Abdominal assessment nursing: a step-by-step guide

Abdominal assessment is a core nursing skill performed on admission, at every shift change, and whenever a patient reports new or worsening GI symptoms. The abdomen houses a dense cluster of digestive, urinary, and vascular structures, and changes can signal everything from a benign gas pocket to a surgical emergency. Catching those changes early — before the patient decompensates — depends on a consistent, systematic technique.

Abdominal assessment is part of every head-to-toe assessment and is the primary physical examination tool for detecting bowel obstruction, appendicitis, peritonitis, cholecystitis, ascites, organomegaly, and internal bleeding. This guide covers the complete procedure — from patient preparation through special maneuvers — with documentation language examples and high-yield NCLEX scenarios.

The IAPP sequence — and why the order matters

For most body systems, physical examination follows the sequence Inspection → Palpation → Percussion → Auscultation (IPPA). Abdominal assessment uses a different order: Inspection → Auscultation → Percussion → Palpation (IAPP).

The reason is mechanical, not arbitrary. Palpation and percussion stimulate the bowel wall directly. Even light palpation can increase peristaltic activity, artificially alter bowel sound frequency, and change the character of sounds produced. If you auscultate after palpating, you are no longer hearing the bowel’s baseline state — you are hearing a bowel you have already disturbed.

Auscultating before any mechanical stimulus gives you an accurate baseline. Percussion comes next because it is less stimulating than deep palpation. Palpation — particularly deep palpation — is performed last, after all acoustic and visual data have been gathered.

This sequence is not merely convention. Bates’ Guide to Physical Examination and History Taking (13th ed.) and Jarvis’ Physical Examination and Health Assessment (8th ed.) both specify IAPP as the correct abdominal examination order, and NCLEX questions test this reasoning directly. If you are asked why auscultation precedes palpation, the answer is: to prevent artificially altering bowel sounds before they are assessed.

Before you begin

Bladder: Ask the patient to empty their bladder before the assessment. A full bladder displaces abdominal structures, is uncomfortable during palpation, and can be misidentified as a mass.

Positioning: Place the patient supine with a pillow under the head and a pillow or rolled blanket under the knees. Slight knee flexion relaxes the abdominal wall musculature and significantly reduces guarding, making palpation findings more reliable.

Hands and equipment: Warm your hands by rubbing them together. Warm your stethoscope diaphragm the same way. Cold contact causes involuntary abdominal guarding that obscures true findings. Equipment needed: stethoscope (diaphragm and bell), a tape measure if measuring abdominal girth, and a single sheet or light drape for dignity.

Environment: The room should be quiet and warm. Ensure adequate lighting for inspection — ideally from the side (tangential lighting) to highlight subtle contour changes and visible peristalsis.

Baseline question: Before starting, ask the patient to point with one finger to the area of greatest pain or discomfort. Begin your assessment away from that area and approach it last. Starting at the painful site causes guarding throughout the rest of the examination.

Abdominal landmarks

The four-quadrant system

The abdomen is divided into four quadrants by a vertical line (midline/linea alba) and a horizontal line through the umbilicus. Quadrant names are referenced from the patient’s perspective.

Note: The bladder and uterus occupy the midline of the lower abdomen.

The nine-region system

For more precise documentation (common in specialist and surgical settings), the abdomen is divided into nine regions using two horizontal and two vertical planes:

In practice, the four-quadrant system is used for bedside reporting and nursing documentation. The nine-region system is more common in radiology and surgical operative reports.

Step-by-step IAPP procedure

Step 1: Inspection

Inspect the abdomen with the patient supine, well-lit from the side. Stand at the patient’s right side and look across the abdomen at a low angle — tangential lighting reveals subtle contour changes and visible peristalsis that straight-on viewing misses.

Contour

Normal adult contours range from flat (typical in muscular patients) to slightly rounded. Clinically significant contours:

• Scaphoid (concave): sunken abdomen; seen with severe weight loss, dehydration, or cachexia
• Rounded/protuberant: soft, generalized fullness; normal variation in older adults and patients with obesity
• Distended: taut, drum-like fullness; pathological — suggests gas, fluid (ascites), obstruction, or organomegaly
• Asymmetric distension: one quadrant more prominent than others; may suggest organomegaly, tumor, or localized ileus

When distension is present, note whether it is generalized or localized, and whether it is tympanitic (gas) or dull (fluid). The fluid wave test (described under Percussion) helps distinguish them.

