hyperactive, high-pitched bowel sounds with rushes•Diarrhea in partial obstruction
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Signs and Symptoms
Large bowel obstruction:•More gradual onset of symptoms• Increasing constipation leading to obstipation and abdominal distension• Lower abdominal cramping unproductive of feces• Loud, hyperactive bowel sounds•Symptoms are mild
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Red Flags
•Severe steady pain•Tender with light palpation•Absent bowel sounds•Shock (tachycardia, low BP)•Oliguria• Fever/chills, or abnormal vital signs•Rectal bleeding•Older adults
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When to Report
Findings
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• Presence of red flags•Any abnormal finding on abdominal exam•Suspected intestinal obstruction•Change in bowel patterns, stool consistency, stool colour•Change in nutritional status•Suspected constipation or fecal impaction•Acute abdominal pain
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DiscussionAnd
Questions