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Test Bank for Health Assessment for Nursing Practice, 4th Edition: Wilson

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Test Bank for Health Assessment for Nursing Practice, 4th Edition: Wilson

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Using a nursing-oriented, holistic approach, this straightforward text provides you with a visual presentation to conducting physical examinations. This textbook clearly delineates the routine exam techniques from those exams for special circumstances or advanced practice.

  • UNIQUE! Routine exams and exams for advanced practice are identified with a special icon to help you quickly and easily determine essential assessment content.
  • Body system chapters are subdivided into clearly delineated sections to allow easy navigation among these consistent sections within the chapters.
  • UNIQUE! End-of-chapter Documentation Samples demonstrate how to document client data and provide a practice context for client charting.
  • UNIQUE! Special feature boxes outline common, Frequently Asked Questions (FAQs) about health assessment and provide corresponding answers.
  • Ethnic and Cultural Variations boxes present differences to anticipate among today’s multicultural client population and show how to vary the exam for varied populations.
  • Separate sections for special circumstances or special needs show how to vary the exam for clients with special needs.
  • Feature boxes outline Healthy People 2010 objectives to provide you thorough discussions of recommendations for health promotion and reducing risk.
  • Interactive Activity Lists at the end of each chapter outline corresponding exercises, checklists, and lab forms that can be found on the companion CD-ROM.
  • Case Studies with Clinical Reasoning Questions are provided at the end of each chapter to test your application of textbook material.
  • NCLEX® exam-style review questions are included at the end of each chapter.
  • PDA-Downloadable Exam Techniques are included on the Evolve companion website to allow you to easily access important summary exam information.
  • UNIQUE! The 30 Core Assessment Skills identified by research as most commonly performed by nurses are now highlighted with a unique icon.
  • UNIQUE! The companion CD-ROM now provides the Core Assessment Skills Checklists as quick step-by-step summaries for each of the 30 Core Assessment Skills.
  • Two new chapters pull all of the essential exam and assessment content together into cohesive chapters for the infant and child and the older adult.
  • UNIQUE! Clinical Reasoning Exemplars walk you through the thinking process of how an experienced nurse makes decisions.
  • UNIQUE! Concept boxes feature eight concepts in the context of health assessment including pain, sleep, oxygenation, perfusion, tissue integrity, motion, sensory, and intracranial regulation.

 

Table of Content:

  1. UNIT 1 FOUNDATIONS FOR HEALTH ASSESSMENT
  2. CHAPTER 1 Why Learn Health Assessment?
  3. COMPONENTS OF HEALTH ASSESSMENT
  4. Health History
  5. Physical Examination
  6. Documentation of Data
  7. BOX 1-1 STANDARDS OF NURSING PRACTICE The Nursing Process
  8. Standard 1: Assessment
  9. Standard 2: Diagnosis
  10. Standard 3: Outcome Identification
  11. Standard 4: Planning
  12. Standard 5: Implementation
  13. Standard 6: Evaluation
  14. TYPES OF HEALTH ASSESSMENT
  15. BOX 1-2 CLARIFICATION OF TERMS Signs & Symptoms and Clinical Manifestations
  16. Signs & Symptoms
  17. Clinical Manifestations
  18. Context of Care
  19. Fig. 1-1 The nurse may take notes while conducting a health assessment.
  20. BOX 1-3 TYPES OF HEALTH ASSESSMENT
  21. Client Need
  22. Expertise of the Nurse
  23. CLINICAL REASONING AND JUDGMENT
  24. BOX 1-4 CORE EXAMINATION SKILLS*
  25. Skin
  26. Head, Eyes, Ears, Nose, Throat
  27. Chest & Lungs
  28. Cardiovascular
  29. Musculoskeletal
  30. Abdomen
  31. Neurologic
  32. Genitalia
  33. Data Organization
  34. TABLE 1-1 Functional Health Pattern Organization
  35. FREQUENTLY ASKED QUESTIONS
  36. Data Analysis, Interpretation, and Clinical Judgment
  37. Fig. 1-2 Clinical Judgment Model. Noticing refers to the nurse’s expectations and initial grasp of a situation. Noticing triggers reasoning patterns that allow the nurse to interpret the situation and respond with interventions. Reflection-in-action specifically relates to evaluating outcomes of interventions while reflection-on-action represents the contribution of an experience to a nurse’s collective experiences.
  38. TABLE 1-2 NANDA Taxonomy II Domains
  39. HEALTH PROMOTION AND HEALTH PROTECTION
  40. TABLE 1-3 Levels of Health Promotion
  41. Fig. 1-3 Overview of Healthy People 2010 goals, leading health indicators, and focus areas.
  42. CLINICAL APPLICATION & CLINICAL REASONING
  43. REVIEW QUESTIONS
  44. CASE STUDY 1
  45. CASE STUDY 2
  46. Interview Data
  47. Examination Data
  48. INTERACTIVE ACTIVITIES
  49. CHAPTER 2 Ethnic and Cultural Considerations
  50. Fig. 2-1 Ethnicity is indicative of a common race, language, and dialect, as well as shared tradition.
  51. Fig. 2-2 Clients receive effective, understandable, and respectful care.
  52. BECOME CULTURALLY COMPETENT
  53. BOX 2-1 WAYS TO ACHIEVE CULTURAL COMPETENCE
  54. DON’T STEREOTYPE
  55. Fig. 2-3 When interviewing clients, recognize that cultural diversity exists.
  56. Fig. 2-4 It is important to develop sensitivity to the differences between your own culture and that of clients from another culture.
  57. DEVELOP A TEMPLATE FOR ASSESSMENT
  58. Introductory Questions
  59. What is the Client’s Primary Language and Method of Communication?
  60. What are the Client’s Personal Beliefs about Health and Illness?
  61. What Religious or Spiritual Influences Affect the Client?
  62. What are the Roles of Individual People in the Family?
  63. Does the Client have Special Dietary Practices?
  64. REMEMBER …
  65. CLINICAL APPLICATION & CLINICAL REASONING
  66. REVIEW QUESTIONS
  67. INTERACTIVE ACTIVITIES
  68. CHAPTER 3 Interviewing to Obtain a Health History
  69. THE INTERVIEW
  70. BOX 3-1 PHASES OF AN INTERVIEW
  71. Introduction Phase
  72. Discussion Phase
  73. Summary Phase
  74. Therapeutic Communication: The Foundation for Interviewing
  75. Fig. 3-1 Introduce yourself when you begin an interview.
  76. The Physical Setting
  77. Professional Nursing Behavior
  78. Client-Related Variables
  79. The Art of Asking Questions
  80. Types of Questions to Ask
  81. Techniques that Enhance Data Collection
  82. Active Listening
  83. Facilitation
  84. Clarification
  85. Restatement
  86. Reflection
  87. Confrontation
  88. Interpretation
  89. Summary
  90. Techniques that Diminish Data Collection
  91. Using Medical Terminology
  92. Expressing Value Judgments
  93. Interrupting the Client
  94. Being Authoritarian or Paternalistic
  95. Using “Why” Questions
  96. Managing Awkward Moments During an Interview
  97. Answering Personal Questions
  98. Silence
  99. Displays of Emotion
  100. Challenges to the Interview
  101. Managing the Overly Talkative Client
  102. Others in the Room
  103. Language Barrier
  104. Cultural Differences
  105. Fig. 3-2 Interact with the client as a unique person and be sensitive to cultural diversities.
  106. THE HEALTH HISTORY
  107. Types of Health Histories
  108. FREQUENTLY ASKED QUESTIONS
  109. Components of the Health History
  110. Biographic Data
  111. Reason for Seeking Health Care
  112. BOX 3-2 BIOGRAPHIC DATA
  113. History of Present Illness
  114. Present Health Status
  115. BOX 3-3 MNEMONIC FOR SYMPTOM ANALYSIS OLD CARTS
  116. Onset: When Did the Symptoms Begin?
  117. Location: Where Are the Symptoms?
  118. Duration: How Long Do the Symptoms Last?
  119. Characteristics: Describe the Characteristics of the Symptom
  120. Aggravating and Alleviating Factors: What Affects the Symptoms?
  121. Related Symptoms: What Other Symptoms Are Present?
  122. Treatment: Describe Self-Treatment Tried before Seeking Care
  123. Severity: Describe the Severity of the Symptom
  124. Past Health History
  125. Family History
  126. Personal and Psychosocial History
  127. Personal Status.
  128. Family and Social Relationships.
  129. Fig. 3-3 Sample genogram identifying grandparents, parents, aunts and uncles, siblings, spouse, and children.
  130. Diet/Nutrition.
  131. Functional Ability.
  132. Mental Health.
  133. Personal Habits.
  134. BOX 3-4 DOMESTIC VIOLENCE
  135. Recognizing Domestic Violence
  136. Screening Questions for Domestic Violence
  137. Health Promotion Activities.
  138. Environment.
  139. Review of Systems
  140. General Symptoms
  141. Integumentary System
  142. Head and Neck
  143. Breasts
  144. Respiratory System/Chest
  145. Cardiovascular System
  146. Gastrointestinal System
  147. Urinary System
  148. Reproductive System
  149. Musculoskeletal System
  150. Neurologic System
  151. Health History Based on Functional Health Patterns
  152. AGE-RELATED VARIATIONS
  153. Infants, Children, and Adolescents
  154. Pregnancy
  155. Older Adults
  156. SUMMARY
  157. CLINICAL APPLICATION & CLINICAL REASONING
  158. REVIEW QUESTIONS
  159. CASE STUDY
  160. Questions
  161. INTERACTIVE ACTIVITIES
  162. CHAPTER 4 Techniques and Equipment for Physical Assessment
  163. TECHNIQUES OF PHYSICAL ASSESSMENT
  164. Inspection
  165. Palpation
  166. Fig. 4-1 Tangential light used to inspect jugular vein pulsation.
  167. Percussion
  168. Direct Percussion
  169. Indirect Percussion
  170. Fig. 4-2 Palpation. A, Superficial palpation. B, Deep palpation.
  171. Fig. 4-3 Hand position for direct fist percussion of kidney.
  172. FREQUENTLY ASKED QUESTIONS
  173. Auscultation
  174. Fig. 4-4 Indirect percussion of lateral chest wall.
  175. Fig. 4-5 The diaphragm of the stethoscope is stabilized between the index and middle fingers.
  176. TABLE 4-1 Percussion Tones
  177. BOX 4-1 CHARACTERISTICS OF SOUNDS HEARD BY AUSCULTATION
  178. POSITIONING
  179. EQUIPMENT USED DURING THE EXAMINATION PROCESS
  180. Thermometers (Temperature Measurement)
  181. TABLE 4-2 Positions for Examination
  182. Fig. 4-6 A, Electronic thermometer. B, Tympanic thermometer.
  183. Stethoscope
  184. Fig. 4-7 A, Acoustic stethoscope. B, Fetoscope.
  185. Equipment to Measure Blood Pressure
  186. Fig. 4-8 A, Aneroid sphygmomanometer. B, Noninvasive blood pressure (NIBP) monitor with disposable blood pressure cuff.
  187. Fig. 4-9 Blood pressure cuffs in various sizes. A, Reusable cuffs in large adult (top), adult (middle), and child (bottom) sizes. Note the range lines above the Velcro material on the right side of each cuff. B, Disposable infant (top) and neonatal (bottom) cuffs. (B,
  188. Fig. 4-10 Pulse oximeter shown with a clip and tape sensor probe.
  189. TABLE 4-3 Sizes for Blood Pressure Cuffs Based on Arm Circumference*
  190. Pulse Oximetry
  191. Scales
  192. Visual Acuity and Screening
  193. Snellen’s Chart
  194. Fig. 4-11 A, Adult platform scale. B, Infant platform scale.
  195. Jaeger and Rosenbaum Charts
  196. Ophthalmoscope
  197. Fig. 4-12 A, Snellen’s visual acuity chart. B, “E” chart.
  198. Fig. 4-13 Rosenbaum near-vision chart.
  199. Fig. 4-14 Ophthalmoscope.
  200. Fig. 4-15 A, Traditional otoscope with pneumatic bulb. B, MacroView ototscope.
  201. Otoscope
  202. Penlight
  203. Fig. 4-16 Penlight.
  204. Fig. 4-17 Centimeter ruler.
  205. Ruler and Tape Measure
  206. Nasal Speculum
  207. Tuning Fork
  208. Fig. 4-18 Nasal speculum.
  209. Percussion, or Reflex, Hammer
  210. Doppler
  211. Fig. 4-19 Tuning forks for vibratory sensation (top) and auditory screening (bottom).
  212. Fig. 4-20 Percussion hammer.
  213. Goniometer
  214. Fig. 4-21 Doppler.
  215. Fig. 4-22 Goniometer.
  216. Calipers for Skinfold Thickness
  217. Vaginal Speculum
  218. Fig. 4-23 Skinfold calipers.
  219. Fig. 4-24 Vaginal specula.
  220. Audioscope
  221. Fig. 4-25 Audioscope.
  222. Monofilament
  223. Fig. 4-26 A, Monofilament. B, Assessing peripheral sensation.
  224. Fig. 4-27 Transilluminator.
  225. Transilluminator
  226. Wood’s Lamp
  227. Magnification Device
  228. Fig. 4-28 Wood’s lamp. The purple color on the skin indicates that no fungal infection is present.
  229. APPLICATION OF INFECTION CONTROL PRINCIPLES
  230. Latex Allergy
  231. BOX 4-3 STANDARD PRECAUTION GUIDELINES Personal Protective Equipment
  232. Gloves
  233. Masks, Eye Protection, Face Shields
  234. Gown
  235. Patient Care Equipment
  236. BOX 4-4 PREVENTING LATEX ALLERGY
  237. BOX 4-2 STANDARD PRECAUTION GUIDELINES Hand Hygiene
  238. CLINICAL APPLICATION & CLINICAL REASONING
  239. REVIEW QUESTIONS
  240. INTERACTIVE ACTIVITIES
  241. CHAPTER 5 General Inspection and Measurement of Vital Signs
  242. GENERAL INSPECTION
  243. Physical Appearance and Hygiene
  244. Body Structure and Position
  245. Body Movement
  246. Fig. 5-1 General inspection begins immediately on meeting the client. Note physical appearance, hygiene, body structure, movement, posture, emotional status, and behavior.
  247. Emotional and Mental Status and Behavior
  248. MEASUREMENT OF VITAL SIGNS, HEIGHT, AND WEIGHT
  249. Temperature
  250. FREQUENTLY ASKED QUESTIONS
  251. Oral Temperature
  252. BOX 5-1 CONVERSIONS BETWEEN FAHRENHEIT AND CELSIUS
  253. Tympanic Membrane Temperature
  254. Axillary Temperature
  255. Fig. 5-2 Taking a tympanic membrane temperature.
  256. Rectal Temperature
  257. Heart Rate
  258. TABLE 5-1 Average Vital Signs Throughout the Life Span
  259. Fig. 5-3 Radial pulse.
  260. Fig. 5-4 Brachial pulse.
  261. Respiratory Rate
  262. Fig. 5-5 Carotid pulse.
  263. Blood Pressure
  264. Measurement of Blood Pressure
  265. Fig. 5-6 Auscultating Korotkoff sounds to measure blood pressure.
  266. Mechanism of Blood Pressure Measurement
  267. BOX 5-2 PROCEDURE FOR MEASURING BLOOD PRESSURE (AUSCULTATION METHOD)
  268. Physiologic Factors that Affect Blood Pressure Measurements
  269. Fig. 5-7 Sounds auscultated during blood pressure measurement can be differentiated into five Korotkoff phases. In this example the blood pressure is 140/90.
  270. Common Errors Associated with Blood Pressure Measurement
  271. BOX 5-3 ERRORS IN BLOOD PRESSURE MEASUREMENT
  272. Errors Resulting in False-High Blood Pressure Measurement
  273. Errors Resulting in False-Low Blood Pressure Measurement
  274. Oxygen Saturation
  275. Pain
  276. Weight
  277. Height
  278. Fig. 5-8 Assessment of height using a platform scale.
  279. AGE-RELATED VARIATONS
  280. Infants and Children
  281. Older Adults
  282. CLINICAL APPLICATION & CLINICAL REASONING
  283. REVIEW QUESTIONS
  284. INTERACTIVE ACTIVITIES
  285. CHAPTER 6 Pain Assessment
  286. Fig. 6-1 A method of classifying pain is by the pathophysiology involved. I, Nociceptive pain (stimuli from somatic and visceral structures). II, Neuropathic pain (stimuli abnormally processed by nervous system).
  287. ANATOMY & PHYSIOLOGY
  288. Fig. 6-2 Outlines the four basic processes involved in nociception: 1, transduction; 2, transmission; 3, perception; and 4, modulation.
  289. Fig. 6-2, cont’d
  290. Fig. 6-3 Illustrates the four steps involved in the pain process: transduction, when nociceptors stimulate the free nerve endings; transmission, when nociceptor stimulation initiates action potentials along A-delta or C fibers to open the gate in the substantia gelatinosa and ascend to the brain in the spinothalamic tract through the thalamus (or stimulate A-alpha or A-beta fibers that close the gate); perception, when impulses move from the thalamus to the parietal lobe, where pain is felt, and to the limbic system, which derives the emotional response to pain; and modulation, when the body produces endorphins and enkephalins to occupy the opiate receptor sites to close the gate.
  291. TABLE 6-1 Examples of How Various Stimuli Produce Pain
  292. LINK TO CONCEPTS Pain
  293. HEALTH HISTORY
  294. HEALTH HISTORY
  295. Present Health Status
  296. DESCRIPTION OF PAIN
  297. Location
  298. Quality
  299. Quantity
  300. Chronology
  301. Setting
  302. Associated Manifestations
  303. Alleviating Factors
  304. Aggravating Factors
  305. RESPONSE TO PAIN
  306. Fig. 6-4 McGill Pain Questionnaire. The descriptors fall into four major groups: sensory, 1 to 10; affective, 11 to 15; evaluative, 16; and miscellaneous, 17 to 20. The rank value of each descriptor is based on its position in the word set. The sum of the rank values is the pain rating index (PRI). The present pain intensity (PPI) is based on a scale of 0 to 5.
  307. Fig. 6-5 A, Descriptive pain intensity scale; B, Numeric pain intensity scale; C, Visual analog scale.
  308. Fig. 6-6 Self-contained, portable, pain-rating instrument that can provide immediate assessment of pain. It is a 5 × 20 cm plastic visual analog scale with a sliding marker that moves within a 10 cm groove. The side facing the client (A) resembles a traditional analog scale, whereas the opposite side (B) is marked in centimeters to quantify pain intensity. The tool has been shown to be valid to measure pain intensity.
  309. FREQUENTLY ASKED QUESTIONS
  310. EXAMINATION
  311. PROCEDURE AND TECHNIQUES WITH NORMAL FINDINGS
  312. OBSERVE client for posture and behavior to relieve pain.
  313. ABNORMAL FINDINGS
  314. OBSERVE facial expressions.
  315. ABNORMAL FINDINGS
  316. LISTEN for sounds the client makes.
  317. ABNORMAL FINDINGS
  318. INSPECT AND PALPATE skin for color, temperature, and moisture.
  319. ABNORMAL FINDINGS
  320. MEASURE blood pressure and pulse.
  321. ABNORMAL FINDINGS
  322. ASSESS respiratory rate and pattern.
  323. ABNORMAL FINDINGS
  324. OBSERVE pupillary size.
  325. ABNORMAL FINDINGS
  326. AGE-RELATED VARIATIONS
  327. Infants & Children
  328. Older Adults
  329. CLINICAL APPLICATION & CLINICAL REASONING
  330. REVIEW QUESTIONS
  331. SAMPLE DOCUMENTATION
  332. SUBJECTIVE DATA
  333. OBJECTIVE DATA
  334. Interview Data
  335. Examination Data
  336. CLINICAL Reasoning
  337. INTERACTIVE ACTIVITIES
  338. CHAPTER 7 Mental Health and Mental Status Assessment
  339. ANATOMY & PHYSIOLOGY
  340. Fig. 7-1 The limbic system.
  341. ETHNIC & CULTURAL VARIATIONS
  342. Culturally Relevant Phenomena in Mental Health Nursing
  343. HEALTH HISTORY
  344. RISK FACTORS Depression and Anxiety
  345. Risk Factors for Depression
  346. Risk Factors for Anxiety
  347. GENERAL HEALTH HISTORY
  348. Present Health Status
  349. Self-Concept
  350. TABLE 7-1 Problems of Word Usage Associated with Alterations in Thought Processes
  351. Interpersonal Relationships
  352. Stressors
  353. TABLE 7-2 Holmes Social Readjustment Rating Scale
  354. Anger
  355. Alcohol Use
  356. Recreational Drug Use
  357. Past Medical History
  358. Family History
  359. PROBLEM-BASED HISTORY
  360. Depression
  361. FREQUENTLY ASKED QUESTIONS
  362. Anxiety
  363. Fig. 7-2 Beck Depression Inventory.
  364. Alcohol Abuse
  365. TABLE 7-3 AUDIT Structured Interview*
  366. BOX 7-1 CAGE Questions Used to Screen for Alcoholism
  367. Drug Abuse
  368. ETHNIC & CULTURAL VARIATIONS
  369. Altered Mental Status
  370. HEALTH PROMOTION Mental Illness and Suicide Prevention
  371. Goals and Objectives—Healthy People 2010
  372. Recommendations to Reduce Risk (Primary Prevention)
  373. Institute of Medicine (IOM)
  374. Screening Recommendations (Secondary Prevention)
  375. U.S. Preventive Services Task Force
  376. HEALTH PROMOTION Substance Abuse
  377. Goals and Objectives—Healthy People 2010
  378. Recommendations to Reduce Risk (Primary Prevention)
  379. National Institute on Drug Abuse
  380. Screening Recommendations (Secondary Prevention)
  381. U.S. Preventive Services Task Force
  382. Recommendations for Treatment (Tertiary Prevention)
  383. Substance Abuse and Mental Health Administration
  384. EXAMINATION
  385. PROCEDURE AND TECHNIQUES WITH NORMAL FINDINGS
  386. OBSERVE the client’s posture and movements.
  387. ABNORMAL FINDINGS
  388. OBSERVE for appropriate dress and hygiene.
  389. ABNORMAL FINDINGS
  390. OBSERVE for changes in voice tone, rate of speech, perspiration, and muscle tension or tremors.
  391. ABNORMAL FINDINGS
  392. ASSESS mental status by determining orientation, memory, calculation ability, communication skills, judgment, and abstraction.
