hello every one i am flor mae g.

idao from ateneo de

davao university your student nurse for today, so for
todays video im going to perform assessing the abdomen
return demonstration
assessment of the abdomen consist of inspection,
auscultation, percussion and palpation the physical
examination of the abdomen is the key step in the
evaluation of abdominal complaints such as pain,
distension, enlarged organs or masses
prior to the conduct of the procedure first thing to do is to
review clients previous medcal records if available ( start
looking to the chart)
next is to prepare the necessary equipments needed to
conserve time and energy
the equipments that im going to use includes a tape
measure for the measurement for the patients abdominal
girth, a sharp object such as this ruler for the
hypersensitivity test, and ofcourse a stethoscope to listen
for patients bowel sounds
now perform hand hygiene to prevent the microorganism
from spreading
good morning sir i am flormae your student nurse for today
and may i see your wrist bond sir please state your full
name, your birthday please, ok thank you verymuch sir
so today ill be assessing your abdomen which means ill
have to expose your abdomen, ill have to listen for your
bowelsounds and also feel for your internal organs will that
be alright, okay
is it okay to close the door so no one from outside will be
able to disturb you while were doing the assessment, okay
before we start i encourage you to void first so it will be
much comfortable with you while were doing the
assessment.
ensure that the patient has emptied his bladder prior to the
conduct of the procedure because a full bladder can make
the examination uncomfortable, and it can be reduce the
accuracy of the bundle height measurement
now position the client to the supine position with the arms
folded over his chest or just by lying at his side and then
place ta pillow underneath the patients knees, this position
ensures abdominal muscle relaxation to avoid putting
additional pressure on the patients abdomen
now cover the upper and lower body parts of the patient
leaving only the abdomen exposed from the sephoid
process down to just above the symphysis pubis ( start
exposing the abdomen)
sir do you feel and pain in your abdomen, okay so ill begin
inspecting your abdomen first
begin with the inspection of the abdominal skin
characteristics assess for abdominal skin temperature
collar ( start pindot ) note for any vascularities, striae or
stretch marks and also note for any scars lessions or
rashes and if there is any document for its history and its
location by quadrant
now inspect the umbilical location color and contour the
umbilical skin tones is similar the surrounding skin tones
or even pinkish it should be recessed inverted or
protruding no more than .5 centimeters and it should be
round and conical and now also observe for any presence
of masses or bulges suggesting ventral hernia which is
any protrusion of the intestine or other tissues through a
weakness or gap in the abdominal wall.
now to observe for abdominal symmetry while the patient
lies supine on the bed sit bedside the client and look
across the abdomen at a level slightly higher than the
patients abdomen ( start looking )
and the stand at the foot of the bed and observe for
abdominal symmetry ( start observing)
so the abdomen is normally flat rounded or scaphoid in
which is seen in thin adults and it should be evenly
rounded and symmetrical so while doing the inspection
also observe for abdominal respiratory movements aortic
pulsations and peristalsis
(stand patient) measure the patients abdominal around by
placing a measuring tape around the patients abdomen
( start measure) at the level of the umbilicus
so the abdominal girth should be measured at the same
time of the day ideally in the morning just after voiding
now auscultation of the patients vowel sounds
ok sir im going to proceed to a listening over your
abdomen, I just want to ask when did you last eat, okay
recent intake may have increased the peristaltic activity,
warm hands and the diaphragm of the stethoscope to
avoid startling the patient of the coldness of the
stethoscope ,now auscultate all four abdominal quadrants
for at least 1minute each starting from the right lower
quadrant and the proceeding to a clockwise pattern
noting for the intensity pitch and frequency of the vowel
sounds ( start stet)
now listen for the vascular sounds use the bell of the
stethoscope and listen for brewee over the abdominal
aorta, renal iliac and femoral arteries ( start stet )
now to listen for peritoneal friction rod use diaphragm of
the stethoscope to listen for friction rod over the liver and
spleen ( start stet )
proceeding now to the percussion patients abdomen
because several areas in each in the four quadrants to
determine presence of tympani or dullness, tympani is a
high pitch musical sound that indicates a hollow space
filled by air and dullness suggests fluid or feces (start
percussing)
now percuss for the vertical liver span at the midclavicular
line so from the right lower quadrant along the mid
clavicular line percuss upwards towards the liver and note
the note the change from tympani to dullness and mark
this point ( start percussing)
now percuss on the right mid clavicular line on the area of
the lung resonance around the third intercoastal space
and percuss downwards to the liver note the change from
lung resonance to liver dullness mark this ( start
percussing )
now for vertical liver span at the mid sternal line starting
just above the umbilicus purpose upward toward the liver
and note the change from tympani to dullness and mark
this point ( start percussing )
now for the upper border start percussion at the body of
the sternum along the third intercoastal space and
perhaps downwards until the tone changes from flat to the
liver dullness ( start percussing )
now measure the distance between the two points ( start
measuring )
a normal liver span at the mid clavicular line is about 6-12
centimeters and the normal liver span along the midsternal
line is 4-8 centimeters
to assess for liver descent ask the patient to take a deep
breath and hold it while percussing the right lower
quadrant towards the liver and note the change from
tympani to dullness and mark this point, ok sir I need you
to take a deep breath and hold it please( start percussing )
ok you can exhale.
