Abdominal assessment is different from cardiac and pulmonary assessment in that auscultation is the second type of assessment to be done, before palpation (which is before percussion). This is because palpation may increase bowel activity and therefore give inaccurate results. Therefore, abdominal assessment should be done in the following order:
inspection: is the abdomen distended? Is there any bruising? Is the abdomen symmetric? For trauma--is there any scrapes, lacerations, burns. Useful to note, as well, any scars or lesions.
The abdomen can be divided into 2 different naming systems: the first is a 4-part naming system: Left Upper Quadrant (LUQ), Right Upper Quadrant (RUQ), Left Lower Quadrant (LLQ) and Right Lower Quadrant (RLQ). The other is a nine-part system that I understand when I read or hear it, but I don't remember the specific names offhand.
auscultation: each quadrant of the abdomen should be auscultated. They say that you are supposed to auscultate for at least 5 minutes (!) before deciding there is no bowel sounds. (20 minutes ??? Yikes!!! I don't think anyone auscultated my abdomen for 20 minutes after my abdominal surgery!) Depending upon the frequency of bowel sounds, they are described as hyperactive, active and hypoactive. Some people just indicate whether bowel sounds are present or not, for each quadrant.
Palpation: palpation is done in all four quadrants and light palpation is done first. If the abdomen is rigid or the abdomen is tender to light palpation in a particular quadrant, deep palpation is not performed in that quadrant. (You wouldn't want to cause the rupture of an infected appendix, for instant.) You can get more sophisticated if a patient has pain upon palpation depending upon whether the pain occurs when you press in, when you relieve pressure ("rebound tenderness"), or both.
Percussion: can't help you too much here. Percussion is performed by hitting the fingers of one hand with the fingers of the other hand over different parts of the body. Depending upon the sound, you can tell whether what below you is solid or hollow. Frequently used to determine where the edge of the liver is.
I'm sure there are things that I've missed--so, everyone, feel free to jump in!!!
Quote from pookie83
hello to everyone. I am in my first semester in nursing school
to get my RN. I just found out that I did not pass my proficiency today on the abdominal assessment
. I feel extremely stupid and like I can't succeed at it. Does anyone have any advice to offer me? I have to repeat the profiency in two weeks and I must pass! Please help me if you can. I feel totally lost about what to do, even though I have no other problems.
Hope everyone is having a good day. Good luck to all in all of your classes.
I am 22 years old, an only child, and I really enjoy helping others.