H.A ABDOMEN

• Structures and functions of the digestive system

  • Mouth
  • Esophagus
  • Stomach
  • Small intestines
  • Large intestines
  • Rectum
  • Anus

  
• Associated organs of the digestive system

  • Liver
  • Gall bladder
  • Pancreas
• Process of digestion and elimination

  1. Ingestion (Taking In Food)

  2. Digestion (Breakdown of Food)

  3. Absorption (transfer of food products into the circulation)

  4. Elimination
• Regions of the abdomen

  • Epigastric: area between costal margins
  • Umbilical: area around umbilicus
  • Suprapubic or hypogastric: area above pubic bone

  
• Quadrants of the abdomen


  • RUQ
  • RLQ
  • LUQ
  • LLQ

  
• Assessment techniques for the abdomen

  • Inspection
  • Auscultation
  • Percussion
  • Palpation
• When assessing the abdomen, the nurse performs inspection first, followed by auscultation, percussion, and/or palpation
• Right upper quadrant (RUQ)

  • Stomach
  • Left lobe of liver
  • Left kidney and adrenal
  • Part of transverse and descending colon

  
• Left upper quadrant (LUQ)

  • Spleen
  • Body of Pancreas
  • Splenic flexure of colon
  • Part of transverse and descending colon

  
• Right lower quadrant (RLQ)

  • Part of descending colon
  • Sigmoid colon
  • Right ovary and tube
  • Right spermatic cord

  
• Left lower quadrant (LLQ)

  • Part of descending colon
  • Sigmoid colon
  • Left ovary and tube
  • Left spermatic cord
• Subjective data (health history questions)


  • Change in appetite
  • Usual weight; Changes in usual weight
  • Difficulty swallowing
  • Foods you have difficulty tolerating
  • Nausea
  • Vomiting
  • Indigestion
  • Heartburn or Belching
  • Use of antacids
  • Abdominal bloating after eating
  • Abdominal pain
  • Alcohol use
  • Medications
  • Bowel habits: Frequency, Usual color and consistency, Diarrhea/constipation/flatulence, Use of laxatives
• Past abdominal history


  • GI problems: ulcer, hepatitis, jaundice, appendicitis, colitis, hernia
  • Surgical history of abdomen
  • Abdominal x-rays, sonograms, CT results, colonoscopy results
• Prior to performing the procedure, check the doctor's order for the need to perform the assessment
• Perform hand hygiene, apply gloves, and observes other appropriate infection prevention procedures
• Prepare equipment needed for the assessment
• Introduce self and verifies the client's identity using agency protocol
• Explain the procedure to the client, and how he or she can participate, especially about the need to assume several positions for this examination
• Ask the client to empty the bladder before beginning the examination
• Ensure that the room is warm
• Instruct the client to remove clothes and to put on a gown
• Help the client to lie supine with the arms folded across the chest or sides
• Place a flat pillow under the client's head for comfort
• Slightly flex the client's legs by placing a pillow or rolled blanket under the client's knees
• Drape the client with sheets so that the abdomen is visible from the lower rib cage to the pubic area
• Instruct the client to breathe through the mouth and to take slow, deep breaths
• Provide for client privacy
• Inquire if the client has any history of abdominal pain, tender areas; location, onset, sequence, chronology; quality; frequency; associated symptoms; constipation or diarrhea; change in appetite, food intolerances, and foods ingested in past 24 hours
• Assist the client to a supine position, with the arms placed comfortably at the sides
• Place small pillows beneath the knees
• Expose the client's abdomen only from the chest line to the pubic area to avoid chilling and shivering, which can tense the abdominal muscles
• Inspect the abdomen for skin integrity, coloration of the skin, vascularity of the abdominal skin, any striae, scars, lesions and rashes
• Normal findings for the appearance of the abdomen (skin)

  Unblemished skin, Uniform color, Silver-white striae (stretch marks) or surgical scars

  
• Deviations from normal appearance of the abdomen (skin)

  Abnormal venous patterns, Abnormal discoloration, Umbilicus is sunken, Presence of rash or other lesions, Tense, glistening skin (may indicate ascites, edema), Purple striae (associated with Cushing's disease or rapid weight gain and loss)
• Ask the client to take a deep breath and to hold it
• Normal findings for enlarged liver or spleen


  No evidence of enlargement of liver or spleen
• Deviations from normal for enlarged liver or spleen


  Evidence of enlargement of liver (Hepatomegaly) or spleen (Spleenomegaly)
• If distention is present, measure the abdominal girth by placing a tape around the abdomen at the level of the umbilicus
• Use the flat-disk diaphragm to auscultate bowel sounds. Intestinal sounds are relatively high pitched and best accentuated by the diaphragm. Light pressure with the stethoscope is adequate
• Ask when the client last ate