Nursing Theory and Practice 5 BASIC CONCEPTS Abdominal assess ment ment.pdf

Nursing Theory and Practice 5 BASIC CONCEPTS Abdominal assess ment ment.pdf

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  Abdominal assessment YEAR 3 SEMESTER5
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  https://youtu.be/1Xc7RYkz-CE • Learning Objectives •Perform an abdominal assessment • Differentiate normal and abnormal bowel sounds • Modify assessment techniques to reflect variations across the life span • Document actions and observations • Recognize and report significant deviations from norms
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  Key points • Athorough abdominal assessment helps evaluate the function of the gastrointestinal (GI) and genitourinary (GU) systems. • Proper assessment and recognition of normal and abnormal findings enable nurses to provide high-quality patient care.
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  Gastrointestinal Basics • Nursesmust understand abdominal structures for accurate assessment. • Knowledge of organ positioning is crucial for: • Auscultation • Palpation • Percussion • Visual references (GI system, bladder, male urinary system) aid assessment.
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  Gastrointestinal & GenitourinaryAssessment • Functions of the GI & GU Systems: • GI system: Ingestion of food & nutrient absorption • GI & GU systems: Waste elimination • Assessment Approach: • Subjective Data Collection: • Signs & symptoms of GI/GU diseases • Digestive & nutritional concerns • Medical & family history • Current treatments & medications
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  Interview Question Follow-up Haveyou ever been diagnosed with a GI, kidney, or bladder condition? Describe condition & treatments. Have you had abdominalsurgery? Describe surgery & any complications. Are you taking any medications, herbs, or supplements? List details. Do you have abdominal pain? Associated symptoms (fever, nausea, vomiting, bowel changes)? Are you experiencingbloody stools, dark stools, abdominal distention, or vomitingblood? Specify symptoms. Pain Assessment (OLDCARTS Method) When did the pain start? Onset Where is the pain? Location How long does it last? Duration Describe the pain. Characteristics What triggers the pain? Aggravating factors What relieves the pain? Alleviatingfactors Does the pain radiate? Radiation What treatments have you tried? Treatment How does the pain affect you? Effects How severe is the pain (0-10 scale)? Severity Have you had nausea, vomiting, food intolerance, heartburn, ulcers, appetite, or weight changes? Describe & treatment used. What is your typical 24-hour diet? List dietary habits. Do you have difficultyswallowingfood or liquids (dysphagia)? Describe & history of stroke/TIA. When was your last bowel movement? Changes in pattern or stool consistency? Are you passing gas? Yes/No Have you experienced constipation or diarrhea? Duration & treatments used. Constipation: Has it been a lifelongissue? Frequency of bowel movements? Diarrhea: Are stools watery or formed? Episodes in last 24 hours? Do you have pain or discomfort when urinating (dysuria)? Internal or external discomfort? Treatments used? Do you experience frequent urination? Occurs during day or night? This table provides a structured approach for nurses to gather comprehensive GI and GU history.
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  Gastrointestinal Assessment Summary •Gastrointestinal (GI) System • Pain is the most common abdominal complaint, requiring thorough assessment. • Additional symptoms to assess: • Bloody stools (hematochezia) • Dark, tarry stools (melena) • Bloating (abdominal distention) • Vomiting blood (hematemesis) • Common GI Issues in Hospitalized Patients: • Nausea, vomiting, diarrhea, and constipation—often due to medications or procedures. • Monitor last bowel movement & flatus for bowel management needs. • Diarrhea risks: Dehydration & electrolyte imbalances (dry skin, dry mucous membranes, sunken eyes). • Specialized GI Assessments: • Examine oropharynx & esophagus for swallowing difficulties (dysphagia). • Stroke (CVA) patients may struggle with swallowing, leading to weight loss or aspiration pneumonia.
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  Genitourinary (GU) System •Focus on bladder function and urinary symptoms. • Key symptoms & conditions: • Dysuria (painful urination): Common in UTIs, presents as burning, stinging, or itching. • Urinary frequency: Abnormally frequent urination, often at night (nocturia in older adults). • Urinary urgency: Sudden, strong urge to urinate, possibly causing incontinence. • Incontinence: Leakage of urine, often associated with urgency. • Considerations for Specific Populations: • Elderly patients: Mental status changes may indicate a UTI. • Women: Distinguish between vaginal inflammation vs. UTI-related dysuria. • Men: Frequent urination may signal prostate enlargement.
