ASSESSING THE ABDOMEN (RETURN DEMONSTRATION)

[Music] hello everyone i am srikaina aquino maranga from bsn111a and for today's video i am going to perform assessing the abdomen return demonstration assessment of the abdomen consists of inspection auscultation precaution 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 to the conduct of the procedure first thing to do is to review clients previous medical records if available [Music] next is to prepare the necessary equipments needed to conserve time and energy the equipments that i'm going to use includes a tape measure for the measurement of the patient's abdominal girth a sharp object such as this ruler for the hypersensitivity test and of course a stethoscope to listen for patients bowel sounds now perform hand hygiene to protect the patient and myself as well from infection and cross contamination good morning sir i am sripayna aquino moranga your student nurse for today and may i see your spencer please take your complete name richard gomez and your birthday please okay thank you very much sir and how would you like me to call you today okay richard so today i'll be assessing your abdomen which means i'll have to expose your abdomen i'll have to listen for your vowel sounds and also um feel for your internal organs will that be all right okay okay so um is it okay if i close the door so no one from outside will be able to disturb you or will doing the assessment that sounds good okay so before we start i encourage you to void first so um it will be much comfortable for you while we're doing the assessment okay okay 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 reduce the accuracy of the bundle height measurement now position the client in a supine position with arms folded over his chest or by just lying at his sides and then place a pillow underneath the patient's knees this position ensures abdominal muscle relaxation to avoid putting additional pressure on the patient's 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 these synthesis pubis do you feel any pain in your abdomen okay so i'll begin inspecting your abdomen first begin with the inspection of the abdominal skin characteristics assess for abdominal skin temperature collar note for any vascularities striae or stretch marks and also uh note for any scars lesions 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 to the surrounding skin tones or even pinkish if it should be recessed inverted or protruding no more than 0.5 centimeters and it should be round and conical 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 contor and symmetry while the patient lies so fine on the bed sit beside the client and look across the abdomen at a level slightly higher than the patient's abdomen okay and then stand at the foot of the bed and observe four abdominal symmetry so the abdomen is normally flat rounded or scaphoid in which is seen in uh thin adults and it should be uh evenly rounded and symmetrical so while doing the inspection also observe for abdominal respiratory movements aortic pulsations and peristalsis measure the patient's abdominal group by placing a measuring tape around the patient's abdomen 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 proceeding now to auscultation of the patient's vowel sounds so sir now i'm going to proceed to a listening over your abdomen um i just want to ask when did you last eat last night 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 one minute each starting from the right lower quadrant and then proceeding in a clockwise pattern noting for the intensity peach and frequency of the vowel sounds so now to listen for the vascular sounds use the bell of the stethoscope and listen for breweries over the abdominal aorta renal iliac and femoral arteries now to listen for peritoneal friction rod use the diaphragm of the stethoscope to listen for friction rub over the liver and splint [Music] proceeding now to the precaution of the patient's abdomen because several areas in each of 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 faeces now forecast 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 change from tympani to dullness and mark this point sir i'll have to mark this point now for cross on the right mid clavicular line on the area of lung resonance around the third intercostal space and percuss downwards to the liver and note the change from lung resonance to liver dullness and mark this point 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 now for the upper border start precaution at the body of the sternum along the third intercostal space and perhaps downwards until the tone changes from flat to liver dullness now measure the distance between the two points a normal liver span at the mid clavicular line is about 6 to 12 centimeters and the normal liver span along the midsternal line is four to eight centimeters to assess for liver descent ask the patient to take a deep breath and hold it while percussing from the right lower quadrant towards the and note the change from tympani to dullness and mark this point okay sir i need you to take a deep breath and hold it please okay i can exhale now measure the distance between the lower border and the right coastal margin along the mid clavicular line to assess for the spleen and evaluate for splenomegaly reposition the patient in a right-sided uh lying position with left knee flexed and identify the left anterior axillary line 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 and down to the coastal margin percuss the lowest interspace in the left anterior axillary line then ask the client to take a deep breath and percuss again sir can you please take a deep breath okay perform the liver blood percussion to assess for liver tenderness place the left hand flat against the lower anterior ribcage and then use the ulnar surface of the left hand to strike the right hand okay sir do you feel any pain no perform the kidney punch to assess for kidney tenderness reposition the patient in a a sitting position and then place the left hand at the coastal vertebral angle over the 12th rib use the ulnar side of the right fist to strike against the left hand and ask for anything sir do you feel anything no no okay okay do you feel any pain test for a scientist test for shifting dullness while the patient is lying supine on