Skin surface findings

• Striae (stretch marks): silver-white = old; pink-purple = recent (new weight gain, ascites, Cushing’s syndrome — fresh striae in Cushing’s are typically wide and purple)
• Scars: document location, approximate length, and whether they are surgical or traumatic. Note any dehiscence or hernia bulging at scar sites.
• Caput medusae: dilated periumbilical veins radiating outward from the umbilicus — a sign of portal hypertension causing collateral venous drainage
• Cullen’s sign: periumbilical bruising/ecchymosis; indicates retroperitoneal hemorrhage, most commonly hemorrhagic pancreatitis or ruptured ectopic pregnancy
• Grey Turner’s sign: flank ecchymosis (bruising over the flanks/lateral abdomen); same cause as Cullen’s sign — retroperitoneal bleeding. Neither sign appears immediately after bleeding begins; they typically develop 24–48 hours after hemorrhage onset.
• Jaundice: yellow tinge to the skin; hepatic or biliary obstruction

Umbilicus

Normally midline, inverted, and without surrounding inflammation. An everted (outward-pointing) umbilicus suggests increased intra-abdominal pressure — ascites, pregnancy, or large tumor. Periumbilical erythema or discharge warrants investigation for infection or hernia strangulation.

Visible peristalsis

Intestinal peristaltic waves are occasionally visible in very thin patients and are not necessarily abnormal. In average-sized patients, visible peristalsis — waves of movement tracking across the abdomen — suggests bowel obstruction: the bowel proximal to the obstruction contracts forcefully and visibly as it attempts to push contents past the blockage.

Visible pulsations

An epigastric pulsation is often visible in thin patients and reflects normal aortic pulsation. A large, laterally expanding pulsation in the epigastric/periumbilical area in an older adult raises concern for abdominal aortic aneurysm (AAA) and should be documented and escalated — do not perform deep palpation over suspected AAA.

Step 2: Auscultation

Use the diaphragm of the stethoscope for bowel sounds (high-frequency). Use the bell for low-pitched vascular sounds. Place the diaphragm gently — pressing too hard muffles the sounds you are trying to detect.

Bowel sounds

Begin in the right lower quadrant at the ileocecal valve — this is the most active area and the best starting point. Then systematically assess all four quadrants: RLQ → RUQ → LUQ → LLQ (or the reverse; consistency matters more than direction).

Listen for a minimum of 60 seconds per quadrant before declaring sounds absent. Bowel sounds can be irregular and intermittent; premature declaration of absence is a common error. To declare sounds truly absent, most clinical guidelines require listening for 3–5 minutes total.

Normal bowel sound frequency is 5–34 sounds per minute across all four quadrants combined, though standards vary slightly by source. Character is more clinically informative than frequency alone.

In bowel obstruction, bowel sounds evolve: early obstruction produces hyperactive, high-pitched tinkling sounds as the bowel fights against the blockage. Late obstruction produces absent or hypoactive sounds as the bowel exhausts itself. This progression is clinically important and frequently tested on NCLEX.

Vascular sounds

Switch to the bell of the stethoscope. Listen over the aorta (midline, above the umbilicus), renal arteries (2–3 cm above and lateral to the umbilicus bilaterally), iliac arteries (lower quadrants), and femoral arteries (inguinal region).

A bruit — a blowing or swooshing sound caused by turbulent blood flow — is abnormal. Renal artery bruits suggest renal artery stenosis (a common cause of secondary hypertension). Aortic bruits suggest aortic stenosis or, in an older patient with abdominal pain, raise concern for AAA. Femoral bruits are associated with peripheral arterial disease (PAD).

Step 3: Percussion

Percussion uses tapping to detect the density of underlying structures. The standard technique: place the middle finger of your non-dominant hand flat against the abdominal wall and strike its middle phalanx sharply with the tip of the middle finger of your dominant hand. Use a quick, snapping wrist motion and strike with the same force at each location.

Systematically percuss all four quadrants. The two most common sounds:

Liver span assessment

Liver size is estimated by percussing from above (the chest) downward in the right midclavicular line (MCL) until the resonant lung percussion note transitions to dullness — this marks the superior liver border. Then percuss from below (the iliac crest) upward in the same line until tympany (bowel) transitions to dullness — this marks the inferior liver border. The distance between the two marks is the liver span.

