Abdominal Assessment - A written out \"script\" covering every important detail for the OSCE, specifically PDF

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A written out "script" covering every important detail for the OSCE, specifically focusing on the abdominal assessment....

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Abdominal Assessment I am now going to wash my hands Hi, I’m Matthew and I’m going to be your student nurse for today. I am going to be performing an abdominal assessment. Is that okay with you? Ensure patient confidentiality *Raise the bed* 1. Before we begin I just have a few questions to ask you. 1. Has there been any change in your appetite? a. I am asking this because anorexia is a loss of appetite that occurs with gastrointestinal disease. 2. Do you have any difficulty swallowing? If so when did you notice this? a. I am asking this because dysphagia occurs with disorders of the throat/esophagus. 3. Do you have any abdominal pain? If so, please point to it. a. I am asking this because abdominal pain may be visceral, from an internal organ (dull, general pain) or parietal, from inflammation of overlying peritoneum. 4. Do you have any nausea or vomiting? a. Nausea/vomiting is a common side effect of many medications. 5. Are you taking any medications currently? If so, what ones? a. I am asking this because many medications can have toxic effects on the liver. 2. Vital signs At this point, I would now check your vital signs which are blood pressure, heart rate, respiratory rate, temperature, and O2 sat. For the OSCE I will only list the normal ranges for each: blood pressure = 120/80, heart rate = 60-100 bpm, respiratory rate = 12-20 breaths/min, temperature = 36.5 - 37.5 degrees celsius, O2 sat = 95%+. I would also use the pain scale OPQRSTUAAA. 3. Inspect skin and condition I am now inspecting their abdomen and looking at their contour and I see that it is flat. I am now looking for symmetry and the abdomen is symmetrical bilaterally. No

bulging, masses or asymmetrical shapes are noticed. The umbilicus is midline and inverted, no signs of discoloration, or hernias. Common site for piercings, should not be red. I am now inspecting their skin colour. I see that it is homogenous to their ethnic background, and there is no sign of cyanosis which would be blue, or pallor, in which the skin would be an ashen pale colour. No pulsations are present, hair distribution seems normal and the demeanor of patient is normal and relaxed and comfortable. 4. Auscultate Bowel Sounds and Vascular Sounds I am auscultating first because percussion and palpation can increase peristalsis. If you hear a bruit during auscultation, you want to skip the other two. I will begin listening in the RLQ at the ileocecal valve. I will listen for 5-30 bowel sounds per quadrant, to hear if they are normal or hypo/hyperactive sounding. If no sounds seem present, listen for 5 minutes to be absolutely sure. Using the bell of my stethoscope I will now listen to the vascular sounds over the aorta, renal and iliac arteries. For the osce I will not listen to the femoral artery. I heard no bruits present. 5. Percuss General Tympany, Liver Span, and Splenic Dullness General Tympany I will percuss in all 4 quadrants to determine the amount of tympany and dullness, working in a clockwise fashion. Tympany should be dominate as air in the intestines rises to the surface when the patient is supine. Dullness would be heard over a distended bladder, adipose tissues, etc. Liver Span I will now percuss to map out the liver borders, beginning in the area of lung resonance and go down the intercostal spaces until the sound becomes dull. I will mark a spot on the patient's body, around the 5th intercostal space and then find abdominal tympany and place another mark where it changes back to a dull sound. I will measure the distance between the points and a normal liver span range in adults is 6-12 cm. Taller people will have longer livers, vice versa. ● Scratch test: Place stethoscope over liver, with 1 fingernail scratch over abdomen starting in the RLQ and move up towards the liver. When the sound gets louder, place a mark. Splenic Dullness

May be able to be located by percussing for a dull note from the 9th-11th intercostal spaces just behind the left midaxillary line. 6. Costovertebral Angle Tenderness I will now perform costovertebral angle tenderness by placing one hand over the twelfth rib at the costovertebral angle, and firmly bump my hand with the ulnar edge of my other hand. Normally the patient feels a thud but no pain should be present. If pain is present, the kidney is likely inflamed. 7. Palpate Surface and Deep Areas Light Palpation Depress skin 1cm, moving in circular motions then lift fingers up and move clockwise around the abdomen, meant to form overall impression of the skin surface. Deep Palpation If appropriate, perform deep palpation by doing same technique as light palpation but depressing skin 5-8cm moving clockwise. 8. Palpate Liver Begin with liver in RUQ, place left hand under patients back parallel to 11th and 12th ribs and lift up to support abdominal contents. Place right hand on RUQ, with fingers parallel to midline. Push down deeply and under the right costal margin, ask patient to take a deep breath. It is normal to feel the edge of the liver bump your fingertips, but it is often not palpable. 9. Palpate Spleen Normally the spleen also isn't palpable and needs to be enlarged to feel, reach over the abdomen with your left hand and behind the left side at the 11th and 12th ribs. Lift up for support, place right hand obliquely on the LUQ with the fingers pointing toward the left axilla and just inferior to rib margin. Push hand down and ask patient to take a deep breath, you shouldn't feel anything firm. 10. Palpate Kidneys

Place hands in duckbill position at patients right flank, press hands together firmly and ask patient to take a deep breath. In most people you won't feel a change. 11. Rebound Tenderness I will now assess rebound tenderness by holding my hands 90 degrees to abdomen. I will push down slowly and deeply and then lift up quickly. A normal/negative response is no pain on the release. 12. Finishing Assessment That concludes my abdominal assessment, do you have any questions?

Now lower the bed and wash my hands...