Page 383 - Saunders Comprehensive Review For NCLEX-RN

endpiece of the stethoscope.
c. Examine painful areas last.

When performing an abdominal

assessment, the specific order for assessment
techniques is inspection, auscultation, percussion,
and palpation.
3. Inspection
a. Contour: Look down at the abdomen
and then across the abdomen from the
rib margin to the pubic bone; describe
as flat, rounded, concave, or
protuberant.
b. Symmetry: Note any bulging or masses.
c. Umbilicus: Should be midline and
inverted
d. Skin surface: Should be smooth and
even
e. Pulsations from the aorta may be noted
in the epigastric area, and peristaltic
waves may be noted across the
abdomen.
4. Auscultation
a. Performed before percussion and
palpation, which can increase
peristalsis.
b. Hold the stethoscope lightly against the
skin and listen for bowel sounds in all
4 quadrants; begin in the right lower
quadrant (bowel sounds are normally
heard here).
c. Note the character and frequency of
normal bowel sounds: high-pitched
gurgling sounds occurring irregularly
from 5 to 30 times a minute.
d. Identify as normal, hypoactive, or
hyperactive (borborygmus).
e. Absent sounds: Auscultate for 5
minutes before determining that
sounds are absent.
f. Auscultate over the aorta, renal arteries,
iliac arteries, and femoral arteries for
vascular sounds or bruits with the bell
of the stethoscope.
5. Percussion
a. All 4 quadrants are percussed lightly.
b. Borders of the liver and spleen are

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