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Table of Contents


	List of Tables	xv
	Introduction	xviii
UNIT I	FOUNDATIONS OF HEALTH ASSESMENT
Chapter 1	Overview: Physical Examination and History Taking	3
	Patient Assessment: Comprehensive or Focused	4
	Comprehensive Assessment of the Adult	6
	The Comprehensive Adult Health History	6
	The Comprehensive Adult Physical Examination	13
	Beginning the Examination: Setting the Stage	13
	Techniques of Examination	17
	Overview�the Physical Examination	19
	Bibliography	23
Chapter 2	Clinical Reasoning, Assessment and Recording Your Findings	25
	Assessment and Plan: The Process of Clinical Reasoning	27
	Recording Your Findings: The Case of Mrs. N and the Challenges of Clinical Data	30
	Recording Your Findings: Checklist for a Clear and Accurate Record	40
	Evaluating Clinical Evidence	43
	Lifelong Learning: Integrating Clinical Reasoning, Assessment, and Analysis of Clinical Evidence	49
	Bibliography	51
Chapter 3	Interviewing and the Health History	55
	Getting Ready: The Approach to the Interview	58
	Learning About the Patient: The Sequence of the Interview	60
	Building a Therapeutic Relationship: The Techniques of Skilled Interviewing	68
	Adapting Your Interview to Specific Situations	75
	Sensitive Topics that Call for Specific Approaches	81
	Societal Aspects of Interviewing	87
	Bibliography	96
UNIT 2	REGIONAL EXAMINATIONS	99
Chapter 4	Beginning the Physical Examination: General Survey, Vital Signs, and Pain	101
	The Wealth History	102
	Health Promotion and Counseling	104
	The General Survey	109
	General Appearance	109
	The Vital Signs	114
	Blood Pressure	114
	Heart Rate and Rhythm	119
	Respiratory Rate and Rhythm	119
	Temperature	120
	Special Situations	121
	Acute and Chronic Pain	121
	Recording Your findings	125
	Bibliography	125
Chapter 5	Behavior and Mental Status	135
	Symptoms and Behavior	136
	The Health History	140
	Health Promotion and Counseling	142
	Techniques of Examination	145
	Appearance and Behavior	146
	Speech and Language	147
	Mood	148
	Thought and Perceptions	149
	Cognitive Functions	151
	Higher Cognitive Functions	153
	Special Techniques	155
	Recording Your Findings	155
	Bibliography	156
Chapter 6	The Skin, Hair, and Nails	163
	Anatomy and Physiology	163
	The Health History	165
	Health Promotion and Counseling	165
	Techniques of Examination	168
	Skin	168
	Skin Lesions in Context	169
	Hair	170
	Nails	170
	Special Techniques	170
	Recording Your Findings	172
	Bibliography	172
Chapter 7	The Head and Neck	195
	Overview: New Format of this Chapter	195
	The Health History	196
	The Head	196
	The Eyes	197
	The Ears	199
	The Nose and Sinuses	200
	The Mouth, Throat, and Neck	201
	Health Promotion and Counseling	201
	Anatomy and Physiology and Techniques of Examination	204
	The Head	204
	Anatomy and Physiology	204
	Techniques of Examination	205
	The Eyes	205
	Anatomy and Physiology	205
	Techniques of Examination	211
	The Ear	222
	Anatomy and Physiology	222
	Techniques of Examination	225
	The Nose and Paranasal Sinuses	228
	Anatomy and Physiology	228
	Techniques of Examination	229
	Mouth and Pharynx	231
	Anatomy and Physiology	231
	Techniques of Examination	234
	The Neck	236
	Anatomy and Physiology	236
	Techniques of Examination	238
	Special Techniques	243
	Recording Your Findings	245
	Bibliography	246
Chapter 8	The Thorax and Lungs	283
	Anatomy and Physiology	283
	The Health History	290
	Health Promotion and Counseling	292
	Techniques of Examination	296
	Initial Survey of Respiration and the Thorax	296
	Examination of the Posterior Chest	297
	Inspection	297
	Palpation	297
	Percussion	299
	Auscultation	302
	Examination of the Anterior Chest	305
	Inspection	305
	Palpation	305
	Percussion	307
	Auscultation	308
	Special Techniques	309
	Recording tour findings	309
	Bibliography	310
Chapter 9	The Cardiovascular System	323
	Anatomy and Physiology	323
	Surface Projections of the Heart and Great Vessels	323
	Cardiac Chambers, Valves, and Circulation	325
	Events in the Cardiac Cycle	326
	The Splitting of Heart Sounds	328
	Heart Murmurs	329