  393. Orientation
  394. ABNORMAL FINDINGS
  395. Memory
  396. ABNORMAL FINDINGS
  397. Calculation ability
  398. ABNORMAL FINDINGS
  399. Communication skills od pressure.
  400. ABNORMAL FINDINGS
  401. PALPATE the radial pulse for rate.
  402. ABNORMAL FINDINGS
  403. OBSERVE and COUNT respirations for rate and breathing pattern.
  404. ABNORMAL FINDINGS
  405. OBSERVE eye movements and MEASURE pupil size.
  406. ABNORMAL FINDINGS
  407. TABLE 7-4 Clinical Findings of Acute Drug Intoxication
  408. TABLE 7-5 Common Eye Signs Detected after Abuse of Selected Drugs
  409. BOX 7-2 RAPID EYE TEST TO DETECT CURRENT DRUG INTOXICATION
  410. General Observation
  411. Pupil Size
  412. Pupil Reaction to Light
  413. Nystagmus
  414. Convergence
  415. Corneal Reflex
  416. AGE-RELATED VARIATIONS
  417. Infants, Children & Adolescents
  418. Older Adults
  419. COMMON PROBLEMS & CONDITIONS
  420. ALTERATIONS OF MOOD AND AFFECT
  421. Major Depression
  422. Bipolar Disorder
  423. Anxiety
  424. Obsessive-Compulsive Disorder
  425. Psychotic Disorders
  426. Schizophrenia (Dopamine Dysregulation Disorder)
  427. Substance Abuse Disorders
  428. Alcohol Withdrawal Syndrome
  429. Drug Intoxication
  430. Delirium and Dementia
  431. Delirium
  432. Dementia
  433. CLINICAL APPLICATION & CLINICAL REASONING
  434. REVIEW QUESTIONS
  435. CASE STUDY
  436. Interview Data
  437. Examination Data
  438. CLINICAL Reasoning
  439. INTERACTIVE ACTIVITIES
  440. CHAPTER 8 Sleep Assessment
  441. ANATOMY & PHYSIOLOGY
  442. STAGES OF SLEEP
  443. Fig. 8-1 The RAS and BSR control sensory input, intermittently activating and suppressing the brain’s higher centers to control sleep and wakefulness.
  444. TABLE 8-1 Physiologic Changes during Sleep
  445. Fig. 8-2 Histogram showing stages of sleep.
  446. LINK TO CONCEPTS Sleep
  447. HEALTH HISTORY
  448. RISK FACTORS Insomnia and Sleep Apnea
  449. INSOMNIA
  450. SLEEP APNEA
  451. Obstructive Sleep Apnea
  452. Central Sleep Apnea
  453. GENERAL HEALTH HISTORY
  454. Present Health Status
  455. BOX 8-1 DRUGS AND THEIR EFFECTS ON SLEEP
  456. Hypnotics
  457. Diuretics
  458. Antidepressants and Stimulants
  459. Alcohol
  460. Caffeine
  461. Beta-Adrenergic Blockers
  462. Benzodiazepines
  463. Narcotics (Morphine/Demerol)
  464. Anticonvulsants
  465. PROBLEM-BASED HISTORY
  466. Insomnia
  467. Sleep Apnea
  468. EXAMINATION
  469. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  470. OBSERVE the client for mental status, thought patterns, and speech patterns.
  471. ABNORMAL FINDINGS
  472. OBSERVE gross motor movements and posture.
  473. ABNORMAL FINDINGS
  474. MEASURE blood pressure and weight.
  475. ABNORMAL FINDINGS
  476. INSPECT nasal septum for patency and deviation.
  477. ABNORMAL FINDINGS
  478. INSPECT pharynx for tonsillar hypertrophy.
  479. ABNORMAL FINDINGS
  480. AGE-RELATED VARIATIONS
  481. Infants, Children, and Adolescents
  482. Older Adults
  483. COMMON PROBLEMS & CONDITIONS
  484. INSOMNIA
  485. NARCOLEPSY
  486. SLEEP APNEA
  487. CLINICAL APPLICATION & CLINICAL REASONING
  488. REVIEW QUESTIONS
  489. SAMPLE DOCUMENTATION
  490. SUBJECTIVE DATA
  491. OBJECTIVE DATA
  492. CASE STUDY
  493. Interview Data
  494. Examination Data
  495. CLINICAL Reasoning
  496. INTERACTIVE ACTIVITIES
  497. CHAPTER 9 Nutritional Assessment
  498. ANATOMY & PHYSIOLOGY
  499. MACRONUTRIENTS
  500. BOX 9-2 CALCULATING THE PERCENT OF CALORIES FROM MACRONUTRIENTS
  501. BOX 9-1 CALCULATING GRAMS OF A MACRONUTRIENT
  502. MICRONUTRIENTS
  503. TABLE 9-1 Vitamins
  504. TABLE 9-2 Minerals
  505. WATER
  506. HEALTH HISTORY
  507. RISK FACTORS Nutrition
  508. GENERAL HEALTH HISTORY
  509. Present Health Status
  510. ETHNIC & CULTURAL VARIATIONS
  511. Past Medical History and Family History
  512. PROBLEM-BASED HISTORY
  513. Weight Loss
  514. Weight Gain
  515. Difficulty Chewing or Swallowing
  516. Loss of Appetite or Nausea
  517. ASSESSMENT OF DIETARY INTAKE
  518. ETHNIC & CULTURAL VARIATIONS
  519. Jewish Dietary Laws
  520. TABLE 9-3 Techniques to Assess Dietary Intake
  521. HEALTH PROMOTION Overweight and Obesity
  522. Goals and Objectives—Healthy People 2010
  523. Recommendations to Reduce Risk (Primary Prevention)
  524. U.S. Preventive Services Task Force
  525. Screening Recommendations (Secondary Prevention)
  526. U.S. Preventive Services Task Force
  527. Recommendations for Treatment/Referral (Tertiary Prevention)
  528. U.S. Preventive Services Task Force
  529. Fig. 9-1 MyPyramid Food Guide.
  530. HEALTH PROMOTION Diabetes Mellitus
  531. Goals and Objectives—Healthy People 2010
  532. Recommendations to Reduce Risk (Primary Prevention)
  533. American Diabetes Association
  534. Screening Recommendations (Secondary Prevention)
  535. American Diabetes Association
  536. Recommendations for Treatment (Tertiary Prevention)
  537. American Diabetes Association
  538. EXAMINATION
  539. TABLE 9-4 Clinical Signs and Symptoms of Various Nutrient Deficiencies
  540. ROUTINE TECHNIQUES: NUTRITION
  541. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  542. MEASURE height and weight for body mass index (BMI).
  543. ABNORMAL FINDINGS
  544. ETHNIC & CULTURAL VARIATIONS
  545. ASSESS general appearance and level of orientation.
  546. ABNORMAL FINDINGS
  547. TABLE 9-5 Body Mass Index Chart*
  548. Fig. 9-2 Nomogram to estimate body mass index. Measure height to the nearest inch and weight to the nearest pound; mark on the two corresponding scales. Use a straight-edge ruler to connect the two points and circle the spot where the straight line crosses the center line.
  549. BOX 9-3
  550. Calculation of Body Mass Index (BMI)
  551. Calculation Using Kilograms and Meters
  552. Calculation Using Pounds and Inches
  553. INSPECT the skin for surface characteristics, hydration, and lesions.
  554. ABNORMAL FINDINGS
  555. Fig. 9-3 Follicular hyperkeratosis.
  556. INSPECT the hair and nails for appearance and texture.
  557. ABNORMAL FINDINGS
  558. INSPECT the eyes for surface characteristics.
  559. ABNORMAL FINDINGS
  560. Fig. 9-4 Xerophthalmia.
  561. INSPECT the oral cavity for dentition and intact mucous membranes.
  562. ABNORMAL FINDINGS
  563. INSPECT and PALPATE the extremities for shape, size, coordinated movement, and sensation.
  564. ABNORMAL FINDINGS
  565. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: NUTRITION
  566. CALCULATE desirable body weight (DBW).
  567. ABNORMAL FINDINGS
  568. BOX 9-4 Calculation of Desirable Body Weight (DBW)
  569. CALCULATE percent change in weight.
  570. ABNORMAL FINDINGS
  571. CALCULATE the waist-to-hip ratio.
  572. ABNORMAL FINDINGS
  573. Fig. 9-5 Distribution of body fat. A, Pear shape. B, Apple shape.
  574. ESTIMATE body fat by measuring triceps skinfold.
  575. ABNORMAL FINDINGS
  576. Fig. 9-6 A, Placement of calipers for triceps skinfold thickness measurement. B, Cross section of arm with triceps skinfold measurement.
  577. ASSESS nutritional status by reviewing laboratory tests.
  578. ABNORMAL FINDINGS
  579. TABLE 9-6 Percentiles for Triceps Skinfold Measurements (Adults)
  580. FREQUENTLY ASKED QUESTIONS
  581. FREQUENTLY ASKED QUESTIONS
  582. TABLE 9-7 Laboratory Tests Used for Nutritional Assessment
  583. AGE-RELATED VARIATIONS
  584. INFANTS AND CHILDREN
  585. OLDER ADULTS
  586. COMMON PROBLEMS & CONDITIONS
  587. OBESITY
  588. Fig. 9-7 Obesity.
  589. HYPERLIPIDEMIA
  590. PROTEIN CALORIE MALNUTRITION (PCM)
  591. Fig. 9-8 Loss of subcutaneous fat and muscle wasting in patient with protein calorie malnutrition.
  592. EATING DISORDERS
  593. Fig. 9-9 Anorexia nervosa.
  594. CLINICAL APPLICATION & CLINICAL REASONING
  595. REVIEW QUESTIONS
  596. SAMPLE DOCUMENTATION
  597. SUBJECTIVE DATA
  598. OBJECTIVE DATA
  599. CASE STUDY
  600. Interview Data
  601. Examination Data
  602. CLINICAL Reasoning
  603. INTERACTIVE ACTIVITIES
  604. UNIT 2 HEALTH ASSESSMENT OF THE ADULT
  605. CHAPTER 10 Skin, Hair, and Nails
  606. ANATOMY & PHYSIOLOGY
  607. SKIN
  608. Epidermis
  609. Fig. 10-1 Anatomic structures of the skin and hair.
  610. Dermis
  611. Subcutaneous Layer
  612. APPENDAGES
  613. Hair
  614. Nails
  615. Eccrine Sweat Glands
  616. Apocrine Sweat Glands
  617. Sebaceous Glands
  618. Fig. 10-2 Structures of the nail.
  619. LINK TO CONCEPTS Tissue Integrity
  620. ETHNIC & CULTURAL VARIATIONS
  621. HEALTH HISTORY
  622. RISK FACTORS Skin, Hair, and Nails
  623. GENERAL HEALTH HISTORY
  624. Present Health Status
  625. Past Medical History and Family History
  626. PROBLEM-BASED HISTORY
  627. Skin
  628. Pruritis
  629. Rash
  630. Pain/Discomfort of Skin
  631. BOX 10-1 FOCUS ON PAIN Skin, Hair, and Nails
  632. Lesion or Changes in Mole
  633. Change in Skin Color
  634. Skin Texture
  635. Wounds
  636. Hair
  637. HEALTH PROMOTION Skin Cancer
  638. Goals and Objectives—Healthy People 2010
  639. Recommendations to Reduce Risk (Primary Prevention)
  640. American Cancer Society (ACS)
  641. Screening Recommendations (Secondary Prevention)
  642. American Cancer Society
  643. Nails
  644. EXAMINATION
  645. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  646. ROUTINE TECHNIQUES
  647. INSPECT the skin for general color.
  648. ABNORMAL FINDINGS
  649. TABLE 10-1 Comparison of Skin-Related Findings in Clients with Light Skin and Clients with Dark Skin
  650. INSPECT the skin for localized variations in skin color.
  651. ABNORMAL FINDINGS
  652. ETHNIC & CULTURAL VARIATIONS
  653. BOX 10-2 EARLY SIGNS OF MELANOMA
  654. PALPATE the skin for texture, temperature, moisture, mobility, turgor, and thickness.
  655. Texture
  656. ABNORMAL FINDINGS
  657. Fig. 10-3 Maceration in a skin fold.
  658. Temperature
  659. ABNORMAL FINDINGS
  660. Moisture
  661. ABNORMAL FINDINGS
  662. Mobility and Turgor
  663. Fig. 10-4 Elastic skin turgor.
  664. ABNORMAL FINDINGS
  665. Fig. 10-5 Poor skin turgor.
  666. Thickness
  667. Fig. 10-6 Callus.
  668. ABNORMAL FINDINGS
  669. INSPECT and PALPATE the scalp and hair for surface characteristics, hair distribution, texture, quantity, and color.
  670. ABNORMAL FINDINGS
  671. ETHNIC & CULTURAL VARIATIONS
  672. INSPECT facial and body hair for distribution, quantity, and texture.
  673. ABNORMAL FINDINGS
  674. INSPECT and PALPATE the nails for shape, contour, consistency, color, thickness, and cleanliness.
  675. ABNORMAL FINDINGS
  676. Fig. 10-7 Severe spooning with thinning of the nail.
  677. ABNORMAL FINDINGS
  678. Fig. 10-8 Nail bed color of a dark-skinned person (pigmented bands occur as a normal finding in over 90% of African Americans).
  679. Fig. 10-9 Leukonychia punctata. Transverse white bands result from repeated minor trauma to the nail matrix.
  680. ABNORMAL FINDINGS
  681. Fig. 10-10 Assessment of finger clubbing. A, Normally when opposing fingers are placed together, a small space is visible between the fingers and the nail beds meet. B, With finger clubbing, no space is observed between the fingers, and the nail beds angle away from one another. C, With finger clubbing, the base if the nail is enlarged and curved.
  682. ABNORMAL FINDINGS
  683. Fig. 10-11 Beau’s lines.
  684. Fig. 10-12 Nail pitting.
  685. ABNORMAL FINDINGS
  686. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE
  687. INSPECT and PALPATE the skin for lesions.
  688. ABNORMAL FINDINGS
  689. BOX 10-3 LESION CHARACTERISTIC TO BE NOTED DURING EXAMINATION
  690. Fig. 10-13 Shapes and patterns of lesions.
  691. Primary Lesions
  692. ABNORMAL FINDINGS
  693. ABNORMAL FINDINGS
  694. TABLE 10-2 Primary Skin Lesions
  695. Secondary Lesions
  696. ABNORMAL FINDINGS
  697. TABLE 10-3 Secondary Skin Lesions
  698. Vascular Lesions
  699. ABNORMAL FINDINGS
  700. TABLE 10-4 Vascular Skin Lesions
  701. Fig. 10-14 Cherry angioma.
  702. FREQUENTLY ASKED QUESTIONS
  703. FREQUENTLY ASKED QUESTIONS
  704. Documenting Expected Findings
  705. Skin Assessment: Adult Female
  706. CLINICAL REASONING Skin, Hair, and Nails
  707. AGE-RELATED VARIATIONS
  708. Infants & Children
  709. Adolescents
  710. Older Adults
  711. CLIENTS WITH SITUATIONAL VARIATIONS
  712. CLIENTS WITH LIMITED MOBILITY (HEMIPLEGIA, PARAPLEGIA, QUADRIPLEGIA)
  713. Expected and Abnormal Findings (Skin)
  714. ETHNIC & CULTURAL VARIATIONS
  715. Fig. 10-15 Bony prominences vulnerable to pressure.
  716. TABLE 10-5 Staging of Pressure Ulcers
  717. COMMON PROBLEMS & CONDITIONS
  718. SKIN
  719. Hyperkeratosis
  720. Clavus (Corn)
  721. Dermatitis
  722. Fig. 10-16 Corn (clavus).
  723. Atopic Dermatitis
  724. Fig. 10-17 Atopic dermatitis.
  725. Contact Dermatitis
  726. Seborrheic Dermatitis
  727. Stasis Dermatitis
  728. Fig. 10-18 Contact dermatitis. In this case, allergic reaction to nickel.
  729. Fig. 10-19 Seborrheic dermatitis.
  730. Fig. 10-20 Stasis dermatitis.
  731. Psoriasis
  732. Fig. 10-21 Psoriasis on elbow and buttocks.
  733. Pityriasis Rosea
  734. Lesions Caused by Viral Infection
  735. Warts (Verruca)
  736. Fig. 10-22 Pityriasis rosea. A, Large herald patch on the chest. B, Many oval lesions on the chest.
  737. Fig. 10-23 Common warts on hand and fingers.
  738. Herpes Simplex
  739. Fig. 10-24 Herpes simplex. Typical manifestation with vesicles appearing on the lips and extending onto the skin.
  740. Herpes Varicella (Chickenpox)
  741. Herpes Zoster (Shingles)
  742. Fig. 10-25 Herpes varicella (chickenpox). Lesions in various stages of development, including red papules, vesicles, umbilicated vesicles, and crusts. A, Light-skinned person. B, Dark-skinned person.
  743. Fig. 10-26 Herpes zoster (shingles).
  744. Lesions Caused by Fungal Infections
  745. Tinea Infections
  746. Fig. 10-27 Fungal infections. A, Tinea corporis. B, Tinea cruris. C, Tinea capitis. D, Tinea pedis.
  747. Candidiasis
  748. Lesions Caused by Bacterial Infections
  749. Cellulitis
  750. Fig. 10-28 Candidiasis.
  751. Fig. 10-29 Cellulitis to the lower leg.
  752. Impetigo
  753. Folliculitis
  754. Fig. 10-30 Impetigo.
  755. Fig. 10-31 Folliculitis.
  756. Fig. 10-32 Furuncle.
  757. Furuncle or Abscess (Boil)
  758. Lesions Associated with Arthropods
  759. Scabies
  760. Lyme Disease
  761. Spider Bites
  762. Fig. 10-33 Lyme disease. Note expanding erythematous lesion with central clearing on trunk.
  763. Fig. 10-34 Brown recluse spider bite. Note necrotic ulcer and erythema.
  764. Neoplasia
  765. Basal Cell Carcinoma
  766. Fig. 10-35 Basal cell carcinoma.
  767. Squamous Cell Carcinoma
  768. Melanoma
  769. Fig. 10-36 Squamous cell carcinoma.
  770. Fig. 10-37 Malignant melanoma.
  771. Kaposi’s Sarcoma
  772. Skin Lesions Caused by Abuse
  773. Bruise (Ecchymosis)
  774. Fig. 10-38 A, Kaposi’s sarcoma of the heel and lateral foot. B, Oral Kaposi’s sarcoma.
  775. Fig. 10-39 Loop mark pattern of bruising caused by whipping with an electrical cord.
  776. Bites
  777. Fig. 10-40 Bite injury.
  778. Burns
  779. Fig. 10-41 Stocking burn patterns to perineum, thighs, legs, and feet.
  780. Fig. 10-42 Cigarette burn to a child’s abdomen.
  781. HAIR
  782. Pediculosis (Lice)
  783. Alopecia Areata
  784. Fig. 10-43 Pediculosis (lice). The eggs, or nits, are visible attached to hair shafts.
  785. Fig. 10-44 Alopecia areata. Note areas of regrowth (fine, light-colored hairs).
  786. Hirsutism
  787. Fig. 10-45 Facial hirsutism. A, Hair growth on the jaw line and neck of a young woman. B, Hair growth on the chin of a postmenopausal woman.