• Normal adult liver span at the MCL: 6–12 cm
• Span >12 cm = hepatomegaly (cirrhosis, hepatitis, heart failure, malignancy)
• Span <6 cm = hepatic atrophy or ptosis (liver displaced downward; reassess at the anterior axillary line)

Spleen assessment

Percuss the left lower chest wall (posterior axillary line, 9th–11th intercostal space) — the Traube’s space. This area is normally tympanitic because the stomach lies beneath. If percussion over Traube’s space is dull, suspect splenomegaly. Confirm with palpation.

Shifting dullness — testing for ascites

With the patient supine, percuss from the umbilicus outward toward the patient’s right flank. When dullness is reached (fluid settles by gravity to the dependent side), mark the spot. Then ask the patient to roll toward their right side. Wait 30–60 seconds (fluid needs time to shift), then percuss again at the same location. If the note changes from dull to tympanitic, ascitic fluid has shifted — this is a positive shifting dullness test, suggesting ascites.

Fluid wave test — confirming ascites

Have an assistant (or ask the patient) place the ulnar edge of one hand firmly along the patient’s midline abdomen (this blocks transmission through subcutaneous fat). Place your left hand on one flank and sharply tap the opposite flank with the fingertips of your right hand. A palpable fluid wave transmitted to your left hand is a positive test — strongly suggestive of ascites. This test is more specific than shifting dullness but requires a moderate-to-large volume of fluid to be positive.

When ascites is confirmed or suspected, measure and document abdominal girth: use a tape measure at the level of the umbilicus, mark the measurement points on the patient’s skin, and record the same reference points each time for consistent trend monitoring.

Step 4: Palpation

Palpation is performed in two phases. Always warm your hands first. Avoid sudden movements — approach the abdomen slowly. Watch the patient’s face throughout; an expression change can signal tenderness before the patient verbalizes it.

Light palpation — 1 cm depth

Use the pads of all four fingers held together. Apply light, circular pressure 1 cm into the abdominal wall. Work systematically through all four quadrants, beginning away from any reported pain site.

Assess for:

• Superficial tenderness: pain with light touch — suggests peritoneal irritation or superficial pathology
• Voluntary guarding: patient consciously tenses the abdominal muscles when you approach — a protective response
• Involuntary guarding (rigidity): constant board-like muscle contraction regardless of approach — a sign of peritoneal irritation or peritonitis. This cannot be relaxed voluntarily and is a serious finding.
• Skin temperature: warm or hot skin over an inflamed area
• Masses near the surface: obvious superficial masses

Deep palpation — 4–5 cm depth

Progress from light to deep palpation only if light palpation has not produced significant pain. Use both hands: dominant hand presses downward, non-dominant hand rests on top to add controlled pressure. This technique provides better depth control and tactile sensitivity than single-handed deep palpation.

Assess for:

• Deep tenderness: pain elicited at 4–5 cm depth — common with organomegaly, deep masses, or mesenteric pathology
• Organomegaly: palpable liver or spleen edges below their normal borders
• Masses: note location, size, shape, consistency (soft/firm/hard), mobility (mobile vs fixed), and whether pulsatile
• Pulsatile mass: a midline mass that expands laterally with each heartbeat — concerning for AAA. Do not apply further pressure; escalate.

Liver palpation

Place your right hand flat in the RLQ, fingers pointing toward the patient’s head, parallel to the right MCL. Press inward and upward as the patient inhales deeply. The diaphragm pushes the liver down on inspiration; if the liver edge is palpable, you will feel it meet your fingertips. A normal liver edge, if palpable, is soft, smooth, and non-tender. A hard, irregular, or nodular edge suggests cirrhosis or malignancy. Tenderness on palpation suggests hepatitis or congestion.

Spleen palpation

The spleen is located in the LUQ under the left costal margin. It is not normally palpable. Position your left hand under the patient’s left flank to support and lift, and place your right hand on the left costal margin angling toward the LUQ. Ask the patient to inhale deeply. On inspiration, a palpable spleen edge descends toward your fingers.

Grading: mild splenomegaly if palpable just below the costal margin; massive splenomegaly if the edge extends past the midline or into the pelvis. Possible causes: infectious mononucleosis, hematologic malignancies, portal hypertension, malaria, sickle cell disease.