	Relation of Auscultatory Findings to the Chest Wall	330
	The Conduction System	331
	The Heart as a Pump	332
	Arterial Pulses and Blood Pressure	333
	Jugular Venous Pressure (JVP)	334
	Jugular Venous Pulsations	336
	Changes Over the Life Span	336
	The Health History	337
	Health Promotion and Counseling	339
	Techniques of Examination	348
	Jugular Venous Pressure and Pulsations	349
	The Carotid Pulse	352
	The Heart	354
	Inspection and Palpation	355
	Percussion	361
	Auscultation	361
	Integrating Cardiovascular Assessment	368
	Special Techniques	369
	Recording Your findings	371
	Bibliography	371
Chapter 10	The Breasts and Axillae	389
	Anatomy and Physiology	389
	The Female Breast	389
	The Male Breast	391
	Lymphatics	391
	The Health History	392
	Health Promotion and Counseling	393
	Overview	393
	Selected Risk Factors that Affect Screening Decisions	397
	Recommendations for Breost Cancer Screening and Chemoprevention	398
	Counseling Women About Breast Cancer	401
	Techniques of Examination	402
	The Female Breast	402
	Inspection	402
	Palpation	405
	The Male Breast	407
	The Axillae	407
	Inspection	408
	Palpation	408
	Special Techniques	409
	Recording Your Findings	411
	Bibliography	411
Chapter 11	The Abdomen	415
	Anatomy and Physiology	415
	The Health History	418
	The Gastrointestinal Tract	420
	The Urinary Tract	427
	Health Promotion and Counseling	429
	Techniques of Examination	434
	The Abdomen	434
	Inspection	434
	Auscultation	436
	Percussion	437
	Palpation	437
	The Liver	439
	Percussion	439
	Palpation	441
	The Spleen	443
	Percussion	443
	Palpation	444
	The Kidneys	445
	Palpation	445
	The Bladder	447
	The Aorta	447
	Special Techniques	448
	Assessing Possible Ascites	448
	Assessing Possible Appendicitis	450
	Assessing Possible Acute Cholecystitis	451
	Assessing Ventral Hernias	451
	Mass in the Abdominal Wall	451
	Recording Your findings	451
	Bibliography	452
Chapter 12	The Peripheral Vascular System	471
	Anatomy and Physiology	471
	Arteries	471
	Veins	473
	The Lymphatic System and Lymph Nodes	475
	Fluid Exchange and the Capillary Bed	476
	The Health History	477
	Health Promotion and Counseling	478
	Techniques of Examination	481
	Arms	481
	Legs	483
	Special Techniques	488
	Recording Your Findings	492
	Bibliography	492
Chapter 13	Male Genitalia and Hernias	501
	Anatomy and Physiology	501
	The Health History	504
	Health Promotion and Counseling	506
	Techniques of Examination	508
	The Penis	508
	Inspection	508
	Palpation	509
	The Scrotum and Its Contents	509
	Inspection	509
	Palpation	510
	Hernias	510
	Inspection	510
	Palpation	511
	Special Techniques	512
	The Testicular Self-Examination	512
	Recording Your findings	513
	Bibliography	513
Chapter 14	Female Genitalia	521
	Anatomy and Physiology	521
	The Health History	524
	Health Promotion and Counseling	528
	Techniques of Examination	533
	External Examination	535
	Internal Examination	536
	Hernias	543
	Special Techniques	543
	Recording Your Findings	543
	Bibliography	544
Chapter 15	The Anus, Rectum, and Prostate	555
	Anatomy and Physiology	555
	The Health History	557
	Health Promotion and Counseling	558
	Techniques of Examination	561
	Male	561
	Female	564
	Recording Your findings	565
	Bibliography	565
Chapter 16	The Musculoskeletal System	571
	Assessing the Musculoskeietal System	571
	Overview	571
	Joint Structure and Function	572
	Types of Joint Articulation	573
	Structure of Synovial Joints	574
	The Health History	575
	Health Promotion and Counseling	578
	Examination of Specific Joints: Anatomy and Physiology and Techniques of Examination	583
	Temporomandibular Joint (TMJ)	586
	Overview, Bony Structures, and Joints	586
	Muscle Groups and Additional Structures	586
	Techniques of Examination	587
	The Shoulder	588
	Overview 588
	Bony Structures 588
	Joints	589
	Muscle Groups	589
	Additional Structures	590
	Techniques of Examination	591
	The Elbow	599
	Overview, Bony Structures, and Joints	599
	Muscle Groups and Additional Structures	599
	Techniques of Examination	600
	The Wrist and Hands	601
	Overview	601
	Bony Structures	602
	Joints	602
	Muscle Groups	603
	Additional Structures	603