  788. NAILS
  789. Onychomycosis
  790. Fig. 10-46 Onychomycosis (fungal infection of the fingernail).
  791. Fig. 10-47 Chronic paronychia with swollen posterior nail folds and nail dystrophy.
  792. Paronychia
  793. Ingrown Toenail
  794. Fig. 10-48 Ingrown toenail.
  795. CLINICAL APPLICATION & CRITICAL THINKING
  796. REVIEW QUESTIONS
  797. SAMPLE DOCUMENTATION
  798. ABNORMAL FINDINGS
  799. SUBJECTIVE DATA
  800. OBJECTIVE DATA
  801. CASE STUDY
  802. Interview Data
  803. Examination Data
  804. CLINICAL Reasoning
  805. INTERACTIVE ACTIVITIES
  806. CHAPTER 11 Head, Eyes, Ears, Nose, and Throat
  807. ANATOMY & PHYSIOLOGY
  808. THE HEAD
  809. THE EYES
  810. External Ocular Structures
  811. Ocular Structures
  812. Fig. 11-1 Bones of the skull and face. A, Anterior view. B, Posterior view.
  813. Fig. 11-2 External ocular structures.
  814. Ocular Function
  815. Fig. 11-3 Anatomy of the human eye.
  816. THE EAR
  817. External Ear
  818. Fig. 11-4 Visual pathway.
  819. Fig. 11-5 Anatomic structure of the auricle (pinna).
  820. Middle Ear
  821. Inner Ear
  822. THE NOSE
  823. Fig. 11-6 Anatomy of the ear showing the outer ear, external auditory canal, tympanic membrane, and structures of the middle and inner ear.
  824. Fig. 11-7 Cross-sectional view of the structures of the nose and nasopharynx.
  825. THE MOUTH AND OROPHARYNX
  826. Oropharynx
  827. Fig. 11-8 Paranasal Sinuses. A, Front view. B, Side view.
  828. Fig. 11-9 Structures of the mouth. A, View of dorsal tongue surface. B, View of ventral tongue surface.
  829. NECK
  830. Fig. 11-10 Underlying structures of the neck.
  831. Larynx
  832. Thyroid Gland
  833. Fig. 11-11 Anterior and posterior triangles of the neck.
  834. Cardiovascular Structures
  835. LYMPH NODES
  836. Fig. 11-12 Lymph nodes of the head and neck.
  837. LINK TO CONCEPTS Sensory Perception
  838. HEALTH HISTORY
  839. GENERAL HEALTH HISTORY
  840. Present Health Status
  841. RISK FACTORS Vision, Hearing, Mouth Cancer
  842. Hearing Loss
  843. Cataracts
  844. Glaucoma
  845. Macular Degeneration
  846. Oropharyngeal Cancer
  847. Past Medical History
  848. Family History
  849. PROBLEM-BASED HISTORY
  850. Headache
  851. BOX 11-1 HEADACHE-TRIGGERING FOODS
  852. Dizziness and Vertigo
  853. BOX 11-2 DIFFERENTIATING DIZZINESS
  854. Difficulty with Vision
  855. Hearing Loss
  856. Ringing in the Ears (Tinnitus)
  857. Earache
  858. BOX 11-3 FOCUS ON PAIN Earache
  859. Nasal Discharge / Nose Bleed
  860. Sore Throat
  861. Mouth Lesions
  862. HEALTH PROMOTION Hearing
  863. Goals and Objectives—Healthy People 2010
  864. Recommendations to Reduce Risk (Primary Prevention)
  865. American Speech-Language Hearing Association (ASLHA)
  866. Screening Recommendations (Secondary Prevention)
  867. Healthy People 2010
  868. Intervention Recommendations (Tertiary Prevention)
  869. CDC
  870. EXAMINATION
  871. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  872. ROUTINE TECHNIQUES: HEAD
  873. INSPECT the head.
  874. Head for size, shape, skin characteristics.
  875. ABNORMAL FINDINGS
  876. Facial structures for size, symmetry, movement, intactness, skin characteristics, and facial expression.
  877. Fig. 11-13 Symmetry of facial features (the eyebrows, palpebral fissures, nasolabial folds, and corners of the mouth) is a normal finding.
  878. ABNORMAL FINDINGS
  879. Fig. 11-14 Right facial palsy causing asymmetry of facial features.
  880. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: HEAD
  881. PALPATE the structures of the head.
  882. Skull for contour, tenderness, and intactness.
  883. ABNORMAL FINDINGS
  884. Bony structures of the face and jaw noting size, intactness, and tenderness, and jaw movement.
  885. ABNORMAL FINDINGS
  886. Fig. 11-15 Position fingers in front of each ear to palpate the temporomandibular joint (TMJ).
  887. Temporal arteries.
  888. ABNORMAL FINDINGS
  889. ROUTINE TECHNIQUES: EYES
  890. TEST visual acuity (distance vision).
  891. ABNORMAL FINDINGS
  892. TEST visual acuity (near vision).
  893. ABNORMAL FINDINGS
  894. INSPECT the external ocular structures.
  895. Eyebrows, eyelashes, and eyelids for symmetry, hair distribution, skin characteristics, and discharge.
  896. ABNORMAL FINDINGS
  897. Fig. 11-16 Ptosis. Client with left ptosis and right upper lid retraction.
  898. Fig. 11-17 Exophthalmos.
  899. Fig. 11-18 Enophthalmos. The eyelid and lashes are rolled in.
  900. ETHNIC & CULTURAL VARIATIONS
  901. ETHNIC & CULTURAL VARIATIONS
  902. Conjunctiva for color, moisture, drainage, lesions.
  903. Fig. 11-19 To inspect the palpebral conjunctiva, gently pull down and evert the lower eyelid.
  904. Fig. 11-20 Everting upper eyelid.
  905. ABNORMAL FINDINGS
  906. INSPECT the ocular structures.
  907. Corneal light reflex for symmetry (Hirschberg’s test).
  908. Fig. 11-21 Normal position of eyes and eyelids. The symmetric light reflection in both corneas is a normal finding.
  909. ABNORMAL FINDINGS
  910. Sclera for color, surface characteristics.
  911. ABNORMAL FINDINGS
  912. ETHNIC & CULTURAL VARIATIONS
  913. Cornea for transparency and surface characteristics.
  914. ABNORMAL FINDINGS
  915. Iris for shape and color.
  916. ABNORMAL FINDINGS
  917. Pupils for size, shape, reaction to light, accommodation, and consensual reaction.
  918. ABNORMAL FINDINGS
  919. BOX 11-4 DOCUMENTATION TIPS FOR EYES
  920. PERRLA
  921. Remembering C’s and D’s for Expected Findings for Accommodation
  922. TABLE 11-1 Pupil Abnormalities
  923. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: EYE
  924. ASSESS visual fields for peripheral vision (confrontation test).
  925. ABNORMAL FINDINGS
  926. Fig. 11-22 Assessing a client’s peripheral vision nasally by moving object medially into the field of vision.
  927. ASSESS eye movement.
  928. Six Cardinal Fields of Gaze (tests cranial nerves III, IV, and VI).
  929. Fig. 11-23 The six cardinal fields of gaze.
  930. ABNORMAL FINDINGS
  931. Cover-Uncover Test
  932. ABNORMAL FINDINGS
  933. Fig. 11-24 The cover-uncover test is used to evaluate function of eye muscles. A, Left eye covered; observe right eye. B, Left eye uncovered; observe it for movement. C, Exophoria; the right eye shifted from right to center when the eye was uncovered.
  934. PALPATE the eye, eyelids, and lacrimal puncta.
  935. ABNORMAL FINDINGS
  936. TEST the corneal reflex.
  937. ABNORMAL FINDINGS
  938. INSPECT the anterior chamber for transparency, iris surface, and chamber depth.
  939. ABNORMAL FINDINGS
  940. Fig. 11-25 Evaluation of depth of anterior chambers. A, Normal anterior chamber. B, Shallow anterior chamber.
  941. INSPECT intraocular structures (ophthalmoscopic examination).
  942. Inspect for a red reflex.
  943. ABNORMAL FINDINGS
  944. Inspect the optic disc for discrete margin, shape, size, color, and physiologic cup.
  945. ABNORMAL FINDINGS
  946. ABNORMAL FINDINGS
  947. Fig. 11-26 Examining the retina. A, The red reflex is created by light illuminating the retina. B, Move close to the client until you nearly touch foreheads.
  948. ABNORMAL FINDINGS
  949. ABNORMAL FINDINGS
  950. Fig. 11-27 Retinal structures of the left eye.
  951. Inspect the retinal vessels for color, arteriolar light reflex, artery-to-vein ratio, and arteriovenous crossing changes.
  952. ABNORMAL FINDINGS
  953. Inspect the retinal background for color, presence of microaneurysms, hemorrhages, and exudates.
  954. ABNORMAL FINDINGS
  955. Inspect the macula for color and surface characteristics.
  956. ABNORMAL FINDINGS
  957. ROUTINE TECHNIQUES: EARS
  958. ASSESS hearing based on response from conversation.
  959. ABNORMAL FINDINGS
  960. INSPECT the external ears.
  961. Observe the alignment and position.
  962. Fig. 11-28 Normal ear position and alignment.
  963. ABNORMAL FINDINGS
  964. Inspect for size, shape, symmetry, skin color, and skin intactness.
  965. ABNORMAL FINDINGS
  966. Fig. 11-29 A darwinian tubercle.
  967. TABLE 11-2 Abnormal Findings of the External Ear
  968. Inspect the external auditory meatus for discharge or lesions.
  969. ABNORMAL FINDINGS
  970. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: EARS
  971. PALPATE the external ears and mastoid areas for tenderness, edema, and nodules.
  972. ABNORMAL FINDINGS
  973. INSPECT the internal ear structures.
  974. Fig. 11-30 Use of an otoscope. A, Pull the client’s helix upward and slightly toward the back of the head. B, Holding the otoscope “upside down,” rest the back of your hand against the client’s temple area to steady the otoscope.
  975. Inspect the external ear canal for cerumen, edema, erythema, discharge, and foreign bodies.
  976. ABNORMAL FINDINGS
  977. ETHNIC & CULTURAL VARIATIONS
  978. BOX 11-5 REMOVING CERUMEN FROM THE AUDITORY CANAL
  979. Fig. 11-31 A, Normal piece of cerumen (earwax) in the external meatus. B, Excessive earwax in the external auditory canal.
  980. Inspect the tympanic membrane for landmarks, color, contour, translucence, and fluctuation.
  981. ABNORMAL FINDINGS
  982. Fig. 11-32 The tympanic membrane. A, Landmarks of tympanic membrane with “clock” superimposed (right ear). B, Photograph of a normal-appearing tympanic membrane.
  983. Fig. 11-33 Perforated tympanic membrane.
  984. BOX 11-6 ABNORMAL COLOR CHARACTERISTICS OF THE TM AND POSSIBLE CAUSES
  985. TEST the acoustic cranial nerve (VIII) to evaluate auditory function.
  986. Whispered Voice Test
  987. ABNORMAL FINDINGS
  988. Finger-Rubbing Test
  989. ABNORMAL FINDINGS
  990. Weber’s Test
  991. ABNORMAL FINDINGS
  992. Fig. 11-34 Weber’s test. The tuning fork is placed on the midline of the skull.
  993. Fig. 11-35 A, Client with conduction loss; sound lateralizes to the defective ear because the sound transmits through the bone rather than air. B, Client with sensorineural loss; sound lateralizes to the unaffected ear.
  994. Fig. 11-36 Rinne test. A, The tuning fork is placed on the mastoid bone for bone conduction. B, The tuning fork is placed in front of the ear for air conduction.
  995. Fig. 11-37 A, Client with conduction loss will hear bone conduction longer than air conduction (BC greater than AC). B, Client with sensorineural loss will hear air conduction longer than bone conduction (AC greater than BC).
  996. Rinne Test
  997. ABNORMAL FINDINGS
  998. Audioscope
  999. ABNORMAL FINDINGS
  1000. ROUTINE TECHNIQUES: NOSE
  1001. INSPECT the nose for general appearance, symmetry, discharge, and tenderness.
  1002. ABNORMAL FINDINGS
  1003. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: NOSE
  1004. PALPATE the nose for tenderness and to assess patency.
  1005. ABNORMAL FINDINGS
  1006. INSPECT the internal nasal cavity.
  1007. Fig. 11-38 Inspect the nasal cavity with a light source.
  1008. ABNORMAL FINDINGS
  1009. Fig. 11-39 View of the nasal mucosa through the nasal speculum.
  1010. PALPATE the frontal and maxillary paranasal sinus areas for tenderness.
  1011. ABNORMAL FINDINGS
  1012. TRANSILLUMINATE the sinus area.
  1013. ABNORMAL FINDINGS
  1014. Fig. 11-40 Palpation of the sinuses. A, Frontal. B, Maxillary.
  1015. ROUTINE TECHNIQUES: MOUTH
  1016. INSPECT the mouth and oropharynx.
  1017. Lips for color, symmetry, moisture, and texture.
  1018. ABNORMAL FINDINGS
  1019. Teeth and gums for condition, color, surface characteristics, stability, and alignment.
  1020. ABNORMAL FINDINGS
  1021. Fig. 11-41 Malocclusion of the teeth.
  1022. ETHNIC & CULTURAL VARIATIONS Variations in the Number and Size of Teeth
  1023. ETHNIC & CULTURAL VARIATIONS
  1024. Tongue for movement, color, and surface characteristics.
  1025. ABNORMAL FINDINGS
  1026. Buccal mucosa and anterior and posterior pillars for color and surface characteristics.
  1027. ABNORMAL FINDINGS
  1028. Fig. 11-42 Leukoplakia.
  1029. Palate, uvula, posterior pharynx, and tonsils for texture, color, surface characteristics, and movement.
  1030. ABNORMAL FINDINGS
  1031. ETHNIC & CULTURAL VARIATIONS
  1032. Fig. 11-43 Displace the tongue with a tongue depressor for inspection of the pharynx.
  1033. Fig. 11-44 Tonsil enlargement. A, 1+, visible; B, 2+, halfway between tonsilar pillars and uvula; C, 3+, nearly touching the uvula; D, 4+, touching each other.
  1034. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: MOUTH
  1035. PALPATE structures of the mouth.
  1036. Teeth, inner lips, and gums for condition and tenderness.
  1037. ABNORMAL FINDINGS
  1038. Tongue for texture
  1039. ABNORMAL FINDINGS
  1040. Fig. 11-45 Grasp the tongue with a 4 × 4 inch gauze pad.
  1041. ROUTINE TECHNIQUES: NECK
  1042. INSPECT the neck.
  1043. Position in relation to the head and trachea.
  1044. ABNORMAL FINDINGS
  1045. Fig. 11-46 Bilateral symmetry of the neck muscles.
  1046. Fig. 11-47 Goiter. Note visible enlargement over the anterior neck.
  1047. Skin characteristics, presence of lumps, masses.
  1048. ABNORMAL FINDINGS
  1049. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: NECK
  1050. INSPECT the neck for range of motion.
  1051. ABNORMAL FINDINGS
  1052. PALPATE the neck.
  1053. Positioning of anatomic structures and trachea.
  1054. ABNORMAL FINDINGS
  1055. Thyroid gland for size, shape consistency, tenderness, and presence of nodules.
  1056. Fig. 11-48 Palpation of the thyroid gland. A, Posterior approach. B, Anterior approach.
  1057. ABNORMAL FINDINGS
  1058. ABNORMAL FINDINGS
  1059. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: LYMPH NODES
  1060. PALPATE lymph nodes for size, consistency, mobility, boarders, tenderness, and warmth.
  1061. Fig. 11-49 Palpation of the preauricular nodes.
  1062. Fig. 11-50 Palpation of the posterior superficial cervical chain nodes.
  1063. Documenting Expected Findings
  1064. Head, Ears, Eyes, Nose, and Throat in an Adult Male
  1065. CLINICAL REASONING HEENT
  1066. AGE-RELATED VARIATIONS
  1067. INFANTS AND CHILDREN
  1068. OLDER ADULTS
  1069. COMMON PROBLEMS & CONDITIONS
  1070. HEAD & NECK
  1071. Headaches
  1072. Migraine Headache
  1073. Cluster Headache
  1074. Tension Headache
  1075. Posttraumatic Headache
  1076. Hydrocephalus
  1077. Fig. 11-51 Three-month-old infant with hydrocephalus.
  1078. EYES
  1079. External Eye
  1080. Chalazion
  1081. Hordeolum (Sty)
  1082. Conjunctivitis
  1083. Fig. 11-52 Chalazion (right upper eyelid).
  1084. Fig. 11-53 Hordeolum (sty).
  1085. Corneal Abrasion or Ulcer
  1086. Strabismus
  1087. Fig. 11-54 Acute conjunctivitis.
  1088. Fig. 11-55 Paralytic strabismus involving left lateral rectus muscle innervated by cranial nerve VI (abducens nerve).
  1089. Internal Eye
  1090. Cataract
  1091. Fig. 11-56 Cataract. Note cloudy white spot over pupil.
  1092. Fig. 11-57 Diabetic retinopathy. A, Nonproliferative. B, Proliferative.
  1093. Diabetic Retinopathy
  1094. Glaucoma
  1095. EARS
  1096. Foreign Body
  1097. Infection
  1098. Acute Otitis Media
  1099. Fig. 11-58 Client inserted a small stone into the deep part of the external ear canal. It is lying against the tympanic membrane.
  1100. Fig. 11-59 Acute otitis media with redness and edematous swelling of the pars flaccida, shown in the central part of the illustration (left ear).
  1101. Otitis Media with Effusion
  1102. Fig. 11-60 Otitis media with effusion.
  1103. Hearing Loss
  1104. Conductive Hearing Loss
  1105. Sensorineural Hearing Loss
  1106. NOSE
  1107. Epistaxis
  1108. Inflammation
  1109. Allergic Rhinitis
  1110. Rhinophyma
  1111. Acute Sinusitis
  1112. Fig. 11-61 Rhinophyma associated with rosacea.
  1113. MOUTH
  1114. Inflammation/Infection
  1115. Herpes Simplex Type 1 (Cold Sore)
  1116. Fig. 11-62 Herpes simplex lesion (cold sore) of the lower lip.
  1117. Fig. 11-63 Gingivitis. Note enlargement of the gums.
  1118. Gingivitis
  1119. Tonsillitis
  1120. Fig. 11-64 Tonsillitis and pharyngitis.
  1121. Candidiasis (Thrush)
  1122. Lesions
  1123. Aphthous Ulcer (Canker Sore)
  1124. Oral Cancer
  1125. Fig. 11-65 Candidiasis.
  1126. Fig. 11-66 A small aphthous ulcer (canker sore) on the lower lip.
  1127. Oral Kaposi’s Sarcoma
  1128. NECK
  1129. Thyroid Disorders
  1130. Hyperthyroidism
  1131. Fig. 11-67 A, Early squamous cell carcinoma on the floor of the mouth. B, Squamous cell carcinoma on the lip.
  1132. Fig. 11-68 The bluish raised lesion seen on the palate of this client who has AIDS is Kaposi’s sarcoma.
  1133. Hypothyroidism
  1134. Thyroid cancer
  1135. Lymphoma
  1136. CLINICAL APPLICATION & CLINICAL REASONING
  1137. REVIEW QUESTIONS
  1138. SAMPLE DOCUMENTATION
  1139. SUBJECTIVE DATA
  1140. OBJECTIVE DATA
  1141. CASE STUDY
  1142. Interview Data
  1143. Examination Data
  1144. CLINICAL Reasoning
  1145. INTERACTIVE ACTIVITIES
  1146. CHAPTER 12 Lungs and Respiratory System
  1147. ANATOMY & PHYSIOLOGY
  1148. STRUCTURES WITHIN THE THORAX
  1149. EXTERNAL THORAX
  1150. Fig. 12-1 Structures within the thoracic cavity.
  1151. Fig. 12-2 Right and left lung. Note fissures dividing lobes of the lungs.
  1152. MECHANICS OF BREATHING
  1153. Fig. 12-3 Thorax and underlying structures. A, Anterior view. B, Posterior view.
  1154. Fig. 12-4 Muscles involved in ventilation. A, Anterior view. B, Posterior view.
  1155. Fig. 12-5 Structures of the upper airway.
  1156. Fig. 12-6 Structures of the lower airway.
  1157. Fig. 12-7 Alveolar sac.
  1158. TOPOGRAPHIC MARKERS
  1159. Anterior Chest Wall
  1160. Fig. 12-8 Topographic landmarks of the thorax. A, Anterior. B, Lateral. C, Posterior.
  1161. Lateral Chest Wall
  1162. Posterior Chest Wall
  1163. LINK TO CONCEPTS Oxygenation
  1164. Concept Model: Oxygenation
  1165. HEALTH HISTORY
  1166. RISK FACTORS Lung Cancer
  1167. GENERAL HEALTH HISTORY
  1168. Present Health Status
  1169. Past Medical History
  1170. Family History
  1171. BOX 12-1 RECORDING TOBACCO USE
  1172. Home Environment
  1173. Occupational Environment
  1174. Travel
  1175. PROBLEM-BASED HISTORY
  1176. Cough
  1177. Shortness of Breath
  1178. BOX 12-2 CLINICAL NOTES
  1179. Chest Pain with Breathing
  1180. HEALTH PROMOTION Tobacco Use
  1181. Goals and Objectives—Healthy People 2010
  1182. Recommendations to Reduce Risk (Primary Prevention)
  1183. U.S. Preventive Services Task Force
  1184. Recommendations for Treatment (Tertiary Prevention)
  1185. U.S. Preventive Services Task Force
  1186. EXAMINATION
  1187. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  1188. ROUTINE TECHNIQUES
  1189. INSPECT the client for general appearance, posture, and breathing effort.
  1190. ABNORMAL FINDINGS
  1191. Fig. 12-9 Observing the client for breathing effort.
  1192. Fig. 12-10 Tripod position.
  1193. OBSERVE respirations for rate and quality, breathing pattern, and chest expansion.
  1194. ABNORMAL FINDINGS
  1195. Fig. 12-11 Normal breathing pattern.
  1196. Fig. 12-12 Sigh.
  1197. Fig. 12-13 Abnormal breathing patterns. A, Bradypnea is a respiratory rate less than 12 breaths per minute. The rate and depth remain smooth and even. B, Tachypnea is a respiratory rate greater than 20 breaths per minute. The rate and depth remain smooth and even. Tachypnea can be caused by a number of factors, including fever, fear, or activity. C, Hyperventilation is characterized by increased rate and depth of respiration. D, When hyperventilation occurs with ketoacidosis, it is very deep and laborious and is termed Kussmaul breathing. E, Biot breathing pattern is characterized by irregularly interspersed periods of apnea in a disorganized and irregular pattern, rate, or depth. It may be associated with persistent intracranial pressure, respiratory distress, or damage to the medulla. F, Cheyne-Stokes is characterized by intervals of apnea interspersed with a deep and rapid breathing pattern. This may be seen in clients with severe illness, brain damage, or drug overdose. G, Air trapping is an abnormal respiratory pattern frequently seen in clients with chronic obstructive pulmonary disease. It is characterized by rapid inspirations with prolonged, forced expirations. Air is not fully exhaled; thus it becomes trapped in the lungs, which eventually leads to a barrel chest.
