Name: ____________________________________________ Date of Lecture Demo: ________

Assessing the Abdomen

Basic Concept: Abdominal assessment is a valuation of the abdomen, liver and bladder
involving four methods of examination: inspection, auscultation, palpation, and percussion.

Objectives:
1. To obtain an accurate nursing health history of the client’s abdomen and related
functions.
2. To determine for any deviations or abnormalities of the abdomen.
3. To be able to formulate nursing diagnosis, collaborative problem and referral.

Preparation:

1. Assemble equipment:
Examining light
Tape measure (metal or non-stretchable cloth)
Water-soluble skin-marking pencil
Stethoscope
2. Introduce yourself, and verify the client’s identity. Explain to the client what you are going
to do, why it is necessary, and how the client can cooperate.
3. Perform hand hygiene, and observe other appropriate infection control procedures.
4. Provide for client privacy.

PROCEDURE RATIONALE
1. Determine the client’s history of the
following:
Incidence of abdominal pain: its
location, onset, sequence, and
chronology; its quality (description);
its frequency; associated and the
symptoms
Bowel habits
Incidence of constipation or diarrhea
Change in appetite
Food intolerances
Foods ingested in the last 24 hours
Specific signs and symptoms
Previous problems and treatment
2. Assist the client to a supine position,
with the arms placed comfortably at
the sides.
-Place small pillows beneath the knees To reduce tension in the abdominal muscles.
and the head.
- Expose only the client’s abdomen To avoid chilling and shivering, this can tense
from the chest line to the pubic area. the abdominal muscles.
Inspection of the abdomen
3. Inspect the abdomen for skin integrity.
4. Inspect the abdomen for contour and
symmetry.
- Observe the abdominal contour while
standing at the client’s side when the
client is in supine.
- Ask the client to take a deep breath
and to hold it.
- Assess the symmetry of contour
while standing at the foot of the bed.
- If distension is present, measure the
abdominal girth by placing a tape
around the abdomen at the level of the
umbilicus.
 5. Observe the abdominal movements
associated with respiration, peristalsis,
or aortic pulsations.
6. Observe the vascular pattern.
Auscultation of the abdomen
7. Auscultate the abdomen for bowel
sounds, vascular sounds, and
peritoneal friction rubs.
Percussion of the Abdomen
8. Percuss several areas in each of the To determine presence of tympany and
four quadrants. dullness.
- Use a systematic pattern: Begin in
the lower left quadrant, then proceed
to the lower right quadrant, the upper
right quadrant, and the upper left
quadrant.
Percussion of the Liver To determine its size.
9. Percuss the liver.
- Begin percussing the abdomen along
the right midclavicular line, starting
below the level of the umbilicus. This indicates the lower border of the liver.
- Move upward until the percussion
notes change from tympany to
dullness, usually at or slightly below
the costal margin.
- Mark the point of change with a felt-
tip pen. This indicates the upper border of the liver.
-Percuss downward along the right
midclavicular line, starting above the
nipple. Move downward until
percussion notes change from normal
lung resonance to dullness, usually at
the fifth to seventh intercostal space.
- Again, mark the point of change with
a felt-tip pen.
-Estimate the liver’s size by measuring
the distance between the two marks.
(Health Assessment made Incredibly Easy,2007. LWW)
Palpation of the Abdomen To detect areas of tenderness and/or muscle
10. Perform light palpation first. guarding.
- Systematically explore all four
quadrants.
- Perform deep palpation over all four
quadrants.
Palpation of the Liver To detect enlargement and tenderness.
11. Palpate the liver.
a. Method 1: Standard palpation
-Place the patient in the supine position,
-Stand at the right side of client, place
your left hand under client’s back at the
approximate location of the liver.
- Place your right hand slightly below the
mark at the liver’s upper border that you
made during percussion.
-Point the fingers of your right hand
toward the patient’s head just under the
costal margin.
-As the patient inhales, deeply, gently The edge should be smooth, firm and
press in and up on the abdomen until the somewhat round.
liver brushes under your right hand.
- Note any tenderness.
b. Method 2: Hooking the liver
 -Stand next to the patient’s right shoulder,
facing his feet.
- Place hands side by side, and hook your
fingertips over the right costal margin,
below the lower mark of dullness. If the liver is palpable, you may feel its edge
- Ask the patient to take a deep breath as as it slides down in the abdomen as he
you push your fingertips in and up. breathes in.
(Health Assessment made Incredibly Easy,2007. LWW

Palpation of the Bladder

12. Palpate the area above the pubic
symphysis, if the client’s history
indicates possible urinary retention.
13. Document findings in the client
record.
Adapted from Kozier and Erb’s Fundamentals of Nursing (2015).
Berman, Audrey, et.al. (2015). Kozier and Erb’s Fundamentals of Nursing: Concept, Process and Practice, 10th ed.
Lynn, P.(2008). Taylor’s Clinical Nursing Skills, 2nd ed.
Weber, Janet R., et.al. (2014). Health Assessment in Nursing, 5th ed.
Health Assessment made Incredibly Easy (2007). Lippincott William and Wilkins
 PERFORMANCE CHECKLIST