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  References This work isa derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0 Ferguson, C. M. (1990). Inspection, auscultation, palpation, and percussion of the abdomen. In Walker, H. • K., Hall W. D., Hurst J. W. (Eds.), Clinical methods: The history, physical, and laboratory examinations • (3rd • ed.). Butterworths. https://www.ncbi.nlm.nih.gov/books/NBK420/ • 13. Ferguson, C. M. (1990). An overview of the gastrointestinal system. In Walker, H. K., Hall W. D., Hurst J. W. • (Eds.), Clinical methods: The history, physical, and laboratory examinations (3rd ed.). Butterworths. • https://www.ncbi.nlm.nih.gov/books/NBK405/ • 14. “DSC_2286-1024x678.jpg” by British Columbia Institute of Technology is licensed under CC BY 4.0. Access • for free at https://opentextbc.ca/clinicalskills/chapter/2-5-focussed-respiratory-assessment/
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  Objective Assessment ofthe Abdomen • Assessment Steps (In Order): • Inspection • Auscultation (performed before palpation to avoid disrupting bowel sounds) • Palpation • Percussion • The abdomen is divided into four quadrants: • Right Upper (RUQ) • Right Lower (RLQ) • Left Upper (LUQ) • Left Lower (LLQ)
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  Objective Assessment ofthe Abdomen This table provides a structured overview of the steps and key points for the abdominal objective assessment Assessment Step Details Preparation - Ensure patient comfort (empty bladder, warm room/stethoscope). - Position patient supine with head and knees supported. Ensure privacy while exposing abdomen. Inspection - Contour: Assess shape (flat, rounded, scaphoid, protuberant). - Check for distention (obesity, gas, fluid). - Look for masses or bulges (deformities, organ issues). - Examine skin for color, integrity, scarring, or striae (stretch marks). - Umbilicus: Should be inverted and midline. - Observe for abnormal movements or pulsations (e.g., visible peristalsis, epigastric pulsations). Auscultation - Begin in RLQ and move clockwise. - Listen for high-pitched, irregular gurgles (peristaltic murmurs). - Hyperactive sounds: Indicate bowel obstruction, gastroenteritis. - Hypoactive sounds: Suggest constipation, post-surgery, peritonitis. - No vascular sounds should be heard. Report any vascular sounds to the healthcare provider. Palpation - Light palpation: Use the flat of the hand to check for masses, tenderness, or abnormal muscle tone. - Begin in RLQ and move clockwise. - Deeppalpation: Done by advanced clinicians to check for enlarged organs. - Palpate bladder for distention. - Assess response to palpation: - Guarding: Voluntary muscle contraction due to fear/anxiety. - Rigidity: Involuntary muscle contraction due to peritoneal inflammation. - Rebound tenderness: Pain when pressure is released after palpation, indicating peritoneal inflammation. .
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  • Light palpation Percussion Youmay observe advanced practice nurses and other health care providers percussing the abdomen to obtain additional data. Percussing can be used to assess the liver and spleen or to determine if costovertebral angle (CVA) tenderness is present, which is related to inflammation of the kidney. Encourage the patient to empty their bladder prior to palpation. When palpating the abdomen, ask the patient to bend their knees when lying in a supine position to enhance relaxation of abdominal muscles.
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  Assessment Expected Findings UnexpectedFindings (Document & NotifyProviderof New Findings) Inspection - Symmetrical shape & color - Asymmetry - Flat or rounded contour (protuberantin children ≤ 4 years) - Distension - No visible lesions - Scars, wounds, skin breakdown - Intact skin - Pulsations,visible peristalsis - Presence of colostomy (if applicable) Auscultation - Presence of normoactive bowel sounds - Hypoactive bowel sounds - Hyperactive bowel sounds - Absent bowel sounds Palpation - No pain or tenderness - Pain on palpation - No masses - Guarding, rigidity, rebound tenderness - Newly noted masses Genitourinary - Clear, pale yellow urine - Dark or bloody urine, foul odor, or sediment present - No pain, urgency, frequency, or retention - Dysuria, urinary frequency/urgency,urinary retention CRITICAL CONDITIONS(Report Immediately) - New/worseningmelena - Bloody stools or hematemesis - Signs of dehydration from diarrhea/vomiting(<30mL urine/hour) Expected vs. Unexpected Gastrointestinal and Genitourinary Assessment Findings
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  References • Ferguson, C.M. (1990). Inspection, auscultation, palpation, and percussion of the abdomen. In Walker, H. K., Hall W. D., Hurst J. W. (Eds.), Clinical methods: The history, physical, and laboratory examinations (3rd ed.). Butterworths. www.ncbi.nlm.nih.gov/books/NBK420/↵