  1198. INSPECT the client’s nails, skin, and lips for color.
  1199. ABNORMAL FINDINGS
  1200. POSTERIOR THORAX
  1201. INSPECT the posterior thorax for shape and symmetry and muscle development.
  1202. ABNORMAL FINDINGS
  1203. AUSCULTATE the posterior and lateral thorax for breath sounds.
  1204. Fig. 12-14 Auscultating the posterior and lateral chest. A, Posterior thorax. B, Lateral thorax.
  1205. Fig. 12-15 Landmarks for chest auscultation and percussion. A, Posterior view. B, Anterior view. C, Lateral view.
  1206. ABNORMAL FINDINGS
  1207. Fig. 12-16 Auscultatory sounds. A, Anterior thorax. B, Posterior thorax.
  1208. TABLE 12-1 Characteristics of Breath Sounds
  1209. BOX 12-3 CLINICAL NOTES
  1210. ABNORMAL FINDINGS
  1211. TABLE 12-2 Characteristics of Adventitious Sounds
  1212. ANTERIOR THORAX
  1213. INSPECT the anterior thorax for shape and symmetry, muscle development, anteroposterior diameter to lateral diameter, and costal angle.
  1214. ABNORMAL FINDINGS
  1215. Fig. 12-17 Normal chest findings. A, Angulation of ribs. B, AP diameter is about half the lateral diameter. C, Costal angle less than 90 degrees.
  1216. Fig. 12-18 Barrel chest. A, Horizontal ribs. B, Increased AP diameter. C, Costal angle greater than 90 degrees.
  1217. AUSCULTATE the anterior thorax for breath sounds.
  1218. ABNORMAL FINDINGS
  1219. Fig. 12-19 Pectus carinatum, or pigeon chest. Note prominent sternum.
  1220. Fig. 12-20 Pectus excavatum, or funnel chest. Note that sternum is indented above xiphoid.
  1221. Fig. 12-21 Auscultating the anterior chest. A, Left apex. B, Right middle anterior thorax. C, Left lower anterior thorax.
  1222. ABNORMAL FINDINGS
  1223. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE POSTERIOR THORAX
  1224. PALPATE posterior thoracic muscles for tenderness, bulges, and symmetry.
  1225. ABNORMAL FINDINGS
  1226. PALPATE the posterior chest wall for thoracic expansion.
  1227. ABNORMAL FINDINGS
  1228. Fig. 12-22 Assessing for posterior thoracic expansion.
  1229. PALPATE the posterior thoracic wall for vocal (tactile) fremitus.
  1230. ABNORMAL FINDINGS
  1231. Fig. 12-23 Assessing for posterior vocal (tactile) fremitus. A, Hand positions for assessment. B, Position hands over both lung fields, making bilateral comparisons.
  1232. PERCUSS the posterior and lateral thorax for tone.
  1233. ABNORMAL FINDINGS
  1234. Fig. 12-24 Percussing the posterior thorax using the tip of the middle finger of the right hand to strike the middle finger of the left hand.
  1235. TABLE 12-3 Percussion Tones over the Lungs
  1236. Fig. 12-25 Percussion tones of the chest. A, Anterior chest. B, Posterior chest.
  1237. PERCUSS the thorax for diaphragmatic (respiratory) excursion.
  1238. ABNORMAL FINDINGS
  1239. Fig. 12-26 Measuring amount of diaphragmatic excursion. Excursion usually measures 3 to 5 cm.
  1240. AUSCULTATE the thorax for vocal sounds (vocal resonance).
  1241. ABNORMAL FINDINGS
  1242. Bronchophony
  1243. Whispered Pectoriloquy
  1244. ABNORMAL FINDINGS
  1245. Egophony
  1246. ABNORMAL FINDINGS
  1247. ANTERIOR THORAX
  1248. PALPATE the trachea for position.
  1249. Fig. 12-27 Palpating to evaluate midline position of trachea.
  1250. ABNORMAL FINDINGS
  1251. PALPATE the anterior thoracic muscles for tenderness, bulges, and symmetry.
  1252. ABNORMAL FINDINGS
  1253. PALPATE the anterior chest wall for thoracic expansion.
  1254. ABNORMAL FINDINGS
  1255. Fig. 12-28 Assessing for anterior thoracic expansion.
  1256. PALPATE the anterior thoracic wall for vocal (tactile) fremitus.
  1257. ABNORMAL FINDINGS
  1258. Fig. 12-29 Assessing for anterior vocal (tactile) fremitus.
  1259. PERCUSS the anterior thorax for tone.
  1260. ABNORMAL FINDINGS
  1261. AGE-RELATED VARIATIONS
  1262. INFANTS, CHILDREN, AND ADOLESCENTS
  1263. OLDER ADULTS
  1264. Documenting Expected Findings
  1265. CLINICAL REASONING Respiratory System
  1266. COMMON PROBLEMS & CONDITIONS
  1267. INFECTIONS AND INFLAMMATORY CONDITIONS
  1268. Acute Bronchitis
  1269. Pneumonia
  1270. Fig. 12-30 Bronchitis. Irritation of the bronchi causes inflammation.
  1271. Fig. 12-31 Right upper lobe pneumonia.
  1272. Tuberculosis
  1273. Pleural Effusion
  1274. Fig. 12-32 Tuberculosis.
  1275. Fig. 12-33 Pleural effusion.
  1276. CHRONIC PULMONARY DISEASE
  1277. Asthma
  1278. Emphysema
  1279. Chronic Bronchitis
  1280. Fig. 12-34 Factors causing airway obstruction in asthma. A, Cross section of a bronchiole occluded by muscle spasm, mucosal edema, and mucus. B, Longitudinal section of a bronchiole.
  1281. Fig. 12-35 Emphysema in upper left lobe.
  1282. ACUTE OR TRAUMATIC CONDITIONS
  1283. Pneumothorax
  1284. Fig. 12-36 Chronic bronchitis.
  1285. Fig. 12-37 Tension pneumothorax.
  1286. Fig. 12-38 Hemothorax.
  1287. Hemothorax
  1288. OTHER PULMONARY CONDITIONS
  1289. Atelectasis
  1290. Lung Cancer
  1291. Fig. 12-39 Atelectasis.
  1292. Fig. 12-40 Cancer of the lung. A, Squamous cell carcinoma. B, small cell (oat cell) carcinoma. C, Adenocarcinoma. D, Large cell carcinoma.
  1293. CLINICAL APPLICATION & CLINICAL REASONING
  1294. REVIEW QUESTIONS
  1295. SAMPLE DOCUMENTATION
  1296. SUBJECTIVE DATA
  1297. OBJECTIVE DATA
  1298. CASE STUDY
  1299. Interview Data
  1300. Examination Data
  1301. CLINICAL Reasoning
  1302. INTERACTIVE ACTIVITIES
  1303. CHAPTER 13 Heart and Peripheral Vascular System
  1304. ANATOMY & PHYSIOLOGY
  1305. THE HEART AND GREAT VESSELS
  1306. PERICARDIUM AND CARDIAC MUSCLE
  1307. Fig. 13-1 Position of the heart chambers and great vessels. Intercostal spaces 1 to 9 are numbered.
  1308. BLOOD FLOW THROUGH THE HEART: THE CARDIAC CYCLE
  1309. Diastole
  1310. Fig. 13-2 Cross section of cardiac muscle.
  1311. Fig. 13-3 Anterior cross section showing the valves and chambers of the heart.
  1312. Fig. 13-4 Blood flow during diastole.
  1313. Fig. 13-5 Blood flow during systole.
  1314. Fig. 13-6 Events of the cardiac cycle showing venous pressure waves, electrocardiograph, and heart sounds in systole and diastole. a, Atrial contraction; AV, atrioventricular; c, carotid artery; ECG, electrocardiogram; PCG, phonocardiogram; p, p wave (atrial contraction); QRS, QRS complex (ventricular contraction); S1, first heart sound; S2, second heart sound; S3, third heart sound; S4, fourth heart sound; T, T wave (ventricular repolarization); v, venous return coming into the atrium.
  1315. Systole
  1316. Cardiac Cycle
  1317. ELECTRIC CONDUCTION
  1318. PERIPHERAL VASCULAR SYSTEM
  1319. Fig. 13-7 Cardiac conduction.
  1320. LYMPH SYSTEM
  1321. Fig. 13-8 Schematic drawing of artery and vein. Shown are the comparative thickness of three layers (tunica adventitia), muscle layer (tunica media), and lining of endothelium (tunica intima). Note the muscle and outer coats are much thinner in the veins than in the arteries and that veins have valves.
  1322. Fig. 13-9 System of deep and superficial collecting ducts, carrying lymph from upper extremity to subclavian lymphatic trunk. The only peripheral lymph center is the epitrochlear, which receives some of the collecting ducts from the pathway of the ulnar and radial vessels.
  1323. Fig. 13-10 Lymphatic drainage of lower extremity.
  1324. LINK TO CONCEPTS Perfusion
  1325. Concept Model: Perfusion
  1326. HEALTH HISTORY
  1327. RISK FACTORS Hypertension and Coronary Artery Disease
  1328. Hypertension
  1329. Coronary Artery Disease
  1330. GENERAL HEALTH HISTORY
  1331. Present Health Status
  1332. Past Medical History
  1333. Family History
  1334. PROBLEM-BASED HISTORY
  1335. Chest Pain
  1336. TABLE 13-1 Differentiation of Chest Pain
  1337. Shortness of Breath
  1338. Cough
  1339. Urinating During the Night
  1340. Fatigue
  1341. Fainting
  1342. HEALTH PROMOTION Cardiovascular Disease
  1343. Goals and Objectives—Healthy People 2010
  1344. Recommendations to Reduce Risk (Primary Prevention)
  1345. American Heart Association
  1346. Screening Recommendations (Secondary Prevention)
  1347. U.S. Preventive Services Task Force
  1348. Tertiary Prevention
  1349. American Heart Association
  1350. Swelling of Extremities
  1351. Leg Cramps or Pain
  1352. EXAMINATION
  1353. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  1354. ROUTINE TECHNIQUES
  1355. ASSESS General Appearance
  1356. INSPECT the client for general appearance, skin color, and breathing effort.
  1357. ABNORMAL FINDINGS
  1358. ASSESS the Peripheral Vascular System
  1359. PALPATE temporal and carotid pulses for amplitude.
  1360. ABNORMAL FINDINGS
  1361. Fig. 13-11 Palpating temporal pulses lateral to each eyebrow.
  1362. Fig. 13-12 Arteries of the head and neck.
  1363. Fig. 13-13 Palpating carotid pulse in the lower third of the neck.
  1364. Fig. 13-14 Right and left common carotid arteries that are palpated.
  1365. BOX 13-1 PALPATING PULSES
  1366. Procedures and Techniques
  1367. Rate
  1368. Abnormal Findings
  1369. Rhythm
  1370. Abnormal Findings
  1371. Amplitude
  1372. Abnormal Findings
  1373. Contour (Outline of the Pulse that is Felt)
  1374. INSPECT the jugular vein for pulsations.
  1375. ABNORMAL FINDINGS
  1376. Fig. 13-15 Tangential light to view jugular veins and pulsations.
  1377. Fig. 13-16 Neck vein distention.
  1378. MEASURE blood pressure.
  1379. ABNORMAL FINDINGS
  1380. Fig. 13-17 Assessing blood pressure.
  1381. ETHNIC & CULTURAL VARIATIONS
  1382. ABNORMAL FINDINGS
  1383. INSPECT and PALPATE the upper extremities for skin turgor.
  1384. ABNORMAL FINDINGS
  1385. Fig. 13-18 Technique for testing for pitting edema. A, The nurse presses into the shin area. B, An indentation remains after the fingers are lifted when pitting edema is present.
  1386. TABLE 13-2 Pitting Edema Scale
  1387. INSPECT and PALPATE the upper extremities for symmetry, skin integrity, color, and temperature, capillary refill, and color and angle of the nail beds.
  1388. ABNORMAL FINDINGS
  1389. Fig. 13-19 Clubbing of fingers.
  1390. PALPATE brachial and radial pulses for rate, rhythm, amplitude, and contour.
  1391. ABNORMAL FINDINGS
  1392. Fig. 13-20 Palpating brachial pulse at the antecubital fossa.
  1393. Fig. 13-21 Palpating radial pulse on the thumb side of the forearm at the wrist.
  1394. Fig. 13-22 Arteries of the upper extremity that are palpated.
  1395. FREQUENTLY ASKED QUESTIONS
  1396. INSPECT and PALPATE the lower extremities for skin turgor.
  1397. ABNORMAL FINDINGS
  1398. INSPECT and PALPATE the lower extremities for symmetry, skin integrity, color, and temperature, hair distribution, capillary refill, color and angle of nail beds, tenderness, and superficial veins.
  1399. ABNORMAL FINDINGS
  1400. ABNORMAL FINDINGS
  1401. ABNORMAL FINDINGS
  1402. Fig. 13-23 Chronic venous stasis.
  1403. PALPATE femoral, popliteal, posterior tibial, and dorsalis pedis pulses for amplitude.
  1404. Fig. 13-24 Palpating femoral pulse below the inguinal ligament between the symphysis pubis and anterior superior iliac crest.
  1405. Fig. 13-25 Palpating popliteal pulse behind the knee.
  1406. ABNORMAL FINDINGS
  1407. Fig. 13-26 Palpating posterior tibial pulse on the inner aspect of the ankle.
  1408. Fig. 13-27 Palpating dorsalis pedis pulse on top of the foot between the first and second toes.
  1409. FREQUENTLY ASKED QUESTIONS
  1410. Fig. 13-28 Arteries of the leg that are palpated.
  1411. ASSESS THE HEART
  1412. INSPECT the anterior chest wall for contour, pulsations, lifts, heaves, and retractions.
  1413. ABNORMAL FINDINGS
  1414. BOX 13-2 ABBREVIATIONS FOR TOPOGRAPHIC LANDMARKS
  1415. BOX 13-3 DEFINITIONS OF LIFT, HEAVE, THRILL, AND RETRACTION
  1416. PALPATE apical pulse for location.
  1417. ABNORMAL FINDINGS
  1418. Fig. 13-29 Palpating the apical pulse at the fourth or fifth intercostal space, left midclavicular line.
  1419. AUSCULTATE S1 and S2 heart sounds for rate, rhythm, pitch, and splitting.
  1420. BOX 13-4 TECHNIQUE FOR LOCATING INTERCOSTAL SPACES FOR AUSCULTATION OF THE HEART
  1421. BOX 13-5 LOW- AND HIGH-PITCHED SOUNDS OF THE HEART
  1422. FREQUENTLY ASKED QUESTIONS
  1423. Fig. 13-30 Transmission of closure sounds from the heart valves.
  1424. BOX 13-6 TIP TO REMEMBER
  1425. Fig. 13-31 Position for cardiac auscultation. A, Aortic area. B, Pulmonic area. C, Erb’s point. D, Tricuspid area. E, Mitral area.
  1426. ASSESS Heart Rate
  1427. ABNORMAL FINDINGS
  1428. ASSESS Rhythm
  1429. ABNORMAL FINDINGS
  1430. TABLE 13-3 Abnormal Heart Sounds
  1431. ASSESS Pitch
  1432. ABNORMAL FINDINGS
  1433. ASSESS Splitting
  1434. TABLE 13-4 Listening to Murmurs
  1435. TABLE 13-5 Murmurs Caused by Valvular Defects
  1436. INTERPRET the electrocardiogram of the conduction of the heart.
  1437. Fig. 13-32 Electrocardiogram (EKG) and cardiac electrical activity. A, Ideal EKG deflections represent depolarization and repolarization of cardiac muscle tissue. B, Principal EKG interval among P, QRS, and T waves. Note that the RP interval is measured from the start of the P wave to the end of the Q wave. C, Schematic representation of EKG and its relationship to the cardiac electrical activity. AV, Atrioventricular; LA, left atrium; LBB, left bundle branch; LV, left ventricle; RA, right atrium; RBB, right bundle branch; RV, right ventricular, SA, sinoatrial.
  1438. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE
  1439. ASSESS the Peripheral Vascular System
  1440. AUSCULTATE the carotid artery for bruits.
  1441. ABNORMAL FINDINGS
  1442. Fig. 13-33 Auscultating the carotid artery.
  1443. ESTIMATE jugular venous pressure for pulsations.
  1444. ABNORMAL FINDINGS
  1445. Fig. 13-34 Measuring jugular venous pressure.
  1446. PALPATE epitrochlear lymph nodes for size, consistency, mobility, borders, tenderness, and warmth.
  1447. ABNORMAL FINDINGS
  1448. Fig. 13-35 Palpation for epitrochlear lymph nodes is performed in the depression above and posterior to the medial condyle of the humerus.
  1449. PALPATE inguinal lymph nodes for size, consistency, mobility, borders, tenderness, and warmth.
  1450. ABNORMAL FINDINGS
  1451. Fig. 13-36 A, Palpation of inferior superficial inguinal (femoral) lymph nodes. B, Palpation of superior superficial inguinal lymph nodes.