now measure the distance between the border and the
right coastal margin along the midclavicular line ( start
measuring )
to assess for the spleen and evaluate for splenomegaly
reposition the patient in a right sided lying position with left
knee flexed and identify the left anterior axillary line ( start
assisting the patient )
to assess the sides of the spleen, percuss the left anterior
chest wall roughly from the border of the cardiac dullness
at the sixth rib to the anterior axillary line down to the
coastal margin ( start percussing while talking)
percuss the lower interspace in the left anterior axillary line
and ask the client to take a deep breath and percuss again
( start percussing )
Perform the liver blood percussion to assess for liver
tenderness place the right hand flat against the lower
anterior rib cage (start putting it) and then use the ulnar
surface of the left hand to strike right hand( start striking)
ok sir do you any pain
Perform the kidney punch to assess for kidney tenderness
reposition the patient in a sitting position and then place
the left hand at the coastal vertebral over the 12th rib use
the ulnar side of the right Fist to strike against the left hand
and ask for anything ( start striking) and do on the other
side
Test for a scientist test for shifting dullness while the
patient lying supine on the bed percuss the planks of the
patient from the bed towards the umbilicus noting the
change from dullness to tympani and mark this (start
percussing)
now reposition the patient to a side lying position and
perhaps the abdomen from the bed upward and noting for
the change from dullness to tympani ( start assessing the
client to roll in his side) ( start percussing)
so for fluid wave test while the client is lying in a supine
position, ask the patient to press the edges of his hand
firmly down the midline of his abdomen ( ask the patient
sir I need you to place your hand here and press it down
please thank you, and then tap one flank sharply with
finger tips to fill for a fluid wave transmitted across the
abdomen to the opposite flank) ( start pressing)
perform light palpation to assess for tenderness and
presence of mass with client lying relaxed in a supine
position begin with a light systematic palpation of all four
quadrants or nine regions (start palpating) using the finger
pads initially avoiding any areas that the patient had
identified as painful and then observe for reports of pain,
tenderness, guarding behavior and masses
perform the palpation which is done to feel for the internal
organs and masses ( start palpating) compress the
abdomen to a maximum of five to six centimeter using the
palmer surface of the hands and initially avoiding the
painful areas and palpated for muscle resistance or
masses
perform moderate palpation at umbilical ring noting for any
presence of masses, swelling, nodules, granulation to
assess tenderness and presence of mass ( start palpating)
palpation of the abdominal aorta use both hands to deeply
palpate the pedestrian slightly to the left midline( start
palpating)
now palpate for the liver to assess for liver contour surface
presence of nodule, tenderness, and irregularity, place the
left hand under the clients back at the level of the 11th and
12th ribs while the right hand is laid parallel to the right
coastal margin with fingertips pointing towards clients lead
( start palpating) instruct the client to take a deep breath
then compress the fingertips upward and inward to the
lower border of the liver and assess for contour surface
presence of nodules, tenderness and irregularity ( start
take a deep breath )
now perform the hooking technique stand at the clients
right side facing his feet, press in and upward the coastal
margin with your fingertips and ask the patient to take a
deep breath gently and firmly pull inward and upward with
the fingers palpate for the liver edge as it descends to
meet the fingers nothing to contour surface presence of
nodules, tenderness, and irregularity, sir can you please
take a deep breath (start palpating)
percuss the spleen and assess for splenomegaly stand at
the patient’s right side and reach over the patients
abdomen with the left hand under the posterior lower ribs
and pull u gently place the right hand below the left coastal
margin pressed in I toward the spleen ask the patient to
take a deep breath then press inward and upward using
the right hand as the left hand provided support, begin
palpation below the coastal margin and try to feel the tipp
or edge of the spleen as it comes down to meet the
fingertips note for any tenderness and assess the splenic
contour ( start palpating) sir can you please take a deep
breath 2x,
repeat the procedure with the client lying on the right side
lying on the right side with legs somewhat flex of the hips
and knees as needed, (assist the patient to roll on the
