Abdomen & NG tube insertion and Tube Feed

Question 1

Preparation

Answer 1

● Make the abdomen fully visible
● Instruct to empty bladder
● Position the pt in supine
● Do PQRSTUV to assess the pain level and where the pain is

Question 2

Subjective Questions

Answer 2

Appetite
● Any Change in Appetite?

Dysphagia
● Any difficulty in swallowing?

Food Intolerance
● Are there any foods you cannot eat or are allergic to?

Abdominal Pain
● Do you have any abdominal pain? Can you tell me where it starts?
● Is the pain constant or does it come and go?
● Do PQRSTUV

Nausea & Vomiting
● Any nausea or vomiting? How often do they happen? How much? Does it have a color or smell?

Bowel Habits
● How often do you have a bowel movement?

Past abdominal history & Medication
● Any history of GI problems? Ever had any operations on the abdomen?
● Are you currently taking any medication?

Question 3

Inspection of the Abdomen

Answer 3

Contour
● Stand on pt’s right side and look down at the abdomen
● Determine the profile from the rib margin to the pubic bone, the contour describes the nutritional state and normally ranges from flat to rounded

Symmetry
● Shine a light across the abdomen and lengthwise across the pt
● Should be symmetrical bilaterally
● Note any localized bulging, visible mass, or asymmetrical shape (small bulges will be detected by the light)
● Ask the pt to take a deep breath to further highlight any change.
● Abdomen should stay smooth and symmetrical

Umbilicus
● Normally midline and inverted, with no signs of discoloration

Skin
● Surface should be smooth and even with homogenous color, striae (stretch marks) are common and caused by pregnancy or rapid weight gain
● Should have no lesions present, note for any scar, ask about it and measure the size of the scar
● Good skin turgor reflects healthy nutrition, gently pinch the skin and release skin immediately should come back to the original position

Pulsation & Movement
● Should see pulsation from the aorta beneath the skin in the epigastric area, respiratory movement also shows in the abdomen, particularly in men.
● Waves of peristalsis are present in pt who are very thin, they ripple obliquely across the abdomen

Hair distribution
● Hair is normally distributed in both men and female

Demeanor
● Comfortable pt is relaxed quietly on the examining table, has a normal facial expression (Not reacting badly)

Question 4

Why Auscultate first?

Answer 4

● Auscultate is done first because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
● If you hear a bruit during auscultation, you should not do percussion and palpation

Question 5

Auscultate bowel Sounds

Answer 5

Bowel Sounds
● Use the diaphragm end piece and press lightly and listen in all 4 quadrants starting in the right lower quadrant at the ileocecal valve
● Note the character and frequency of the bowel sounds
- Bowel sounds are high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute
- Hyperactive: loud, high-pitched, rushing, tinkling sounds
- Hypoactive: diminished/absent

Question 6

Auscultate vascular Sounds

Answer 6

● Use the bell of the stethoscope
● Using the bell listen and check over the aorta and renal arteries, iliac, and femoral arteries
● Note for the presence of any vascular sound or bruits
- usually sound should not be present

Question 7

Percuss Generall Tympany

Answer 7

● Before starting make sure your hands are warm
● Percuss lightly the four quadrants to determine the prevailing amount of tympany and dullness

Question 8

Percuss Costovertebral Tenderness

Answer 8

● Ask the pt to sit upright
● To assess the kidney, place one hand over the twelfth rib at the costovertebral angle of the back
● Thump the hand with the ulnar edge of your other fist
● The pt should not feel any pain
● Assess it bilaterally

Question 9

Do light Palpation

Answer 9

● Begin with the first 4 fingers close together, depress the skin approximately 1 cm
● Use a gentle rotary motion, sliding the fingers and skin together
● Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen
● Objective is not to search for organs but to form an overall impression of the skin surface and superficial musculature
● Voluntary guarding occurs when the pt is cold, tense, or ticklish