NURS 344 (Health Assessment): Objective Abdominal Assessment

What can cause a bruit with both systolic and diastolic components?

A bruit with both systolic and diastolic components occurs when blood flow in an artery is turbulent or obstructed. This may indicate an aneurysm or renal arterial stenosis (RAS).

Auscultation for Vascular Sounds: ABNORMAL Findings

A bruit with both systolic and diastolic components occurs when blood flow in an artery is turbulent or obstructed. This may indicate an aneurysm or renal arterial stenosis (RAS). When blood flows through a narrow vessel, it makes a whooshing sound, called a bruit. However, the absence of this sound does not exclude the possibility of RAS.

What conditions can cause a deviated umbilicus?

A deviated umbilicus may be caused by pressure from a mass, enlarged organs, hernia, fluid, or scar tissue.

What conditions can cause friction rubs, and how do they present?

A friction rub heard over the lower right costal area is associated with hepatic abscess or metastases. A rub heard at anterior axillary line in the lower left costal area is associated with splenic infarction, abscess, infection, or tumor.

Liver Palpation: ABNORMAL Findings

A hard, firm liver may indicate cancer. Nodularity may occur with tumors, metastatic cancer, late cirrhosis, or syphilis. Tenderness may be from vascular engorgement (e.g., congestive heart failure), acute hepatitis, or abscess. Enlargement may be due to hepatitis, liver tumors, cirrhosis, and vascular engorgement. A liver more than 1-3 cm below the costal margin is considered enlarged (unless displaced by the diaphragm).

If a patient has a hernia, how does it present?

A hernia (protrusion of the bowel through the abdominal wall) is seen as a bulge in the abdominal wall. This condition is of little significance.

What can cause a liver to have a lower or higher than usual position?

A liver in a lower position than normal may be caused by emphysema, whereas a liver in a higher position than normal may be caused by an abdominal mass, ascites (fluid buildup physically pushes liver downwards), or a paralyzed diaphragm (lack of contraction limits upward movement of liver).

What can cause a palpable spleen, and what does it indicate?

A palpable spleen suggests enlargement resulting from infections, trauma, mononucleosis, chronic blood disorders, and cancers. The splenic notch may be felt, which is an indication of splenic enlargement. Splenic enlargement may not always be pathologic. The spleen feels soft with a rounded edge when it is enlarged from infection. It feels firm with a sharp edge when it is enlarged from chronic disease.

If a person has hyperactive bowel sounds, how would they present? What could abnormal ones be indicative of?

A person with hyperactive bowel sounds presents with prolonged, loud, and sometimes high-pitched rumbling or gurgling sounds in their abdomen. Hyperactive bowel sounds that are rushing, tinkling, and high pitched may be abnormal, indicating very rapid motility heard in early bowel obstruction, gastroenteritis, diarrhea, or with use of laxatives.

If a person has hypoactive bowel sounds, how would they present? What could abnormal ones be indicative of?

A person with hypoactive bowel sounds would present with significantly reduced or very quiet abdominal noises. These bowel sounds indicate diminished or absence bowel motility. Common causes include paralytic ileus following abdominal surgery, inflammation of peritoneum, or late bowel obstruction.

Testing for Ascites: Fluid Wave Test

A second special technique to detect ascites is the fluid wave test. The client should remain supine. Ask the client or an assistant to place the ulnar side of the hand and the lateral side of the forearm firmly along the midline of the abdomen. Firmly place the palmar surface of your fingers and hand against one side of the client's abdomen. Use your other hand to tap the opposite side of the abdominal wall

When you palpate the umbilicus and surrounding area, what can cause swellings, bulges, or masses?

A soft center of the umbilicus can be a potential for herniation. Palpation of a hard nodule in or around the umbilicus may indicate metastatic nodes from an occult gastrointestinal cancer.

What is a venous hum, and how do you auscultate for it?

A venous hum is a continuous, low-pitched murmur. You can listen for a venous hum by using the bell of the stethoscope, to listen in the epigastric and umbilical areas.

While auscultating a client's abdomen, the nurse hears the client's stomach growling. The nurse knows that this is which type of bowel sound? A) Borborygmus B) Erratic C) Hypoactive D) Absent

A) Borborygmus Hyperactive bowel sounds referred to as "borborygmus" present as loud, prolonged gurgles characteristic of one's "stomach growling."

