(1) To ensure accurate abdominal assessment and consistent documentation
of your findings, mentally divide the patient's abdomen into four quadrants (figure 6-8).
Begin by inspecting the patient's entire abdomen, noting overall contour (flat, round,
concave, protruding), skin integrity, appearance of the umbilicus, and any visible
pulsations. Note any localized distention or irregular contours, rashes, dilated veins, and
Figure 6-8. Abdominal regions.
(2) After inspecting the patient's abdomen, use a stethoscope to auscultate for
bowel and vascular sounds. Lightly press the stethoscope diaphragm on the abdominal
skin in all four quadrants. The bowel may be active, hyperactive, or hypoactive. Normally,
air and fluid moving through the bowel by peristalsis create soft, bubbling sounds, mixed
with clicks and gurgles, every 5 to 20 seconds. Loud, gurgling irregular sounds heard
about every three seconds are hyperactive and may occur normally in a hungry person.
Following, or when the colon is filled with feces, hypoactive bowel sounds may occur at a
rate of one every minute or longer. Abdominal auscultation should be performed before
percussion and palpation, because intestinal activity and bowel sounds may be altered by
the motion of percussion and palpation.
(3) Palpation elicits useful clues about the character of the abdominal wall; the
size, condition, and consistency of abdominal organs; the presence and nature of
abdominal masses; and the presence, degree, and location of any abdominal pain. Gently
press your fingertips about inch into the abdominal wall. Move your hands in a slightly
circular fashion so that the abdominal wall moves over the underlying structures. Note the
character of the abdomen (soft, rigid, firm, tender, or nontender). Assess for organ
location, masses, and areas of tenderness or increased muscle resistance. If you detect a
mass, note its location, size, shape, degree of tenderness and mobility, and the presence
of pulsations. When assessing a patient with abdominal pain, always auscultate and
palpate in the painful quadrant last, touching the painful area may cause the patient to
tense the abdominal muscles, making further assessment difficult.