College of Health Sciences Document Code CHS-NURS-NPC-068

Department of Nursing
PERFORMANCE EVALUATION Revision No. 0 Page 1 of 5
CHECKLIST ON THE ASSESSMENT OF Effectivity Date January 2021
THE ABDOMEN

Name: _____________________________________ Date Performed: _________

Year Level & Section: _________________________ Rating: _________________
Purpose: To evaluate the student’s performance on the use of correct techniques in
performing a thorough physical assessment and to differentiate normal from
abnormal findings of the abdomen.
Materials:
Small Pillow
Centimeter Ruler
Stethoscope with diaphragm and bell
Marking pen

STEPS RATING
1. Perform hand-washing.
2. Gather the materials needed.
3. Explain the procedure to the client.
4. Ask the client to put on a gown.
5. Inspect the skin, noting color, vascularity, striae, scars and lesions (wear gloves
to inspect lesions).
6. Inspect the umbilicus, noting color, location and contour.
7. Inspect the contour of the abdomen. Look across the abdomen at eye level
from the client’s side, from behind the clients head and from the foot of the
bed.
8. Inspect the symmetry of the abdomen. Look at the clients abdomen as she lies
in a relaxed supine position.
9. Inspect abdominal movement, noting respiratory movement, aortic pulsations,
and/or peristaltic waves.
10. Auscultate for bowel sounds, noting intensity, pitch and frequency. Use the
diaphragm of the stethoscope and make sure that it is warm before you place it
on the clients abdomen. Begin in the RLQ and proceed clockwise, covering all
quadrants. Conform bowel sounds in each quadrant. Listen up to 5 mins
(minimum of 1 minute) to confirm the absence of bowel sounds.
11. Auscultate for vascular sounds by using the bell of the stethoscope to listen for
bruits over the abdominal aorta and renal, iliac and femoral arteries.
   

College of Health Sciences Document Code CHS-NURS-NPC-068

Department of Nursing
PERFORMANCE EVALUATION Revision No. 0 Page 2 of 5
CHECKLIST ON THE ASSESSMENT OF Effectivity Date January 2021
THE ABDOMEN

12. Auscultate for friction rub over the liver and spleen. Listen over the right and
lower rib cage with the diaphragm of the stethoscope.
13. Percuss the abdomen for tone. Lightly and systematically percuss all quadrants.
Abdominal percussion may proceed clockwise or up and down over the
abdomen.
14. Percuss the span or height of liver by determining its lower and upper borders.
a. To assess the lower border, begin in the RLQ at the mid-clavicular
line and percuss upward. Note the change from tympany to
dullness. Mark this point: it is the lower border of the liver dullness.
To assess the decent of the liver, ask the client to take a deep breath
and hold; then repeat the procedure. Remind the client to exhale
after percussing.
b. To assess the upper border, percuss over the upper right chest at
the MCL and percuss downward, noting the change from lung
resonance to liver dullness. Mark this point: It is the upper border of
liver dullness.
c. Measure the distance between the two marks: this is the span of the
liver.
d. Repeat percussion of the liver at the midsternal line (MSL).
15. Percuss the spleen. Begin posterior to the left mid-axillary line (MAL), and
percuss downward, noting the change from lung resonance to splenic dullness.
A second method for detecting splenic enlargement is to percuss the last left inter-
space at the anterior axillary line (AAL) while the client takes a deep breath.
16. Perform blunt percussion on the liver and the kidneys. This is to assess for
tenderness in difficult-to-palpate structures. Percuss the liver by placing your
left hand flat against the lower right anterior rib cage. Use the ulnar side of your
right fist to strike your left hand.
Perform blunt percussion on the kidneys at the costovertebral angles (CVA) over
the twelfth rib.
17. Perform light palpation, noting tenderness or guarding in all quadrants. Light
palpation is used to identify areas of tenderness and muscular resistance. Using
the fingertips, begin palpation in a nontender quadrant, and compress to a
depth of 1 cm in a dipping motion. Then gently lift the fingers and move to the
next area. To minimize the client’s voluntary guarding (a tensing or rigidity of
the abdominal muscles usually involving the entire abdomen). Keep in mind
that the rectus abdominis muscle relaxes on expiration
   

College of Health Sciences Document Code CHS-NURS-NPC-068

Department of Nursing
PERFORMANCE EVALUATION Revision No. 0 Page 3 of 5
CHECKLIST ON THE ASSESSMENT OF Effectivity Date January 2021
THE ABDOMEN