While assessing an adult client's abdomen, the nurse observes that the client's umbilicus is deviated to the left. The nurse should refer the client to a health care provider for possible A) Masses. B) Kidney trauma. C) Cachexia. D) Gallbladder disease.

A) Masses

A client with which medical condition requires a regular assessment for ascites? Select all that apply. A) Nephrosis B) Peritonitis C) Congestive heart failure D) Gastroenteritis E) Cirrhosis of the liver

A) Nephrosis B) Peritonitis C) Congestive heart failure E) Cirrhosis of the liver Ascites, the accumulation of fluid in the abdomen, is characteristic of cirrhosis of the liver, congestive heart failure, nephrosis, peritonitis, and metastatic neoplasms. Gastritis is not a cause of ascites.

What four spots do you listen to for vascular sounds?

Abdominal Aorta Renal Arteries Iliac Arteries Femoral Arteries

Skin Coloration: NORMAL FINDINGS

Abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elements.

What conditions can cause absent bowel sounds?

Absent bowel sounds can be associated with peritonitis (inflamed peritoneum inhibits intestinal movement) OR paralytic ileus (smooth muscles of intestinal wall are paralyzed preventing peristaltic movement and causing abdominal construction)

What are the different percussion sounds, and where would you hear each?

All 4 quads Tympany- the predominate sound (air) Hyperresonance - with gaseous distention Dullness- organs and fluid

What can cause an accentuated venous hum?

An accentuated venous hum heard in the epigastric or umbilical areas suggests increased collateral circulation between the portal and systemic venous systems, as in cirrhosis of the liver

What can cause an enlarged kidney, and how do you differentiate it from an enlarged spleen?

An enlarged kidney may be due to a cyst, tumor, or hydronephrosis. It can be differentiated from splenomegaly by its smooth rather than sharp edge, absence of a notch, and overlying tympany on percussion.

What can cause an everted umbilicus?

An everted umbilicus is seen with abdominal distention. An enlarged, everted umbilicus suggests umbilical hernia.

Assessment and Inspection of Umbilical Contour: ABNORMAL FINDINGS

An everted umbilicus is seen with abdominal distention. An enlarged, everted umbilicus suggests umbilical hernia. A generalized protuberant or distended abdomen may be due to obesity, air (gas), or fluid accumulation. Distention below the umbilicus may be due to a full bladder, uterine enlargement, or an ovarian tumor or cyst. Distention of the upper abdomen may be seen with masses of the pancreas or gastric dilation.

_____________________ is known as fluid accumulation in the abdominal cavity, causing abdominal swelling.

Ascites

Ascites: Definition, Causes, Symptoms

Ascites is fluid accumulation in the peritoneal (abdominal) cavity, causing significant abdominal swelling. It's usually caused by liver failure or severe liver disease due to portal hypertension (high pressure in the blood vessels of the liver and low albumin levels). It can present with pale and taut skin, dilated veins, and striae because of the swelling stretching the skin.

When conducting the physical examination of a client's abdomen, the nurse auscultates 20 clicks and gurgles over 1 minute. Which of the following statements would accurately describe this finding? A) Bowel sounds inconsistent. B) Bowel sounds normal. C) Bowel sounds hyperactive. D) Bowel sounds hypoactive.

B) Bowel sounds normal Normal bowel sounds consist of clicks and gurgles that occur at an estimated frequency of 5 to 34 per minute. The nurse should document that the bowel sounds are normal. Twenty bowel sounds in a minute is not hyperactive, hypoactive, or inconsistent.

The nurse is assessing a client's abdomen. For which reason should the nurse perform deep palpation? A) Discern muscular resistance B) Identify abdominal organs C) Detect abdominal tenderness D) Complete a surface evaluation

B) Identify abdominal organs Deeply palpate all quadrants to delineate (identify) abdominal organs and detect subtle masses.

What conditions can cause dilated veins?

Cirrhosis of the liver, obstruction of the inferior vena cava, portal hypertension, or ascites (abdominal fluid accumulation)

Cullen's vs. Grey Turner's Sign

Cullen's sign presents with bluish or purple discoloration (bruising) around the umbilicus (belly button), and Grey Turner's sign presents with bluish or purple discoloration (bruising) on the abdominal flanks (lower back)

Cullen's Sign

Cullen's sign presents with bluish or purple discoloration (bruising) around the umbilicus (belly button/periumbilical ecchymosis) indicating intra-abdominal bleeding.