  1452. CALCULATE the ankle brachial index (ABI) to estimate arterial occlusion.
  1453. ABNORMAL FINDINGS
  1454. PERFORM Trendelenburg’s test to evaluate competence of venous valves in clients who have varicose veins.
  1455. ABNORMAL FINDINGS
  1456. ASSESS the Heart
  1457. PALPATE the precordium for pulsations, thrills, lifts, and heaves.
  1458. ABNORMAL FINDINGS
  1459. ABNORMAL FINDINGS
  1460. ABNORMAL FINDINGS
  1461. ABNORMAL FINDINGS
  1462. ABNORMAL FINDINGS
  1463. Fig. 13-37 Palpation of precordium. A, Palpating base. B, Palpating left sternal border. C, Palpating apex.
  1464. PERCUSS the heart borders for the heart size.
  1465. ABNORMAL FINDINGS
  1466. AGE-RELATED VARIATIONS
  1467. INFANTS, CHILDREN, AND ADOLESCENTS
  1468. OLDER ADULTS
  1469. Documenting Expected Findings
  1470. Heart and Peripheral Vascular System
  1471. CLINICAL REASONING Cardiovascular System
  1472. COMMON PROBLEMS & CONDITIONS
  1473. CARDIAC DISORDERS
  1474. Valvular Heart Disease
  1475. Angina Pectoris
  1476. Myocardial Infarction
  1477. Heart Failure
  1478. Fig. 13-38 Bacterial endocarditis.
  1479. Fig. 13-39 Pericarditis.
  1480. Left ventricular failure
  1481. Right ventricular failure
  1482. Infective Endocarditis
  1483. Pericarditis
  1484. PERIPHERAL VASCULAR DISEASE
  1485. Hypertension
  1486. BOX 13-7 CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS AGE 18 AND OLDER
  1487. Venous Thrombosis and Thrombophlebitis
  1488. Aneurysm
  1489. Fig. 13-40 Sites of venous thrombosis.
  1490. Fig. 13-41 Arterial aneurysm.
  1491. CLINICAL APPLICATION & CLINICAL REASONING
  1492. REVIEW QUESTIONS
  1493. SAMPLE DOCUMENTATION
  1494. CASE STUDY
  1495. Interview Data
  1496. SUBJECTIVE DATA
  1497. OBJECTIVE DATA
  1498. Examination Data
  1499. CLINICAL Reasoning
  1500. INTERACTIVE ACTIVITIES
  1501. CHAPTER 14 Abdomen and Gastrointestinal System
  1502. ANATOMY & PHYSIOLOGY
  1503. PERITONEUM, MUSCULATURE, AND CONNECTIVE TISSUE
  1504. ALIMENTARY TRACT
  1505. Fig. 14-1 Anatomy of the gastrointestinal system.
  1506. Fig. 14-2 Anatomy of the urinary system and major vessels of the abdominal cavity.
  1507. Fig. 14-3 Muscles of the abdomen.
  1508. Stomach
  1509. Small Intestine
  1510. Large Intestine (Colon) and Rectum
  1511. ACCESSORY ORGANS
  1512. Liver
  1513. Gallbladder
  1514. Pancreas
  1515. Spleen
  1516. URINARY TRACT
  1517. Kidneys
  1518. Ureters
  1519. Bladder
  1520. VASCULATURE OF THE ABDOMEN
  1521. HEALTH HISTORY
  1522. RISK FACTORS Abdominal Cancers
  1523. Esophageal Cancer
  1524. Stomach Cancer
  1525. Colon Cancer
  1526. Liver Cancer
  1527. Pancreatic Cancer
  1528. Bladder Cancer
  1529. GENERAL HEALTH HISTORY
  1530. Present Health Status
  1531. Past Medical History
  1532. Family History
  1533. PROBLEM-BASED HISTORY
  1534. Abdominal Pain
  1535. TABLE 14-1 Differentiation of Abdominal Pain
  1536. Nausea and Vomiting
  1537. Indigestion
  1538. Abdominal Distention
  1539. Change in Bowel Habits
  1540. Yellow Discoloration of Eyes or Skin (Jaundice)
  1541. Problems with Urination
  1542. HEALTH PROMOTION Colorectal Cancer
  1543. Goals and Objectives—Healthy People 2010
  1544. Recommendations to Reduce Risk (Primary Prevention)
  1545. American Cancer Society
  1546. EXAMINATION
  1547. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  1548. ROUTINE TECHNIQUES
  1549. OBSERVE client’s general behavior and position.
  1550. ABNORMAL FINDINGS
  1551. INSPECT the abdomen for skin color, surface characteristics, contour, and surface movements.
  1552. ABNORMAL FINDINGS
  1553. ABNORMAL FINDINGS
  1554. Fig. 14-4 Landmarks of the abdomen.
  1555. ABNORMAL FINDINGS
  1556. ABNORMAL FINDINGS
  1557. ABNORMAL FINDINGS
  1558. ABNORMAL FINDINGS
  1559. ABNORMAL FINDINGS
  1560. AUSCULTATE the abdomen for bowel sounds.
  1561. Fig. 14-5 Quadrants of the abdomen.
  1562. BOX 14-1 ANATOMIC CORRELATES OF THE QUADRANTS OF THE ABDOMEN
  1563. ABNORMAL FINDINGS
  1564. Fig. 14-6 Nine regions of the abdomen.
  1565. BOX 14-2 ANATOMIC CORRELATES OF THE NINE REGIONS OF THE ABDOMEN
  1566. AUSCULTATE the abdomen for arterial and venous vascular sounds.
  1567. Fig. 14-7 Sites to auscultate for bruits: renal arteries, iliac arteries, aorta, and femoral arteries.
  1568. ABNORMAL FINDINGS
  1569. PALPATE the abdomen lightly for tenderness, muscle tone, and surface characteristics.
  1570. ABNORMAL FINDINGS
  1571. Fig. 14-8 Light palpation of the abdomen.
  1572. PALPATE the abdomen deeply for tenderness, masses, and aortic pulsation.
  1573. ABNORMAL FINDINGS
  1574. Fig. 14-9 Deep palpation of the abdomen.
  1575. Fig. 14-10 Deep bimanual palpation.
  1576. Fig. 14-11 Palpating the aorta.
  1577. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE
  1578. PERCUSS the abdomen for tones.
  1579. Fig. 14-12 Systematic route for abdominal percussion.
  1580. ABNORMAL FINDINGS
  1581. PERCUSS the liver to determine span and descent.
  1582. ABNORMAL FINDINGS
  1583. Fig. 14-13 A, Liver percussion route. B, Percussion method of estimating size of liver in the midclavicular line. C, Distance between the two marks measured in estimating the liver span in midclavicular line is usually 2.5 to 4.5 inches (6 to 12 cm).
  1584. PERCUSS the spleen for size.
  1585. ABNORMAL FINDINGS
  1586. PALPATE around the umbilicus for bulges, nodules, and the umbilical ring.
  1587. ABNORMAL FINDINGS
  1588. Fig. 14-14 Percussion of the spleen.
  1589. PALPATE the liver for lower border and tenderness.
  1590. ABNORMAL FINDINGS
  1591. Fig. 14-15 Methods of palpating the liver. A, Fingers are extended, with tips on right midclavicular line below the level of liver tenderness and pointing toward the head. B, Fingers parallel to the costal margin. C, Fingers hooked over the costal margin.
  1592. PALPATE the gallbladder for tenderness.
  1593. ABNORMAL FINDINGS
  1594. PALPATE the spleen for border and tenderness.
  1595. ABNORMAL FINDINGS
  1596. Fig. 14-16 Palpation of the spleen.
  1597. PALPATE the kidneys for presence, contour, and tenderness.
  1598. ABNORMAL FINDINGS
  1599. Fig. 14-17 Palpation of the left kidney.
  1600. Fig. 14-18 Eliciting superficial abdominal reflexes. Stroke the upper abdominal area upward, away from the umbilicus, and the lower umbilicus area downward, away from the umbilicus.
  1601. ELICIT abdominal reflexes for presence.
  1602. ABNORMAL FINDINGS
  1603. PERCUSS the kidneys for costovertebral angle (CVA) tenderness.
  1604. ABNORMAL FINDINGS
  1605. Fig. 14-19 Fist percussion of costovertebral angle for kidney tenderness. A, Direct percussion. B, Indirect percussion.
  1606. Fig. 14-20 Anatomic drawing showing landmarks for indirect percussion of the costovertebral angle.
  1607. ASSESS the abdomen for fluid.
  1608. ABNORMAL FINDINGS
  1609. ABNORMAL FINDINGS
  1610. Fig. 14-21 Testing for shifting dullness. Dullness shifts to the dependent side.
  1611. Fig. 14-22 Testing for fluid wave. Strike one side of the abdomen sharply with the fingertips. Feel for the impulse of a fluid wave with the other hand.
  1612. Fig. 14-23 Massive ascites in an individual with cirrhosis. Distended abdomen, dilated upper abdominal veins, and inverted umbilicus are classic manifestations.
  1613. ASSESS the abdominal pain due to inflammation.
  1614. ABNORMAL FINDINGS
  1615. ABNORMAL FINDINGS
  1616. ABNORMAL FINDINGS
  1617. ABNORMAL FINDINGS
  1618. Fig. 14-24 Testing for rebound tenderness. A, Press deeply and gently into the abdomen; then, B, rapidly withdraw the hand and fingers.
  1619. Fig. 14-25 Iliopsoas muscle test.
  1620. Fig. 14-26 Obturator muscle test.
  1621. ASSESS the abdomen for floating mass.
  1622. ABNORMAL FINDINGS
  1623. Fig. 14-27 Ballottement technique. A, Single-handed ballottement. Push inward at a 90-degree angle; if the object is freely movable, it will float upward to touch the fingertips. B, Bimanual ballottement. P, Pushing hand; R, Receiving hand.
  1624. Documenting Expected Findings
  1625. Abdomen and Gastrointestinal System
  1626. CLINICAL REASONING Gastrointestinal System
  1627. AGE-RELATED VARIATIONS
  1628. INFANTS, CHILDREN, AND ADOLESCENTS
  1629. OLDER ADULTS
  1630. COMMON PROBLEMS & CONDITIONS
  1631. ALIMENTARY TRACT
  1632. Gastroesophageal Reflux Disease
  1633. Hiatal Hernia
  1634. Fig. 14-28 Hiatal hernia. A, Sliding hernia. B, Paraesophageal.
  1635. Peptic Ulcer Disease
  1636. Fig. 14-29 Duodenal peptic ulcer.
  1637. Crohn’s Disease
  1638. Ulcerative Colitis
  1639. Fig. 14-30 Crohn’s disease showing deep ulcers and fissures, creating “cobblestone” effect.
  1640. Fig. 14-31 Ulcerative colitis showing severe mucosal edema and inflammation with ulcerations and bleeding.
  1641. Diverticulitis
  1642. HEPATOBILIARY SYSTEM
  1643. Viral Hepatitis
  1644. Cirrhosis
  1645. Cholecystitis with Cholelithiasis
  1646. Fig. 14-32 Diverticulosis (diverticulitis).
  1647. PANCREAS
  1648. Pancreatitis
  1649. Fig. 14-33 Cirrhosis of the liver.
  1650. Fig. 14-34 The gallstone in the common bile duct causes biliary colic and may cause jaundice when the bile cannot flow from the liver and gallbladder to the duodenum.
  1651. URINARY SYSTEM
  1652. Urinary Tract Infections
  1653. Nephrolithiasis
  1654. Fig. 14-35 Most common locations of renal calculi formation.
  1655. CLINICAL APPLICATION & CLINICAL REASONING
  1656. REVIEW QUESTIONS
  1657. SAMPLE DOCUMENTATION
  1658. Subjective Data
  1659. Objective Data
  1660. CASE STUDY
  1661. Interview Data
  1662. Examination Data
  1663. CLINICAL Reasoning
  1664. INTERACTIVE ACTIVITIES
  1665. CHAPTER 15 Musculoskeletal System
  1666. ANATOMY & PHYSIOLOGY
  1667. SKELETON
  1668. SKELETAL MUSCLES
  1669. JOINTS
  1670. Fig. 15-1 Structures of a synovial joint (the knee).
  1671. LIGAMENTS AND TENDONS
  1672. Fig. 15-2 A posterior view of the left knee. The medial collateral ligament prevents the knee from going into too much valgus during stress (inward). The lateral collateral ligament prevents the knee from going into too much varus during stress (outward).
  1673. CARTILAGE AND BURSAE
  1674. AXIAL SKELETON AND SUPPORTING STRUCTURES
  1675. Skull and Neck
  1676. Trunk and Pelvis
  1677. APPENDICULAR SKELETON AND SUPPORTING STRUCTURES
  1678. Upper Extremities
  1679. Shoulder and Upper Arm
  1680. Elbow, Forearm, and Wrist
  1681. Fig. 15-3 Bones of the trunk and pelvis.
  1682. Fig. 15-4 Muscles of the trunk and pelvis.
  1683. Hand
  1684. Lower Extremities
  1685. Hip and Thigh
  1686. Fig. 15-5 Bones of the upper extremities.
  1687. Fig. 15-6 Muscles of the upper extremities.
  1688. Fig. 15-7 Structures of the glenohumeral and acromioclavicular joint of the shoulder.
  1689. Fig. 15-8 Bones of the lower extremities.
  1690. Fig. 15-9 Muscles of the lower extremities.
  1691. Fig. 15-10 Structures of the hip.
  1692. Knee and Lower Leg
  1693. Ankle and Foot
  1694. Fig. 15-11 Bones and joints of the ankle and foot.
  1695. LINK TO CONCEPTS Motion
  1696. Concept Model: Motion
  1697. ETHNIC & CULTURAL VARIATIONS
  1698. HEALTH HISTORY
  1699. RISK FACTORS Musculoskeletal System
  1700. Temporomandibular Joint (TMJ) Dysfunctiona
  1701. Goutb
  1702. Osteoarthritis (OA)c
  1703. Osteoporosisd
  1704. GENERAL HEALTH HISTORY
  1705. Present Health Status
  1706. Past Medical History
  1707. Family History
  1708. PROBLEM-BASED HISTORY
  1709. Pain
  1710. Problems with Movement
  1711. Problems with Daily Activities
  1712. HEALTH PROMOTION Osteoporosis
  1713. Goals and Objectives—Healthy People 2010
  1714. Recommendations to Reduce Risk (Primary Prevention)
  1715. National Osteoporosis Foundation
  1716. Screening Recommendations (Secondary Prevention)
  1717. U.S. Preventive Services Task Force
  1718. HEALTH PROMOTION Low Back Pain
  1719. Goals and Objectives—Healthy People 2010
  1720. Recommendations to Reduce Risk (Primary Prevention)
  1721. American Academy of Orthopaedic Surgeons
  1722. EXAMINATION
  1723. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  1724. ROUTINE TECHNIQUES
  1725. INSPECT axial skeleton and extremities for alignment, contour, symmetry, size, and gross deformities.
  1726. ABNORMAL FINDINGS
  1727. Fig. 15-12 Inspection of overall body posture. Note the even contour of the shoulders, level scapulae and iliac crests, alignment of the head over the gluteal folds, and symmetry and alignment of extremities. A, Anterior view. B, Posterior view. C, Lateral view showing normal cervical concave, thoracic convex, and lumbar concave curves of the spine.
  1728. INSPECT muscles for size and symmetry.
  1729. ABNORMAL FINDINGS
  1730. Fig. 15-13 Sites at which a limb is measured. A, Measure limb length from the anterior superior iliac spine to the medial malleolus. B, Measurement of the lower leg at 5 cm below the patella and of the upper leg at 5 and 10 cm above the patella. Exact location of measurement should be noted for future comparison.
  1731. PALPATE bones for tenderness; joints for tenderness, heat, and edema; and muscles for tenderness, heat, edema, and tone.
  1732. ABNORMAL FINDINGS
  1733. OBSERVE range of motion for major joints and adjacent muscles for tenderness on movement, joint stability, and deformity.
  1734. ABNORMAL FINDINGS
  1735. TABLE 15-1 Range of Motion for Diarthrodial Joints
  1736. Fig. 15-14 Use of goniometer to measure joint range of motion.
  1737. BOX 15-1 HOW TO USE A GONIOMETER
  1738. TEST muscle strength and compare sides.
  1739. ABNORMAL FINDINGS
  1740. TABLE 15-2 Screening Tests for Muscle Strength
  1741. TABLE 15-3 Criteria for Grading and Recording Muscle Strength
  1742. EXAMINATION OF SPECIFIC MUSCULOSKELETAL REGIONS
  1743. OBSERVE gait for conformity, symmetry, and rhythm.
  1744. ABNORMAL FINDINGS
  1745. INSPECT musculature of the face and neck for symmetry.
  1746. ABNORMAL FINDINGS
  1747. PALPATE each temporomandibular joint for movement, sounds, and tenderness.
  1748. ABNORMAL FINDINGS
  1749. OBSERVE jaw for range of motion.
  1750. ABNORMAL FINDINGS
  1751. Fig. 15-15 A, Palpation of temporomandibular joint. B, Lateral range of motion in the temporomandibular joint.
  1752. PALPATE the neck for pain.
  1753. ABNORMAL FINDINGS
  1754. OBSERVE the neck for range of motion.
  1755. ABNORMAL FINDINGS
  1756. TEST the neck muscles for strength.
  1757. ABNORMAL FINDINGS
  1758. Fig. 15-16 Range of motion of the cervical spine. A, Flexion and hyperextension. B, Lateral bending. C, Rotation.
  1759. Fig. 15-17 Examining the strength of the sternocleidomastoid and trapezius muscles. A, Rotation against resistance. B, Flexion with palpation of the sternocleidomastoid muscle. C, Extension against resistance.
  1760. INSPECT the shoulders and cervical, thoracic, and lumbar spine for alignment and symmetry.
  1761. ABNORMAL FINDINGS
  1762. Fig. 15-18 Landmarks of the back.
  1763. Fig. 15-19 Defects of the spinal column. A, Normal spine. B, Kyphosis. C, Lordosis. D, Normal spine in balance. E, Mild scoliosis. F, Severe scoliosis, not in balance. G, Rib hump and flank asymmetry seen in flexion.
  1764. OBSERVE range of motion of the thoracic and lumbar spine.
  1765. ABNORMAL FINDINGS
  1766. ABNORMAL FINDINGS
  1767. ABNORMAL FINDINGS
  1768. Fig. 15-20 Range of motion of the thoracic and lumbar spine. A, Flexion. B, Hyperextension. C, Lateral bending. D, Rotation of the upper trunk.
  1769. PALPATE the posterior neck, spinal processes, and paravertebral muscles for alignment and tenderness.
  1770. ABNORMAL FINDINGS
  1771. PERCUSS the spinal processes for tenderness.
  1772. ABNORMAL FINDINGS
  1773. INSPECT the shoulders and shoulder girdle for equality of height and contour.
  1774. ABNORMAL FINDINGS
  1775. PALPATE the shoulders for firmness, fullness, tenderness, and masses.
  1776. ABNORMAL FINDINGS
  1777. TEST the trapezius muscles for strength.
  1778. ABNORMAL FINDINGS
  1779. Fig. 15-21 Palpation of the spinal processes of the vertebrae.
  1780. Fig. 15-22 Test strength of the trapezius muscle with the shrugged shoulder movement.
  1781. Fig. 15-23 Range of motion of the shoulders. A, Forward flexion and hyperextension. B, Abduction and adduction. C, External rotation and abduction. D, Internal rotation and adduction.
  1782. OBSERVE the shoulders for range of motion.
  1783. ABNORMAL FINDINGS
  1784. TEST the arms for muscle strength.
  1785. ABNORMAL FINDINGS
  1786. Fig. 15-24 Testing muscle strength of arms. A, Testing triceps muscle strength. B, Testing biceps muscle strength.
  1787. PALPATE the elbows for tenderness, edema, and nodules.
  1788. ABNORMAL FINDINGS
  1789. Fig. 15-25 Palpation of the olecranon process grooves.
  1790. OBSERVE the elbows for range of motion.
  1791. ABNORMAL FINDINGS
  1792. Fig. 15-26 Range of motion of the elbow. A, Flexion and extension. B, Palm up, supination; palm down, pronation.
  1793. INSPECT the joints of the wrists and hands for position, contour, and number of digits.
  1794. ABNORMAL FINDINGS
  1795. Fig. 15-27 A, Bony structures of the right hand and wrist. Note alignment of fingers with the radius. B, Palmar aspect of right hand.
  1796. Fig. 15-28 A, Ulnar deviation and subluxation of metacarpophalangeal joints. B, Swan-neck deformity. C, Boutonnière deformity.
  1797. Fig. 15-29 Osteoarthritis.
  1798. Fig. 15-30 Palpation of joints of the hand and wrist. A, Interphalangeal joints. B, Metacarpophalangeal joints. C, Radiocarpal groove.
  1799. PALPATE each joint of the hand and wrist for surface characteristics and tenderness.
  1800. ABNORMAL FINDINGS
  1801. TEST for muscle strength and OBSERVE for range of motion of wrists and fingers.
  1802. ABNORMAL FINDINGS
  1803. Fig. 15-31 A, Assessment of finger strength. B, Assessment of grip strength.
  1804. Fig. 15-32 Range of motion of hand and wrist. A, Wrist flexion and hyperextension. B, Metacarpophalangeal flexion and hyperextension. C, Wrist radial and ulnar deviation. D, Finger abduction. E, Finger flexion: fist formation. F, Finger extension: thumb to each fingertip and to base of little finger.
  1805. ABNORMAL FINDINGS
  1806. INSPECT the hips for symmetry.
  1807. ABNORMAL FINDINGS
  1808. PALPATE the hips for stability and tenderness.
  1809. ABNORMAL FINDINGS
  1810. OBSERVE the hips for range of motion.
  1811. ABNORMAL FINDINGS
  1812. Fig. 15-33 Range of motion of hips. A, Hip flexion, knee flexed. B, Hip flexion, leg extended. C, External rotation of hip. D, Internal rotation of hip. E, Abduction and adduction of hip. F, Hyperextension of hip, leg extended.
  1813. TEST the hips for muscle strength.
  1814. ABNORMAL FINDINGS
  1815. TEST the leg muscles for strength.
  1816. ABNORMAL FINDINGS
  1817. Fig. 15-34 Assessment of hamstring muscle strength. Client flexes knee while examiner tries to straighten it.
  1818. INSPECT the knees for symmetry and alignment.
  1819. ABNORMAL FINDINGS
  1820. PALPATE the knees for contour, tenderness, and edema.
  1821. ABNORMAL FINDINGS
  1822. OBSERVE the knees for range of motion.
  1823. ABNORMAL FINDINGS
  1824. Fig. 15-35 Flexion and hyperextension of knee.
  1825. INSPECT the ankles and feet for contour, alignment, and number of toes.
  1826. ABNORMAL FINDINGS
  1827. Fig. 15-36 Hallux valgus with bunions and hammer toes.
  1828. PALPATE the ankles and feet for contour, edema, and tenderness.
  1829. ABNORMAL FINDINGS
  1830. OBSERVE the ankles and feet for range of motion.
  1831. ABNORMAL FINDINGS
  1832. TEST the ankle and feet muscles for strength.
  1833. ABNORMAL FINDINGS
  1834. Fig. 15-37 Range of motion of the ankle. A, Dorsiflexion and plantar flexion. B, Inversion and eversion. C, Abduction and adduction.
