Okay so for all you single nurses and nursing students out there who you don't have a roommate
to practice your abdominal assessment on I'm going to show you today how you can do that, of course,
you can pick a stuffed animal but I actually have the best patient for you - me! Yeah that's right
I'm going to show you how to do the abdominal assessment using myself so if you do have
nobody who will let you practice on them, that was my situation, you do want to get good at actually
doing the thing that you need to do to pass your test or to do your assessment on your patient and
so I am going to show you how you can do that with yourself and do an abdominal exam so you know the
steps the patterns and what light palpation is deep palpation all in this video. Now of course
stay till the end because there will be an NCLEX question that you can answer based
on the information covered in this video are you ready to get started.
Welcome back my name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below so that you get the next video
when it's released. We will assume that your subjective data gathering is already done,
you know the questions about how long has your pain been there, what triggers it, those kinds
of things. Any past medical history, all of that is already done we're getting into the assessment.
Three things we're going to cover in this video: the first is just the basic foundational stuff you
need in order to go into your abdominal abdominal assessment, the second is I will show you the
abdominal assessment using moi and then the third we'll talk about a few special tests at the end of
this video and of course stay tuned for the NCLEX question. So let's get started first with some
of that foundational information that helps us pinpoint what might be going on with our patients.
All right so one of the first things we need to know is the anatomical locations of things and so
we have a thing called the right upper quadrant, left upper quadrant, left lower quadrant,
and right lower quadrant. That's probably the most common that you're going to hear in nursing but
we can also have the epigastric, the umbilical region, and the hypogastric or the suprapubic
region just so that if you're hearing these terms you kind of know what you're looking for,
and then we're going to add even more so if you're a little bit more specific about
what you're looking at we have the right and left hypochondriac regions, the right and left lumbar
regions, and the right and left iliac regions. Now what I like about this diagram with the with
the nine is that it actually shows you where you would find the different organs such as the liver,
the spleen, the kidney those kind of things and the bladder right and so when you're giving your
information you can be very specific about the region in which you found an issue, but I don't
want you to be fooled by this because; all right so we don't want you to be fooled into thinking
that if somebody has pain in the right upper quadrant it's related to the liver in fact we know
that the abdominal cavity is very generalized in terms of where it will refer pain, so for example
the gallbladder will refer pain to your back and so just making note of where the organs are
within the abdomen cavity is all you need to know for now. Okay confession time how many of you,
and let me know in the comments below, have had to practice your abdominal assessment on a picture,
on a pillow on a stuffed animal, because you had nobody available to help you do this?
Let me know below and what I'm going to show you next is, I'm going to show you the abdominal
assessment on me so I'm going to use my body as the demo and my hands as the instructor or as the
nurse doing the work so this is another way that you can practice your abdominal assessment should
you not have anybody There as a live patient to practice on. Now when it comes to the abdominal
assessment we're going to jump into this video assuming you've already done your subjective
questions so you've asked them what their chief complaint is, you've asked them all the questions
around their pqrs to you for their pain assessment or whatever it is you use for that framework,
you have also done a health history, a family history, a work history, a medication profile;
all of those pieces are done and we're ready now to look at the abdomen, so let's get started.
Alrighty, so the first thing we need to do is be able to see it so you're going to have
your patient lift their shirt or take it off if they're comfortable and if you can't see
the entire abdomen with them lowering their pant, you're going to have to ask them to undo it so you
can physically see what you're looking at. Now the first thing we're going to do is inspect. We're
looking for color hair distribution, we're looking for any lumps and bumps that might be obvious,
surgical scars, moles, that kind of thing and if surgical scars and lesions exist you'd want to
measure them, you also want to note if there's any hernias, you can ask them to bear down
and if there's any bulges then you'll notice that there's a hernia present,
and then lastly don't forget to check the umbilicus and make sure it is it is midline.
You might notice some pulsations here about the aorta, you may see the heart beating there that
would be normal in a thinner walled person, and you may see some peristalsis movement there or
if the patient is pregnant you may see the baby moving. So that's all part of inspection
from the side we're going to be checking to see the contour
so a scaphoid is where the abdomen is lower than the rib cage to pelvis line,
a flat abdomen, we might have a slightly rounded, or we may have a protuberant distended belly.