Kidney assessment — ballottement

The kidneys are retroperitoneal and not normally palpable in average-sized adults. Kidney ballottement detects abnormal kidney enlargement. Place one hand in the patient’s flank (posterior) and one on the corresponding anterior upper quadrant. Apply a sharp upward push with the posterior hand — a palpable kidney “bouncing” against the anterior hand is a positive finding, suggesting hydronephrosis, polycystic kidney disease, or renal tumor.

Costovertebral angle (CVA) tenderness: while the patient is sitting upright, place one hand over the CVA (where the 12th rib meets the spine) and strike it with the ulnar fist of the other hand. Sharp pain indicates kidney pathology — pyelonephritis is the most common cause.

Special maneuvers

These maneuvers are used when specific abdominal pathology is suspected. They require careful technique and should be interpreted in clinical context, not in isolation.

Rebound tenderness is a particularly important finding to know: a positive Blumberg’s sign indicates peritoneal involvement and classifies the patient as having peritoneal signs. This triggers urgent assessment and escalation regardless of what other findings are present. See peritonitis nursing for complete management.

Referred pain patterns

Pain originating in a deep abdominal or retroperitoneal structure is often perceived at a skin surface location innervated by the same spinal segments. These referred pain patterns are clinically important because they can direct assessment before the abdominal examination reveals clear local findings.

Kehr’s sign: left shoulder pain (referred via the phrenic nerve, which shares C3–C5 innervation with the diaphragm) caused by blood or fluid irritating the left hemidiaphragm. Classic presentation: ruptured spleen. Blood pooling under the left diaphragm refers pain to the left shoulder in the supine position; the pain intensifies when the patient lies down.

Cullen’s sign: periumbilical ecchymosis (bruising) from retroperitoneal blood tracking along the falciform ligament to the umbilical region. Associated with hemorrhagic pancreatitis and ruptured ectopic pregnancy. Appears 24–48 hours after hemorrhage onset — not an immediate sign. See pancreatitis nursing for full clinical context.

Grey Turner’s sign: flank ecchymosis from blood tracking through retroperitoneal tissues to the flank. Same causes as Cullen’s sign (hemorrhagic pancreatitis, retroperitoneal bleeding). Also delayed 24–48 hours. Both Cullen’s and Grey Turner’s signs indicate significant ongoing or recent hemorrhage and require immediate escalation.

McBurney’s point pain (RLQ): pain localizing to one-third of the way from the right ASIS to the umbilicus, indicating appendiceal inflammation.

Epigastric to RLQ migration: classic appendicitis pain trajectory — visceral appendiceal pain is initially felt as diffuse periumbilical or epigastric discomfort, then localizes to the RLQ as the parietal peritoneum becomes involved.

Documentation language

Clear, objective documentation describes findings precisely without interpretation unless supported by data. Use anatomical landmarks and standard clinical terminology.

Normal abdominal assessment — documentation example:

Abdomen soft, flat, and non-distended. Bowel sounds present and normoactive in all four quadrants, 12–15 sounds per minute. No bruits auscultated over aorta, renal, or iliac vessels. Tympanic throughout on percussion; liver span 9 cm at right MCL. No hepatomegaly or splenomegaly. No tenderness on light or deep palpation in any quadrant. No masses or guarding. No rebound tenderness. Umbilicus midline and inverted. Skin without lesions, striae, or ecchymosis.

Abnormal finding — RLQ tenderness with rebound:

RLQ tenderness to palpation at McBurney’s point, 7/10 on NRS. Rebound tenderness present (Blumberg’s sign positive). Rovsing’s sign positive — LLQ pressure reproduces RLQ pain. Voluntary guarding noted on approach to RLQ. Bowel sounds hypoactive: 3 sounds/min in RLQ over 60-second interval. Abdomen otherwise soft with tympany throughout. No flank ecchymosis. Vital signs: T 38.3°C, HR 104, BP 118/72. MD [name] notified at [time]; orders received.

Abnormal finding — distension with dullness:

Abdomen moderately distended, girth 98 cm at umbilicus (reference marks in place). Dullness on percussion in all dependent quadrants; shifting dullness positive bilaterally. Fluid wave transmitted on ballottement. Tympany in central/periumbilical area. No tenderness on light or deep palpation. Liver span 14 cm at right MCL — hepatomegaly noted. Bowel sounds present, 8 sounds/min. Periumbilical venous distension (caput medusae) visible. Findings communicated to provider at [time].