  1835. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE
  1836. ASSESS for carpal tunnel syndrome.
  1837. ABNORMAL FINDINGS
  1838. Fig. 15-38 Phalen’s test for carpal tunnel syndrome.
  1839. ABNORMAL FINDINGS
  1840. Fig. 15-39 Tinel’s sign for carpal tunnel syndrome.
  1841. ASSESS for rotator cuff damage.
  1842. ABNORMAL FINDINGS
  1843. ASSESS for knee effusion.
  1844. ABNORMAL FINDINGS
  1845. ABNORMAL FINDINGS
  1846. Fig. 15-40 Bulge sign to detect small effusion in knee joint. A, Milk the medial aspect of the knee two or three times. B, Then tap the lateral side of the patella.
  1847. Fig. 15-41 Ballottement procedure to detect large effusion in knee joint.
  1848. ASSESS for knee stability.
  1849. ABNORMAL FINDINGS
  1850. ABNORMAL FINDINGS
  1851. ABNORMAL FINDINGS
  1852. Fig. 15-42 Assessing knee stability. A, Assessing collateral ligaments. B, Drawer test for assessing anterior and posterior cruciate ligaments.
  1853. Fig. 15-43 Examination of the knee with McMurray’s test. Knee is flexed, stabilized with thumb and index finger; with the other hand rotate and extend the lower leg.
  1854. Fig. 15-44 Examination of the knee with the Apley test.
  1855. ABNORMAL FINDINGS
  1856. ASSESS for hip flexion contractures.
  1857. ABNORMAL FINDINGS
  1858. ASSESS for nerve root compression.
  1859. ABNORMAL FINDINGS
  1860. Fig. 15-45 Examination of the hip with the Thomas test. Response is negative in this client because the extended leg remains flat on the table.
  1861. Fig. 15-46 Straight leg raising test.
  1862. AGE-RELATED VARIATIONS
  1863. Infants, Children, and Adolescents
  1864. Older Adults
  1865. Documenting Expected Findings
  1866. Musculoskeletal System
  1867. CLINICAL REASONING Musculoskeletal System
  1868. COMMON PROBLEMS & CONDITIONS
  1869. BONES
  1870. Fracture
  1871. Osteoporosis
  1872. Fig. 15-47 Open and closed fractures.
  1873. JOINTS
  1874. Rheumatoid Arthritis
  1875. Fig. 15-48 Hallmark of osteoporosis: dowager’s hump (kyphosis).
  1876. Osteoarthritis
  1877. Bursitis
  1878. Gout
  1879. Fig. 15-49 Olecranon bursitis.
  1880. SPINE
  1881. Herniated Nucleus Pulposus (HNP)
  1882. Fig. 15-50 Gout with many tophi present on the hands, on the wrists, and in both olecranon bursae.
  1883. Fig. 15-51 Herniated intervertebral disk.
  1884. Fig. 15-52 Scoliosis.
  1885. Scoliosis
  1886. LIGAMENTS AND MUSCLES
  1887. Carpal Tunnel Syndrome
  1888. CLINICAL APPLICATION & CLINICAL REASONING
  1889. REVIEW QUESTIONS
  1890. SAMPLE DOCUMENTATION
  1891. SUBJECTIVE DATA
  1892. OBJECTIVE DATA
  1893. CASE STUDY
  1894. Interview Data
  1895. Examination Data
  1896. CLINICAL Reasoning
  1897. INTERACTIVE ACTIVITIES
  1898. CHAPTER 16 Neurologic System
  1899. ANATOMY & PHYSIOLOGY
  1900. CENTRAL NERVOUS SYSTEM
  1901. Protective Structures
  1902. Cerebrospinal Fluid and Cerebral Ventricular System
  1903. Brain
  1904. Fig. 16-1 Structures of the brainstem and cerebrospinal fluid (CSF) circulation. Red arrows represent the route of the CSF. Black arrows represent the route of blood flow. Cerebrospinal fluid is produced in the ventricles, exits the fourth ventricle, and returns to the venous circulation in the superior sagittal sinus. The inset depicts the arachnoid granulations in the superior sagittal sinus, where the CSF enters the circulation.
  1905. Cerebrum
  1906. Fig. 16-2 A, Major arteries supplying blood to the brain. B, The circle of Willis. Note the anterior, middle, and posterior cerebral arteries, which are the major pairs of arteries supplying the cerebrum.
  1907. Fig. 16-3 Cerebral hemispheres. Lateral view of the brain. The motor cortex in the frontal lobe is depicted in pink, and the somesthetic cortex in the parietal lobe is depicted in blue.
  1908. Diencephalon
  1909. Basal Ganglia
  1910. Brainstem
  1911. Fig. 16-4 Topography of the somesthetic and motor cortex. Cerebral cortex seen in coronal section on the left side of the brain. The figure of the body (homunculus) depicts the relative nerve distributions; the size indicates the relative number of nerves in the distribution. Each cortex occurs on both sides of the brain but appears only on one side in this illustration. The inset shows the motor and somesthetic regions of the left hemisphere. A, Somesthetic cortex. B, Motor cortex.
  1912. Fig. 16-5 Diencephalon. Lateral view of the brain.
  1913. Fig. 16-6 Coronal section of the brain shows six ganglia that make up the basal ganglia.
  1914. Cerebellum
  1915. Spinal Cord
  1916. Fig. 16-7 Inferior surface of the brain showing the origin of the cranial nerves.
  1917. Fig. 16-8 View of the spinal column showing vertebrae, spinal cord, and spinal nerves exiting.
  1918. Fig. 16-9 Examples of somatic motor and sensory pathways. A Motor: the pyramidal pathway through the lateral corticospinal tract and the extrapyramidal pathways through the rubrospinal and reticulospinal tracts.
  1919. PERIPHERAL NERVOUS SYSTEM
  1920. Cranial Nerves
  1921. Spinal Nerves
  1922. B Sensory: pathways of the medial lemniscal system that conducts information about discriminating touch and kinesthesis and the spinothalamic pathway that conducts information about pain and temperature.
  1923. Reflex Arc
  1924. AUTONOMIC NERVOUS SYSTEM
  1925. TABLE 16-1 The Cranial Nerves and Their Functions
  1926. BOX 16-1 HOW TO REMEMBER NAMES AND NERVE TYPE OF CRANIAL NERVES
  1927. Fig. 16-10 Dermatomal map. Letters and numbers indicate the spinal nerves innervating a given region of skin.
  1928. Fig. 16-11 Cross section of the spinal cord showing three-neuron reflex arc.
  1929. TABLE 16-2 Superficial and Deep Tendon Reflexes
  1930. Fig. 16-12 Innervation of organs by the autonomic nervous system. Preganglionic fibers are indicated by solid lines, and postganglionic fibers are indicated by broken lines.
  1931. LINK TO CONCEPTS Intracranial Regulation
  1932. Concept Model: Intracranial Regulation
  1933. HEALTH HISTORY
  1934. RISK FACTORS CVA, Stroke
  1935. Cerebrovascular Accident (CVA), Stroke
  1936. GENERAL HEALTH HISTORY
  1937. Present Health Status
  1938. Past Medical History
  1939. Family History
  1940. PROBLEM-BASED HISTORY
  1941. Headache
  1942. Dizziness
  1943. Seizures
  1944. Loss of Consciousness
  1945. Changes in Movement
  1946. Changes in Sensation
  1947. Difficulty Swallowing (Dysphagia)
  1948. Difficulty Communicating (Dysphasia/Aphasia)
  1949. HEALTH PROMOTION Traumatic Brain Injury
  1950. Goals and Objectives—Healthy People 2010
  1951. Recommendations to Reduce Risk (Primary Prevention)
  1952. U.S. Preventive Services Task Force
  1953. Centers for Disease Control and Prevention
  1954. EXAMINATION
  1955. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  1956. ASSESS mental status and level of consciousness.
  1957. ABNORMAL FINDINGS
  1958. EVALUATE speech for articulation and voice quality and conversation for comprehension of verbal communication.
  1959. ABNORMAL FINDINGS
  1960. NOTICE cranial nerve functions.
  1961. ABNORMAL FINDINGS
  1962. ABNORMAL FINDINGS
  1963. ABNORMAL FINDINGS
  1964. ABNORMAL FINDINGS
  1965. ABNORMAL FINDINGS
  1966. ABNORMAL FINDINGS
  1967. ABNORMAL FINDINGS
  1968. ABNORMAL FINDINGS
  1969. ABNORMAL FINDINGS
  1970. ABNORMAL FINDINGS
  1971. OBSERVE gait for balance and symmetry.
  1972. ABNORMAL FINDINGS
  1973. EVALUATE extremities for muscle strength.
  1974. ABNORMAL FINDINGS
  1975. SPECIAL CIRCUMSTANCES AND ADVANCED PRACTICE
  1976. ASSESS individual cranial nerves.
  1977. TEST nose for smell.
  1978. ABNORMAL FINDINGS
  1979. Fig. 16-13 Examination of the olfactory cranial nerve (CN I).
  1980. TEST eyes for visual acuity.
  1981. ABNORMAL FINDINGS
  1982. TEST eyes for peripheral vision.
  1983. ABNORMAL FINDINGS
  1984. OBSERVE eyes for extraocular muscle movement.
  1985. ABNORMAL FINDINGS
  1986. OBSERVE eyes for pupillary size, shape, equality, constriction and accommodation.
  1987. ABNORMAL FINDINGS
  1988. EVALUATE face for movement and sensation.
  1989. ABNORMAL FINDINGS
  1990. ABNORMAL FINDINGS
  1991. Fig. 16-14 Examination of the trigeminal nerve (CN V) for motor function, A, and sensory function, B.
  1992. ABNORMAL FINDINGS
  1993. ABNORMAL FINDINGS
  1994. ABNORMAL FINDINGS
  1995. Fig. 16-15 Examination of the facial nerve (CN VII). Ask the client to make the following movements: A, Raise eyebrows and wrinkle forehead. B, Smile. C, Puff out cheeks. D, Purse lips and blow out. E, Show teeth. F, Squeeze eyes shut while you try to open them.
  1996. TEST ears for hearing.
  1997. ABNORMAL FINDINGS
  1998. TEST tongue for taste.
  1999. ABNORMAL FINDINGS
  2000. INSPECT oropharynx for gag reflex and movement of soft palate.
  2001. ABNORMAL FINDINGS
  2002. Fig. 16-16 Location of the taste bud regions tested for sensory function of the facial and glossopharyngeal cranial nerves.
  2003. TEST the tongue for movement, symmetry, strength, and absence of lesions; test for muscle strength.
  2004. ABNORMAL FINDINGS
  2005. Fig. 16-17 Examination of the hypoglossal nerve (CN XII).
  2006. TEST shoulders and neck muscles for strength and movement.
  2007. ABNORMAL FINDINGS
  2008. ABNORMAL FINDINGS
  2009. TEST cerebellar function for balance and coordination.
  2010. ABNORMAL FINDINGS
  2011. Tests for Balance
  2012. ABNORMAL FINDINGS
  2013. ABNORMAL FINDINGS
  2014. ABNORMAL FINDINGS
  2015. ABNORMAL FINDINGS
  2016. ABNORMAL FINDINGS
  2017. ABNORMAL FINDINGS
  2018. Fig. 16-18 Evaluation of balance with heel-toe walking on a straight line.
  2019. Fig. 16-19 Evaluation of balance with the client hopping in place on one foot.
  2020. Upper Extremity
  2021. ABNORMAL FINDINGS
  2022. ABNORMAL FINDINGS
  2023. ABNORMAL FINDINGS
  2024. ABNORMAL FINDINGS
  2025. Fig. 16-20 Examination of coordination with rapid alternating movements. Ask client to tap top of thighs with both hands, alternately with palms down (A) and palms up (B).
  2026. Fig. 16-21 Examination of finger coordination. Ask client to touch each finger to thumb in rapid sequence.
  2027. Fig. 16-22 Examination of fine motor function. Ask client to alternately touch own nose and the nurse’s index finger with the index finger of one hand.
  2028. Lower Extremity
  2029. ABNORMAL FINDINGS
  2030. Fig. 16-23 Examination of lower extremity coordination. Ask client to run heel of one foot down shin of other leg. Repeat with opposite leg.
  2031. ASSESS peripheral nerves.
  2032. ASSESS for sensation.
  2033. ABNORMAL FINDINGS
  2034. ABNORMAL FINDINGS
  2035. ABNORMAL FINDINGS
  2036. ABNORMAL FINDINGS
  2037. Fig. 16-24 Evaluation of peripheral nerve sensory function. A, Superficial tactile sensation. B, Superficial pain sensation. C, Vibratory sensation. D, Position sense of joints.
  2038. ABNORMAL FINDINGS
  2039. ABNORMAL FINDINGS
  2040. ABNORMAL FINDINGS
  2041. ABNORMAL FINDINGS
  2042. Fig. 16-25 Evaluation of cortical sensory function. A, Stereognosis: identification of a familiar object by touch. B, Two-point discrimination. C, Graphesthesia: draw letter or number on palm and ask client to identify by touch.
  2043. BOX 16-2 MINIMAL DISTANCES FOR DISTINGUISHING TWO POINTS
  2044. EVALUATE extremities for deep tendon reflexes.
  2045. ABNORMAL FINDINGS
  2046. BOX 16-3 SCORING DEEP TENDON REFLEXES
  2047. Fig. 16-26 Location of tendons for evaluation of deep tendon reflexes. A, Triceps reflex. B, Biceps reflex. C, Brachioradialis reflex. D, Patellar reflex. E, Achilles reflex. F, Babinski’s reflex. G, Ankle tonus.
  2048. ABNORMAL FINDINGS
  2049. ABNORMAL FINDINGS
  2050. EVALUATE for superficial reflexes.
  2051. ABNORMAL FINDINGS
  2052. ABNORMAL FINDINGS
  2053. ADDITIONAL ASSESSMENT TECHNIQUES FOR SPECIAL CASES
  2054. Altered Level of Consciousness
  2055. Assessing Awareness
  2056. Assessing Arousal
  2057. Documenting Altered Level of Conscious Using Descriptors or a Scale
  2058. TABLE 16-3 Techniques for Applying Painful Stimuli
  2059. Fig. 16-27 Glasgow Coma Scale.
  2060. Meningeal Irritation
  2061. Documenting Expected Findings
  2062. Neurologic System
  2063. Fig. 16-28 Kernig’s sign and Brudzinski’s sign are tests of meningeal irritation. A, Kernig’s sign. Flex one of the client’s legs at the hip and knee. Note resistance or pain. B, Brudzinski’s sign. With the client recumbent, place your hands behind the client’s head and flex the neck forward. Note resistance or pain. Watch also for flexion of the client’s hips and knees in reaction to your maneuver.
  2064. AGE-RELATED VARIATIONS
  2065. INFANTS, CHILDREN, AND ADOLESCENTS
  2066. OLDER ADULTS
  2067. CLINICAL REASONING Neurologic System
  2068. COMMON PROBLEMS & CONDITIONS
  2069. DISORDERS OF THE CENTRAL NERVOUS SYSTEM
  2070. Multiple Sclerosis
  2071. Meningitis
  2072. Encephalitis
  2073. Spinal Cord Injury
  2074. Fig. 16-29 Posture and shuffling gait associated with Parkinson’s disease.
  2075. Craniocerebral Injury (Head Injury)
  2076. Parkinson’s Disease
  2077. Cerebrovascular Accident (Stroke)
  2078. Alzheimer Disease
  2079. DISORDERS OF CRANIAL NERVES
  2080. Trigeminal Neuralgia
  2081. Bell’s Palsy
  2082. DISORDERS OF PERIPHERAL NERVES
  2083. Myasthenia Gravis
  2084. Guillain-Barré Syndrome
  2085. CLINICAL APPLICATION & CLINICAL REASONING
  2086. REVIEW QUESTIONS
  2087. SAMPLE DOCUMENTATION
  2088. SUBJECTIVE DATA
  2089. OBJECTIVE DATA
  2090. CASE STUDY
  2091. Interview Data
  2092. Examination Data
  2093. CLINICAL Reasoning
  2094. INTERACTIVE ACTIVITIES
  2095. CHAPTER 17 Breasts and Axillae
  2096. ANATOMY & PHYSIOLOGY
  2097. FEMALE BREAST
  2098. Fig. 17-1 Quadrants of the left breast and axillary tail of Spence.
  2099. Fig. 17-2 Anatomy of the breast, showing position and major structures.
  2100. Lymphatic Network
  2101. Fig. 17-3 Lymphatic drainage of the breast.
  2102. MALE BREAST
  2103. HEALTH HISTORY
  2104. RISK FACTORS Breast Cancer
  2105. GENERAL HEALTH HISTORY
  2106. Present Health Status
  2107. Past Medical History
  2108. Family History
  2109. PROBLEM-BASED HISTORY
  2110. Breast Pain or Tenderness
  2111. Breast Lump
  2112. Nipple Discharge
  2113. Axillary Lumps or Tenderness
  2114. Breast Swelling or Enlargement (Men)
  2115. HEALTH PROMOTION Breast Cancer
  2116. Goals and Objectives—Healthy People 2010
  2117. Recommendations to Reduce Risk (Primary Prevention)
  2118. U.S. Preventive Services Task Force
  2119. Screening Recommendations (Secondary Prevention)
  2120. American Cancer Society
  2121. EXAMINATION
  2122. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  2123. FEMALE BREAST EXAMINATION
  2124. ROUTINE TECHNIQUES
  2125. INSPECT the breasts, noting size, shape, contour, and symmetry.
  2126. ABNORMAL FINDINGS
  2127. INSPECT the skin of the breasts for color, pigmentation, vascularity, surface characteristics, and lesions.
  2128. Fig. 17-4 Breasts should appear bilaterally symmetric.
  2129. Fig. 17-5 Erythema of the breast.
  2130. ABNORMAL FINDINGS
  2131. Fig. 17-6 Peau d’orange appearance caused by edema.
  2132. INSPECT the areolae for color and surface characteristics.
  2133. ABNORMAL FINDINGS
  2134. INSPECT the nipples for position, symmetry, surface characteristics, lesions, bleeding, and discharge.
  2135. Fig. 17-7 Variations in color of areola. A, Pink. B, Brown. C, Black. Note presence of Montgomery’s tubercles in B.
  2136. ABNORMAL FINDINGS
  2137. Fig. 17-8 Nipple retraction.
  2138. Fig. 17-9 A, Supernumerary nipple. B, Supernumerary nipples may arise along the “milk line.”
  2139. ABNORMAL FINDINGS
  2140. Fig. 17-10 Paget’s disease.
  2141. BOX 17-1 COLLECTING A SPECIMEN FOR CYTOLOGIC EXAMINATION
  2142. TABLE 17-1 Nipple Discharge
  2143. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE
  2144. INSPECT the breasts in various positions for bilateral pull, symmetry, and contour.
  2145. ABNORMAL FINDINGS
  2146. Fig. 17-11 A, Client with arms extended overhead. B, Client with arms raised and leaning forward. C, Client sitting and pressing her hands on hips.
  2147. INSPECT and PALPATE the axillae for evidence of rash, lesions, or masses.
  2148. ABNORMAL FINDINGS
  2149. PALPATE the breasts for tissue characteristics.
  2150. Fig. 17-12 Raise and support client’s arm while palpating axilla.
  2151. Fig. 17-13 Palpate the breasts using your finger pads.
  2152. ABNORMAL FINDINGS
  2153. TABLE 17-2 Methods for Breast Palpation
  2154. Fig. 17-14 Manual palpation of large breasts.
  2155. Fig. 17-15 Palpate the borders and mobility of a breast mass.
  2156. BOX 17-2 BREAST MASS CHARACTERISTICS
  2157. PALPATE the nipples for surface characteristics and discharge.
  2158. Fig. 17-16 Express nipple discharge by palpating on the areola.
  2159. ABNORMAL FINDINGS
  2160. MALE BREAST EXAMINATION
  2161. INSPECT the breasts and nipples.
  2162. ABNORMAL FINDINGS
  2163. PALPATE the breasts and nipples
  2164. ABNORMAL FINDINGS
  2165. PALPATE the axilla.
  2166. ABNORMAL FINDINGS
  2167. FREQUENTLY ASKED QUESTIONS
  2168. FREQUENTLY ASKED QUESTIONS
  2169. Documenting Expected Findings
  2170. Breast
  2171. Female breast exam
  2172. Male breast exam
  2173. AGE-RELATED VARIATIONS
  2174. INFANTS AND CHILDREN
  2175. ADOLESCENTS
  2176. OLDER ADULTS
  2177. CLIENTS WITH SITUATIONAL VARIATIONS
  2178. CLIENTS WITH A MASTECTOMY
  2179. Fig. 17-17 A, Appearance of chest following bilateral mastectomy. Postoperative breast reconstruction before, B, and after, C, nipple-areolar reconstruction.