On inspection of the abdomen, a nurse notes that the client's skin appears pale and taut. The nurse recognizes that this finding is most likely due to what process occurring within the abdominal cavity? A) Inflammation B) Obstruction C) Bleeding D) Fluid accumulation

D) Fluid Accumulation Pale, taut skin may be seen with ascites, which is caused by fluid accumulation within the abdominal cavity.

How and why do you deeply palpate the abdomen?

Deeply palpate all quadrants to delineate (identify) abdominal organs and detect subtle masses. Using the palmar surface of the fingers, compress to a maximum depth (5-6 cm). Perform bimanual palpation if you encounter resistance or to assess deeper structures. Note the location, size, consistency, and mobility of any palpable organs.

If a patient has diastasis recti, how does it present?

Diastasis recti is a separation of the rectus abdominis muscles, which run vertically along the front of the abdomen. It appears as a bulge between the vertical midline separation of the abdominis rectus muscles.

Inspection of Abdominal Skin Vascularity: ABNORMAL FINDINGS

Dilated veins may be seen with cirrhosis of the liver, obstruction of the inferior vena cava, portal hypertension, or ascites. Dilated surface arterioles and capillaries with a central star (spider angioma) may be seen with liver disease or portal hypertension.

What conditions can cause distension below the umbilicus?

Distention below the umbilicus may be caused by a full bladder, uterine enlargement, or an ovarian tumor or cyst. Distention of the upper abdomen may be seen with masses of the pancreas or gastric dilation.

What conditions can cause distension of the upper abdomen?

Distention of the upper abdomen may be seen with masses of the pancreas or gastric dilation. When the stomach becomes excessively distended due to gas buildup or obstruction at the pylorus (the exit from the stomach), it can also lead to noticeable upper abdominal distension.

Early bowel obstruction presents with _____________ bowel sounds, and late bowel obstruction presents with _____________ bowel sounds.

Early bowel obstruction presents with hyperactive bowel sounds, and late bowel obstruction presents with hypoactive bowel sounds.

What conditions can cause liver enlargement?

Enlargement may be due to hepatitis, liver tumors, cirrhosis, and vascular engorgement.

How do you auscultate for friction rubs, and what are they?

Friction rubs are high-pitched, rough, grating sounds produced when the large surface area of the liver or spleen rubs the peritoneum. To auscultate for friction rubs over the spleen and liver, listen over the right and left lower rib cage with the diaphragm of the stethoscope.

Percussion for Tone: NORMAL Findings

Generalized tympany (drum-like sound) is heard over majority of the abdomen because of air in the stomach and intestines. Dullness is heard over the liver and spleen because these solid organs don't contain air. Dullness may also be elicited over a non-evacuated descending colon (colon still holding stool that hasn't been emptied)

What conditions can cause hypoactive and hyperactive bowel sounds?

HYPOACTIVE: paralytic ileus following abdominal surgery, inflammation of peritoneum, or late bowel obstruction HYPERACTIVE: early bowel obstruction, gastroenteritis, diarrhea, or with use of laxatives.

What can cause an hepatomegaly (enlarged liver)?

Hepatomegaly (enlarged liver) is characteristic of liver tumors, cirrhosis, congestive heart failure, abscess, vascular engorgement, or certain cancers that cause the liver to swell. Once the liver is enlarged, it can cause it to have an abnormally low or high position.

If a person has obstruction, how would their bowel sounds present?

High-pitched tinkling and rushes of high-pitched sounds with abdominal cramping usually indicate obstruction.

Testing for Ascites: Shifting Dullness Technique

If you suspect that the client has ascites because of a distended abdomen or bulging flanks, perform the shifting dullness percussion technique. The client should remain supine while you percuss the umbilicus. Note the change from dullness to tympany and mark this point. Turn the patient to their side, percuss the abdomen from the bed upward, and mark the level where dullness changes to tympany.

Causes of Abnormal Bowel Sounds

Increased sounds with gastroenteritis, hunger, or early obstruction High pitched may mean obstruction of bowel Loud, prolonged sounds (borborygmus) Diminished BS - mechanical obstruction, abdominal surgery, narcotic use, peritonitis, constipation

What are the four techniques used for abdominal assessments?