Name: __________________________________________ Date of Return Demo: __________

Assessing the Abdomen

Criteria for evaluation or rating the student’s performance:

1 - Performs the step or procedure independently, correctly and appropriately. Shows excellent
attitude and gives the correct rationale of the step/ procedure to be performed. Answers the
question/s correctly and analyzes the situation on or before performing the procedure.
2 – Performs more independently with increasing dependability but occasionally needing
assistance. Shows very satisfactory attitude and gives the correct rationale of the step/ procedure
to be performed but occasionally needing follow-up instructions and explanations.
3 – Performs expected step/ procedure but needs supervision, follow-up instructions and
explanations. Has knowledge about the topic, step or procedure but needs reinforcement.
4 – Performs with close supervision. The student needs repeated, specific, detailed guidance and
direction to be able to perform the step/ procedure correctly and appropriately. There is a need to
improve performance.
5 – Performs with very close supervision. The student shows poor or no interest in the step/
procedure to be performed; cannot answer the question raised by the supervising clinical
instructor based on the step or procedure to be performed; unable to grasp understanding of the
topic or procedure; unable to perform the required step and state the rationale after being
instructed, guided or directed. Student’s behavior is inappropriate and potentially harmful to the
client.

1 2 3 4 5
ASSESSMENT
1. Verifies the client’s identity.
PLANNING
1. Reviews previously learned concepts and principles.
2. Explains the procedure to the client and how the client can cooperate.
3. Prepares and assembles all equipment.
IMPLEMENTATION
1. Introduces self.
2. Provides client privacy.
3. Determines the client’s history of the following:
a. Incidence of abdominal pain: its location, onset, sequence, and
chronology; its quality (description); its frequency; associated and the
symptoms
b. Bowel habits
c. Incidence of constipation or diarrhea
d. Change in appetite
e. Food intolerances
f. Foods ingested in the last 24 hours
g. Specific signs and symptoms
h. Previous problems and treatment
4a. Assists the client to a supine position, with the arms placed
comfortably at the sides.
b. Places small pillows beneath the knees and the head.
c. Exposes only the client’s abdomen from the chest line to the pubic
area.
Inspection of the abdomen
5. Inspects the abdomen for skin integrity.
6a.Inspects the abdomen for contour and symmetry.
b. Observes the abdominal contour while standing at the client’s side
when the client is in supine.
c. Asks the client to take a deep breath and to hold it.
d. Assesses the symmetry of contour while standing at the foot of the
bed.
e. If distension is present, measures the abdominal girth by placing a tape
around the abdomen at the level of the umbilicus.
7. Observes the abdominal movements associated with respiration,
peristalsis, or aortic pulsations.
8. Observes the vascular pattern.
Auscultation of the abdomen
9. Auscultates the abdomen for bowel sounds, vascular sounds, and
peritoneal friction rubs.
Percussion of the Abdomen
10a. Percusses several areas in each of the four quadrants.
b. Uses a systematic pattern: Begin in the lower left quadrant, then
proceed to the lower right quadrant, the upper right quadrant, and the
upper left quadrant.
Percussion of the Liver
11. Percusses the liver.
a. Begins percussing the abdomen along the right midclavicular line,
starting below the level of the umbilicus.
b. Moves upward until the percussion notes change from tympany to
dullness.
c. Marks the point of change with a felt-tip pen.
d. Percusses downward along the right midclavicular line, starting above
the nipple.
e. Moves downward until percussion notes change from normal lung
resonance to dullness.
f. Marks the point of change with a felt-tip pen.
g. Estimates the liver’s size by measuring the distance between the two
marks.
Palpation of the Abdomen
12a. Perform light palpation first.
b. Systematically explore all four quadrants.
c. Perform deep palpation over all four quadrants.
Palpation of the Liver
13. Palpates the liver.
Method 1: Standard palpation
a. Places patient in position in supine position.
b. Stands at the right side of client.
c. Places left hand under client’s back at the approximate location of the
liver.
d. Places right hand slightly below the mark at the liver’s upper border.
e. Points the fingers of right hand toward the patient’s head just under the
costal margin.
f. As the patient inhales, deeply, gently presses in and up on the abdomen
until the liver brushes under the right hand.
g. Notes any tenderness.
Method 2: Hooking the liver
a. Stands next to the patient’s right shoulder, facing client’s feet.
b. Places hands side by side.
c. Hooks fingertips over the right costal margin, below the lower mark of
dullness.
d. Asks the patient to take a deep breath.
e. Pushes fingertips in and up while client is taking a deep breath.
Palpation of the Bladder
12. Palpates the area above the symphysis pubis, if the client’s history
indicates a possible urinary retention.
14. Performs hand hygiene.
15. Documents findings.
EVALUATION
1. Observes appropriate infection control measures throughout the
performance of the procedure.
2. Applies related and relevant principles / concepts.
3. Distinguishes what is normal findings and deviation to normal
findings,
4. Relates findings or assessment to client’s culture, socioeconomic
status and current circumstances, certain condition or disorder.
5. Shows understanding of the terms, description or findings stated.
6. Performs the procedure with mastery and confidence.
7. Shows a positive and caring attitude towards the client.

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