9780781780698

Table of Contents


	Acknowledgments	vii
	Preface	xv
UNIT 1	FOUNDATIONS	1
Chapter 1	Introduction to Health Assessment	3
	Health Assessment	4
	Role of the Nurse in Assessment	8
Chapter 2	Critical Thinking in Health Assessment	11
	Nursing Process	14
	Assessment: The Process of Clinical Reasoning	15
	Identifying Problems and Making Nursing Diagnoses: Steps in Clinical Reasoning	16
	Recording Your Findings: The Case of Mrs. N	19
	Evaluating Clinical Findings	30
	Lifelong Learning: Integrating Clinical Reasoning, Assessment, and Analysis of Clinical Evidence	31
Chapter 3	Interviewing and Communication	35
	Phases of Interviewing	36
	Phase 1: Pre-Interview	37
	Phase 2: Introduction	39
	Phase 3: Working Phase	41
	Phase 4: Termination	46
	Therapeutic Communication Techniques	46
	Adapting the Interview for Special Patients	51
	Ethics of Interviewing	58
	Ethics and Professionalism	58
Chapter 4	The Health History	61
	The Comprehensive Adult Health History	63
	Sensitive Topics that Call for Specific Approaches	72
	Documenting the Health History	76
Chapter 5	Cultural and Spiritual Assessment	78
	Cultural Assessment	78
	Transcultural Perspectives on the Health History	83
	Spiritual Assessment	85
	Death and the Dying Patient	87
Chapter 6	Physical Examination	90
	The Comprehensive Adult Physical Examination	91
	Beginning the Examination: Setting the Stage	91
	Techniques of Examination	98
	Overview�The Physical Examination	101
Chapter 7	Beginning the Physical Examination: General Survey, Vital Signs, and Pain	105
	General Survey	105
	Vital Signs	106
	Pain, the Fifth Vital Sign	106
	General Appearance	106
	Apparent Stale of Health	106
	Level of Consciousness	106
	Facial Expression	106
	Odors of the Body and Breath	107
	Posture, Gait, Motor Activity, and Speech	107
	Signs of Distress	108
	Skin Color and Obvious Lesions	108
	Dress, Grooming, and Personal Hygiene	108
	The Vital Signs	109
	Blood Pressure	109
	Choice of Blood Pressure Cuff (Sphygmomanometer)	109
	Technique for Measuring Blood Pressure	110
	Classification of Normal and Abnormal Blood Pressure	113
	Special Techniques	114
	Heart Rate and Rhythm	116
	Heart Rate	116
	Rhythm	116
	Respiratory Rate and Rhythm	116
	Temperature	116
	Oral Thermometers	117
	Rectal Temperatures	117
	Tympanic Membrane Temperatures	117
	Temporal Artery Temperatures	117
	Axillary Temperatures	118
	Skin Temperatures	118
	Fever, Chills, and Night Sweats	118
	Acute and Chronic Pain	118
	Pain	118
	Understanding Acute and Chronic Pain	119
	Assessing the Patient�s History	119
	Types of Pain	120
	Pain Management	121
	Recording Your Findings	122
	Health Promotion	122
	Temperature	122
	Pulse	123
	Respirations	123
	Blood Pressure	123
Chapter 8	Nutrition	127
	Overview	127
	Hydration Status	128
	The Health History	128
	Common or Concerning Symptoms	128
	Changes in Weight	129
	Physical Examination	131
	General Survey	131
	Height Measurement	131
	Weight Measurement	132
	Skin, Hair, and Nails	133
	Head, Ears, Eyes, Nose, and Throat (Heent)	133
	Cardiovascular and Peripheral Vascular	133
	Gastrointestinal	133
	Musculoskeletal	134
	Neurologic	134
	Calculating the BMI	134
	Health Promotion and Counseling	136
	Important Topics for Health Promotion and Counseling	136
	Optimal Weight, Nutrition, and Diet	136
	Exercise	139
	Hydration	140
UNIT 2	BODY SYSTEMS	151
Chapter 9	The Integumentary System	153
	Anatomy and Physiology	154
	The Health History	156
	Common or Concerning Symptoms	156
	Past History	157
	Family History	157
	Lifestyle and Personal Habits	157
	Physical Examination	158
	Skin	158
	Hair	164
	Nails	164
	Recording Your Findings	165
	Health Promotion and Counseling	165
	Important Topics for Health Promotion and Counseling	165
Chapter 10	The Head and Neck	189