	Techniques of Examination	603
	The Spine	609
	Overview	609
	Bony Structures	610
	Joints	611
	Muscle Groups	611
	Techniques of Examination	611
	The Hip	617
	Overview	617
	Bony Structures and Joints	617
	Muscle Groups	618
	Additional Structures	619
	Techniques of Examination	619
	The Knee	625
	Overview	625
	Bony Structures	625
	Joints	625
	Muscle Groups	626
	Additional Structures	626
	Techniques of Examination	627
	The Ankle and Foot	634
	Overview	634
	Bony Structures and Joints	634
	Muscle Groups and Additional Structures	635
	Techniques of Examination	635
	Special Techniques	637
	Recording Your Findings	639
	Bibliography	639
Chapter 17	The Nervous System	655
	Anatomy and Physiology	656
	Central Nervous System	656
	The Brain	656
	The Spinal Cord	657
	Peripheral Nervous System	658
	The Cranial Nerves	658
	The Peripheral Nerves	658
	Motor Pathways	660
	Sensory Pathways	662
	Spinal Reflexes: The Deep Tendon Response	663
	The Health History	664
	Health Promotion and Counseling	667
	Techniques of Examination	671
	The Cranial Nerves	672
	The motor System	678
	The Sensory System	690
	Deep Tendon Reflexes	696
	Cutaneous Stimulation Reflexes	701
	Special Techniques	702
	Recording Your Findings	710
	Bibliography	711
UNIT 3	SPECIAL POPULATIONS	735
Chapter 18	Assessing Children: Infancy Through Adolescence	737
	General Principles of Child Development	738
	Health Promotion and Counseling: Key Components	740
	Assessing the Newborn	743
	Immediate Assessment at Birth	744
	Assessment Several Hours After Birth	749
	Assessing the Infant	750
	Development	750
	The Health History	751
	General Guidelines	751
	Testing for Developmental Milestones	752
	Health promotion and counseling	755
	Techniques of examination	756
	General Survey and Vital Signs	756
	The Skin	760
	The Head	765
	The Eyes	768
	The Ears	770
	The Nose and Sinuses	771
	The Mouth and Pharynx	771
	The Neck	773
	The Thorax and Lungs	773
	The Heart	776
	The Breasts	783
	The Abdomen	783
	Male Genitalia	784
	Female Genitalia	785
	Rectal Examination	786
	The Musculoskeletal System	786
	The Nervous System	790
	Assessing Young and School-Aged Children	797
	Development	797
	Early Childhood: 1 to 4 Years	797
	Middle Childhood: 5 to 1 0 Years	798
	The Health History	799
	Assessing Younger Children	799
	Assessing Older Children	801
	Health Promotion and Counseling	804
	Children 1 to 4 Years	804
	Children 5 to 10 Years	805
	Techniques of Examination	806
	General Survey and Vital Signs	806
	The Skin	810
	The Head	810
	The Eyes	811
	The Ears	812
	The Nose and Sinuses	815
	The Mouth and Pharynx	816
	The Neck	819
	The Thorax and Lungs	820
	The Heart	821
	The Abdomen	823
	Male Genitalia	825
	Female Genitalia	826
	The Rectal Examination	830
	The Musculoskeletal System	830
	The Nervous System	832
	Assessing Adolescents	834
	Development: 11 To 20 Years	834
	The Health History	836
	Health Promotion and Counseling	838
	Techniques of Examination	839
	General Survey and Vital Signs	839
	The Skin	839
	Head, Ears, Eyes, Throat, and Neck	840
	The Heart	840
	The Breasts	841
	The Abdomen	842
	Male Genitalia	843
	Female Genitalia	844
	The Musculoskeletal System	846
	The Nervous System	850
	Recording Your Findings	850
	Bibliography	853
Chapter 19	The Pregnant Woman	871
	Anatomy and Physiology	871
	The Health History	876
	Health Promotion and Counseling	878
	Techniques of Examination	881
	General Inspection	882
	Vital Signs, Height, and Weight	882
	Head and Neck	883
	Thorax and Lungs	883
	Heart	884
	Breasts	884
	Abdomen	884
	Genitalia, Anus, and Rectum	886
	Extremities	888
	Special Techniques	888
	Modified Leopold�s Maneuvers	888
	Concluding the Visit	891
	Recording Your findings	891
	Bibliography	891
Chapter 20	The Older Adult	893
	Anatomy and Physiology	894
	The Wealth History	901
	Approach to the patient	901
	Special Areas of Concern When Assessing Common or Concerning Symptoms	905
	Health Promotion and Counseling	909
	Techniques of Examination	913
	Assessing functional status: The �Sixth Vital Sign�	913
	Physical Examination of the Older Adult	916
	Recording Your findings	924
	Bibliography	926
	Index	935