18. Deeply palpate all quadrants to delineate abdominal organs and detect subtle
masses. Using the palmar surface of the fingers, compress to a maximum depth
(5–6 cm). Perform bimanual palpation if you encounter resistance or to assess
deeper structures.
19. Palpate for masses. Note their location, size (cm), shape, consistency,
demarcation, pulsatility, tenderness, and mobility. Do not confuse a mass with
an organ or structure.
20. Palpate the umbilicus and surrounding area for swelling, bulges or masses.
21. Palpate the aorta. Use your thumb and first finger or use two hands and palpate
deeply in the epigastrium, slightly to the left of midline. Assess the pulsation of
the abdominal aorta.
22. Palpate the liver, noting consistency and tenderness. To palpate bimanually,
stand at the client’s right side and place your left hand under the client’s back
at the level of the eleventh to twelfth ribs. Lay your right hand parallel to the
right costal margin (your fingertips should point toward the client’s head). Ask
the client to inhale, then compress upward and inward with your fingers.
To palpate by hooking, stand to the right of the client’s chest. Curl (hook) the
fingers of both hands over the edge of the right costal margin. Ask the client to take
a deep breath and gently but firmly pull inward and upward with your fingers
23. Palpate the spleen, noting consistency and tenderness. Stand at the client’s
right side, reach over the abdomen with your left arm, and place your hand
under the posterior lower ribs. Pull up gently. Place your right hand below the
left costal margin with the fingers pointing toward the client’s head. Ask the
client to inhale and press inward and upward as you pro- vide support with your
other hand.
Alternatively, asking the client to turn onto the right side may facilitate splenic
palpation by moving the spleen downward and forward. Document the size of the
spleen in centimeters below the left costal margin. Also note consistency and
tenderness.
24. Palpate the kidneys. To palpate the right kidney, support the right posterior
flank with your left hand and place your right hand in the RUQ just below the
costal margin at the MCL.
To capture the kidney, ask the client to inhale. Then compress your fingers deeply
during peak inspiration. Ask the client to exhale and hold the breath briefly.
Gradually release the pressure of your right hand. If you have captured the kidney,
you will feel it slip beneath your fingers. To palpate the left kidney, reverse the
   

College of Health Sciences Document Code CHS-NURS-NPC-068

Department of Nursing
PERFORMANCE EVALUATION Revision No. 0 Page 4 of 5
CHECKLIST ON THE ASSESSMENT OF Effectivity Date January 2021
THE ABDOMEN

procedure.
25. Palpate the urinary bladder. Palpate for a distended bladder when the client’s
history or other findings warrant (e.g., dull percussion noted over the symphysis
pubis). Begin at the symphysis pubis and move upward and outward to
estimate bladder borders.
Special Abdominal Test
Test for Ascites
26. Perform the test for shifting dullness. The client should remain supine. Percuss
the flanks from the bed upward toward the umbilicus. Note the change from
dullness to tympany and mark this point. Now help the client turn onto the
side. Percuss the abdomen from the bed upward. Mark the level where dullness
changes to tympany.
27. Perform the fluid wave test. The client should remain supine. You will need
assistance with this test. Ask the client or an assistant to place the ulnar side of
the hand and the lateral side of the forearm firmly along the midline of the
abdomen. Firmly place the palmar surface of your fingers and hand against one
side of the client’s abdomen. Use your other hand to tap the opposite side of
the abdominal wall.
28. Perform the ballottement test.
Single-Hand Method – using a tapping or bouncing motion of the finger pads over
the abdominal wall, feel for a floating mass.
Bimanual Method – place one hand under the flank (receiving/feeling hand) and
push the anterior abdominal wall with the other hand.
29. Perform the test for appendicitis:
a. Rebound tenderness and Rovsing sign.
Palpate deeply in the abdomen where the client has pain then suddenly release
pressure. Listen and watch for the clients expression of pain. Ask the client to
describe which hurt more – the pressing in or the releasing – and where on the
abdomen the pain occurred.
b. Referred rebound tenderness.
Palpate deeply in the LLQ and quickly release pressure.
c. Psoas sign.
Raise the client’s right leg from the hip and place your hand on the lower thigh. Ask
the client to try to keep the leg elevated as you apply pressure downward against
   

College of Health Sciences Document Code CHS-NURS-NPC-068

Department of Nursing
PERFORMANCE EVALUATION Revision No. 0 Page 5 of 5
CHECKLIST ON THE ASSESSMENT OF Effectivity Date January 2021
THE ABDOMEN

the lower thigh.

d. Obturator sign.
Support the client’s right knee and ankle. Flex the hip and knee, and rotate the leg
internally and externally
e. Hypersensitivity test.
Stroke the abdomen with a sharp object (e.g., broken cotton tipped applicator or
tongue blade) or grasp a fold of skin with your thumb and index finger and quickly
let go. Do this several times along the abdominal wall
30. Perform the test for cholecystitis (Murphy’s sign):
Assess RUQ pain or tenderness, which may signal cholecystitis (inflammation of
the gall- bladder). Press your fingertips under the liver border at the right costal
margin and ask the client to inhale deeply.
31. Perform hand hygiene.
32. Validate and document findings.

TOTAL

Rating
Rating Scale:
Scale:
5-
5- Outstanding
Outstanding
4-
4- Very
Very Satisfactory
Satisfactory
3- Satisfactory
3- Satisfactory
2-Needs
2-Needs Improvement
Improvement
11 -- Not
Not Observed
Observed

Clinical Instructor