Inspect: Visually examine the abdomen for its contour, scars, and other characteristics Auscultate: Listen to the abdomen with a stethoscope to assess bowel sounds Percuss: Tap the abdomen to determine the size and location of organs Palpate: Feel the abdomen with firm pressure to evaluate organs and identify pain

In terms of different assessment techniques, what is the order for abdominal objective assessments?

Inspection, Auscultation, Percussion, Light Palpation, and Deep Palpitation Auscultation is done before b/c percussion and palpitation can alter the frequency of bowel sounds

Light Abdominal Palpitation and Guarding: ABNORMAL Findings

Involuntary reflex guarding is serious and reflects peritoneal irritation. The abdomen is rigid and the rectus muscle fails to relax with palpation when the client exhales as it normally should. It can involve all or part of the abdomen but is usually seen on the side (i.e., right vs. left rather than upper or lower) because of nerve tract patterns. Right-sided guarding may be due to cholecystitis.

How do you percuss the span of the liver by determining its lower and upper borders?

LOWER: Begin in the RLQ at the mid-clavicular line (MCL) and percuss upward. Note the change from tympany to dullness and mark this point because it's the lower border of liver dullness. To assess the descent of the liver, ask the client to take a deep breath and hold and repeat. UPPER: Percuss over the upper right chest at the MCL and percuss downward, noting the change from lung resonance to liver dullness. Mark this point because it is the upper border of liver dullness. Measuring the distance between the two marks gives you the span of the liver

What is light palpation used to assess, and how is it done?

Light palpation is used to identify areas of tenderness and muscular resistance. Using the fingertips, begin palpation in a nontender quadrant, and compress to a depth of 1 cm in a dipping motion. Then gently lift the fingers and move to the next area.

How do you auscultate for bowel sound?

Listen in all 4 quads - start in RLQ Normal = Gurgles 5-30 per minute Absent BS - after listening for >5 minutes in each quad

Types of Abdominal Contour (4)

Most abdomens are more or less flat; rounded, scaphoid, or distended/protuberent

When you auscultate for bowel sounds, what are normal and abnormal findings?

NORMAL: A series of intermittent, soft clicks and gurgles are heard at a rate of 5-30/minute. ABNORMAL: Hyperactive bowel sounds referred to as "borborygmus" may also be heard. These are the loud, prolonged gurgles characteristic of one's "stomach growling."

Aortic Pulsations: NORMAL vs. ABNORMAL Findings

NORMAL: A slight pulsation of the abdominal aorta, which is visible in the epigastrium, extends full length in thin people. ABNORMAL: Vigorous, wide, exaggerated pulsations may be seen with abdominal aortic aneurysm

Inspection of Lesions and Rashes: NORMAL vs. ABNORMAL Findings

NORMAL: Abdomen is free of lesions or rashes. Flat or raised brown moles are normal and may be there. ABNORMAL: Changes in moles including size, color, and border symmetry. Bleeding moles or petechiae (reddish or purple lesions) may also be abnormal

Assessment of Abdominal Symmetry: NORMAL vs. ABNORMAL Findings

NORMAL: Abdomen is symmetric. ABNORMAL: Asymmetry may be seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction.

Aorta Palpation: NORMAL vs. ABNORMAL Findings

NORMAL: Aorta is approximately 2.5-3.0 cm wide with a moderately strong and regular pulse. Possibly mild tenderness may be elicited. ABNORMAL: A wide, bounding pulse may be felt with an abdominal aortic aneurysm. A prominent, laterally pulsating mass above the umbilicus with an accompanying audible bruit strongly suggests an aortic aneurysm.

Assessment and Inspection of Umbilical Contour: NORMAL FINDINGS

NORMAL: It is recessed (inverted) or protruding no more than 0.5 cm and is round or conical. Abdomen is flat, evenly rounded, or scaphoid. ABNORMAL: Distention below the umbilicus may be due to a full bladder, uterine enlargement, or an ovarian tumor or cyst. Distention of the upper abdomen may be seen with masses of the pancreas or gastric dilation.

Inspection of Striae: NORMAL vs. ABNORMAL Findings

NORMAL: New striae are pink or bluish in color; old striae are silvery, white, linear, and uneven stretch marks from past pregnancies or weight gain. ABNORMAL: Dark bluish-pink striae are associated with Cushing syndrome. Striae may also be caused by ascites, which stretches the skin.

