NRSG258: Comprehensive Abdominal Assessment in Acute Care Nursing

This report provides a detailed overview of abdominal assessment techniques within the context of acute care nursing. It covers the key components of the assessment process, including inspection, auscultation, percussion, and palpation, highlighting the specific steps and findings associated with each. The report also discusses the clinical indications for abdominal assessment, particularly in the case of a patient named Steve, who presents with symptoms such as a distended abdomen, suspected paralytic ileus, discomfort related to an indwelling urinary catheter, and electrolyte imbalance. The assessment aims to identify the underlying causes of these symptoms and guide appropriate treatment strategies. The document emphasizes the importance of abdominal assessment in detecting health conditions early and preventing further complications.

Running head: ABDOMINAL ASSESSMENT 1
Abdominal Assessment
Student’s Name
Institutional Affiliations

ABDOMINAL ASSESSMENT 2
Abdominal Assessment
Abdominal assessment is a critical component of a systematic diagnostic evaluation. The
assessment involves inspection, auscultation, percussion, and palpation. This process is quite
distinct from the other body systems’ examination processes which require inspection,
percussion, palpation, and auscultation. In abdominal assessment, inspection involves first
looking at the abdomen; including inspecting for symmetry whilst standing at the patient’s side
(Brown et al. 2015). The inspection would aid in the identification of the abdomen’s contour
whether protuberant, scaphoid or flat. Subsequently, it is important to examine the abdomen to
note any change in skin color or pigmentation. For example, Grey Tuner’s sign indicates
retroperitoneal bleeding while a bluish colour at the umbilicus (Cullen’s sign) indicates bleeding
in the peritoneum. The inspection would also involve examining nodules and lesions.
The second phase referred to as auscultation involves listening to the gut sounds. The
ordinary gut sounds gurgle at a rate of 5-35 per minute (Osborne et al., 2015). Declined sounds
indicate a decline in gut activity. Remarkably, gut sounds can decrease after injury, abdominal
infection, or abdominal surgery. The assessment involves detecting ominous signs (absent
sounds) and can be caused by infarction, intestinal ischemia, intestinal perforation, and intestinal
obstruction.
The third, percussion, provides three outcomes including tympany (pitch higher than the
lungs), resonance (hollow and low-pitched sounds), and dullness (flat sounds without echoes).
The assessment involves the nurse or clinician percussing all the four abdomen’s quadrants. The
nurse hyperextends the central finger of his or her non-dominant hand and places the middle
finger against the patient’s abdomen firmly (Lampert, Lampert & Lampert, 2018). Using the end
of his or her dominant central finger, the nurse uses a swift flick of his or her wrist to airstrike

ABDOMINAL ASSESSMENT 3
the middle finger on the patient’s abdomen. The nurse then uses what she hears to categorize the
result as either dull or tympanitic. The nurse would use percussion to identify dullness.
Percussion also helps the nurse in the determination of the rate at which the bladder may be
rising beyond symphysis pubis.
On the other hand, in palpation, with the client in a supine position, the nurse begins light
palpation through depressing the wall of the abdomen to length less than 1 centimeter to look for
regions of sensitivity and tenderness. The nurse would detect sensitive areas through the client’s
facial expression and noticing present abdominal guarding. Subsequently, the nurse proceeds to
deeper palpation, depressing 3.7 to around 5 centimeters (Fritz & Weilitz et al., 2016). This
geared towards identifying regions of deep tenderness and abdominal mass areas. The liver is
palpated by putting the left hand under the patient while placing the right hand laterally to the
muscle of the rectus. The nurse would gently press in as well as up as the client takes deep
breaths since the liver usually moves down during inhalation. Conversely, spleen palpation
involves the nurse standing on the client’s right side and reaching over using his or her left hand
to lift the patient’s left-lower flank as well as ribcage. The nurse would then press down
underneath the left costal margins.
First, abdominal assessment is indicated for Steve to aid the nurse detect health
conditions or problem earlier enough to deter the development of further complications with the
disease at hand. Steve has a distended abdomen, meaning substances such as fluid, gas, or air
might have accumulated in the abdomen leading to its expansion. He, therefore, has a
dysfunctional body and feels bloated. The abdomen assessment will thus help in establishing the
diseases Steve may be suffering from. Secondly, the doctor also suspects that Steve may be
having paralytic ileus; therefore, it is important to assess the abdomen to establish whether the

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intestines are inactive or paralyzed resulting in the inability of the contents to move through. On
a similar note, the assessment is indicated to the patient because he complains of discomfort,
irritation around his indwelling urinary catheter, and full bladder. It is important to note that the
aforementioned are basic symptoms of an abdominal disease. Irritation and full bladder indicates
that there are serious problems with the abdomen making it not to release or excrete urine
(Bryant & Knights, 2015). Lastly, Steve has electrolyte imbalance which can occur due to kidney
failure and can result in life threatening and chronic diseases. Electrolytes imbalance is also
associated with seizures, weakness, irregular heartbeat, bone disorders, twitching, change in
blood pressure, excessive tiredness, and convulsions (Brown, Purdon & Van Dort, 2011).
Therefore, the abdominal assessment would help the nurse or doctor to detect the above-
mentioned symptoms and offer better treatments to avoid further complication to the patient.
Generally, abdominal assessment has been indicated to Steve to help examine the etiology of the
disease he might be suffering from.

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References
Brown, D., Edwards, H., Seaton, L., & Buckley, T (2015). Lewis’s medical-surgical nursing:
Assessment & management of clinical problems. (4th Australian & New Zealand edition).
Ch39. Sydney: Elsevier. (Via Clinical Key).
Brown, E.N., Purdon, P.L., & Van Dort, C.J. (2011). General anesthesiaand altered states of
arousal: A systems neuroscience analysis. Neuroscience,34, 601-628.
Bryant, B., & Knights, K. (2015). Pharmacology for health professionals. (4th ed.). Australia:
Elsevier. (Via Clinical Key).
Fritz, D., & Weilitz, P. B. (2016). Abdominal Assessment. Home healthcare now, 34(3), 151-
155.
Lampert, L., Lampert, L., & Lampert, L. (2018). Abdominal Assessment: Beyond Bowel Sounds
- Ausmed. Retrieved from https://www.ausmed.com/articles/abdominal-assessment/
Osborne, S., Douglas, C., Reid, C., Jones, L., & Gardner, G. (2015). The primacy of vital signs–
acute care nurses’ and midwives’ use of physical assessment skills: a cross sectional
study. International Journal of Nursing Studies, 52(5), 951-962.