Last updated on May 21st, 2022 at 06:39 am
Abdominal Distention Nursing Care Plans Diagnosis and Interventions
Abdominal Distention NCLEX Review and Nursing Care Plans
Abdominal distention is a condition in which the abdomen swells due to the buildup of gas or fluid, resulting in outward expansion and increased abdominal girth.
It is not a disease in and of itself but rather a symptom of an underlying disease. Patients with the condition frequently experience bloating or swelling, typically accompanied by feelings of fullness, nausea, and cramps.
Signs and Symptoms of Abdominal Distention
- Nausea and Vomiting
- Fever
- Diarrhea
- Dyspnea
- Pain
- Bloating
- Constipation
- Abdominal tenderness
- Feelings of fullness
- Cramps
- Belching
- Weakness
Causes of Abdominal Distention
Non-obstructive Causes of Abdominal Distention
- Pregnancy
- Lactose intolerance
- Overeating
- Obesity
- Irritable bowel syndrome (IBS)
- Ascites caused by congestive heart failure, cirrhosis, peritoneal carcinomatosis, etc.
- Intra-abdominal bleeding
Other Causes of Abdominal Distention
- Infections. Diverticular disease or an abscess in the abdominal cavity can lead to AD and its accompanying symptoms of cramps, constipation, and problems with defecation. Bacterial infections such as Helicobacter pylori infection can also cause distention due to gastritis, leading to the formation of ulcers, muscle spasms, and gas production.
- Foreign object ingestion. The patient may complain or present with abdominal tenderness if an object becomes lodged in the stomach.
- Lead poisoning
- Trauma
- Mechanical ventilation (MV). Increased intra-abdominal pressure is associated with MV. Prolonged pressure can lead to profound abdominal swelling or distention.
- Stomach (e.g., pyloric stenosis, peptic ulcer)
- Bowel (e.g., Crohn’s disease, colorectal carcinoma)
- Urinary abnormalities (e.g., acute pyelonephritis, acute renal infarction)
- Renal (e.g., cyst, polycystic kidney, hydronephrosis)
- Pancreatitis. Inflammation of the pancreas causes abdominal pain, abdominal tenderness, nausea, and vomiting. Exocrine pancreatic insufficiency may also lead to AD due to excessive gas production.
- Splenomegaly
- Hepatomegaly
- Malignancies (e.g., stomach cancer, pancreatic carcinoma, renal tumor, colonic carcinoma, hepatoma, liver cancer, ovarian carcinoma)
- Gynaecological (e.g., ectopic pregnancy, fibroids, endometriosis, twisted ovarian tumors, ovarian follicular cysts rupture)
Risk Factors to Abdominal Distention
- Female gender
- Obesity
- Individuals with gastrointestinal disorders
- Lactose Intolerance
- Children
Diagnosis of Abdominal Distention
- Medical history. Attempts to establish a differential diagnosis. Obtaining a medical history includes evaluating the possible cause of AD, constipation, and ascites.
- Physical examination. It involves a general abdominal examination of the patient. This can provide many cues regarding the patient’s diagnosis, such as yellowish skin pigmentation or jaundice indicating a possible liver disorder. Inflammatory sores around the mouth may suggest a deficiency in iron-related to malabsorption. The presence of oral ulcers may also indicate the presence of Crohn’s disease. Examine for any atypical masses that may indicate an inguinal hernia, umbilical hernia, or a ventral wall hernia.
Assessing bowel sounds using auscultation of the abdominal region is also possible, wherein the absence of bowel noises may suggest paralytic ileus. Additionally, percussion of the abdominal region can determine the presence of air-filled structures and tenderness. By mildly percussing the abdomen, the location of pain that suggests peritoneal or intraabdominal inflammation can be identified.
- Abdominal X-ray. Diagnoses changes in intestinal structure, bowel movements, constipation, and bowel obstruction.