Blunt Percussion of Liver and Kidneys: NORMAL vs. ABNORMAL Findings

NORMAL: No tenderness or pain is elicited or reported by the client. The examiner senses only a dull thud. ABNORMAL: Tenderness or sharp pain elicited over the CVA suggests kidney infection (pyelonephritis), renal calculi, or hydronephrosis.

Deep Abdominal Palpation: NORMAL vs. ABNORMAL Findings

NORMAL: Normal (mild) tenderness is possible over the xiphoid, aorta, cecum, sigmoid colon, and ovaries with deep palpation. ABNORMAL: Severe tenderness or pain may be related to trauma, peritonitis, infection, tumors, or enlarged or diseased organs.

Inspection of Scars: NORMAL vs. ABNORMAL Findings

NORMAL: Pale, smooth, minimally raised old scars may be seen. ABNORMAL: Nonhealing wounds, redness, inflammation. Deep, irregular scars may occur from burns

Inspection of Umbilical Cord

NORMAL: Umbilical skin tones are similar to surrounding abdominal skin tones or even pinkish. ABNORMAL: Cullen's sign presents with bluish or purple discoloration (bruising) around the umbilicus (periumbilical ecchymosis) indicating intra-abdominal bleeding. Grey Turner sign presents with bluish of purplish discoloration on the abdominal flanks.

Inspection of Umbilical Location: NORMAL vs. ABNORMAL Findings

NORMAL: Umbilicus is midline at lateral line. ABNORMAL: Deviated umbilicus may be caused by pressure from a mass, enlarged organs, hernia, fluid, or scar tissue.

What conditions can cause liver nodularity?

Nodularity may occur with tumors, metastatic cancer, late cirrhosis, or syphilis.

How do you palpate the liver?

Note consistency and tenderness. To palpate bimanually, stand at the client's right side and place your left hand under the client's back at the level of the eleventh to twelfth ribs. Lay your right hand parallel to the right costal margin (your fingertips should point toward the client's head). Ask the client to inhale, then compress upward and inward with your fingers. Have the client exhale and hold your hand in place as the client inhales a second time. With deep inhalation, the edge of the liver is more easily palpated

What should be observed for the abdominal assessment?

Observe the coloration, vascularization, scars, rashes, and lesions of the abdominal skin. Observe umbilicus. Observe abdominal contour and symmetry. Observe for aortic pulsations and peristaltic waves.

Percussion of Liver: NORMAL Findings

On deep inspiration, the lower border of liver dullness may descend from 1 to 4 cm below the costal margin. The upper border of liver dullness is located between the left fifth and seventh intercostal spaces. The normal liver span at the MCL is 6-12 cm (greater in men and taller clients, less in shorter clients).

How do you palpate the urinary bladder?

Palpate for a distended bladder when the client's history or other findings warrant (e.g., dull percussion noted over the symphysis pubis). Begin at the symphysis pubis and move upward and outward to estimate bladder borders

How do you palpate for abdominal masses, and what can cause them?

Palpate for masses noting their location, size (cm), shape, consistency, demarcation, pulsatility, tenderness, and mobility. Do not confuse a mass with an organ or structure. A mass detected in any quadrant may be due to a tumor, cyst, abscess, enlarged organ, aneurysm, or adhesions.

If a person has an intestinal obstruction, how would their peristalsis present as?

Peristaltic waves are increased and progress in a ripple-like fashion from the left upper quadrant to right lower quadrant. In addition, abdominal distention typically is present with intestinal wall obstruction.

If a patient had peritonitis, how would it present as?

Peritonitis causes a rigid abdomen with generalized severe abdominal pain and fever.

Inspection of Skin Coloration: ABNORMAL FINDINGS

Purple discoloration at the flanks (Grey Turner sign) indicates bleeding within the abdominal wall, possibly from trauma to the kidneys, pancreas, or duodenum or from pancreatitis. Yellow hue of jaundice may be more apparent on the abdomen. Pale, taut skin may be seen with ascites (significant abdominal swelling indicating fluid accumulation in the abdominal cavity). Redness may indicate inflammation. Bruises or areas of local discoloration are also abnormal.

Inspection of Abdominal Skin Vascularity: NORMAL FINDINGS

Scattered fine veins may be visible. Blood in the veins located above the umbilicus flows toward the head; blood in the veins located below the umbilicus flows toward the lower body.

How does the spleen feel when enlarged from infection vs. chronic disease?

