Clinical Instructor-College of Nursing

The abdominal assessment is routine in a physical examination and is performed on patients of all ages.

The abdominal cavity contains several of the body's vital organs and can provide valuable clues as to the patient's diagnosis and condition.


Landmarks help the nurse map out the abdominal region.
Assessment involves examination of organs and tissues anteriorly and posteriorly.
Patients must be relaxed, warm, and provided privacy for the examination.
Adequate light is essential for inspection and visualization during examination.
Nurse must begin with inspection then follow with auscultation.



The nurse must begin with inspection and then follow with auscultation.
Palpation and percussion may alter the frequency and character of bowel sounds.
During auscultation, the nurse asks the patient to refrain from talking. If the patient has a nasogastric tube or an orogastric tube connected to suction, it should be turned off so that the sound from the suction will not obscure the bowel sounds.



1.Nutrition, altered related to infection
2.Pain related to injury



Assessment completed while maintaining patient's privacy and comfort
Awareness of cultural and traditional health practices

/Supplies
Stethoscope
Ruler or nonstretchable measuring tape
Marking pen


Wash hands.
Reduces transmission of microorganisms.
Explain procedure to patient.
Explanation reduces the patient's anxiety.
Position the patient supine with arms down at sides, and place a small pillow beneath the knees.
Supine position facilitates the examination of the entire abdomen. Pillow supports the patient's back.
Provide adequate cover for the patient.
This helps to reserve the patient's privacy and provide warmth before proceeding with rest of the assessment.

The nurse must stand on the patient's right side and sit in a position to look across the abdomen's surface.
Standing helps detect abnormal shadows and movement. Sitting position provides horizontal view that allows detection of abnormal protuberances and contours.
Divide the abdomen into four quadrants.
Landmarks help the nurse map out the abdominal regions.

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Examiner needs to make sure the patient is disrobed and provide privacy with adequate covers and warmth of the examination room.
Inspection of skin.
The location of scars, venous patterns, rashes, lesions, pigmentation changes, and stretch marks are noted. This can help identify previous surgeries or trauma and show if skin has been stretched from obesity or pregnancy. Striations can also signal possible adrenal problems.

Inspection of umbilicus.
Normally the umbilicus is flat. You may notice a different shape or color, which could indicate pathology.
Underlying masses may displace the umbilicus, and an everted umbilicus indicates distention.
Watch for umbilical discharge; this is an abnormal sign.

Inspect contour and symmetry.
The presence of a mass or masses on one side may indicate a problem. Intestinal gas, tumor, or fluid in the abdomen may cause distention.
Do not confuse distention with obesity.

Observe the abdomen while asking the patient to take a deep breath.
This moves the diaphragm downward and decreases the size of the abdominal cavity; any enlarged organs may cause a bulge.
Observe the abdomen while the patient raises his or her hands over the head.
This helps to evaluate the abdominal musculature. Any hernias, masses, and muscle separation will become more apparent.

Inspect for movement and pulsations.
With pain, respiratory movement is diminished, and the patient may guard against the pain by tightening the abdominal muscles. (Women breathe costally, and men breath more abdominally.)

Looking across the abdomen, the nurse may see peristaltic movement and aortic pulsations (midline, above the umbilicus).

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Auscultation comes next in the physical examination.
The examiner should listen to bowel sounds before palpating or percussing.
These actions will stimulate bowel action and provide unreliable data for the examiner.
Warm the diaphragm of the stethoscope, and with light pressure auscultate in all four quadrants to detect normal, high-pitched bowel sounds.

Sounds are normally described as
Normal
Audible
Absent—absence of gastrointestinal motility and a late stage of bowel obstruction

Hyperactive or hypoactive—Hyperactive sounds indicate hypermotility caused by inflammation of the bowel, anxiety, diarrhea, bleeding, excess ingestion of laxatives, and reaction of the intestine to certain foods.
You must listen 5 to 15 seconds in each quadrant.

Place the bell of the stethoscope diaphragm over the epigastrium to auscultate for bruits, which manifests as a whooshing or blowing sound.

Renal-artery bruits can be heard by placing the stethoscope over each upper quadrant anteriorly or over the costovertebral angle posteriorly.

If a bruit is heard, it is not normal and should be reported to a physician immediately.
Place bell of the stethoscope above the liver and spleen and listen for a friction rub.

An inflamed liver or spleen may rub against the peritoneum during inspiration, creating a grating sound.

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Percussion allows the examiner to determine borders of the spleen, liver, and other major organs in the abdomen. It also provides information regarding presence of fluid in the abdominal cavity.
Systematically percuss each quadrant to assess areas of tympany and dullness.

Tympany is percussed when there is air in the stomach or intestine. Dull percussion is heard over solid masses as in an enlarged liver, spleen, tumor, or a full bladder.