- Complete blood count. Increased leukocyte count signals infection (e.g., peritonitis) or malignancy, which causes stomach distention. Abnormal vaginal bleeding caused by fibroids or malignancy might be diagnosed by a persistently low RBC count.
- Electrolyte panel. Hypokalemia may be noted in patients with severe emesis, diarrhea, or abdominal disorders, causing serious clinical manifestations such as AD, constipation, and dyspnea. Other electrolyte imbalances can result in constipation and abdominal distention due to endocrine and neurologic disorders (e.g., Parkinson’s disease, Hirschprung’s disease).
- Liver function test. This laboratory examination identifies the presence of malignancy and liver disease. Hypoalbuminemia may imply ascites, but hyperbilirubinemia may suggest pancreatic cancer.
- Urinalysis. Patients with kidney or bladder tumors may exhibit hematuria.
- Pregnancy test
- Double-contrast barium enema. Used to detect the presence of malignancies, inflammation, blockages, polyps, and diverticula and to evaluate functional abnormalities in the large intestine.
- Computed Tomography (CT) scan. Diagnoses intestinal obstruction with distal bowel compression.
- Sigmoidoscopy
Treatment for Abdominal Distention
- Dietary Intervention. The low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is by far the most significant treatment for abdominal distention. FODMAPs are forms of carbohydrates present in particular foods, such as wheat and beans. Careful consideration must be given to fiber and meal choices. Additionally, excessive consumption of dietary fiber promotes stomach distention and gas. Broccoli, beans, and cabbage are just a few of the vegetables that might cause a bloated stomach. Due to their high levels of indigestible carbohydrates and fiber, these vegetables promote gas production.
Patients who suffer from gastrointestinal issues, such as irritable bowel syndrome (IBS), should steer clear of whole wheat fiber supplements like wheat bran since they tend to have high levels of FODMAP compounds, which produce gas and abdominal discomfort. Abdominal distention is a common sign of fructose and lactose intolerance, both of which impair absorption. Symptomatic improvement and a reduction in bloating can be achieved by restricting the intake of fructose and lactose in the diet.
- Drug therapy. The vast majority of treatments for bloating focus on increasing the movement of stool through the colon. However, several osmotic and bulking medications cause the gut lumen to expand due to their water holding capacity and gas formation. Enzymes and nutritional supplements may also be needed to break down complex carbs in the event of recurrent abdominal distention.
Some individuals may benefit from taking low-dose antidepressants. In addition to alleviating fear and anxiety, these medications alter the sensation of fullness in the stomach. Antibiotics that modify the microbiome and lower gas-producing bacteria may also aid in reducing excessive fermentation and abdominal distention. Meanwhile, probiotics aid in the treatment of stomach distention by increasing the gut flora and metabolism and minimizing gas production.
- Parenteral Nutrition. Used when a patient is not taking drugs. The placement of nasogastric (NG) tubes assists in decompressing the stomach, hence alleviating symptoms. Signs of clearance typically include a decrease in abdominal distention, the passage of flatus or stool, and a decrease in NG tube output. Likewise, if the tube becomes obstructed, it might worsen abdominal distention.
- Surgical interventions. This is performed to repair bowel strictures, strictureplasty, and other surgical techniques are performed. These strictures may arise due to disease (e.g., inflammatory bowel diseases) or previous operation. During the procedure, the small passage is enlarged, consequently improving constipation symptoms and decreasing the risk of abdominal distention.
- Abdominal Biofeedback Therapy. Breathing using the diaphragm or abdomen may be beneficial for people with abdominal distention. Biofeedback effectively decreases diaphragmatic and intercostal muscle contraction, reducing perceived bloating and abdominal girth.
Prevention of Abdominal Distention
- Increase water consumption.