  2180. COMMON PROBLEMS & CONDITIONS
  2181. BENIGN BREAST DISEASE
  2182. Fibrocystic Changes to the Breast
  2183. Fibroadenoma
  2184. Fig. 17-18 Fibrocystic changes to the breast. The cysts are depicted as green masses.
  2185. Ductal Ectasia
  2186. Intraductal Papilloma
  2187. BREAST CANCER
  2188. ETHNIC & CULTURAL VARIATIONS
  2189. Invasive Breast Cancer
  2190. TABLE 17-3 Differentiation of Breast Masses
  2191. Noninvasive Breast Cancer
  2192. Fig. 17-19 Fibroadenoma.
  2193. Fig. 17-20 Clinical signs of breast cancer: nipple retraction and dimpling of skin.
  2194. OTHER BREAST CONDITIONS
  2195. Mastitis
  2196. Galactorrhea
  2197. Gynecomastia
  2198. Fig. 17-21 Clinical signs of acute mastitis.
  2199. Fig. 17-22 Galactorrhea.
  2200. Fig. 17-23 Gynecomastia in an adult male.
  2201. CLINICAL APPLICATION & CLINICAL REASONING
  2202. REVIEW QUESTIONS
  2203. SAMPLE DOCUMENTATION
  2204. Subjective Data
  2205. Objective Data
  2206. CASE STUDY
  2207. Interview Data
  2208. Examination Data
  2209. CLINICAL Reasoning
  2210. INTERACTIVE ACTIVITIES
  2211. CHAPTER 18 Reproductive System and the Perineum
  2212. ANATOMY & PHYSIOLOGY
  2213. FEMALE REPRODUCTIVE SYSTEM
  2214. External Genitalia
  2215. Fig. 18-1 Female external genitalia.
  2216. Fig. 18-2 Midsagittal view of female pelvic organs.
  2217. Internal Structures and Organs
  2218. Fig. 18-3 Types of cervical cells: endocervical, external os, and ectocervix.
  2219. Vagina
  2220. Uterus
  2221. Fallopian Tubes
  2222. Ovaries
  2223. Fig. 18-4 Cross-sectional view of internal female genitalia and pelvic contents.
  2224. Menstrual Cycle
  2225. Stage 1: Menstrual Phase (Days 1 to 4).
  2226. Stage 2: Postmenstrual or Preovulatory Phase (Days 5 to 12).
  2227. Stage 3: Ovulation (Days 13 or 14).
  2228. Fig. 18-5 Female menstrual cycle. Diagram shows the interrelationship of the cerebral, hypothalamic, pituitary, and uterine functions throughout a standard 28-day menstrual cycle. The variations in basal body temperature are also shown.
  2229. Stage 4: Secretory Phase (Days 15-20).
  2230. Stage 5: Premenstrual Phase (Days 21 to 28).
  2231. Menopause
  2232. MALE REPRODUCTIVE SYSTEM
  2233. Internal Structures
  2234. Testes
  2235. Ducts
  2236. Fig. 18-6 Male reproductive organs.
  2237. Glands
  2238. External Genitalia
  2239. Scrotum
  2240. Fig. 18-7 Scrotum and its contents.
  2241. Penis
  2242. RECTUM AND ANUS
  2243. Rectum
  2244. Anal Canal and Anus
  2245. Fig. 18-8 Anatomy of the anus and rectum.
  2246. HEALTH HISTORY
  2247. RISK FACTORS Reproductive Cancer
  2248. FEMALE REPRODUCTIVE CANCERS
  2249. Cervical Cancer
  2250. Ovarian Cancer
  2251. Endometrial Cancer
  2252. MALE REPRODUCTIVE CANCERS
  2253. Testicular Cancer
  2254. Prostate Cancer
  2255. RISK FACTORS Sexually Transmitted Disease (STD)
  2256. GENERAL HEALTH HISTORY
  2257. Present Health Status
  2258. Past Medical History
  2259. Family History
  2260. Sexual History
  2261. OBSTETRIC HISTORY
  2262. Menstruation
  2263. Pregnancy
  2264. FREQUENTLY ASKED QUESTIONS
  2265. PROBLEM-BASED HISTORY
  2266. Pain
  2267. Lesion
  2268. BOX 18-1 FOCUS ON PAIN Anus and Rectum
  2269. Vaginal or Penile Discharge
  2270. Problems with Menstruation
  2271. Menopausal Symptoms
  2272. ETHNIC & CULTURAL VARIATIONS
  2273. Difficulty with Erection
  2274. Problems with Urination
  2275. HEALTH PROMOTION Sexually Transmitted Disease
  2276. Background
  2277. Goals and Objectives—Healthy People 2010
  2278. Recommendations to Reduce Risk (Primary Prevention)
  2279. Centers for Disease Control and Prevention (CDC)
  2280. Screening Recommendations (Secondary Prevention)
  2281. Centers for Disease Control and Prevention
  2282. Rectal Bleeding
  2283. TABLE 18-1 The American Urological Association Symptom Index for Benign Prostatic Hyperplasia
  2284. HEALTH PROMOTION Reproductive Cancers
  2285. Background
  2286. Goals and Objectives—Healthy People 2010
  2287. Recommendations to Reduce Risk (Primary Prevention)
  2288. U.S. Preventive Services Task Force
  2289. Screening Recommendations (Secondary Prevention)
  2290. EXAMINATION
  2291. FEMALE EXAM
  2292. PREPARING FOR THE FEMALE EXAMINATION
  2293. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  2294. ROUTINE TECHNIQUES: FEMALE EXAM
  2295. INSPECT the pubic hair and skin over the mons pubis and inguinal area for distribution and surface characteristics.
  2296. ABNORMAL FINDINGS
  2297. INSPECT and PALPATE the labia majora, labia minora, and clitoris for pigmentation and surface characteristics.
  2298. ABNORMAL FINDINGS
  2299. ABNORMAL FINDINGS
  2300. ABNORMAL FINDINGS
  2301. Fig. 18-9 Inspection of the external genitalia.
  2302. Fig. 18-10 Inspection of the labia.
  2303. INSPECT the urethral meatus, vaginal introitus, and perineum for positioning and surface characteristics.
  2304. ABNORMAL FINDINGS
  2305. INSPECT the perianal area and anus for color and surface characteristics.
  2306. ABNORMAL FINDINGS
  2307. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: FEMALE EXAM
  2308. PALPATE the Skene’s and Bartholin’s glands for surface characteristics, discharge, and pain or discomfort.
  2309. ABNORMAL FINDINGS
  2310. Fig. 18-11 Palpation of Skene’s gland.
  2311. Fig. 18-12 Palpation of Bartholin’s gland.
  2312. Fig. 18-13 Assessing vaginal tone.
  2313. ABNORMAL FINDINGS
  2314. INSPECT and PALPATE for vaginal wall tone.
  2315. ABNORMAL FINDINGS
  2316. SPECULUM EXAMINATION
  2317. BOX 18-2 CLINICAL NOTES
  2318. Fig. 18-14 Apply downward pressure on vagina before inserting the speculum.
  2319. Fig. 18-15 Insertion of closed speculum blades with oblique angle.
  2320. Fig. 18-16 A, Direct the speculum downward at a 45-degree angle. B, Cross-sectional view.
  2321. Fig. 18-17 A, Open speculum blades. B, Cross-sectional view.
  2322. INSPECT the cervix for color, surface characteristics, position, size and shape, and discharge.
  2323. ABNORMAL FINDINGS
  2324. ABNORMAL FINDINGS
  2325. ABNORMAL FINDINGS
  2326. ABNORMAL FINDINGS
  2327. BOX 18-3 CLINICAL NOTE
  2328. Fig. 18-18 Common appearances of the cervix. A, Nulliparous cervix. Note rounded os. B, Parous cervix. Note slit appearance of os. C, Multigravidous, lacerated. D, Everted. E, Eroded. F, Nabothian cysts.
  2329. OBTAIN smears and cultures.
  2330. TABLE 18-2 Procedure for Collecting Pap Smear Specimen
  2331. BOX 18-4 TESTING FOR CERVICAL CANCER
  2332. INSPECT the vaginal walls for color and surface characteristics.
  2333. ABNORMAL FINDINGS
  2334. BIMANUAL EXAMINATION
  2335. PALPATE the vagina for surface characteristics and discomfort.
  2336. ABNORMAL FINDINGS
  2337. PALPATE the cervix and uterus for position, size, surface characteristics, mobility, and discomfort.
  2338. ABNORMAL FINDINGS
  2339. Fig. 18-19 Bimanual palpation.
  2340. ABNORMAL FINDINGS
  2341. ABNORMAL FINDINGS
  2342. PALPATE the adnexa and ovaries for size, shape, and tenderness.
  2343. ABNORMAL FINDINGS
  2344. Fig. 18-20 Bimanual palpation of the adnexa.
  2345. TABLE 18-3 Positions of the Uterus
  2346. PALPATE the uterus and ovaries using the rectovaginal approach.
  2347. ABNORMAL FINDINGS
  2348. Fig. 18-21 Rectovaginal examination.
  2349. RECTAL EXAMINATION
  2350. PALPATE the rectal wall for surface characteristics.
  2351. ABNORMAL FINDINGS
  2352. PALPATE the anal sphincter for muscle tone.
  2353. ABNORMAL FINDINGS
  2354. EXAMINE stool for characteristics and presence of occult blood.
  2355. ABNORMAL FINDINGS
  2356. BOX 18-5 GUAIAC TESTING
  2357. BOX 18-6 STOOL COLORS AND SIGNIFICANCE
  2358. Documenting Expected Findings
  2359. Male Examination
  2360. MALE EXAM
  2361. PREPARING FOR THE MALE EXAMINATION
  2362. BOX 18-7 CLINICAL NOTE
  2363. ROUTINE TECHNIQUES: MALE EXAM
  2364. INSPECT pubic hair for distribution and general characteristics.
  2365. ABNORMAL FINDINGS
  2366. INSPECT and PALPATE the penis for surface characteristics, color, tenderness, and discharge.
  2367. ABNORMAL FINDINGS
  2368. Fig. 18-22 A, Uncircumcised penis. B, Circumcised penis.
  2369. Fig. 18-23 Phimosis.
  2370. Fig. 18-24 Paraphimosis.
  2371. ABNORMAL FINDINGS
  2372. ABNORMAL FINDINGS
  2373. Fig. 18-25 Balanitis.
  2374. Fig. 18-26 Purulent penile discharge.
  2375. ABNORMAL FINDINGS
  2376. ABNORMAL FINDINGS
  2377. Fig. 18-27 Examination of urethral meatus.
  2378. INSPECT and PALPATE the sacrococcygeal areas for surface characteristics and tenderness.
  2379. ABNORMAL FINDINGS
  2380. INSPECT the perianal area and anus for pigmentation and surface characteristics.
  2381. ABNORMAL FINDINGS
  2382. INSPECT the scrotum for color, texture, surface characteristics, and position.
  2383. ABNORMAL FINDINGS
  2384. Fig. 18-28 Inspect the scrotum and ventral surface of the penis as the client positions his penis.
  2385. INSPECT the inguinal region and the femoral area for bulges.
  2386. ABNORMAL FINDINGS
  2387. SPECIAL CIRCUMSTANCES OR ADVANCED PRACTICE: MALE EXAM
  2388. PALPATE the scrotum for surface characteristics and tenderness.
  2389. ABNORMAL FINDINGS
  2390. PALPATE the testes, epididymides, and vas deferens for location, consistency, tenderness, and nodules.
  2391. ABNORMAL FINDINGS
  2392. ABNORMAL FINDINGS
  2393. ABNORMAL FINDINGS
  2394. Fig. 18-29 Palpating the scrotum and testes.
  2395. TRANSILLUMINATE the scrotum for evidence of fluid and masses.
  2396. ABNORMAL FINDINGS
  2397. Fig. 18-30 Transillumination of the scrotum.
  2398. INGUINAL REGION
  2399. PALPATE the inguinal canal for evidence of indirect hernia or direct hernia.
  2400. ABNORMAL FINDINGS
  2401. Fig. 18-31 A, Palpating for inguinal hernia. B, Position of gloved finger inserted through inguinal canal.
  2402. RECTAL EXAMINATION
  2403. PALPATE the anus for sphincter tone.
  2404. ABNORMAL FINDINGS
  2405. Fig. 18-32 Positions for rectal examination. A, Left lateral or Sims’ position. B, Knee-chest position. C, Standing position. D, Lithotomy position.
  2406. Fig. 18-33 Rectal examination. A, Relax sphincter with gentle pressure with the palmar surface of the finger. B, Insert the finger into the anal canal.
  2407. PALPATE the anal canal and rectum for surface characteristics.
  2408. ABNORMAL FINDINGS
  2409. PALPATE the prostate (through the anterior rectal surface) for size, contour, consistency, mobility, and tenderness.
  2410. ABNORMAL FINDINGS
  2411. BOX 18-8 CLASSIFICATIONS OF PROSTATE ENLARGEMENT
  2412. Fig. 18-34 Palpation of the anterior surface of the prostate gland. Feel for the lateral lobes and median sulcus.
  2413. EXAMINE stool for characteristics and presence of occult blood.
  2414. ABNORMAL FINDINGS
  2415. Documenting Expected Findings
  2416. Male Examination
  2417. FREQUENTLY ASKED QUESTIONS
  2418. ETHNIC & CULTURAL VARIATIONS
  2419. AGE-RELATED VARIATIONS
  2420. INFANTS AND CHILDREN
  2421. ADOLESCENTS
  2422. OLDER ADULTS
  2423. COMMON PROBLEMS & CONDITIONS
  2424. INFECTIONS
  2425. Bacterial Vaginosis
  2426. Candida Vaginitis
  2427. Sexually Transmitted Disease
  2428. Chlamydia
  2429. Gonorrhea
  2430. Syphilis
  2431. Trichomonas
  2432. Herpes Genitalis
  2433. Fig. 18-35 A, Syphilis chancre on vulva. B, Syphilis chancre on the penis. C, Secondary syphilis lesions (condylomata lata) around the anus.
  2434. Fig. 18-36 Trichomoniasis. The vaginal mucosa and cervix are inflamed and speckled with petechial lesions.
  2435. BOX 18-9 CLINICAL NOTE
  2436. Human Papillomavirus (Genital Warts, Condylomata Acuminatum)
  2437. Fig. 18-37 Herpes lesions. A, Female. B, Male.
  2438. Fig. 18-38 Condyloma acuminatum. A, Female. B, Male.
  2439. Fig. 18-39 Pelvic inflammatory disease.
  2440. Pediculosis Pubis (Crabs, Pubic Lice)
  2441. Pelvic Inflammatory Disease (Women)
  2442. Epididymitis
  2443. Fig. 18-40 Epididymitis.
  2444. BENIGN REPRODUCTIVE CONDITIONS AFFECTING WOMEN
  2445. Premenstrual Syndrome
  2446. Endometriosis
  2447. Uterine Leiomyomas
  2448. Ovarian Cysts
  2449. MALIGNANT REPRODUCTIVE CONDITIONS AFFECTING WOMEN
  2450. Cervical Cancer
  2451. Fig. 18-41 Common sites of endometriosis.
  2452. Fig. 18-42 Uterine leiomyomas (fibroids).
  2453. Fig. 18-43 Ovarian cyst.
  2454. Fig. 18-44 Cervical cancer. The lesion is seen on the cervical os.
  2455. Fig. 18-45 Endometrial cancer.
  2456. Fig. 18-46 Cancer of the ovaries.
  2457. ETHNIC & CULTURAL VARIATIONS
  2458. Endometrial Cancer
  2459. Ovarian Cancer
  2460. CONDITIONS OF THE SCROTUM/TESTICLES
  2461. Testicular Torsion
  2462. Fig. 18-47 A, Hydrocele. B, Cross section of hydrocele.
  2463. Hydrocele
  2464. Spermatocele
  2465. Varicocele
  2466. Testicular Cancer
  2467. Fig. 18-48 Spermatocele.
  2468. Fig. 18-49 Varicocele.
  2469. Fig. 18-50 Scrotal asymmetry caused by testicular cancer.
  2470. CONDITIONS OF THE PROSTATE
  2471. Benign Prostatic Hyperplasia
  2472. Prostatitis
  2473. Fig. 18-51 Benign prostatic hyperplasia.
  2474. Fig. 18-52 Prostatitis.
  2475. Prostate Cancer
  2476. Fig. 18-53 Carcinoma of the prostate.
  2477. CONDITIONS OF THE ANUS AND RECTUM
  2478. Pilonidal Sinus
  2479. Fig. 18-54 A, Pilonidal sinus. B, Inflamed pilonidal cyst.
  2480. Fig. 18-55 A, Internal and external hemorrhoids. B, External hemorrhoid.
  2481. Fig. 18-56 Lateral anal fissure.
  2482. Fig. 18-57 Common sites of anorectal fistula and abscess formation.
  2483. Hemorrhoids
  2484. Fig. 18-58 A, Types of rectal polyps. B, Endoscopic image of a pedunculated polyp.
  2485. Anorectal Fissure
  2486. Anorectal Abscess and Fistula
  2487. Rectal Polyp
  2488. Fig. 18-59 Rectal carcinoma.
  2489. Carcinoma of the Rectum and Anus
  2490. PROLAPSE OR HERNIATION
  2491. Hernia
  2492. TABLE 18-4 Comparisons of Hernias
  2493. Fig. 18-60 Prolapse of the rectum.
  2494. Rectal Prolapse
  2495. Uterine Prolapse
  2496. Cystocele
  2497. Rectocele
  2498. Fig. 18-61 Uterine prolapse. A, First-degree prolapse of the uterus. B, Second-degree prolapse of the uterus. C, Third-degree prolapse of the uterus.
  2499. Fig. 18-62 A, Normal anatomical position. B, Cystocele, protrusion of the wall of urinary bladder through the vagina. C, Rectocele, protrusion of the rectal wall through the vagina.
  2500. CLINICAL APPLICATION & CLINICAL REASONING
  2501. REVIEW QUESTIONS
  2502. SAMPLE DOCUMENTATION
  2503. SUBJECTIVE DATA
  2504. OBJECTIVE DATA
  2505. CASE STUDY
  2506. Interview Data
  2507. Examination Data
  2508. CLINICAL Reasoning
  2509. INTERACTIVE ACTIVITIES
  2510. UNIT 3 HEALTH ASSESSMENT ACROSS THE LIFE SPAN
  2511. CHAPTER 19 Developmental Assessment Throughout the Life Span
  2512. THEORIES OF DEVELOPMENT
  2513. Personality Development: Erikson’s Theory
  2514. TABLE 19-1 Erikson’s Eight Stages of Human Development
  2515. Cognitive Development: Piaget’s Theory
  2516. TABLE 19-2 Piaget’s Levels of Cognitive Development
  2517. Adult Intelligence
  2518. DEVELOPMENTAL TASKS
  2519. INFANTS
  2520. Physical Growth
  2521. Behavioral and Cognitive Development
  2522. Fig. 19-1 At 4 months, infant actively lifts head and looks about.
  2523. TABLE 19-3 Expected Development of Infants
  2524. BOX 19-1 DEVELOPMENTAL TASKS OF INFANTS
  2525. CHILDREN
  2526. Toddlers
  2527. Physical Growth
  2528. Behavioral and Cognitive Development
  2529. Preschoolers
  2530. Physical Growth
  2531. Behavioral and Cognitive Development
  2532. Fig. 19-2 Denver II.
  2533. Fig. 19-2 , cont’d Denver II.
  2534. Fig. 19-3 The toddler takes great pleasure in building a tower of four blocks.
  2535. TABLE 19-4 Expected Development of Toddlers
  2536. BOX 19-2 DEVELOPMENTAL TASKS OF TODDLERS
  2537. ETHNIC & CULTURAL VARIATIONS
  2538. School-Age Children
  2539. BOX 19-3 DEVELOPMENTAL TASKS OF PRESCHOOLERS
  2540. TABLE 19-5 Expected Development of Preschoolers
  2541. Physical Growth
  2542. Fig. 19-4 Preschooler develops the ability to help dress self.
  2543. ETHNIC & CULTURAL VARIATIONS
  2544. Fig. 19-5 School-age children learn the basic skills required for school.
  2545. Behavioral and Cognitive Development
  2546. ADOLESCENTS
  2547. Physical Growth
  2548. BOX 19-4 DEVELOPMENTAL TASKS OF SCHOOL-AGE CHILDREN
  2549. Fig. 19-6 The peer group is a major influence in adolescent development.
  2550. Behavioral and Cognitive Development
  2551. ADULTS
  2552. Early Adulthood
  2553. BOX 19-5 DEVELOPMENTAL TASKS OF ADOLESCENTS
  2554. Career Choice
  2555. Mate Selection
  2556. Middle Adulthood
  2557. Physical Growth
  2558. Behavioral and Cognitive Development
  2559. Older Adulthood
  2560. Physical Growth
  2561. BOX 19-6 DEVELOPMENTAL TASKS OF YOUNG ADULTS
  2562. BOX 19-7 DEVELOPMENTAL TASKS OF MIDDLE ADULTS
  2563. BOX 19-8 DEVELOPMENTAL TASKS OF OLDER ADULTS
  2564. Behavioral and Cognitive Development
  2565. FAMILY DEVELOPMENT AND ASSESSMENT
  2566. Fig. 19-7 The family unit typically shares some degree of time, financial, and physical resources and responsibilities for the unit maintenance.
