Health Assessment, part 36: Abdominal Assessment

Hi. I'm Meris, and in this video, I'm going to be talking to you about how to perform an abdominal assessment, including how to auscultate and palpate. I'm going to be following along using our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you are more of a fan of a digital product, I would invite you to check out Flashables, which is the digital version of all of our flashcards. All right. Let's go ahead and get started.

Now, if you remember an earlier video, I explained to you that we perform an abdominal assessment in a slightly different order than other assessments, which is we start by inspecting, but then we auscultate, and we move on after that to percussion and then palpation. And again, the reason for this is so that we are listening to where the bowel gas is right now, before I go pushing on the belly and possibly altering the bowel gas pattern. That could give me some false bowel sounds that aren't actually there, and that could lead me to believe that my patient has a normal abdominal assessment when, in reality, they have absent bowel sounds, for instance.

So how am I going to auscultate the belly? Well, we're going to move in a very specific pattern. And the reason for this is that we are going to be following the anatomic pathway of the colon. That's what we are doing. We're listening to the colon, in some regard to the small bowels as well. But what I want is I want to follow it from the most proximal portion of the colon all the way through to the most distal.

So the colon moves in the following way. It starts at the right lower quadrant. Then I have the ascending colon that moves up to the right upper quadrant. Then I have the transverse colon that moves across over to the left upper quadrant. And then I have the descending colon, which would move me down to the left lower quadrant, plus the sigmoid colon can be auscultated in that area, too. So similarly, that's how I want to listen. I'm going to start with the right lower, then right upper, then left upper, and finally, left lower.

If I don't hear bowel sounds somewhere along that way, it is very unlikely that I'm going to hear them distal or farther from that spot. So by tracing the pattern of that bowel, I can hopefully identify where along the way I lose bowel sounds, if that is the case, so that I can try to give that helpful information to the provider and say, "Hey, listen, I had bowel sounds right lower and right upper, but once I got to left upper, I didn't have them," or whatever the situation may be. Then you'll do your percussion, and we're going to percuss over the belly. And we're also going to be percussing for the size of the liver, which would be done by auscultating for dullness. With that percussion, we're going to hit and hopefully hear dullness on that right side, and we expect that liver to be about 6 to 12 centimeters in size. And lastly, we will palpate the abdomen. And we're going to similarly start on the right, move all the way around in that clockwise motion. And we are going to be feeling for any sort of, "Do I feel anything hard or unusual in the belly?" And then also, "Is my patient displaying any grimacing? Do they seem to have any pain?"

I want to point out something to you which is called guarding. So muscle guarding sometimes. There's two different things. There's guarding, and there's muscle guarding. Guarding is when your patient physically is holding their belly. I don't want you to touch me because it hurts so bad. So I'm going to hold my belly, or I'm going to protect that. Muscle guarding is when I go to press on my patient's abdomen, and they tense their belly up, ooh, because it's going to hurt. I know it's going to hurt. So I tense the muscles in my abdomen to try to protect somewhat against that pain. That's called muscle guarding. Both of these are abnormal, and this should suggest to you that your patient has some sort of process intra-abdominally that is causing them pain.

Now, the thing that I want to point out to you is, if my patient is experiencing abdominal pain, I want to palpate those areas last. So let's say my patient is complaining of pain on the lower left quadrant. I don't want to start there. I want to start with the places that don't hurt so that I can feel what those areas feel like first and so that my patient can have that sensation of, "Okay. We're going to do the less painful thing right now. No need to guard." And then I'm going to palpate that tender area last, the reason being, I'm going to cause them pain potentially, and I don't want to then be pushing on other areas of the belly. They could report to me that that is painful, but it's not actually that area that is painful. It's that lingering sensation of the pain caused by palpating that tender area. So start with the parts that don't hurt and then palpate tender areas last.

All right. Now I've got some quiz questions for you to test your knowledge of key facts I provided in this video. Which quadrant of the abdomen should be auscultated first? The right lower quadrant. How should the nurse palpate the abdomen of a patient with abdominal pain? By palpating the tender areas last. All right. That is it for this video. Thank you so much for joining me. How many quiz questions did you get right? I want to hear. And if you have a great way of remembering something, please leave me a comment. I want to hear it, and I know that it benefits other learners as well. All right. That's it for this video. I'll see you in the next one. Thanks so much, and happy studying.