- Switch to a low FODMAP diet
- Avoid meals that induce gas (e.g., dried beans, lentils)
- Eat slowly
- Consume dairy products that are lactose-free
- Seek medical attention for underlying conditions
- Reduce intake of carbonated beverages
Nursing Diagnosis for Abdominal Distention
Nursing Care Plan for Abdominal Distention 1
Nursing Diagnosis: Nausea related to abdominal distention, secondary to gastroparesis, as evidenced by gagging, increased swallowing and salivation, refusal to eat, increased heart rate, and sweating.
Desired Outcomes:
- The patient will notice an improvement in his/her nausea.
- The patient will be able to apply effective techniques to prevent nausea after the health teaching session.
| Nursing Intervention for Abdominal Distention | Rationale |
| Identify the underlying cause of the patient’s nausea. | Developing an effective care plan begins with identifying the cause of nausea. |
| Obtain information about patients with a previous history of nausea and vomiting. Note the following characteristics: Quantity and character of vomit (e.g., watery, undigested food, watery, bile) The character of pain (e.g., intensity, location) Associated symptoms such as vomiting, headache, and diarrhea. Onset | Gastroparesis is diagnosed through a routine physical examination that includes asking the patient about their symptoms and medical history. Abdominal distention or swelling is typically observed. A complete history and description of the symptoms of nausea and vomiting will help determine the best treatment plan. |
| Determine the dietary status and sleep pattern of the patient. Refer to a dietician when necessary. | Sufficient energy reserves are required while engaging in regular physical activities. Prior to a patient’s successful activity progression, healthcare providers must address the patient’s sleep deprivation or difficulties. |
| Evaluate the patient’s fluid intake and take note of his/her hydration status by assessing the following: blood pressure, daily weight, skin turgor, and mucous membranes. | Patients who suffer from abdominal distention are more likely to skip meals or consume less water due to pain and discomfort caused by nausea and vomiting. Moreover, dehydration may occur due to vomiting, a common symptom of nausea. |
| Eliminate strong and unpleasant odors from the patient’s care environment. | The effects of nausea can be exacerbated by strong or offending odors. |
| Administer anti-emetic medications as indicated. | To decrease metabolic rate and intestinal irritation, hence promoting pain alleviation and healing. To decrease nausea and vomiting, both of which can exacerbate abdominal pain. |
Nursing Care Plan for Abdominal Distention 2
Nursing Diagnosis: Deficient Knowledge related to abdominal distention, secondary to Hirschsprung disease, as evidenced by constipation, vomiting, poor feeding, malnourished, anemia, stunted growth, and ribbon or pellet-like stools.
Desired Outcome: The patient will be able to express understanding on how to maintain fluid balance, maintain oral hygiene, and increase comfort in the absence of pain.
| Nursing Intervention for Abdominal Distention | Rationale |
| Provide family teaching about care for colostomy and devices at home to increase the child’s acceptance of the physical change. | A temporary colostomy has been recommended for patients who are experiencing significant symptoms. Before being discharged, the caregivers should demonstrate their knowledge of colostomy care by having a return demonstration under the supervision of the nursing staff. |
| If feeding induces increased discomfort due to distention and nausea, emphasize the significance of parenteral nourishment. | The importance of total parental nutrition (TPN) as therapeutic care for pediatric patients should be communicated to the patient’s family and significant other/s, as elemental feeding helps to minimize the retention of stool and secondary enterocolitis. |
| Assist in bowel elimination by administering repeated enemas. Teach the patient colonic irrigation techniques. | To promote bowel movements. Consult a physician for a nasogastric (NG) tube if enemas do not ease abdominal distention and placement of a rectal tube fails to provide relief. |
| Discuss preventative feeding techniques, including using a pacifier for infants receiving parenteral fluids. Teach the family how to properly hold and rock the infant. | Pacifiers are utilized during parenteral feeding to promote coordination between sucking and swallowing and prevent feed aversion. Meanwhile, a distended abdomen is a symptom of Hirschsprung’s disease. By providing gentle pressure or rocking the newborn, it is possible to alleviate gas and constipation. |
| For older children, demonstrate and advise the family on administering saline enemas, the use of stool softeners, and a high-fiber diet. | Enemas clean the colon by enabling a solution to enter (via the rectum) and assisting in removing excrement from the colon. Moreover, stool softeners prevent constipation, a symptom of AD that would otherwise induce straining and pain. |
| Discuss the need and relevance of preserving nasogastric tube patency postoperatively. | In order to decompress the abdomen, nasogastric tubes (NG) are placed. If the patient complains of abdominal discomfort, pain, or nausea, or if he or she begins to vomit, immediately notify the physician. The drainage flow is likely blocked, and the tube must be cleaned. Grounds for infection include irritated skin, burning pain, a rash surrounding the catheter, and a pungent odor. |
Nursing Care Plan for Abdominal Distention 3
Nursing Diagnosis: Impaired Comfort related to abdominal distention secondary to ascites, as evidenced by crying, guarding of the abdominal area, shallow breathing, frequent grimacing, anxiety, irritability, and restlessness.