Percuss to identify the liver border by starting at the iliac crest and proceeding upward on the right midclavicular line. As you percuss upward, the percussion note changes from tympanic to dull at the liver's lower border. (Mark the point.)

The upper border is found by percussing downward from the ni**le along the midclavicular line. When the note changes from resonance to dull, make a mark. The distance between the points should be 6 to 12 cm.

Percussion allows the nurse to identify borders of the liver and to detect any organ enlargement. Diseases such as cirrhosis, cancer, and hepatitis can cause this liver enlargement.

Percuss for the gastric air bubble in the left lower anterior rib cage and left epigastric area.
Note: The tympany heard when percussing the gastric bubble is lower in pitch than the tympany of the intestines.

Have the patient sit or stand erect to assess for kidney inflammation. With the ulnar surface of a partially closed fist, percuss the costovertebral angle at the scapular line.

If the kidneys are inflamed, the patient will feel tenderness during percussion.

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Palpation is the last process of the abdominal examination and provides the examiner with data concerning areas of tenderness and presence of fluid, masses.

Hold the palm of your hand and forearm horizontally and lightly palpate each quadrant.
See Fig. 4.9 Light Palpation

Superficial palpation (1 cm)
Deep palpation (2.5 to 7.5 cm). If you are experienced, you may do this.
You are palpating for muscular resistance, distention, tenderness, and superficial organs or masses.

Wash hands.
Reduces transmission of microorganisms, which could cause infection.

[Outline]

Information
Inspection
Auscultation
Percussion
Palpation
Evaluation and Follow-Up Activities
Evaluation and Follow-Up Activities

Compare assessment findings to normal
Pursue more specific tests and assessment regarding abnormal findings if warranted



If patient has abdominal or lower back pain, record the pain in detail (location, onset, frequency, severity, precipitating factors, aggravating factors).
Assess normal bowel habits and any history of changes.
Determine if patient has had abdominal surgery or trauma to the abdomen in the past.
Assess for difficulty swallowing, heartburn, black or tarry stools, diarrhea, or constipation.
Determine if patient is pregnant, and note last menstrual period.
Ask patient about history of alcohol or aspirin intake.

With Kindness,
Sister Hnin
Ref: Guide to clinical nursing skills.

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Steps of Emergency Management
Prevention, mitigation, preparedness, response and recovery are the five steps of Emergency Management.


5 Phases Actions taken to avoid an incident. Stopping an incident from occurring. Deterrence operations and surveillance.


Refers to measures that prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies. Typical mitigation measures include establishing building codes and zoning requirements, installing shutters, and constructing barriers such as levees.


Activities increase a community's ability to respond when a disaster occurs. Typical preparedness measures include developing mutual aid agreements and memorandums of understanding, training for both response personnel and concerned citizens, conducting disaster exercises to reinforce training and test capabilities, and presenting all-hazards education campaigns.


Actions carried out immediately before, during, and immediately after a hazard impact, which are aimed at saving lives, reducing economic losses, and alleviating suffering. Response actions may include activating the emergency operations center, evacuating threatened populations, opening shelters and providing mass care, emergency rescue and medical care, fire fighting, and urban search and rescue.


Actions taken to return a community to normal or near-normal conditions, including the restoration of basic services and the repair of physical, social and economic damages. Typical recovery actions include debris cleanup, financial assistance to individuals and governments, rebuilding of roads and bridges and key facilities, and sustained mass care for displaced human and animal populations.

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Today, I would like to share regarding the basic of ECG Interpretation.

Session 1

ECG

The ECG must always be interpreted systematically. Failure to perform a systematic interpretation of the ECG may be detrimental. The interpretation algorithm presented below is easy to follow and it can be carried out by anyone. The reader will gradually notice that ECG interpretation is markedly facilitated by using an algorithm, as it minimizes the risk of missing important abnormalities and also speeds up the interpretation.



1.Assess ventricular (RR intervals) and atrial (PP intervals) rate and rhythm.
2. Is ventricular rhythm regular?
What is the ventricular rate (beats/min)?
3. Is atrial rhythm regular? What is the atrial rate (beats/min)?

P-waves should precede every QRS complex and the P-wave should be positive in lead II.

Sinus rhythm (which is the normal rhythm) has the
following characteristics: (1) heart rate 50 to 100 beats per minute; (2) P-wave precedes every QRS complex; (3) the P-wave is positive in lead II and (4) the PR interval is constant.

Causes of bradycardia: sinus bradycardia, sinoatrial block, sinoatrial arrest/inhibition, second-degree AV block, third-degree AV block. Note that escape rhythms may arise during
bradycardia. Also note that bradycardia due to dysfunction in the sinoatrial node is referred to as sinus node dysfunction (SND). If a person with ECG signs of SND is symptomatic, the
condition is classified as sick sinus syndrome (SSS).

Causes of tachycardia (tachyarrhythmia) with narrow QRS complexes (QRS duration

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ECG....

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