Physical Assessment (Clinical)
Abdomen Physical Assessment
Student’s Name:_________________
ID # : _________________________
No
Procedure Steps
A
B
C.
1.
2.
3.
4.
5.
10.
1
2
11.
Date : ____________
Yes
No
Comments
History Taking :
a) Current Symptoms
5.2
b) Past History
5.2
c) Family History
5.2
d) Lifestyle and Health Practices
Preparation
5.2
a) Gather equipment (stetheoscope)
5.1
b) Provide comfortable environment
5.2
c) Explain procedure to client.
5.2
d) Wash Hands
5.2
e) Provide privacy
Procedure
Inspection of the abdomen
5.2
1. Stand on the right side of the patient
a) Inspect the skin for scars, striae, dilated veins,
rashes and lesions.
b) The umbilicus for contour, location any signs of
inflammation or hernia.
c) The contour of the abdomen; flat, protuberant or
scaphoid. Symmetry, bulging flanks, visible organs or
masses.
d) Peristalsis : may be visible normally in very thin
people
e) Pulsations: The normal aortic pulsation is
frequently visible in the epigastrium.
Liver Percussion
5.2
Measuring the vertical span of the liver in the right
midclavicular line.
a) Start at a level below the umbilicus at area of
tympany.
b) lightly percuss upward toward the liver.
5.2
c) Ascertain the lower border of liver dullness in the
midclavicular line.
d) Identify the upper border of liver dullness by lightly
percusing from lung resonance down toward liver
dullness.
e) Measure in centimeters the distance between the
two points. ( 6-12cm).
Measuring the vertical span in the midsternal line
5.2
a) Start percussing at an area of tympany
5.2
b) Lightly Percuss upward toward the liver
5.2
c) Identify the upper border of the liver dullness by
percussing from the xyphoid flatness down toward
liver dullness.
d) measure in centimeters the distance between the
two points .( 4-8cm)
Palpating the Liver ( Hooking Technique)
5.2
23
5.2
5.2
5.2
5.2
5.2
5.2
5.2
5.2
5.2
5.2
5.2
a) Stand to the right of the patient’s chest.
5.2
b) Place both hands side by side on the right
abdomen below the border of the liver dullness.
c) Press in with fingers and up toward the costal
margin.
d) Ask the patient to take a deep breath.
To assess possible acute cholecystitis ( Murphy’s
Sign )
a) Hook the left thumb or the fingers of the right hand
under the costal margin at the point where the lateral
border of the rectus muscle intersects with the costal
margin.
b) Ask the patient to take a deep breath
5.2
5.2
12.
c) Watch the patient’s breathing and note the degree
of tenderness.
Assessing Kidney Tenderness
5.2
13.
a) Palpate by the fingertips in each costovertebral
angel.
b) If no tenderness in (a), place the ball of one hand in
the costovertebral angle and strike it with the ulnar
surface of the fist.
Ascites
13.1
Mapping for ascites
12.
5.2
5.2
5.2
5.2
5.2
a) With the patient supine
5.2
b) Percuss outward in several directions from the
central area of tympany
c) map the border between tympany and dullness
Test for shifting dullness (after mapping)
5.2
a) ask the patient to turn onto one side
5.2
5.2
13.3
b) Percuss and mark the borders of tympany and
dullness again
Test for a fluid wave
5.2
14.
a) Ask the patient or an assistant to press the edges
of both hands firmly down the midline of the abdomen
b) Tap sharply on the flank with the fingertips, feel on
the opposite flank for an impulse transmitted through
the fluid.
Assess for Possible Appendicitis
Rebound tenderness
5.2
a) Press deeply and evenly in the right lower quadrant
5.2
b) Quickly withdraw the fingers
5.2
c) Ask the patient when pain is felt more.
Rovsing’s sign and referred rebound tenderness
5.2
a) Press deeply and evenly in the left lower quadrant
5.2
b) quickly withdraw the fingers
Psoas Sign
5.2
13.2
14.1
14.2
14.3
5.2
5.2
5.2
5.2
5.2
a) Place hand just above the patient’s right knee
14.4
b) Ask the patient to raise that thigh against hand
5.2
c) Ask the patient to turn onto the left side
5.2
d) extend the patient’s right leg at the hip
Obturator Sign
5.2
24
5.2
14.5
a) Flex the patient’s right thigh at the hip, with the
knee bent.
b) Rotate the leg internally at the hip by stabilizing the
thigh with one hand and grasping the ankle with the
other and swing the lower leg laterally.
Cutaneous hyperesthesia
5.2
D
At a series of points down the abdominal wall, gently
pick up a fold of skin between thumb and index finger,
without pinching it.
Procedure Termination
5.2
16.
a) Put client in comfortable position according to
health status
b) Provide patient with reassurance
17.
c) Return back equipments
5.2
18.
d) Wash hands
5.2
15.
25
5.2
5.2