side) ( start palpating with inhale and exhale)
palpate the kidneys to assess for kidney enlargement
stand at the patients right side lace the left hand under the
patients right posterior flank and the right hand at the right
coastal margin at the mid clavicular line instruct the client
to take a deep breath and compress the fingers during
peak inspiration and then ask him to exhale and hold his
breath briefly and gradually release the pressure of the
right hand to feel the right kidney sleeping beneath the
fingers ( start palpating ) ask to take a deep breath and
hold the breath
palpate the left kidney with the procedure reverse, state
the urinary bladder begin palpating at the synthesis pubis
and move upward and outward to estimate the bladder
borders ( began palpating)
as for the appendicitis or peritoneal irritation rebound
tenderness or Bloomberg sign palpate deeply at 90
degrees into the abdomen halfway between the umbilicus
and the anterior iliac crest or the muck burnish point then
suddenly release the pressure ( start palpating ) listen and
watch the clients expression of pain as the client to
describe which hurt more the pressing in or the releasing
and where on the abdomen the pain occur ( start palpating
) okay sir did you feel pain while I was pressing your
abdomen (no) did you feel pain when I released
oppressing your abdomen (no) okay
pain induced or worsened by withdrawal is rebound
tenderness suggesting peritoneal inflammation
now for the referred rebound tenderness or rubs inside
palpate deeply in the left lower quadrant and quickly
release the pressure ( start palpating ) okay sir did you
feel any pain while I was pressing your abdomen (no) did
you feel pain when I release pressing your abdomen ( no )
okay
pain in the lower quadrant during pressure in the left lower
quadrant is positive of promising signs suggesting acute
appendicitis
test for soa was sign reposition the patient in a right lying
position and then hyperextend the right leg, ( start testing)
okay sir tell me if you feel any pain, you feel pain (no) okay
pain in the right lower quadrant or the soa sign is
associated with the irritation of the iliopsoas muscles due
to appendicitis
test for obturators sign, now support the clients knee and
ankle and flex the hip and leg and rotate the leg internally
and externally ( start testing )
pain in the right lower quadrant indicates irritation of the
obturator muscle due to appendicitis or perforated
appendix
hypersensitivity test using a sharp objects stroke the
patients abdomen (palpate while talking) do this several
times and note for any complaints of pain, sir are you
feeling a pain in your abdomen (no)
pain or an exaggerated sensation felt on the right lower
quadrant is a positive skin hypersensitivity test and may
indicate an appendicitis
test for murphy’s sign or test for cholecystitis, press your
fingertips under the liver border at the right coastal margin
and ask the client to inhale deeply and note for any
increase in painful (ask the patient to inhale deeply and tell
me if you feel a pain and begun the test)
a positive murphy sign is when pain occurs when
examiner’s hand comes in contact with the gallbladder
okay sir now that were done with the assessment of your
abdomen here is the summary of what we have just done
okay
so upon inspection your skin is uniform in color no rashes,
no lesions, no scars and your umbilicus or your navel is
midline and inverted which is pretty normal your abdomen
is symmetrical and upon auscultation of your bowel
sounds while I was listening to your abdomen the sounds
are pretty normal and I hear no brewees or venus hum
while I was measuring for your liver size on your liver span
at the midclavicular line here I measured it is 7
centimeters and while I was measuring for your liver at the
mid sternal line it is measured at five centimeters which
falls within the normal range
upon percussion and palpation there were no tenderness,
no masses, no bulges, and no swelling overall your
abdomen is doing pretty good
do you any questions or clarifications
overall your abdomen is doing really good but before I
leave I just like give you some advice how to keep your
abdominal internal organs healthy okay
so first is as much as possible avoid from drinking too
much alcohol or hard liquor because it may cause damage
to your liver and instead of drinking alcohol might as well
increase your fluid intake such as water to flush out
unwanted residues in your liver and in your bladder in your
intestines
and if you have any urge to pee then do not hold back or
do not delay because holding back your pee might cause
the bacteria to multiply and can cause serious diseases
such as urinary tract infection
that is all do you have any questions or clarifications
perhaps
that is all thank you very much for your cooperation
perform hand hygiene and document findings