Spleen feels soft with a rounded edge when it is enlarged from infection. It feels firm with a sharp edge when it is enlarged from chronic disease.

What is splenomegaly, and what causes it?

Splenomegaly is characterized by an area of dullness greater than 7 cm wide. The enlargement may result from traumatic injury or portal hypertension (increases BP in portal vein forcing blood into the spleen and causing swelling). It can also be caused by mononucleosis that stimulates the spleen to produce more immune cells and antibodies to fight EBV.

How do you palpate the spleen?

Stand at the client's right side, reach over the abdomen with your left arm, and place your hand under the posterior lower ribs. Pull up gently. Place your right hand below the left costal margin with the fingers pointing toward the client's head. Ask the client to inhale and press inward and upward as you provide support with your other hand. Normal to not be able to feel the spleen.

What conditions can cause liver tenderness?

Tenderness may be from vascular engorgement (e.g., congestive heart failure), acute hepatitis, or abscess.

Kidney Palpation: NORMAL Findings

The kidneys are usually not palpable. If palpated, it should feel firm, smooth, and rounded. The kidney may or may not be slightly tender.

Liver Palpation: NORMAL Findings

The liver is usually not palpable, although it may be felt in some thin clients. If the lower edge is felt, it should be firm, smooth, and even. Mild tenderness may be normal.

How does a weak or paralyzed diaphragm cause the liver to have a higher position than normal?

When the diaphragm is weak or paralyzed, its ability to contract and move downwards during inhalation is impaired. In turn, this causes the liver (situated directly below the right side of the diaphragm) from being pushed upwards as it normally would during breathing. Since the diaphragm can't create enough space for the liver and other abdominal organs to move downwards as usual during inspiration, this causes them to be displaced upwards and have a higher than usual position.

Percussion for Tone: ABNORMAL Findings

When you hear accentuated tympany or hyperresonance over a distended abdomen, it indicates the presence of excessive gas within the abdominal cavity, typically signifying a condition like intestinal obstruction or severe bloating. An enlarged area of dullness is heard over an enlarged liver or spleen. Abnormal dullness is heard over a distended bladder, large masses, or ascites.

What condition can cause a yellow hue on the abdomen?

Yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood; usually indicative of liver problems

What is the scratch test?

The scratch test is a technique that can be used to ascertain the location and size of the liver and spleen. This test can be particularly useful if the abdomen is tense (rigid or guarded), distended, obese, or too tender to palpate. To perform the scratch test, place the diaphragm of your stethoscope at the second to last intercostal space, MCL. Use one finger to very lightly stroke the skin horizontally, starting at the umbilicus. Continue to stroke the skin, moving toward the lower costal margin. The sound will suddenly be transmitted through the stethoscope and increase in intensity. This indicates the lower border of the liver.

Spleen Palpation: NORMAL Findings

The spleen is typically not palpable at the left costal margin. Rarely, the tip is palpable in the presence of a low, flat diaphragm (e.g., chronic obstructive lung disease) or with deep diaphragmatic descent on inspiration. If the edge of the spleen can be palpated, it should be soft and nontender.

How do you auscultate for bowel sounds? What is the listening order?

To auscultate bowel sounds, use the warmed-up diaphragm of the stethoscope to apply light pressure and listen to all quadrants of the abdomen for gurgling sounds. Begin in the RLQ and proceed clockwise, covering all quadrants. Confirm bowel sounds in each quadrant. Listen for up to 5 minutes (minimum of 1 minute per quadrant) to confirm the absence of bowel sounds.

If a patient presents with an asymmetrical abdomen, what further testing can be done to determine the cause and location?

To further assess the abdomen for herniation or diastasis recti or to differentiate a mass within the abdominal wall from one below it, ask the client to raise the head. This is done because a mass within the abdominal wall is more prominent when the head is raised, whereas a mass below the abdominal wall is obscured.

How do you palpate the liver via hooking method?

To palpate by hooking, stand to the right of the client's chest. Curl (hook) the fingers of both hands over the edge of the right costal margin. Ask the client to take a deep breath and gently but firmly pull inward and upward with your fingers

How do you palpate the kidneys?

To palpate the right kidney, support the right posterior flank with your left hand and place your right hand in the RUQ just below the costal margin at the MCL. Ask the client to inhale and compress your fingers deeply during peak inspiration. Ask the client to exhale and hold the breath briefly. Gradually release the pressure of your right hand. If you have captured the kidney, you will feel it slip beneath your fingers. To palpate the left kidney, reverse the procedure.