	The Head	189
	Anatomy and Physiology of the Head	189
	The Health History	190
	The Neck	193
	Anatomy and Physiology of the Neck	193
	Physical Examination	197
	Recording Your Findings	202
	Recording the Physical Examination�The Head and Neck	202
	Health Promotion and Counseling	203
	Important Topics	203
Chapter 11	The Eyes	211
	Anatomy and Physiology	211
	The Eyes	211
	Eye Structures	211
	The Health History	217
	Eye History	219
	Family History	220
	Lifestyle Habits	220
	Physical Examination	220
	Preparation of the Patient	220
	Vision Tests	221
	Steps for Examining the Optic Disc	229
	Special Techniques	232
	Recording the Physical Examination -The Eye	234
	Health Promotion, Disease Prevention, and Education	234
	Important Topics	234
	Vision Screening	234
	Eye Protection	235
	Care of Contact Lenses	235
Chapter 12	Ears, Nose, Mouth, and Throat	249
	The Ear	250
	Anatomy and Physiology	250
	The Health History	252
	Ear History	253
	Past History	255
	Family History	255
	Lifestyle Habits	255
	The Nose and Poranasal Sinuses	256
	Anatomy and Physiology	256
	The Health History	258
	Past History	260
	Family History	260
	Lifestyle Habits	260
	Mouth and Pharynx	261
	Anatomy and Physiology	261
	The Health History	264
	Past History	266
	Family History	266
	Lifestyle Habits	266
	Physical Examination of the Ear	266
	Physical Examination of the Nose	270
	Physical Examination of the Mouth and Throat	272
	Recording Your Findings	274
	Health Promotion, Disease Prevention, and Education: Ears	274
	Health Promotion, Disease Prevention, and Education: Mouth and Throat	275
Chapter 13	The Respiratory System	292
	Anatomy and Physiology	292
	The Health History	299
	Overview	299
	Past History	303
	Family History	304
	Lifestyle and Personal Habits	304
	Physical Examination	305
	Overview	305
	Initial Survey of Respiration and the Thorax	305
	Examination of the Posterior Chest	306
	Inspection	306
	Palpation	307
	Percussion	308
	Auscultation	312
	Examination of the Anterior Chest	316
	Inspection	316
	Palpation	316
	Percussion	318
	Auscultation	319
	Special Techniques	320
	Recording Your Findings	321
	Health Promotion and Counseling	321
Chapter 14	The Cardiovascular System	336
	Anatomy and Physiology	337
	Location of the Heart and Great Vessels	337
	The Heart Wall	339
	Cardiac Chambers, Valves, and Circulation	339
	The Cardiac Cycle	340
	The Splitting of Heart Sounds	342
	Heart Murmurs	343
	Relation of Auscultatory Findings to the Chest Wall	344
	The Conduction System	345
	The Heart as a Pump	347
	Arterial Pulses and Blood Pressure	347
	Jugular Venous Undulations	348
	Jugular Venous Pressure	348
	The Health History	350
	Past History	354
	Family History	354
	Lifestyle Habits	354
	Physical Examination	354
	Preparation of the Patient	354
	Face	355
	Great Vessels of the Neck	355
	The Heart	361
	Peripheral Edema	376
	Integrating Cardiovascular Assessment	376
	Recording Your Findings	376
	Recording the Physical Examination�The Cardiovascular Examination	376
	Health Promotion	377
	Health Promotion Topics	377
	Incidence	377
	Risk Reduction	379
	Healthy Lifestyles	381
Chapter 15	The Peripheral Vascular System and Lymphatic System	398
	Anatomy and Physiology	398
	Arteries	399
	Veins	401
	The Lymphatic System and Lymph Nodes	403
	Fluid Exchange and the Capillary Bed	404
	The Health History	405
	Past History	407
	Family History	408
	Lifestyle or Health Patterns	408
	Physical Examination	408
	Important Areas of Examination	409
	Arms	409
	Legs	410
	Recording Your Findings	416
	Special Techniques	417
	Health Promotion and Counseling	422
	Important Topics for Health Promotion and Counseling	422
Chapter 16	The Gastrointestinal and Renal Systems	431
	Anatomy and Physiology	431
	The Health History	435