Post-operative bowel assessment documentation:

Patient reports no passage of flatus or stool since surgery [date/time]. Abdomen soft, mildly distended, and tympanitic throughout. Bowel sounds hypoactive — 2 sounds/min in all quadrants over 60-second interval each. No abdominal tenderness. Last NGT output: 300 mL bilious fluid at [time]. Ambulated to chair for 20 minutes this shift.

NCLEX tips and scenarios

High-yield NCLEX tips

1. The correct sequence for abdominal assessment is IAPP — Inspection, Auscultation, Percussion, Palpation. Palpation comes last because it alters bowel sounds.

2. Auscultation precedes palpation because palpation and percussion stimulate peristalsis, making bowel sounds louder and more frequent than baseline. NCLEX may phrase this as “why should the nurse auscultate before palpating?”

3. Normal bowel sounds: 5–34 per minute; soft gurgles and clicks. Listen at least 60 seconds per quadrant before assessing frequency.

4. Absent bowel sounds require listening 3–5 minutes total, not just 60 seconds in one quadrant. Premature diagnosis of absent bowel sounds is a common error.

5. Begin auscultation in the RLQ — the ileocecal valve area is the most active area and provides the most reliable baseline.

6. Hypoactive bowel sounds suggest ileus (post-op, peritonitis), opioid effect, or hypokalemia. Hyperactive, high-pitched tinkling sounds suggest early mechanical bowel obstruction.

7. A board-like (rigid) abdomen with rebound tenderness = peritonitis until proven otherwise. This is a medical emergency. See peritonitis nursing.

8. Murphy’s sign is specific to acute cholecystitis. The patient cannot complete a deep breath due to RUQ pain as the gallbladder descends.

9. Cullen’s sign = periumbilical ecchymosis. Grey Turner’s sign = flank ecchymosis. Both indicate retroperitoneal hemorrhage and appear 24–48 hours after bleeding begins — not immediately.

10. Kehr’s sign = left shoulder pain from diaphragmatic irritation by blood. Classic for splenic rupture. The pain worsens in the supine position because blood pools under the diaphragm.

11. Rebound tenderness (Blumberg’s sign): pain worse on release than compression. Indicates peritoneal irritation.

12. Rovsing’s sign: LLQ pressure causes RLQ pain — specific to appendicitis.

13. For suspected AAA, do not perform deep palpation over a pulsatile midline mass. Escalate immediately.

14. Normal liver span at the right MCL is 6–12 cm. Span >12 cm = hepatomegaly.

15. Shifting dullness and a positive fluid wave test both indicate ascites. Shifting dullness requires only moderate fluid; fluid wave test requires larger volumes.

16. A patient with knee flexion during abdominal palpation is positioned correctly — this relaxes the abdominal wall and improves assessment accuracy.

17. Caput medusae (periumbilical dilated veins) = portal hypertension.

18. The psoas sign and obturator sign are positive in appendicitis that is retrocecal (psoas) or pelvic (obturator) in location.

NCLEX scenarios

Scenario 1 — IAPP order question

A nursing student is preparing to perform an abdominal assessment on a post-operative patient. In which order should the nurse perform the assessment?

A) Inspection, palpation, percussion, auscultation
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Palpation, inspection, auscultation, percussion

Answer: B. The correct abdominal assessment sequence is IAPP. Palpation and percussion stimulate peristalsis and alter bowel sounds, so auscultation must precede them to capture an accurate baseline.

Scenario 2 — Absent bowel sounds in bowel obstruction

A nurse is assessing a patient admitted with suspected bowel obstruction. The nurse auscultates one quadrant for 60 seconds and hears no sounds. What is the most appropriate next action?

A) Document absent bowel sounds and notify the physician immediately
B) Continue auscultating each quadrant for at least 60 seconds, listening a total of 3–5 minutes before concluding sounds are absent
C) Proceed to palpation and percussion before reassessing bowel sounds
D) Administer a tap water enema and reassess bowel sounds in 30 minutes

Answer: B. Bowel sounds can be intermittent and irregular. The clinical standard for absent bowel sounds requires listening for 3–5 minutes total across quadrants. Sixty seconds in one quadrant is insufficient to make this determination. See bowel obstruction nursing for full management.

