A client presents to the clinic reporting nausea and a recent onset of abdominal cramping. To obtain accurate clinical data, which approach should the nurse take when examining this client's abdomen?
- Visually inspect the contour of the abdomen, auscultate for bowel sounds, and then proceed with percussion and palpation.Answer
- BInspect the abdominal surface, palpate all quadrants for tenderness, percuss for tympany, and then auscultate.
- CImmediately apply the stethoscope to auscultate bowel sounds before exposing the abdomen for visual inspection.
- DAsk the unlicensed assistive personnel to initially feel the abdomen for obvious rigidity or masses.
Answer
The correct approach is to visually inspect the contour of the abdomen, auscultate for bowel sounds, and then proceed with percussion and palpation.
When performing an abdominal assessment, the standard physical examination sequence is uniquely modified. The nurse must inspect the abdomen first, followed immediately by auscultation. Palpating or percussing the abdomen before listening can stimulate intestinal activity and artificially increase bowel sounds, resulting in false clinical findings.
Step-by-Step Solution
Key Concept
Abdominal Physical Assessment Sequence