Pediatric Abdominal Pediatric Abdominal AssessmentAssessment

Hind Al-SuwaisHind Al-SuwaisNursing internNursing intern

PICUPICU

ObjectivesObjectives At the end of this presentation I At the end of this presentation I

hope you will be able tohope you will be able to::• remember the anatomy of the abdomen and its remember the anatomy of the abdomen and its

contentscontents• Understand why the 4 basic physical

assessment skills are scrambled up for abdominal examination.

• Modify physical assessment techniques Modify physical assessment techniques according to the age and developmental stage according to the age and developmental stage

of the child.of the child. • Identify and implement nursing interventions based on the assessment and triage provided

History

Bio-graphic Demographic

• Name, Age • Parents &

siblings info• Cultural practices

Past Medical History•Allergies•Past illness•Trauma / hospitalizations•Surgeries•Birth history•Developmental•Family Medical/Genetics

Current Health Status•Immunization Status

•Chronic illnesses or conditions•What concerns do you have today?

Review of Systems

• Measurements: weight, height, head circumference, growth chart, BMI

• Nutrition: breastfed, formula, favorite foods, beverages, eating habits

• Growth and Development: Milestones for each age group

Physical Physical AssessmentAssessment

• Four Basic Skills:

1.1. IInspection2.2. PPalpation

3.3. PPercussion4.4. AAuscultation

• Sequence for abdominal: 1.inspection, 2.auscultation,

3.percussion, 4.palpation

Abdominal AssessmentAbdominal Assessment

Gastro-Intestinal

Internal Internal anatomyanatomy

The location of underlying organs and structures of the abdomen must be considered when the abdomen is examined. The abdomen is commonly divided by imaginary lines into quadrants for the purpose of identifying underlying structures

• AppetiteAppetite• DysphagiaDysphagia• Food Food

intoleranceintolerance• Abdominal pain Abdominal pain • Nausea/Nausea/

vomitingvomiting

• Bowel habitsBowel habits• Past abdominal Past abdominal

surgery surgery • MedicationMedication• Nutrition Nutrition

assessmentassessment

Before we start the physical Before we start the physical assessment…….assessment…….

• Perform hand hygiene.• Identify the child using two patient

identification.• Checked the vital signs.

• Begin the examination of the Begin the examination of the abdomen by inspecting the abdomen by inspecting the

• shape and contour.shape and contour.• condition of the umbilicus (hygiene condition of the umbilicus (hygiene

and abnormalities)and abnormalities)• rectus muscle.rectus muscle.• Abdominal movementAbdominal movement

Inspection of the Inspection of the abdomenabdomen

• Auscultate the abdomen with the Auscultate the abdomen with the diaphragm of the stethoscope. diaphragm of the stethoscope.

• Bowel sounds normally occur every Bowel sounds normally occur every 10 to 30 seconds. Loud gurgling is 10 to 30 seconds. Loud gurgling is heard when the child is hungry. heard when the child is hungry.

• Listen in each quadrant long enough Listen in each quadrant long enough to hear at least one bowel sound. to hear at least one bowel sound. Before determining that bowel Before determining that bowel sounds are absent. sounds are absent.

Auscultation of the Auscultation of the abdomenabdomen

Auscultation of the Auscultation of the abdomen continues:abdomen continues:

• Absence of bowel sounds may Absence of bowel sounds may indicate peritonitis or a indicate peritonitis or a paralytic ileus.paralytic ileus.

• Hyperactive bowel sounds Hyperactive bowel sounds may indicate gastroenteritis or may indicate gastroenteritis or a bowel obstruction.a bowel obstruction.

• Use percussion to evaluate borders and sizes Use percussion to evaluate borders and sizes of abdominal organs and masses. Percussion of abdominal organs and masses. Percussion is performed with the child supine.is performed with the child supine.

• Different tones are expected when the Different tones are expected when the abdomen is percussed. abdomen is percussed.

• Dullness is found over the liverDullness is found over the liver

spleen, and full bladder.spleen, and full bladder.• Tympany is found over the Tympany is found over the

stomach or the intestines stomach or the intestines

when an obstruction is present. when an obstruction is present.

Percussion of the Percussion of the abdomenabdomen

• Both light and deep palpation are used Both light and deep palpation are used to examine the abdomen’s organs and to examine the abdomen’s organs and to detect any masses.to detect any masses.

Palpation of the Palpation of the abdomenabdomen

Palpation of the abdomen Palpation of the abdomen cont.cont.

Light Palpation:Light Palpation:• use a superficial, gentle touch that use a superficial, gentle touch that

slightly depresses the abdomen slightly depresses the abdomen approximately 1 cm. Usually the approximately 1 cm. Usually the abdomen feels soft and no abdomen feels soft and no tenderness is detected. tenderness is detected.

• Palpate any bulging along the Palpate any bulging along the abdominal wall, especially along the abdominal wall, especially along the rectus muscle and umbilical ring, rectus muscle and umbilical ring, which could indicate a hernia.which could indicate a hernia.

Palpation of the abdomen Palpation of the abdomen cont.cont.

Deep Palpation:Deep Palpation:• Press the fingers of one hand (for Press the fingers of one hand (for

small children) or two hands (for small children) or two hands (for older children) more deeply into the older children) more deeply into the abdomen 1 to 2 cm. abdomen 1 to 2 cm.

• Because the abdominal muscles are Because the abdominal muscles are most relaxed when the child takes a most relaxed when the child takes a deep breath, ask the child to take deep breath, ask the child to take regular deep breaths when palpating regular deep breaths when palpating each area of the abdomen.each area of the abdomen.

Please remember to:Please remember to:

• Jan Chandler RN, MSN, CNS, PNP Pediatric Nursing: Nursing Care of Children and Young Adults: Pediatric Physical Assessment

• Duderstadt, K. Pediatric Physical Examination. St. Louis, MO: Mosby, Inc.• Jarvis, C. (1992). Physical examination and health assessment. (5th Ed.). Jarvis, C. (1992). Physical examination and health assessment. (5th Ed.).

Philadelphia: W.B. Saunders Company.Philadelphia: W.B. Saunders Company.• Engel, J. Pediatric Assessment 5th. Ed. St. Louis, MO: Mosby, Inc.• Wong’s Essentials of Pediatric Nursing 8th ed.• The Auscultation Assistant @ http://www.wilkes.med.ucla.edu/intro.html• BMI Calculator: http://www.cdc.gov/nccdphp/dnpa/bmi /

Resources and ReferencesResources and References

…….me…..me….Hind Al-SuwaisHind Al-Suwais