Abdominal Assessment Procedure

1. Prepare equipment: examining light, tape measure, water-soluble skin-marking pencil, stethoscope
   • Empty bladder
   • Short fingernails
   • Warm and comfortable environment
2. Hand washing
3. Greet and identify the client
4. Explain the procedure
5. Provide client privacy
6. Inquire client’s history of bowel habits
7. Position the client: supine, with arms comfortable at the side, knees slightly flexed (dorsal recumbent)
   • Place small pillows beneath the knees and the head to reduce abdominal tension. Only expose the area from the chest line to the pubic area.
8. Assessment: Inspection
   • Contour, symmetry. If distention or protrusion (protuberant) is present, measure abdominal girth. Contour may be flat or rounded (normal). Asymmetry is abnormal.
   • Abdominal movements (respiration, peristalsis, aortic pulsation): diminished abdominal respirations may be abnormal. Vigorous, exaggerated pulsations are abnormal. Peristaltic waves should not be visible.
   • Scars, striae, rashes, and lesions.
   • Color: normally lighter than general skin tone; abnormal if purple, yellow, pale, red, or bruised.
   • Vascularity: scattered fine veins; abnormal if dilated.
   • Striae: silvery-white/brown; abnormal if red.
   • Cullen’s sign (acute pancreatitis, ruptured ectopic pregnancy), Grey Turner’s sign (trauma, acute pancreatitis)
   • Characteristics: pale, smooth, minimally raised scars, free of lesions or rashes, flat moles and surgical scars may be present. Record the length in cm and location. Good skin turgor.
   • Umbilicus color, location, contour: similar to surrounding skin tones, settled midline, inverted, and round. Abnormal if everted, enlarged, or discolored.
   • Patient Behavior: relaxed, quiet, relaxed facial expressions, normal respirations.
9. Assessment: Auscultation
   • Should be done before percussing and palpating (these alter bowel sounds). Listen for bowel sounds in all quadrants for at least one minute. One sound should be heard every 5 to 10 seconds.
   • Begin from the RLQ, moving clockwise. Sounds are normally soft, intermittent, and from 5 to 30 sounds per minute.
     • RLQ: ileocecal valve bowel sounds are normally present here.
     • Borborygmus: stomach growling (prolonged gurgling)
     • Bruit: (using the bell) over the abdominal aorta and the renal, iliac, and femoral arteries.
10. Assessment: Percussion
    • Note areas of tympany or dullness. Use a systematic pattern (LLQ, LRQ, URQ, and ULQ; counterclockwise). Indirect percussion is used to determine the size and location of abdominal organs, air, fluid, and muscles.
    • Sounds: flat (bone, muscle), dull (heart, liver, spleen, fluid, feces), resonance (air-filled), hyperresonance (emphysematous lungs; hyperinflated), tympany (drum-like; gas in stomach or intestine)
    • Percuss liver size starting from the umbilical level of the left MCL moving forward and backward to determine the liver borders.
      • Normal height of the liver: 6 to 12 cm (MCL) and 4 to 8 cm (MSL). Enlargement indicates hepatomegaly.
    • Spleen: 7 cm wide near the left 10th rib, slightly posterior to the LMAL.
    • Kidney: blunt percussion (direct or indirect) should result in no tenderness. Inflammation and infection may be indicated if pain is produced.
      • Stricken at the costovertebral angles, noting tenderness or pain.
11. Assessment: Palpation
    • Light palpation in all quadrants, followed by deep palpation (usually not done by nurses)
    • Assess location and abdominal muscle tone
    • Note for unusual masses, pulsation, tenderness, or pain.
    • Abdomen: should be non-tender and soft. Abnormal findings include guarding and rigid.
    • Masses: no palpable masses.
    • Aorta: Palpate the aorta at or slightly above the umbilicus for contour and pulsations. Normally 2.5 to 3 cm wide with a moderately strong and regular pulse.
    • Liver: bimanually palpate; under the patient’s right flank (11th to 12th rib) and press upward. Place the right hand at the level of the dullness, and have the patient take a deep breath. Normally not palpable. Mild tenderness is normal.
    • Spleen: seldom palpable.
    • Kidney: bimanually palpate below the umbilicus. Note the size, shape, and tenderness. Normally not palpable.
    • Inguinal and Femoral Lymph Nodes palpated bilaterally. Note for enlargement.
    • Contraindicated for clients with tumors of the liver and kidney
12. Position the client comfortably, and inform them of findings as necessary.
13. Wash hands and document the procedure.