Desired Outcomes:
- The patient will be able to maintain a desired degree of comfort.
- The patient will exhibit efficient coping techniques when confronted with stress.
| Nursing Intervention for Abdominal Distention | Rationale |
| Initiate patient care by describing procedures and routines related to comfort promotion and anxiety prevention. | Knowing what to expect might alleviate the patient’s anxiety and make them feel more at ease. |
| Promote a therapeutic relationship through open nurse-patient communication, active listening, and empathic understanding. | It is important to build trust with the patient so that they can examine their own feelings, talk openly about current circumstances, and openly express their needs and worries. A trusting relationship and open dialogue are fostered by empathetic communication (which includes recognizing the desire not to respond). |
| Evaluate the contributing causes of the debilitating disease. Make adjustments to the environment to increase the patient’s comfort, such as:Making use of a white noise machineHeating or cooling the roomEliminating or reducing the frequency of visitationsLimiting exposure to distracting stimuli, such as a loud televisionProviding earplugs and eye masks | Reduces pain by relaxing and preventing sensory input from reaching the brain’s cortex |
| Promote progressive relaxation techniques, including soothing music, guided visualization, deep breathing exercises, and meditation. | Anxiety-relieving techniques such as deep breathing and relaxing music work effectively. When a patient is able to learn and practice relaxation techniques on their own, they have a greater sense of autonomy and self-care competency. These methods also aid in redirecting one’s attention away from one’s current state of discomfort, tension, or pain and toward more pleasant ones. |
| Praise the patient whenever he or she effectively employs a newly acquired coping skill. | Complimenting the patient’s accomplishments provides them a sense of success and boosts their confidence. This may also increase levels of comfort. |
| Encourage the patient to engage in assisted or active range of motion exercises. Once every two hours, reposition the patient. | Changing a patient’s position can alleviate pressure points and aid in pain management while fostering a sense of focus. These strategies may be helpful as an adjunct to pharmaceutical treatment. In addition, early mobilization may reduce the discomfort associated with bed rest. |
| Offer the patient grooming items such as a toothbrush, deodorant, lip balm, and mouthwash. | Hospitalizations can be stressful, but these seemingly inconsequential acts of kindness can help bring a sense of regularity and routine back to the situation. |
Nursing Care Plan for Abdominal Distention 4
Nursing Diagnosis: Acute Pain related to abdominal distention secondary to peritonitis, as evidenced by verbal reports of pain, self-focus, guarding of the affected area, distraction behavior, and nausea.
Desired Outcomes:
- The patient will verbalize pain relief, as evidenced by a pain score of less than 3.