Okay so after you've finished your inspection we're going to move on to
auscultation. We want to listen first so that we don't increase any peristalsis and the sound that
we might hear if we were to palpate first. All right so using the diaphragm of our stethoscope
and light pressure we can start in any quadrant. Most textbooks recommend you start in the right
lower quadrant, as long as you're hitting all four areas it is fine to start in any section;
I would suggest you need to ask your patient if they have any pain first because you would
want to leave the painful areas until last. You will listen for 10 to 15 seconds in each
quadrant and as long as you're hearing some high-pitched bowel sounds you can move forward.
If you hear nothing you'd need to listen for a full minute in each section. Next we're going
to go on to the bell and we're going to listen for any bruits in the aortic, in the iliac, and in the
femoral arteries. Typically you should not hear any sounds of blood flow through these arteries
and if you do you'd want to note that and share that information. All right so we're
just moving down to the iliac artery which is just down below the embolica slightly
right and left side and then to access the femoral artery you will need to probably pull those pants
down even a little further than what the patient has had for you already to get down further into
the femoral. Now when it comes to percussion of the abdomen, I find that it's actually
rarely used in practice by nurses but I'll show you the percussion piece here anyways
and talk to you about the different types of sounds you should expect to hear in the abdomen.
All right so next we move on to percussion so if you remember watching the IPPA video
we're gonna do two quick strikes and release our tapping finger
so that we can hear the sound and this is a little challenging on myself I must admit
Moving on to palpation, we're going to start again in a systematic approach we'll assume
that we have right lower quadrant pain. so we're going to start in the right upper.
If you notice your patients tensing you may want to have them hold their fists like this and pull
and that will distract them so that it will soften the abdominal muscles.
So again right pain or right lower quadrant pain so let's start with some light palpation in the
right upper quadrant and then we're just going to go in circles and move around the abdomen,
noting any grimacing or comments or size from the patient. Okay and as you go over that area where
they said it was tender you want to be paying particular attention. Then we move into deep
palpations we're going to actually take either one or two hands and we're going to go further
down into the abdomen so we're looking at a couple two four five centimeters and just check to see
if anything for masses, lesions, any tenderness that's not obvious; again and when you get to that
quadrant where they're tender you want to just go slowly and just watch their reaction okay.
In the right lower quadrant is one of the common locations for appendicitis;
well it is the location for appendicitis, and so what we need to do is find McBurney's point. So
we take the umbilicus that's our landmark and we're going to draw a straight line
down to the anterior iliac spine, that's the front part of your bone here that sticks out,
right, and so what you want to do is as you've drawn this line down you want to stop it two
thirds of the way towards it and that's McBurney's point that's the anticipated location of your
appendix and so you're going to take your hand at a 90 degree angle and as you press down.
The expectation is that the pain is lessened if it's appendicitis and when you release the
pain increases because that inflamed organ is now expanding and so that would be McBburney's
test right there. To check for the liver, to see if it's inflamed, or the gallbladder if
it's inflamed, you're going to do the hook. So you're going to find the rib cage press straight
down and up kind of thing and you can use like the side of your hand or the fingers, I find
the fingernails can be a bit troublesome so just use your palm there have them take a big breath in
and release now typically you cannot feel the border of the liver. If it is enlarged you might
notice that the other thing that happens is as they take a big breath in, if it causes sharp pain
and they stop their inhalation then that might be indicative of gallbladder. All right so now
that the assessment's done, let me know below is this one of those assessments that really got you
stumbling in school. Like you were struggling to figure out just how to do it in a systematic way,
of course this is the one where we change our IPPA; if you watched the last video here about
inspection, palpation, percussion, and auscultation; if you watch that one you
know that we've actually flipped this one on its head we start with inspection
and then we go to auscultation, percussion, palpation. We kind of go from the top; bottom up.
All right my lovelies there should be no reason why you cannot practice your abdominal assessment
on yourself. I just showed you that I could do it for me while I agree it is not ideal,
you can definitely get the flow of your assessment down and some of those pieces. So if you've been
studying and you've been paying attention these NCLEX questions should be no problem for you. So
let's head into those next. All right so question number one, feel free to pause this video:
your patient complains of abdominal pain for three days with tenderness to the left epigastric area
in what order will you complete your assessment? Okay you've got your answer? You've paused the
video, all right so the answer here would be number four: inspection, auscultate, percuss,
and then palpate. Well done. Let's do one more question, okay so in this question we did talk
about a few special tests so we're going to see what you remember. Your patient has acute
right lower quadrant pain with a positive McBurney sign, what diagnosis might this lead to? Go ahead,
pause the video ... and we're back. If you said appendicitis you would be correct. Well done.
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