Percussion of Liver: ABNORMAL Findings

Upper border of liver dullness may be difficult to estimate if obscured by pleural fluid of lung consolidation. Hepatomegaly (enlarged liver) is characteristic of liver tumors, cirrhosis, abscess, and vascular engorgement. Atrophy of the liver is indicated by a decreased span. A liver in a lower position than normal may be caused by emphysema, whereas a liver in a higher position than normal may be caused by an abdominal mass, ascites, or a paralyzed diaphragm. A liver in a lower or higher position should have a normal span, but an enlarged liver may be higher, lower, or both.

How do you auscultate for vascular sounds?

Use the bell of a stethoscope and apply light pressure over abdominal aorta and renal, iliac, and femoral arteries, listening for a blowing or swishing sound called a bruit. Bruits are low-pitched, murmur-like sounds that indicate turbulent blood flow and potential vessel narrowing.

How do you palpate the aorta?

Use your thumb and first finger or use two hands and palpate deeply in the epigastrium, slightly to the left of midline. Assess the pulsation of the abdominal aorta.

How do you percuss the spleen? How can an enlarged spleen be detected?

Begin posterior to the left midaxillary line (MAL), and percuss downward, noting the change from lung resonance to splenic dullness. Splenic enlargement can also be detected by percussing the last left interspace at the anterior axillary line (AAL) while the client takes a deep breath. If dullness is heard at this spot on inspiration, then this suggests an enlarged spleen.

Grey Turner's Sign

Bluish or purple discoloration and bruising of the abdominal flanks (lower back), indicating bleeding within the abdominal wall. It can be caused by trauma to kidneys, pancreas, duodenum, or from pancreatitis (inflammation of pancreas)

How do you perform blunt percussion on liver and kidneys, and what does it assess?

Blunt percussion on the liver and the kidneys is used to assess for tenderness in difficult-to-palpate structures. Percuss the liver by placing your left hand flat against the lower right anterior rib cage. Use the ulnar side of your right fist to strike your left hand. Perform blunt percussion on the kidneys at the costovertebral angles (CVA) over the twelfth rib

Auscultation for Vascular Sounds: NORMAL Findings

Bruits are not normally heard over abdominal aorta or renal, iliac, or femoral arteries. However, bruits confined to systole may be normal in some clients depending on other differentiating factors.

A nurse observes silvery, white striae on the abdomen of a middle-aged female client during the examination of the abdomen. What is an appropriate question to ask this client in regard to this finding? A) "Do you have high blood pressure?" B) "Have you noticed any color change to the skin?" C) "Have you been pregnant?" D) "Are you experiencing any abdominal pain?"

C) "Have you been pregnant?" Striae are silvery white marks that are common on the abdomen from stretching of the skin during pregnancy or weight gain.

A nurse examines a client with a paralytic ileus. Which alteration in bowel sounds should the nurse expect to find with auscultation of the client's abdomen? A) Erratic B) Borborygmus C) Absent D) Hyperactive

C) Absent The nurse should find that bowel sounds are absent in a client with paralytic ileus. Paralytic ileus is a condition characterized by absence of bowel sounds, not normal bowel sounds. Hyperactive bowel sounds may be caused by diarrhea, gastroenteritis, and early bowel obstruction. Hypoactive bowel sounds may be due to surgery or late bowel obstruction.

A client presents to the emergency department with reports of new onset of abdominal pain for the past 3 days. The client states there is also a pulling feeling on the right side. Upon examination, the nurse notices a 5-cm transverse scar in the right lower quadrant. The nurse recognizes that this client may be experiencing what type of process? A) Intestinal obstruction at the sigmoid colon B) Acute onset of appendicitis with possible rupture C) Internal adhesions from previous surgery D) Peritonitis from a ruptured diverticulum

C) Internal adhesions from previous surgery The presence of the scar in the right lower quadrant should alert the nurse to the possibility of internal adhesions, which account for the pulling feeling the client reports. An intestinal obstruction would not produce a pulling feeling, but the client most likely would report nausea and vomiting. With a right lower quadrant scar, the appendix may already be removed. Acute appendicitis would also present with fever, nausea, and vomiting. Peritonitis would cause a rigid abdomen with generalized severe abdominal pain and fever.