Scenario 3 — Acute appendicitis presentation

A 22-year-old male presents with pain that began periumbilically 12 hours ago and has now migrated to the RLQ. Temperature is 38.4°C. The nurse performs an abdominal assessment. Which findings are most consistent with acute appendicitis? Select all that apply.

A) Maximal tenderness at McBurney’s point
B) LLQ pressure causing RLQ pain (Rovsing’s sign)
C) Positive Murphy’s sign
D) Psoas sign positive on right
E) Shifting dullness positive

Answer: A, B, D. McBurney’s point tenderness, positive Rovsing’s sign, and a positive psoas sign are all associated with appendicitis. Murphy’s sign is specific to cholecystitis (RUQ, gallbladder). Shifting dullness indicates ascites, not appendicitis. See appendicitis nursing.

Scenario 4 — Rebound tenderness significance

A nurse is assessing a patient 24 hours post-laparotomy. On releasing deep pressure over the LLQ, the patient cries out in pain — more intense than the pain felt during compression. How should the nurse interpret this finding?

A) This is an expected post-operative finding and does not require escalation
B) The finding indicates involuntary guarding from post-operative discomfort
C) The finding is consistent with peritoneal irritation and requires immediate provider notification
D) The finding suggests the patient needs a higher dose of opioid analgesia before reassessment

Answer: C. A positive Blumberg’s sign (rebound tenderness) indicates peritoneal irritation. In the post-operative context, this raises concern for anastomotic leak, perforation, or developing peritonitis. This is an urgent finding requiring immediate provider notification and clinical evaluation.

Scenario 5 — Hemorrhagic pancreatitis skin signs

A patient with a history of alcohol use disorder is admitted with severe epigastric pain radiating to the back and a lipase level of 1,840 U/L. Twenty-four hours after admission, the nurse observes bluish discoloration around the patient’s umbilicus. What does this finding indicate, and what is the priority nursing action?

A) Caput medusae indicating portal hypertension; monitor and document
B) Cullen’s sign indicating retroperitoneal hemorrhage; notify the provider immediately
C) Grey Turner’s sign indicating splenic rupture; prepare for emergency surgery
D) Livedo reticularis; obtain dermatology consult

Answer: B. Periumbilical ecchymosis (Cullen’s sign) in a patient with hemorrhagic pancreatitis indicates retroperitoneal hemorrhage has tracked to the umbilical region. This is a serious finding indicating severe, possibly life-threatening hemorrhagic pancreatitis. Immediate provider notification is the priority. See pancreatitis nursing.

Common mistakes to avoid

Palpating before auscultating. The most commonly cited abdominal assessment error. Even experienced nurses occasionally reverse the sequence under time pressure — but falsely elevated bowel sounds from a stimulated bowel can lead to incorrect clinical conclusions.

Listening for less than 60 seconds per quadrant. Bowel sounds are intermittent. Thirty seconds of silence does not mean absent sounds. Use a watch and enforce the minimum.

Starting palpation at the site of pain. This triggers immediate guarding that makes the rest of the assessment unreliable. Always begin away from reported pain and approach it last.

Forgetting to check the flanks. Grey Turner’s sign and renal CVA tenderness both require inspection and assessment of the flanks, which are outside the standard four-quadrant view. Roll the patient slightly if needed.

Using cold hands or a cold stethoscope. Involuntary guarding from cold contact masks true abdominal wall tone and tenderness. Two seconds of warming prevents this.

Failing to warm up to assessment. Deep palpation without first performing light palpation removes a sensitive layer of information and can cause unnecessary patient pain.

Documenting “bowel sounds present” without specifics. “Bowel sounds present” conveys minimal clinical information. Document frequency per quadrant, character, and any abnormal features. This matters for tracking the return of bowel function post-operatively and for legal documentation completeness.

Related skills

• Head-to-toe assessment — complete systematic nursing assessment framework
• Appendicitis nursing — McBurney’s point, Rovsing’s sign, and surgical management
• Peritonitis nursing — rebound tenderness, board-like abdomen, and nursing interventions
• Bowel obstruction nursing — bowel sound evolution and obstruction management
• Pancreatitis nursing — Cullen’s sign, Grey Turner’s sign, and hemorrhagic pancreatitis
• OLDCARTS mnemonic — pain characterization framework for abdominal pain history