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Health Assessment Session 9 Class Notes

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NURS 2320U
A.De La Rocha

Abdomen Health Assessment Read chapters 22 & 24 Jarvis, C. (2014). Physical examination & health assessment, Second Canadian Edition. Elsevier: Canada. Right upper Left upper Right lower Left lower quadrant quadrant quadrant quadrant liver Left lobe of liverLower pole of Lower pole of right kidney left kidney Gallbladder Spleen Cecum Sigmoid colon Duodenum Stomach Appendix Portion of descending colon Head of Body of Portion of Left ureter pancreas pancreas ascending colon Right adrenal Left adrenal Right ureter Left ovary gland gland (female) Portion of right Portion of left Right ovary Left fallopian kidney kidney (female) tube (female) Hepatic flexure Splenic flexure Fallopian tube Left spermatic of colon of colon (female) cord (male) Portions of Portions of Right spermatic ascending & transverse & cord (male) transverse colon descending colon In addition, several structures lie in the midline, namely, the abdominal aorta, the urinary bladder (if distended), and the uterus (if enlarged). Subjective data obtained from the patient help the examiner identify actual or potential problems related to the gastrointestinal system. As the examiner gains experience, the depth of questioning will be based on the prior responses of the patient. Topics that are of special relevance to the abdomen include nutrition and appetite, ability to chew and swallow foods, food intolerances (or nausea and vomiting), and any pain associated with the abdomen. Questions to identify bowel habits and the use of any laxatives must be included. The interview must also obtain information regarding any present or past rectal problems and gastrointestinal problems. Because many medications are metabolized by the liver or have gastrointestinal side effects, a review of current medications is also indicated. The sequence for examining the abdomen is inspection, auscultation, percussion, and palpation. This is done because percussion and palpation can increase peristalsis and might cause a false interpretation of bowel sounds. Contour, symmetry, the shape of the umbilicus, the condition of the skin on the abdomen, and the presence of pulsations or movement must all be observed during an inspection of the abdomen. The examiner must discriminate between normal and abnormal findings and use the information obtained through inspection as a basis for further exploration if indicated. The pattern of pubic hair growth and the demeanor of the patient should be assessed with the inspection. Auscultation of the abdomen is an important nursing assessment, especially for postoperative patients. Although the clicks of a normal bowel can occur from 5 to 30 times per minute, the nurse must listen for up to 5 minutes before deciding that bowel sounds are completely absent. The examiner also must note whether any vascular sounds or bruits are present. Knowledge of the location of various organs in the abdomen is especially important during percussion. This knowledge will help the examiner relate the sounds that are heard to those that are expected from the organs in the region being percussed. Percussion reveals the relative density of the abdominal contents. Because of air in the intestines, tympany is the predominant sound. Dullness may be heard over a distended bladder, adipose tissue, fluid, or a mass. A change in tone may be noted over the descending colon if there is a need for evacuation. A change from lung resonance to dullness will iden
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