NUR 100 Abdominal Assessment

Abdominal Subjective Data

1. Abdominal general questions

2. Abdominal history

3. OLDCARTS

General Abdominal Questions

Ask about

1. Appetite

2. Weight changes

3. Abdominal pain

4. Nausea/vomiting

5. Heartburn

6. Dysphagia

7. Changes in bowel habits

Establish patients usual

Bowel pattern

Stool Questions

Ask about

1. Color

2. Blood

3. Frequency

4. Consistency

5. Last bowel movement

Abdominal History

Ask about

1. GI conditions

2. Previous abdominal surgery

3. Medications and supplements

4. Alcohol use

5. Diet

6. fluids

7. Activity

8. Family history of colorectal cancer or polyps

9. Urinary symptoms and flank pain

OLDCARTS (refresher)

Onset

Location

Duration

Characteristics

Aggravating factors

Relieving Factors

Timing

Severity

Onset

When did it start?

Location

Point to the pain. Does it move or radiate?

Duration

How long does an episode last?

Characteristics

Is it burning, cramping, sharp, or gnawing?

Aggravating/Relieving Factors

What makes it worse or better? (Ask about meals, movement, position, and bowel movements)

Timing

When does it occur and how often?

Severity

Rate the pain 0-10

Technique Order

1. Inspect

2. Auscultate

3. Percuss

4. Palpate

Order of Quadrant Auscultation

1. RLQ

2. RUQ

3. LUQ

4. LLQ

RLQ Organs

1. Cecum

2. Appendix

3. Terminal ileum

4. Right ureter

5. Right ovary and fallopian tube

RUQ Organs

1. Liver

2. Gallbladder

3. Duodenum

4. Head of pancreas

5. Right kidney

6. Hepatic flexure

LUQ Organs

1. Stomach

2. Spleen

3. Left lobe of liver

4. Body and tail of pancreas

5. Left kidney

6. Splenic flexure

LLQ Organs

1. Descending and sigmoid colon

2. Left Ureter

3. Left ovary and fallopian tube

9 Regions

1. Right hypochondriac

2. Epigastric

3. Left hypochondriac

4. Right lumbar

5. Umbical

6. Left lumbar

7. Right inguinal

8. Hypogastric

9. Left inguinal

Abdominal Inspection

1. Position supine

2. Expose appropriately

3. Provide privacy

4. Use warm hands and equipment

5. Assess painful areas last

Aortic Pulse Location

Midline in the epigastrium above the umbilicus

Illiac Pulse Location

Lie below the umbilicus on either side

Renal Pulse Location

Either side of the upper abdominal midline

Femoral Pulse Location

In the groin, below the inguinal ligament

Abdominal Contour Inspection

1. Skin

2. Scars

3. Veins

4. Umbilicus

5. Symmetry

6. Contour

7. Movement

8. Bulges

Abdominal Contour Descriptions

1. Flat

2. Rounded

3. Scaphoid (sunken)

4. Protuberant

Causes of Abdominal Distention

1. Gas

2. Stool

3. Fluid/Ascites

4. Pregnancy

5. Obesity

6. Enlarged Organs

7. Masses

8. Full Bladder

Bulging Flanks Suggests

Ascites

Suprapubic Bulge Suggests

Bladder distention

Focal bulge may suggest

Hernia

Abdominal Auscultation

1. Use the diaphragm for bowel sounds

2. Start in the RLQ, RUQ, LUQ, LLQ

3. Listen for a full minute in each quadrant, up to 5 if no sounds heard

Bowel Sounds

1. Normal

2. Hyperactive

3. Hypoactive

4. Absent

5. High-pitched tinkling/rushing

Normal Bowel Sounds

High-pitched gurgles or clicks, approximately 5-30 per minute

Hyperactive Bowel Sounds

More than 30 per minute. May occur with diarrhea or early/partial obstruction

Hypoactive Bowel Sounds

Infrequent or diminished. May occur after anesthesia, with ileus, or peritonitis

Absent Bowel Sounds

No sounds after prolonged listening. Can occur with paralytic ileus

High-pitched tinkling/rushing Bowel Sounds

May suggest obstruction. Assess alongside pain, vomiting, and distention

Tymphany

Expected predominant sound over air-filled bowels

Dullness

Occurs over solid organs such as the liver, can occur over fluid, stool, a mass, or a full bladder

Costovertebral Angle Tenderness

pain elicited by gentle percussion over the angle where the 12th rib meets the spine.

CVA Tenderness Assessment

Assess posteriorly where the 12th rib meets the spine, using gentle blunt percussion over your supporting hand

CVA Tenderness Significance

May suggest kidney inflammation/infection, such as pyelonephritis

CVA Tender Expected Finding

No tenderness

Light Palpation

Checks

1. Tenderness

2. Surface characteristics

3. Guarding

Light Palpation Depth

1-2 cm

Deep Palpation

Assesses

1. Deeper organs

2. Masses

Deep Palpation Depth

4-6 cm

Expected Abdomen

Soft and nontender

Rigidity and involuntary guarding suggests

Peritoneal Irritation

Older Adult Age Related Changes in Abdominal Organs/System

1. Reduced saliva, gastric acid, motility, thirst, and chewing ability

2. Constipation and dehydration become concerns

3. Abdominal illness may produce vague pain

4. Declining liver or kidney function can affect medication handling

Abdominal Disorders

1. Peptic Ulcers

2. Referred Pain

3. Hernias

Peptic Ulcers

Breaks in the protective lining of the stomach or duodenum

Causes of Peptic Ulcers

1. Helicobacter pylori

2. NSAID use

Peptic Ulcer Signs

1. Burning or gnawing epigastric pain

2. Nausea

3. Pain related to meals

Types of Peptic Ulcers

1. Gastric Ulcer

2. Duodenal Ulcer

Referred Pain Sites

1. Gallbladder

2. Spleen Injury

3. Pancreas

4. Appendix

Gallbladder Referred Pain Pattern

RUQ pain may radiate toward the right shoulder/scapula

Spleen Injury Referred Pain Pattern

LUQ Pain may radiate to left shoulder

Pancreas Referred Pain Pattern

Upper abdominal pain may radiate to the back

Appendix Referred Pain Pattern

Pain may begin around the umbilicus and then localize to the RLQ. This is migration of pain

Bleeding Cues

1. Hematemesis

2. Coffee-ground emesis

3. Melena

4. Sudden severe pain with rigid abdomen may indicate perforation or peritoneal inflammation

Hematemesis

Vomiting blood

Melena

Black, tarry stool

Hernia

Tissue protrudes through a weak area

Common Hernia Sites

1. Inguinal

2. Umbilical

3. Previous incision points

Incarcerated

Trapped

Strangulated

Blood supply is compromised and requires emergency attention

Hiatal hernia

Allows part of the stomach to move through the diaphragm and may cause reflux

Colorectal Cancer

Can be asymptomatic early

Colorectal Cancer Education

1. Screening

2. Reporting blood in stool, Persistent bowel changes, Unexplain weight loss

3. Encourage activity, fiber-rich foods, tobacco avoidance, and limit alcohol and processed meats

Colorectal Screening

1. Begins at age 45 for average-risk adults

Colorectal Risk Factors

1. Family history

2. Polyps

3. Inflammatory bowel disease

Polyp

growth that sticks out from an organ