Chapter 5 – Gastrointestinal System Assessment
Abdominal Assessment
Abdominal assessment involves inspection, auscultation, palpation, and percussion. This order of physical assessment is important to preserve normal bowel sounds when auscultating. For example, pressing on the abdomen can modify bowel sounds by increasing peristalsis (wave-like contractions of the intestines).
Before beginning, ask the client to empty their bladder and bowel so that fullness will not influence the findings.
This assessment is best accomplished in the supine position because this allows any air in the abdominal region to rise to the surface area. The client should lie flat with their head on a pillow. Some clients may find it difficult to lie completely flat; if so, you can slightly elevate the head of the bed (about 10 degrees). To ensure the abdominal musculature is relaxed, ask the client to have their arms resting beside their body and their knees bent with either their feet placed flat on the bed or a pillow placed under their knees. For a newborn or young child, you can ask someone (care partner, parent, healthcare provider) to hold them on their lap.
Always do the assessment on bare skin.
Contextualizing Inclusivity – Discomfort in Exposing Abdomen
Some clients are uncomfortable exposing their abdomen. For example, they may feel uncomfortable because of body image issues associated with weight, modesty related to cultural or religious beliefs, or a new ostomy such as a colostomy or an ileostomy. Ostomies are surgically created openings onto the abdomen that allow stool to bypass a damaged/diseased part of the intestine and leave the body.
It is important that you create an inclusive environment that is judgment free and recognizes the client’s potential discomfort. For example, you may begin the assessment with the following: “I need to assess your abdomen on the bare skin. Is that okay?” (wait for the client to give consent).
