Chapter 5 – Gastrointestinal System Show Palpation of the abdomen provides information about the organs associated with the GI system. The palpation technique follows auscultation, so the abdomen is already exposed. Additionally, you should not palpate the abdomen if vascular bruits are present (e.g., aortic, renal, iliac, and femoral). Remember, always palpate on bare skin. Palpation of the abdomen involves the following steps (see Video 5.3): 1. If not already, ask the client to bend their needs up and ensure they are draped. 2. Use the pads of your four fingers to gently palpate the abdomen, keeping your fingers together and your wrist and forearm at about the same plane as the client’s body.
3. Begin in the right lower quadrant and proceed clockwise. If the client indicates they have pain in the right lower quadrant, begin in the right upper quadrant instead and palpate the area with pain last. 4. Press down about one to two centimeters (light palpation) and move your fingers together in a circular motion.
5. Lift fingers up together and move on to the next location, ensuring that you palpate every square centimeter of the abdomen in all four quadrants. 6. Assess the following:
7. Note the findings.
Video 5.3: Palpation of the abdomen If a client has indicated pain/tenderness, palpate that area last. Palpating a painful area of the abdomen first will aggravate the pain and may affect the accuracy of your assessment. Urgent surgical intervention is required when a client has appendicitis (inflammation of the appendix that is at risk of perforating). In these cases, client usually presents with an increasing level of pain in the right lower quadrant, often beginning in the periumbilical region. This can also be associated with lack of appetite, nausea, vomiting, fever, chills, and muscle rigidity. If you suspect appendicitis, notify the physician immediately. Continue to monitor the client, measure vital signs, do not allow the client to take anything by mouth, and begin an intravenous if there are standing orders. A physician or nurse practitioner may assess for rebound tenderness, which involves palpating in the right lower quadrant and quickly removing one’s hand. Positive rebound tenderness (pain when the assessor removes their hand) is often indicative of appendicitis. All abnormal findings (e.g., masses, swelling, pain, rigidity) should be further investigated with a focused abdominal assessment. Report any new, worsening, or unexpected findings to the physician or nurse practitioner. Activity: Check Your UnderstandingWhat are the 4 types of palpation?The front of your fingers are used to perform light palpation, deep palpation, light ballottement and deep ballottement.
What part of hands is used in palpating for tenderness and sensation?Pain/tenderness is best assessed while palpating with your fingertips in which your hand and wrist are kept parallel to the body so that the action does not involve poking or jabbing the client with your fingertips. Always assess a painful area last.
What method of assessment is used to detect areas of tenderness of the abdomen?Palpation is the examination of the abdomen for crepitus of the abdominal wall, for any abdominal tenderness, or for abdominal masses. The liver and kidneys may be palpable in normal individuals, but any other masses are abnormal.
Does palpation occur with tenderness?During palpation, tenderness should be noted, which may present as guarding.
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