Task 22

Nurse : we're going to assess the abdomen and remember we're switching our sequence and how
we assess we're going to do inspection auscultation and then percussion or palpation so we're
going to auscultation second so whenever you're looking and assessing the abdomen have the
patient lay on their back and what we're gonna do is we're going to inspect the abdomen and first
we want to ask Ben are you having any stomach issues at all
Patient : no
Nurse : okay and when was your last bowel movement
Patient : yesterday morning
Nurse : and how are you urinating do you have any pain while you're peeing do have problems
starting a stream any discharge anything like that
Patient : like that
Nurse : okay and with your male patients you want to ask about that due to prostate enlargement
was starting a stream and if he was female I would ask him when his last menstrual period
was and also again ice to be more patient about urinating and things like that now if the patient
had a Foley this is the time when you would want to look at the urine inspect the Foley and look
at that just conglomerate your urinary system in your GI system together okay so we're
inspecting the abdomen we're looking at the abdominal contour and this patients is scaphoid it
goes in a little bit you can also have flat round it or protuberant and also we're going to know if
there's any pulsations a lot of times in this area right here on thin patients like with being I can
see the aortic pulsation in this patients rod above the umbilicus and looking at the belly button
and checking for any mass do we see any hernias or anything like that also if your patient had
any wounds you wouldn't want to look at that and if they had a peg tube you wouldn't want to
assess the site make sure it's not red and ask them how it feels and with your ostomies with your
ostomies you want to look at the stoma and make sure it is like a rosy pink color it's not a dusky
cyanotic color and it's not prolapsed and look and see what type of stool it's putting out and note
that note the smell note when if the bag needs to be changed anything like that so now we're
ready to listen to the bowel sounds and what we're going to do is we're going to listen with the
diaphragm of our stethoscope and we are going to start in the right lower quadrant and work our
way clockwise and we're gonna listen all four quadrants and you should hear five to thirty
sounds per minute and if you don't hear any bowel sounds you need to listen for five full minutes
and you need to note are these normal are they hyperactive or hypo active so let's listen right
lower quadrant we're gonna move out to the right upper quadrant move over to the left upper
quadrant and then down to the left lower quadrant ambassy ons are normal now we're gonna
listen for vascular sounds and you're gonna do this with the bell of your stethoscope and we're
gonna listen at the aortic we're gonna listen at the renal arteries iliac arteries and you could listen
at the femoral already arteries if you need it to so you're gonna listen at the aorta artery and it's a
little bit below the xiphoid process a little bit above the umbilicus so about right here and we're
listening for like a blowing swishing sound that which would represent a bruit okay and none is
noted then we're gonna listen at the right and left renal arteries which is a little bit down from the
aorta location so here's right okay none note it and then over the left then we're gonna listen at
the iliac and it's a little bit below the belly button right here and this is Illya Carter II and then
listen on the other side and again like I pointed out you could listen at the femoral artery and the
groin if you need it too now we're going to do palpation first we're going to do light palpation
then deep and being as I do this please tell me if you feel any pain or tenderness so first we're
gonna do by palpation we'll just start in the right lower quadrant and work her way around and
you're gonna go about two centimeters and you're just feeling for any rigidity any lumps masses
anything like that how's that feel okay
Patient : okay
Nurse : now we're gonna do deep palpation and we're gonna go about four to five centimeters so
a lot more deep then again you're just feeling for any masses lumps and then tell me if you have
any tenderness and sometimes you can do this with two hands if need be if you're not strong
enough [ __ ] me telling anything feels
Patient : nice
Nurse : and soft hurts um belly sounds that's why you do this after you listen because you
stimulate it good .