- The patient’s pain perception will be tolerable, showing relaxation.
| Nursing Intervention for Abdominal Distention | Rationale |
| Examine the nature of the pain (mild, severe, or persistent), noting its location, duration, and intensity | Peritonitis is often accompanied by nausea and a dull abdominal ache that rapidly transforms into persistent, severe abdominal pain as the acute inflammation develops. Its clinical features include AD or tenderness. Changes in pain level are frequent, but they may also indicate the onset of complications. And if an abscess develops, discomfort may become localized. |
| Maintain bed rest and semi-Fowler’s position as indicated. | This position reduces the risk of aspiration, diaphragmatic irritation, abdominal strain/tension on abdominal organs, and pain by encouraging the passage of fluids by gravity to the stomach and into the pylorus. The abdominal wall will be less strained if the knees are raised. Moreover, resting reduces pain and discomfort. |
| Move the patient slowly and deliberately and instruct him/her to splint the abdomen. | To relieve muscular tension and guarding. Additionally, splinting will alleviate pain during coughing, movement, and deep breathing. |
| Provide oral care on a regular basis. | Oral care helps alleviate the pain and discomfort caused by suctioning, dehydration, and the NPO (no food or liquid) status. It also relieves pain and discomfort caused by nausea and vomiting. |
| Administer medications (e.g., painkillers, anti-emetics) as indicated. | To decrease metabolic rate and intestinal irritation, hence promoting pain alleviation and healing. To decrease nausea and vomiting, both of which can exacerbate abdominal pain. Pain is typically intense and may necessitate narcotic pain relief. Analgesics may be restricted during the early diagnostic phase since they can obscure signs and symptoms. |
Nursing Care Plan for Abdominal Distention 5
Nursing Diagnosis: Activity Intolerance related to abdominal distention, secondary to liver cirrhosis, as evidenced by fatigue, decreased blood pressure, verbalized pain, shortness of breath, restlessness, and agitation.
Desired Outcome: The patient will demonstrate cardiac tolerance to activity, as indicated by a normal heart rate, blood pressure, and the absence of fatigue and dyspnea.
| Nursing Intervention for Abdominal Distention | Rationale |
| Assess the patient’s mobility and degree of activity, and have him/her assess perceived exertion on a scale from 0 to 10. | This evaluation measures the level of activity intolerance. Provides baseline data for nursing goal formulation during goal setting. |
| Evaluate the patient’s physiological response to physical activity. Monitor the blood pressure, resting pulse, breathing rate, quality, and rhythm of the pulse following physical exercise. | If the patient has any of the following: chest pain, exhaustion, decreased pulse rate, systemic blood pressure, increased respiratory response (RR), or pulses that take more than 3-4 minutes to rebound to within 6-7 beats of the resting pulse, the activity should be discontinued or modified. |
| Offer assistance with activities of daily living (ADLs) while preventing patient dependence. | Assisting the patient with ADLs permits energy conservation. Carefully balancing the help provided and encouraging increasing strength and stamina can improve the patient’s exercise tolerance and self-esteem. |
| Provide a bedside commode as indicated. | Using a commode saves time and energy compared to using a bedpan or walking to the bathroom. |
| Inquire into the patient’s perceptions of the causes of their activity intolerance. | Conditions can be temporary or long-term; they can also be physical or psychological. Identifying the underlying reason can aid the nurse in delivering the appropriate treatment plan. |
| Promote physical exercise within the patient’s energy levels, and modify activities as needed. | Instills a sense of self-determination and minimizes the patient’s energy expenditure. |
| Assist the patient in completing ADLs by providing the necessary adaptive aids. | The patient will have a greater sense of control and independence over their own treatment. This will also minimize the patient’s energy expenditure. |
| Determine the dietary status and sleep pattern of the patient. Refer to a dietician when necessary. | Sufficient energy reserves are required while engaging in regular physical activities. Prior to the patient’s successful activity progression, healthcare providers must address the patient’s sleep deprivation or difficulties. |
| Encourage early and regular ambulation, in-bed range-of-motion (ROM) exercises, and position adjustments, as tolerated by the patient. | Progressively increasing the intensity of the activity prevents overexertion and raises the patient’s tolerance for the exercise. Shifting the patient from prolonged bedrest will avoid muscle deconditioning, assist the patient in relaxing while at rest, and promote appropriate stress management. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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