	The Gastrointestinal Tract	437
	The Urinary Tract	444
	Physical Examination	447
	The Abdomen	448
	Inspection	448
	Auscultation	450
	Percussion	451
	Palpation	452
	The Uver	454
	The Kidneys	457
	The Bladder	459
	The Aorta	459
	Special Techniques	460
	The Spleen	460
	Recording Your Findings	466
	Recording the Physical Examination�The Abdomen	466
	Health Promotion	467
	Health Promotion Topics	467
Chapter 17	The Breasts and Axillae	490
	Anatomy and Physiology	490
	The Female Breast	490
	The Mole Breast	492
	Lymphatics	493
	The Health History	493
	History	495
	Family History	496
	Lifestyle Habits	497
	Physical Examination	497
	The Female Breast	497
	Inspection	497
	Palpation	500
	The Male Breast	503
	The Axillae	503
	Inspection	503
	Palpation	503
	Special Techniques	504
	Recording Your Findings	506
	Recording the Physical Examination�Breasts and Axillae	506
	Health Promotion and Counseling	506
	Important Topics for Health Promotion and Counseling	506
	Overview	506
	Selected Risk Factors that Affect Screening Decisions	509
	Recommendations for Breast Cancer Screening and Chemoprevention	510
	Counseling Women about Breast Cancer	512
Chapter 18	The Musculoskeletal System	517
	Assessing the Musculoskeletal System	517
	Overview	517
	Joint Structure and Function	518
	Types of Joint Articulation	519
	Structure of Synovial Joints	520
	The Health History	521
	Examination of Joints: Anatomy and Physiology and Physical Examination	523
	Important Areas of Examination for Each of the Major Joints	523
	Temporomandibular Joint	527
	Overview, Bony Structures, and Joints	527
	Muscle Groups and Additional Structures	528
	Physical Examination	528
	The Shoulder	529
	Overview	529
	Bony Structures	529
	Joints	530
	Muscle Groups	531
	Additional Structures	532
	Physical Examination	533
	The Elbow	538
	Overview, Bony Structures, and Joints	538
	Muscle Groups and Additional Structures	538
	Physical Examination	539
	The Wrist and Hands	541
	Overview	541
	Bony Structures	541
	Joints	542
	Muscle Groups	542
	Additional Structures	543
	Physical Examination	543
	The Spine	550
	Overview	550
	Bony Structures	551
	Joints	552
	Muscle Groups	553
	Physical Examination	553
	The Hip	559
	Overview	559
	Bony Structures and Joints	559
	Muscle Groups	560
	Additional Structures	561
	Physical Examination	561
	The Knee	566
	Overview	566
	Bony Structures	566
	Joints	567
	Muscle Groups	567
	Additional Structures	567
	Physical Examination	568
	The Ankle and Foot	572
	Overview	572
	Bony Structures and Joints	572
	Muscle Groups and Additional Structures	573
	Physical Examination	574
	Special Techniques	576
	Recording Your Findings	578
	Health Promotion	578
	Health Promotion Topics	578
Chapter 19	Mental Status	595
	Symptoms and Behavior	596
	The Health History	597
	Physical Examination	599
	Important Areas of the Mental Status Examination	600
	Appearance and Behavior	601
	Speech and Language	602
	Mood	603
	Thought and Perceptions	604
	Cognitive Functions	605
	Higher Cognitive Functions	607
	Special Techniques	609
	Recording Your Findings	609
	Recording Behavior and Mental Status	609
	Health Promotion and Counseling	610
	Important Topics for Health Promotion and Counseling	610
Chapter 20	The Nervous System	613
	Anatomy and Physiology	613
	Central Nervous System	613
	Peripheral Nervous System	616
	The Peripheral Nerves	616
	Motor Pathways	618
	Sensory Pathways	620
	Spinal Reflexes: the Deep Tendon Response	622
	The Health History	623
	Physical Examination	627
	The Cranial Nerves	630
	The Motor System	635
	The Sensory System	639
	Deep Tendon Reflexes	645
	Cutaneous Stimulation Reflexes (Superficial Reflexes)	650
	Abbreviated Neurologic Assessment	651
	Assessment for Comatose Patient	651
	Special Techniques	656
