Comprehensive Abdominal Assessment
Comprehensive Abdominal Assessment
Healthcare professionals are trained to perform an effective comprehensive patient assessment, including an abdominal one, to facilitate the detection of anomalies. They must be careful and adopt appropriate communication techniques while completing any form of physical examination. Communication challenges are likely to arise if professionals are insensitive to surrounding factors that hamper therapeutic communication. As such, it is appropriate to investigate details of the latter during an abdominal assessment, abdominal evaluation techniques, and special considerations in assessing patients with abdominal pain. Additionally, it is appropriate to identify how critical thinking can facilitate the process and reflect on personal experience of performing it. An efficiently conducted comprehensive abdominal exam is very important because it can lead to the detection and diagnosis of underlying patient problems causing discomfort, enabling to instigate necessary precautions amongst other interventions.
Communication in an Abdominal Assessment
It is vital for nurses to develop a therapeutic communication strategy whenever preparing to perform an abdominal assessment. According to Kourkouta and Papathanasiou (2014), they should create a healthy relationship with the patient at the initial contact stages to facilitate therapeutic communication. It is a recommended communication technique for nurses to ensure that they portray a high level of frankness and honesty in their interaction with clients (Kourkouta & Papathanasiou, 2014). The former should provide all appropriate information with essential details. For example, an incomplete explanation to patients during an abdominal assessment may result in them being suspicious. Hence, it may jeopardize the whole communication process, as the client may not disclose all necessary details.
Additionally, nurses must adopt a bidirectional communication technique, where both the patient and the nurse engage in a meaningful two-way conversation. For example, the latter must enable the former to express themselves with minimal interference unless when asking them to expound. Moreover, nurses must ensure that the timing of the conversation is appropriate. For instance, approaching patients when they are in severe pain may result in them concealing information, and they may even become aggressive if the nurse insists on going on with the abdominal exam. As such, nurses must ensure that patients are comfortable with the whole process before engaging in any discussion or performing an abdominal assessment.
Challenges in communication may occur when there is a language barrier between the provider and the patient. For example, a nurse not familiar with the Spanish language may find it difficult to communicate with an elderly Hispanic patient who lacks English proficiency. An additional challenge may arise because of the use of medical jargon while interacting with clients. For instance, a patient may fail to understand some terminology, such as auscultation and percussion, unless explained in laymans terms. Moreover, communication challenges may also arise if there are numerous distracters within the environment (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 2016). For instance, cries from other patients and beeping sounds from machines in the emergency department may make it difficult for patients to communicate as they may be disrupted by the constant noise.
Abdominal Assessment Techniques
An abdominal physical exam is done systematically using four basic techniques, including inspection, auscultation, percussion, and palpation in this respective order. According to Reuben (2016), auscultation is usually done before percussion to avoid interfering with bowel movements, which may be disrupted during percussion or palpation.
A nurse should inspect all four quadrants of the stomach with the patient being supine. According to Macaluso and McNamara (2012), the technique is essential for identifying any skin changes, surgical scars, and diagnostic signs, including Cullens sign, which if detected can suggest intra-peritoneal bleeding. Inspection can also be utilized to assess any distension, abnormal masses, hernias protrusion, ascites, and abnormal visible pulsations.
As highlighted above, inspection is followed immediately by auscultation in an abdominal assessment. The technique is majorly used to detect the presence or absence of bowel movements. Nurses should consider starting auscultation at the right lower quadrant as it is the most likely location to check bowel sounds easily (Jarvis, 2016). Healthcare professionals should note the frequency, duration, and quality of the latter and make inference as to whether they are normal, hypoactive, or hyperactive. Bowel hyperactivity may be an indication of late obstruction, paralytic ileus disease, or even peritonitis (Reuben, 2016). Hypoactive sounds may point to laxative use, anxiety, inflammatory bowel disease, and early stages of intestinal obstruction (Reuben, 2016). Additionally, Reuben (2016) highlights that clinicians may press firmly with the stethoscope while pretending to be listening to bowel sounds to establish whether the patient has abdominal tenderness or it is just a case of hysteria. Auscultation can also be done along gastric blood vessels to detect any bruits, which may indicate vascular stenosis.
Percussion is the third technique in an abdominal assessment. When performing it, nurses should anticipate for general tympanic and dull sounds over such solid organs as the liver and the spleen, which will enable them to determine the size of the latter and pick out any abnormal masses (Reuben, 2016). Tympany should be the primary abdominal sound as dullness can indicate of either air or fluid-filled abdomen, which needs to be distinguished by a fluid-wave test.
Finally, nurses utilize the technique of palpation to estimate the organ size and detect any abnormal tenderness. According to Reuben (2016), each of the four abdominal quadrants should be palpated both lightly and deeply as permitted by the level of tenderness. Usually, the palpation of the abdomen should not have any tenderness. However, in case of pain, the nurse should begin with less tender regions and finish with areas with the highest tenderness level instead of being systematic. Additionally, the one should perform a thorough assessment, determine whether pain is referred, generalized or localized, and try to establish the cause of the problem. For example, the nurse should perform muscle tests, such as an iliopsoas muscle one, to exam whether the pain is acute and reported around McBurneys point to rule out or confirm appendicitis (Petroianu, 2012). Additionally, in case of an emergency where patients report acute tenderness, nurses may forgo all other assessment techniques to perform muscle tests first.
Critical Thinking in an Abdominal Assessment
Critical thinking is an integral component of a physical assessment. All nurses should apply it to assess and diagnose patient issues and take appropriate interventions that can promote positive patient care outcomes (Bittencourt & Crossetti, 2012). For example, if a novice nurse identifies through inspection that the patient may have peritoneal bleeding, the one should apply critical thinking and take precautionary measures instead of proceeding to complete the assessment and intervene later. As such, Papathanasiou, Kleisiaris, Fradelos, Kakou, and Kourkouta (2014) indicate that critical thinking skills enable nurses to apply nursing knowledge appropriately to offer safe and efficient services to patients. Thus, novice nurses should use critical thinking at all times to ensure that they can intervene appropriately to identify issues while performing an abdominal assessment.
Personal Reflection on Performing an Abdominal Assessment
There is nothing better than performing an abdominal assessment and managing to determine an underlying disorder successfully. Personal experience at the emergency department completely changed assessment skills after identifying positive Cullens signs and diagnosing a patient with intra-abdominal bleeding. This case challenged the personal assessment technique making utilize inspection skills always as previously inspection has not been considered so seriously. The reason is that other techniques have been personally treated more superior in diagnosing patient problems, but this approach has proven wrong in this experience.
It is apparent that a thoroughly undertaken abdominal assessment can lead to the detection and diagnosis of underlying patient problems causing discomfort, enabling to instigate necessary precautions amongst other interventions. Nurses should always utilize therapeutic communication methods with their clients before proceeding to use all four essential skills of a physical examination to detect any ailment. Additionally, they should be guided by critical thinking to intervene appropriately whenever a problem is noted.