the bed percuss the flanks of the patient from the bed towards the umbilicus noting the change from dullness to timpani and mark this poem so 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 timpani here i need you to roll on your side okay so for fluid wave test while the client is lying in a supine position ask the client to press the edges of his hand firmly down the midline of his abdomen sir i need you to place your hand here and press it down please thank you and then tap one flank sharply with fingertips to fill for a fluid wave transmitted across the abdomen to the opposite flange okay perform light palpation to assess for tenderness and presence of mass with the client lying relaxed in a supine position begin with a light systematic palpation of all four quadrants or nine regions using the finger pads initially avoiding any areas that the patient had identified as painful and then observed four reports of pain tenderness guarding behavior and masses perform the palpation which is done to feel for the internal organs and masses 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 the umbilical ring noting for any presence of masses swelling nodules granulation to assess for tenderness and presence of mass palpation of the abdominal aorta use both hands to deeply palpate the pedestrian slightly to the left midline now palpate for the liver to assess for liver contour surface presence of nodules tenderness and irregularity place the left hand under the client's back at the level of the 11th and 12th ribs while the right hand is laid parallel to the right coastal margin with with fingertips pointing towards client's head 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 sir please take a deep breath okay again please okay now perform the hooking technique stand at the client's 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 okay again please okay forecast the spleen and assess for splenomegaly stand at the patient's right side and reach over the patient's abdomen okay reach over the patient's abdomen with the left hand under the posterior lower ribs and pull up gently place the right hand below the left coastal margin pressed in toward the splint ask the client to take a deep breath then press inward and upward using the right hand as the left hand provided support begin faulty begin palpation below the crystal margin and try to feel the tip or edge of the spleen as it comes down to meet the fingertips note for any tenderness and assess the splenic contour sorry can you please take a deep breath again please okay repeat the procedure with the client lying on the right side with legs somewhat flex of the hips and knees as needed sir i need you to turn at your side take a deep breath in okay take a deep breath in please okay palpate the kidneys to assess for kidney enlargement stand at the patient's right side place the left hand under the patient's 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 sir please take a deep breath and exhale and hold your breath please for a moment okay you can breathe now again please take a deep breath exhale and hold please okay well paint the left kidney with the procedure reverse state the urinary bladder begin palpating add these synthesis pubis and move upward and outward to estimate the bladder borders as for 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 listen and watch the client's expression of pain as the client to describe which hurt more the pressing in or the releasing and where on the abdomen the pain occurred okay sir did you feel pain while i was pressing your abdomen no did you feel pain when i released oppressing your abdomen okay pain induced or worsened by withdrawal is rebound tenderness suggesting peritoneal inflammation now for referred rebound tenderness or rubs inside paint deeply in the left lower quadrant and quickly release the pressure okay sir did you feel pain while i was pressing your uh abdomen did you feel pain when i release pressing your abdomen okay pain in the right lower quadrant during pressure in the left lower quadrant is positive of promising signs suggesting acute appendicitis test for so was sign reposition the patient in a right side lying position and then hyperextend the right leg 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 muscle due to appendicitis test for obturator's sign now support the client's knee and ankle and flex the hip and leg and rotate the leg internally and externally pain in the right lower quadrant indicates irritation of the objurator muscle due to appendicitis or perforated appendix hypersensitivity test using a sharp object stroke the patient's abdomen do this several times and note for any complaints of pain sir are you feeling a pain in your abdomen okay pain or an exaggerated sensation felt on the right lower quadrant is a positive skin hypersensitivity test and may indicate appendicitis 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 sir can you please inhale deeply and tell me if you feel a pain okay do you feel pain okay do you feel pain no okay a positive murphy sign is when pain occurs when examiner's hand comes in contact with the gallbladder okay sir so now that we're 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 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 it abdomen the sounds are pretty normal and i hear no bruise or um venus hum okay so while i was measuring for your liver size on your liver span at the your liver span at the mid clavicular line here i measured it is at seven centimeters and while i was measuring for your liver span at the mid sternal line it is measured at five centimeters which falls within the normal range okay so upon percussion and palpation there were no tenderness no masses no bulges and no swelling overall your abdomen is doing pretty good okay do you have any questions or clarifications no overall your abdomen is doing really good but before i leave i just like to give you some advice on how to keep your abdominal internal organs healthy okay so um first is to 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 your blood during your intestines okay and um 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 okay that is all do you have any questions or clarifications perhaps no okay that is all thank you very much sir for your cooperation thank you you