NURS 6512 Practice Assessment: Abdominal Examination

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NURS 6512 Practice Assessment: Abdominal Examination

NURS 6512 Practice Assessment: Abdominal Examination

 

The causes of abdominal pain can be extremely varied due to the sheer number of
structures, organs, and functions within the abdomen. If abdominal pain is caused by a
life-threatening condition, then swift and accurate assessment is essential.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week
9, it is recommended that you practice performing an abdominal examination this week.
Note: This is an optional practice physical assessment.
To Prepare
 Arrange an appropriate time and setting with a volunteer "patient" to perform an
abdominal examination.
 Download and review Adult Examination Checklist: Guide for Abdominal Assessment,
provided in this week's Learning Resources, as well as review the Seidel’s Guide to
Physical Examination online media.
Optional Practice Assessment
 Perform the abdominal examination. Be sure to cover all of the areas listed in the
checklist and to use the equipment appropriately.

What's Coming Up in Week 7?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will explore how to assess the heart, lungs, and peripheral vascular
system as you complete your Discussion.
Week 7 Required Media
Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images
Next week, you will need to view several videos and animations in the Seidel’s Guide to
Physical Examination as well as other media, as required, prior to completing your
Discussion. There are several videos of various lengths. Please plan ahead to ensure
you have time to view these media programs to complete your Discussion on time.

 

General inspection

Clinical signs

Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology:

  • Age: the patient’s approximate age is helpful when considering the most likely underlying pathology, with younger patients more likely to have diagnoses such as inflammatory bowel disease (IBD) and older patients more likely to have chronic liver disease and malignancy.
  • Confusion: often a feature of end-stage liver disease, known as hepatic encephalopathy.
  • Pain: if the patient appears uncomfortable, ask where the pain is and whether they are still happy for you to examine them.
  • Obvious scars: may provide clues regarding previous abdominal surgery.
  • Abdominal distention: may suggest the presence of ascites or underlying bowel obstruction and/or organomegaly.
  • Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g. gastrointestinal bleeding or malnutrition). It should be noted that healthy individuals may have a pale complexion that mimics pallor.
  • Jaundice: a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer).
  • Hyperpigmentation: a bronzing of the skin associated with haemochromatosis.
  • Oedema: typically presents as swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites) and is often associated with liver cirrhosis in the context of an abdominal examination OSCE station.
  • Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation. Cachexia is commonly associated with underlying malignancy (e.g. pancreatic/bowel/stomach cancer) and advanced liver failure.
  • Hernias: may be visible from the end of the bed (e.g. umbilical/incisional hernia). Asking the patient to cough will usually cause hernias to become more pronounced.

Objects and equipment

Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status:

  • Stoma bag(s): note the location of the stoma bag(s) as this can provide clues as to the type of stoma (e.g. colostomies are typically located in the left iliac fossa, whereas ileostomies are usually located in the right iliac fossa).
  • Surgical drains: note the location of the drain and the type/volume of the contents within the drain (e.g. blood, chyle, pus).
  • Feeding tubes: note the presence of feeding tubes (e.g. nasogastric/nasojejunal) and whether the patient is currently being fed.
  • Other medical equipment: ECG leads, medications, total parenteral nutrition, catheters (note volume/colour of urine) and intravenous access.
  • Mobility aidsitems such as wheelchairs and walking aids give an indication of the patient’s current mobility status.

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  • Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.
  • Fluid balance: fluid balance charts will give an indication of the patient’s current fluid status which may be relevant if a patient appears fluid overloaded or dehydrated.
  • Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.

    Hands

    The hands can provide lots of clinically relevant information and therefore a focused, structured assessment is essential.

    Inspection

    Palms

    Inspect the palms for any of the following signs:

    • Pallor: may suggest underlying anaemia (e.g. malignancy, gastrointestinal bleeding, malnutrition).
    • Palmar erythema: a redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy).
    • Dupuytren’s contracture (see more details in the palpation section).

    Nail signs

    Inspect the nails for any of the following signs:

    • Koilonychia: spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).
    • Leukonychia: whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).

    Finger clubbing

    Finger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed. Finger clubbing is associated with several underlying disease processes, but those most likely to appear in an abdominal OSCE station include inflammatory bowel disease, coeliac disease, liver cirrhosis and lymphoma of the gastrointestinal tract.

    To assess for finger clubbing:

    • Ask the patient to place the nails of their index fingers back to back.
    • In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window).
    • When finger clubbing develops, this window is lost.

    Asterixis (flapping tremor)

    Asterixis (also known as ‘flapping tremor’) is a type of negative myoclonus characterised by irregular lapses of posture causing a flapping motion of the hands. In the context of an abdominal examination, the most likely underlying cause is either hepatic encephalopathy (due to hyperammonaemia) or uraemia secondary to renal failure. CO2 retention secondary to type 2 respiratory failure is another possible cause of asterixis.

    • Ask the patient to stretch their arms out in front of them.
    • Then ask them to cock their hands backwards at the wrist joint and hold the position for 30 seconds.
    • Observe for evidence of asterixis during this time period.

    Palpation

    Temperature

    Place the dorsal aspect of your hand onto the patient’s to assess temperature:

    • In healthy individuals, the hands should be symmetrically warm, suggesting adequate perfusion.
    • Cool hands may suggest poor peripheral perfusion.

    Radial pulse

    Assess the patient’s radial pulse:

    • Palpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.
    • Once you have located the radial pulse, assess the rate and rhythm.

    Dupuytren’s contracture

    Dupuytren’s contracture involves thickening of the palmar fascia, resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb. There are a number of factors that have been associated with the development of Dupuytren’s contracture including genetics, excessive alcohol use, increasing age, male gender and diabetes.

    To assess for Dupuytren’s contracture:

    • Support the patient’s hand and palpate the palm to detect bands of thickened palmar fascia that feel cord-like.
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