	Recording Your Findings	657
	Recording the Examination�The Nervous System	657
	Health Promotion and Counseling	658
	Important Topics for Health Promotion and Counseling	658
Chapter 21	Reproductive Systems	683
	Female Reproductive System	684
	Anatomy and Physiology	684
	The Health History	686
	Menstrual History	687
	Obstetric History	690
	Physical Examination	692
	Important Areas of Examination	692
	External Examination	694
	Internal Examination	695
	Recording Your Findings	695
	Recording the Pelvic Examination�Female Genifalia	695
	Health Promotion and Counseling	695
	Important Topics for Health Promotion and Counseling	695
	Male Reproductive System	699
	Anatomy and Physiology	699
	The Health History	701
	Physical Examination	705
	The Penis	705
	Inspection	705
	The Scrotum and its Contents	706
	Inspection	706
	Hernias	706
	Inspection	706
	Recording Your Findings	707
	Recording the Physical Examination� Male Genitalia and Hernias	707
	Health Promotion and Counseling	707
	Important Topics for Health Promotion and Counseling	707
Chapter 22	Putting it All Together	720
	A Sample of the Sequencing for a Head-To-Toe Assessment	722
	Physical Examination Overview	722
UNIT 3	SPECIAL LIFESPAN	729
Chapter 23	Assessing Children: Infancy through Adolescence	731
	General Principles of Child Development	733
	Health Promotion and Counseling: Key Components	734
	Key Components of Pediatric Health Promotion	736
	Assessing the Infant	736
	Development	736
	The Health History	737
	Birth History	738
	Past History	738
	Family History	738
	Health Maintenance	738
	Health Patterns	739
	Approaching the Infant	739
	General Guidelines	740
	Testing for Developmental Milestones	741
	Physical Examination of the Infant	744
	General Survey and Vital Signs	744
	The Skin	748
	The Head	750
	The Eyes	752
	The Ears	754
	The Nose and Sinuses	754
	The Mouth and Pharynx	754
	The Neck	755
	The Thorax and Lungs	756
	The Heart	759
	The Breasts	763
	The Abdomen	763
	Male Genitalia	765
	Female Genitalia	766
	Rectal Examination	766
	The Musculoskeletal System	767
	The Nervous System	769
	Health Promotion and Counseling	775
	Assessing Young and School-Aged Children	776
	Development	776
	Early Childhood: 1 to 4 Years	776
	Middle Childhood: 5 to 10 Years	777
	The Health History	778
	Assessing Younger Children	779
	Assessing Older Children	780
	Physical Examination of Young and School-Aged Children	782
	General Survey and Vital Signs	782
	The Skin	785
	The Head	785
	The Eyes	786
	The Ears	787
	The Nose and Sinuses	789
	The Mouth and Pharynx	790
	The Neck	792
	The Thorax and Lungs	793
	The Heart	794
	The Abdomen	796
	Male Genitalia	797
	Female Genitalia	798
	The Rectal Examination	800
	The Musculoskeletal System	800
	The Nervous System	801
	Health Promotion and Counseling	804
	Children 1 to 4 Years	804
	Children 5 to 10 Years	805
	Assessing Adolescents	806
	Development: 11 to 20 Years	806
	The Health History	808
	Physical Examination of the Adolescent	810
	General Survey and Vital Signs	810
	The Skin	810
	Head, Ears, Eyes, Throat, and Neck	811
	The Heart	811
	The Breasts	811
	The Abdomen	813
	Male Genitalia	813
	Female Genitalia	815
	The Musculoskeletal System	817
	The Nervous System	818
	Health Promotion and Counseling	818
	Recording Your Findings	820
Chapter 24	Assessing Older Adults	840
	Chapter Overview: the Aging Adult	841
	Anatomy and Physiology	841
	The Health History	849
	Approach to the Parent	849
	Approach to the Older Adult Patient	849
	Focus Areas When Assessing Older Adults	852
	Common Concerns	852
	Physical Examination of the Older Adult	860
	Recording Your Findings	866
	Health Promotion and Counseling	868
	Important Topics for Health Promotion and Counseling in the Older Adult	868
	Glossary	883
	Index	887