  2567. TABLE 19-6 Preventive Services Throughout the Life Span*
  2568. BOX 19-9 DEVELOPMENTAL TASKS OF YOUNG-OLD AND OLD-OLD ADULTS
  2569. Young-Old (Approximately 65 to 85 Years)
  2570. Old-Old (Approximately over 85 Years)
  2571. ETHNIC & CULTURAL VARIATIONS
  2572. TABLE 19-7 Developmental Tasks of the Family
  2573. CLINICAL APPLICATION & CLINICAL REASONING
  2574. REVIEW QUESTIONS
  2575. CASE STUDY
  2576. CLINICAL Reasoning
  2577. INTERACTIVE ACTIVITIES
  2578. CHAPTER 20 Assessment of the Infant and Child
  2579. ANATOMY & PHYSIOLOGY
  2580. HEALTH HISTORY
  2581. TABLE 20-1 Pediatric Age Groups
  2582. BOX 20-1 SELECTED ANATOMIC AND PHYSIOLOGIC DIFFERENCES IN CHILDREN
  2583. Skin
  2584. Head
  2585. Ears, Nose, Throat, Mouth
  2586. Lungs
  2587. Heart
  2588. Musculoskeletal
  2589. Lymph System
  2590. Neurologic
  2591. Breasts
  2592. Reproductive System
  2593. RISK FACTORS Ears and Auditory System (Neonates/Infants)
  2594. Risk Factors for Congenital or Perinatal Hearing Loss*
  2595. Neonatal Risk Factors (Birth to 1 Month)
  2596. Infant Risk Factors (1 to 24 Months)
  2597. Risk Factors for Otitis Media
  2598. Fig. 20-1 Most data are obtained from the adult accompanying the child.
  2599. COMPONENTS OF THE PEDIATRIC HEALTH HISTORY
  2600. Biographic Data
  2601. Reason for Seeking Health Care
  2602. History of Present Illness/Present Health Status
  2603. Past Health History
  2604. BOX 20-2 THE PERINATAL HISTORY
  2605. Family History
  2606. Personal and Psychosocial History
  2607. General Status / Child Profile
  2608. Diet and Nutrition
  2609. TABLE 20-2 Adolescent Psychosocial History
  2610. Sleep
  2611. Sexuality
  2612. BOX 20-3 CLINICAL NOTE
  2613. Development
  2614. Health Promotion Habits
  2615. Social and Family Relationships
  2616. Family composition:
  2617. Family life:
  2618. Family Socioeconomic Status:
  2619. Home Environment:
  2620. Friends:
  2621. Mental Health
  2622. BOX 20-4 CRAFFT SCREENING TOOL
  2623. Review of Systems
  2624. General Symptoms
  2625. Integumentary System
  2626. Head and Neck
  2627. Breasts
  2628. Cardiovascular
  2629. Respiratory System
  2630. Fig. 20-2 Wong-Baker FACES Pain Rating Scale. Recommended for children 3 years of age and older. Ask the child to choose the face that best describes how he or she if feeling.
  2631. Fig. 20-3 Oucher Pain Scales. A, Caucasian, B, African American, C, Hispanic.
  2632. Fig. 20-4 Guidelines for Adolescent Preventive Services.
  2633. Fig. 20-4, cont’d Guidelines for Adolescent Preventive Services.
  2634. Fig. 20-5 Pediatric Symptom Checklist and Pediatric Symptom Checklist Youth Report.
  2635. Fig. 20-5 , cont’d Pediatric Symptom Checklist and Pediatric Symptom Checklist Youth Report.
  2636. Urinary System
  2637. Gastrointestinal System
  2638. Reproductive System
  2639. Musculoskeletal System
  2640. BOX 20-5 TALKING WITH CHILDREN WHO REVEAL ABUSE
  2641. Neurologic System
  2642. EXAMINATION
  2643. OVERVIEW: THE ART OF THE PEDIATRIC PHYSICAL EXAM
  2644. Newborns and Infants
  2645. Toddlers and Children
  2646. Fig. 20-6 Allow the child to touch examination equipment to reduce fear.
  2647. Adolescent
  2648. VITAL SIGNS AND BASELINE MEASUREMENTS
  2649. Temperature
  2650. Heart and Respiratory Rates
  2651. Blood Pressure
  2652. BOX 20-6 CLINICAL NOTE
  2653. Height and Weight
  2654. Height
  2655. Fig. 20-7 Measurement of head and chest circumference and recumbent length.
  2656. Weight
  2657. Head and Chest Circumference
  2658. Head Circumference
  2659. ETHNIC & CULTURAL VARIATIONS
  2660. Fig. 20-8 A, Measure the height of a child using a platform with movable headboard. B, Side view showing correct posture for accurate measurement.
  2661. Fig. 20-9 Weighing an infant on an infant scale.
  2662. Fig. 20-10 Measuring head circumference in an infant.
  2663. TABLE 20-3 Average Chest and Head Circumference of U.S. Children
  2664. BOX 20-7 HEAD CIRCUMFERENCE GROWTH RATES
  2665. Chest Circumference
  2666. EXAMINATION OF THE SKIN, HAIR, NAILS
  2667. Newborns and Infants
  2668. Skin
  2669. Normal and Abnormal Findings.
  2670. Fig. 20-11 Mongolian spot.
  2671. Fig. 20-12 Café-au-lait spot.
  2672. Fig. 20-13 Stork bite.
  2673. Fig. 20-14 A, Port-wine stain. B, Strawberry hemangioma.
  2674. Fig. 20-15 Cavernous hemangioma.
  2675. Fig. 20-16 Milia on the forehead of a newborn.
  2676. Fig. 20-17 Erythema toxicum on the trunk of an infant.
  2677. Hair and Nails
  2678. Normal and Abnormal Findings.
  2679. Toddlers and Children
  2680. Skin
  2681. Normal and Abnormal Findings.
  2682. Fig. 20-18 Seborrheic dermatitis (cradle cap).
  2683. Hair and Nails
  2684. Normal and Abnormal Findings.
  2685. Adolescents
  2686. Fig. 20-19 Newborn silky body hair (lanugo).
  2687. Fig. 20-20 Comedonal acne. Note closed comedones.
  2688. Skin
  2689. Normal and Abnormal Findings.
  2690. Hair and Nails
  2691. Normal and Abnormal Findings.
  2692. Fig. 20-21 Severe acne.
  2693. EXAMINATION OF THE HEAD, EYES, EARS, NOSE, THROAT
  2694. Newborns and Infants
  2695. Head
  2696. Procedure and Techniques.
  2697. Normal and Abnormal Findings.
  2698. Eyes
  2699. Procedure and Techniques.
  2700. Normal and Abnormal Findings.
  2701. Fig. 20-22 Alignment of the outer canthus with the pinna of the ear is a normal finding.
  2702. Ears
  2703. Procedures and Techniques.
  2704. Fig. 20-23 Immobilization of young child or infant during otoscopic examination. Note that lower portion of pinna of ear is pulled down and slightly backward. A, Prone position. B, Supine position.
  2705. Normal and Abnormal Findings.
  2706. Fig. 20-24 Microtia. A, Grade I. B, Grade III.
  2707. Nose and Mouth
  2708. Procedures and Techniques.
  2709. Normal and Abnormal Findings.
  2710. Fig. 20-25 Positioning of infant for examination of nose and mouth.
  2711. Neck
  2712. Toddlers and Children
  2713. Head
  2714. Fig. 20-26 Epstein’s pearls (gingival cysts) in an infant.
  2715. Eyes
  2716. Procedures and Techniques.
  2717. Normal and Abnormal Findings.
  2718. Ears
  2719. Procedures and Techniques.
  2720. Fig. 20-27 Corneal light reflex.
  2721. Normal and Abnormal Findings.
  2722. Fig. 20-28 Tympanotomy tube protruding from the right tympanic membrane.
  2723. Nose and Mouth
  2724. Procedures and Techniques.
  2725. Fig. 20-29 Technique for immobilizing a young child’s head for examination.
  2726. Normal and Abnormal Findings.
  2727. Neck
  2728. Procedures and Techniques.
  2729. Fig. 20-30 Koplik spots.
  2730. Normal and Abnormal Findings.
  2731. Adolescents
  2732. EXAMINATION OF THE RESPIRATORY SYSTEM
  2733. Newborns and Infants
  2734. Procedures and Techniques.
  2735. Fig. 20-31 The pediatric stethoscope has a smaller head compared to the adult stethoscope.
  2736. Normal and Abnormal Findings.
  2737. Toddlers and Children
  2738. Procedures and Techniques.
  2739. Fig. 20-32 Auscultation of lungs on a young child.
  2740. Normal and Abnormal Findings.
  2741. Adolescents
  2742. EXAMINATION OF THE CARDIOVASCULAR SYSTEM
  2743. Newborns and Infants
  2744. Procedures and Techniques.
  2745. Normal and Abnormal Findings.
  2746. Toddlers and Children
  2747. Procedures and Techniques.
  2748. Fig. 20-33 Auscultation on a young child.
  2749. Normal and Abnormal Findings.
  2750. Fig. 20-34 Auscultation for venous hum.
  2751. Adolescents
  2752. EXAMINATION OF THE ABDOMEN AND GASTROINTESTINAL SYSTEM
  2753. Newborns and Infants
  2754. Procedures and Techniques.
  2755. Normal and Abnormal Findings.
  2756. Toddlers and Children
  2757. Procedures and Techniques.
  2758. Normal and Abnormal Findings.
  2759. Fig. 20-35 Umbilical hernia on a toddler.
  2760. Adolescents
  2761. EXAMINATION OF THE MUSCULOSKELETAL SYSTEM
  2762. Newborns and Infants
  2763. Procedures and Techniques.
  2764. Normal and Abnormal Findings.
  2765. Fig. 20-36 Barlow-Ortolani maneuver to detect hip dislocation. A, Phase I, adduction. B, Phase II, abduction. This is a negative finding because no dislocation is found.
  2766. Fig. 20-37 Positive Allis’ sign shows that the left leg is shorter than the right leg, indicating left hip dysplasia.
  2767. Toddlers and Children
  2768. Procedures and Techniques.
  2769. ETHNIC & CULTURAL VARIATIONS
  2770. Fig. 20-38 Sign of hip dislocation: the three skin folds on the left upper leg and limited abduction indicate left hip dysplasia.
  2771. Normal and Abnormal Findings.
  2772. Fig. 20-39 Trendelenburg’s test or sign. A, Normally when standing on the left foot, the right pelvis rises. B, Lack of pelvic tilt when standing on the affected leg indicates hip dysplasia, a positive Trendelenburg’s test.
  2773. Adolescents
  2774. Procedures and Techniques.
  2775. Normal and Abnormal Findings.
  2776. EXAMINATION OF THE NEUROLOGIC SYSTEM
  2777. Newborns and Infants
  2778. Procedures and Techniques.
  2779. Normal and Abnormal Findings.
  2780. TABLE 20-4 Infantile Reflexes
  2781. Toddlers and Children
  2782. Procedures and Techniques.
  2783. Fig. 20-40 Ask the child to make a “funny face” to assess Cranial Nerve VII.
  2784. Normal and Abnormal Findings.
  2785. Adolescents
  2786. EXAMINATION OF THE BREASTS
  2787. Newborns and Infants
  2788. Procedures and Techniques.
  2789. Normal and Abnormal Findings.
  2790. Older Children and Adolescents
  2791. Procedures and Techniques.
  2792. Normal and Abnormal Findings.
  2793. EXAMINATION OF THE REPRODUCTIVE SYSTEM AND PERINEUM
  2794. Newborns and Infants
  2795. Female Exam
  2796. Procedures and Techniques.
  2797. Normal and Abnormal Findings.
  2798. TABLE 20-5 Screening Assessment of Neurologic “Soft” Signs
  2799. Male Exam
  2800. Procedures and Techniques.
  2801. Fig. 20-41 Marked enlargement of breast bud in neonate. This is an exaggerated response to maternal hormones.
  2802. Normal and Abnormal Findings.
  2803. Fig. 20-42 Tanner’s five stages of breast development in females. M1—Only the nipple is raised above the level of the breast, as in the child. M2—Budding stage: bud-shaped elevation of the areola. On palpation, a fairly hard disk- or cherry-shaped “button” can be felt. The areola is increased in diameter and the surrounding area is slightly elevated. M3—Further elevation of the mammary gland. Diameter of areola increases further. Shape of mammary tissue is now visibly feminine. M4—Increasing fat deposits. The areola forms a secondary elevation above that of the breast. This secondary mound apparently occurs in roughly half of all young females and in some cases persists in adulthood. M5—Adult stage. The areola (usually) subsides to the level of the breast and is strongly pigmented.
  2804. Toddlers and Children
  2805. Female Exam
  2806. Procedures and Techniques.
  2807. Fig. 20-43 Summary of maturational development of girls. See Fig. 20-42 for explanation of numbers 2 through 5 in breast development. Number ranges in graph (e.g., 9.5-14.5) indicate average or common range of age for development of characteristic.
  2808. Fig. 20-44 Prepubertal gynecomastia.
  2809. Fig. 20-45 Palpation of the scrotum in an infant.
  2810. Normal and Abnormal Findings.
  2811. TABLE 20-6 Tanner’s Sex Maturity Development (Female)
  2812. Male Exam
  2813. Procedures and Techniques.
  2814. Normal and Abnormal Findings.
  2815. Adolescents
  2816. Female Exam
  2817. Procedures and Techniques.
  2818. Fig. 20-46 Position of young child for examination of genitalia.
  2819. Normal and Abnormal Findings.
  2820. Male Exam
  2821. Procedures and Techniques.
  2822. Normal and Abnormal Findings.
  2823. PERIANAL EXAMINATION
  2824. Newborns and Infants
  2825. Procedures and Techniques.
  2826. Fig. 20-47 Development of male genitalia and pubic hair. (2, 3, 4, 5 refer to Tanner’s stages. See Table 20-7.)
  2827. Fig. 20-48 Position for rectal examination of the infant.
  2828. TABLE 20-7 Tanner’s Sex Maturity Development (Male)
  2829. Normal and Abnormal Findings.
  2830. Toddlers and Children
  2831. Procedures and Techniques.
  2832. Fig. 20-49 Imperforate anus.
  2833. Normal and Abnormal Findings.
  2834. Adolescents
  2835. COMMON PROBLEMS & CONDITIONS
  2836. SKIN CONDITIONS
  2837. Atopic Dermatitis
  2838. Diaper Dermatitis
  2839. Fig. 20-50 Atopic dermatitis.
  2840. Impetigo
  2841. Fig. 20-51 Severe diaper rash.
  2842. Fig. 20-52 Impetigo.
  2843. Herpes Varicella (Chickenpox)
  2844. EAR CONDITIONS
  2845. Acute Otitis Media
  2846. Fig. 20-53 Chickenpox (Varicella).
  2847. Fig. 20-54 Acute otitis media of the left ear with redness and edema of the pars flaccid.
  2848. EYE CONDITIONS
  2849. Conjunctivitis
  2850. MOUTH
  2851. Tonsillitis
  2852. Cleft Lip and Cleft Palate
  2853. Fig. 20-55 Tonsillitis and pharyngitis.
  2854. Fig. 20-56 Bilateral cleft lip and complete cleft palate.
  2855. RESPIRATORY CONDITIONS
  2856. Cystic Fibrosis
  2857. Childhood Asthma
  2858. Fig. 20-57 Cystic fibrosis.
  2859. Croup Syndromes
  2860. CARDIOVASCULAR CONDITIONS
  2861. Congenital Heart Defects
  2862. MUSCULOSKELETAL CONDITIONS
  2863. Muscular Dystrophies
  2864. Spina Bifida
  2865. NEUROLOGIC CONDITIONS
  2866. Hydrocephalus
  2867. Fig. 20-58 Infantile hydrocephalus.
  2868. Cerebral Palsy
  2869. Attention Deficit Hyperactivity Disorder
  2870. CLINICAL APPLICATION & CLINICAL REASONING
  2871. REVIEW QUESTIONS
  2872. SAMPLE DOCUMENTATION
  2873. SELECTED SUBJECTIVE DATA
  2874. INITIAL OBJECTIVE DATA
  2875. CASE STUDY
  2876. Interview Data
  2877. Examination Data
  2878. CLINICAL Reasoning
  2879. INTERACTIVE ACTIVITIES
  2880. CHAPTER 21 Assessment of the Pregnant Client
  2881. ANATOMY & PHYSIOLOGY
  2882. SIGNS OF PREGNANCY
  2883. BOX 21-1 SELECTED ANATOMIC AND PHYSIOLOGIC CHANGES ASSOCIATED WITH PREGNANCY
  2884. Integumentary System
  2885. Respiratory System
  2886. Cardiovascular System
  2887. Gastrointestinal System
  2888. Urinary System
  2889. Musculoskeletal System
  2890. Reproductive System
  2891. Breasts
  2892. TABLE 21-1 Signs of Pregnancy
  2893. HEALTH HISTORY
  2894. RISK FACTORS High-Risk Pregnancy
  2895. Maternal Characteristics
  2896. Maternal Habits
  2897. Obstetric History
  2898. Current Medical Problems
  2899. Problems with Current Pregnancy
  2900. COMPONENTS OF PRENATAL HEALTH HISTORY
  2901. Reason for Seeking Care
  2902. Present Health Status
  2903. Past Health History
  2904. Family History
  2905. BOX 21-2 ESTIMATED DATE OF BIRTH (EDB)
  2906. Nagele’s Rule
  2907. Gynecologic and Obstetric History
  2908. Personal and Psychosocial History
  2909. Attitude Toward the Pregnancy
  2910. TABLE 21-2 Determining Gravidity and Parity Using a Five-Digit (GTPAL) System
  2911. BOX 21-3 FOCUS ON PAIN Childbirth
  2912. Nutritional History
  2913. ETHNIC & CULTURAL VARIATIONS
  2914. Personal Habits
  2915. Environment
  2916. Review of Systems
  2917. HEALTH PROMOTION Maternal-Infant Health
  2918. Goals and Objectives—Healthy People 2010
  2919. Recommendations to Reduce Risk (Primary Prevention)
  2920. American College of Obstetricians and Gynecologists (ACOG)
  2921. Screening Recommendations (Secondary Prevention)
  2922. U.S. Preventive Services Task Force
  2923. EXAMINATION
  2924. PROCEDURES AND TECHNIQUES WITH NORMAL FINDINGS
  2925. VITAL SIGNS AND BASELINE MEASUREMENTS
  2926. MEASURE temperature, blood pressure, pulse, and respiration.
  2927. ABNORMAL FINDINGS
  2928. MEASURE height and weight.
  2929. ABNORMAL FINDINGS
  2930. BOX 21-4 EXPECTED WEIGHT GAIN DURING PREGNANCY
  2931. EXAMINATION OF THE EXTREMITIES
  2932. INSPECT the hands and nails for color and surface characteristics, movement, and sensation.
  2933. ABNORMAL FINDINGS
  2934. INSPECT and PALPATE the lower extremities for edema, surface characteristics, redness, and tenderness.
  2935. ABNORMAL FINDINGS
  2936. EXAMINATION OF THE HEAD
  2937. INSPECT the head and face for skin characteristics, pigmentation, and edema.
  2938. ABNORMAL FINDINGS
  2939. INSPECT the eyes and TEST vision for acuity.
  2940. ABNORMAL FINDINGS
  2941. INSPECT the ears, nose, and mouth.
  2942. ABNORMAL FINDINGS
  2943. INSPECT and PALPATE the neck.
  2944. ABNORMAL FINDINGS
  2945. EXAMINATION OF THE ANTERIOR AND POSTERIOR CHEST
  2946. INSPECT, AUSCULTATE, PERCUSS, and PALPATE the anterior and posterior chest.
  2947. ABNORMAL FINDINGS
  2948. Fig. 21-1 Changes in position of heart, lungs, and thoracic cage during pregnancy. Broken line, nonpregnant; solid line, changes during pregnancy.
  2949. Fig. 21-2 Enlarged breasts in pregnancy with venous network and darkened areolae and nipples.
  2950. EXAMINATION OF THE BREAST
  2951. INSPECT and PALPATE the breast for surface and tissue characteristics.
  2952. ABNORMAL FINDINGS
  2953. INSPECT and PALPATE the nipples for surface characteristics and nipple shape.
  2954. ABNORMAL FINDINGS
  2955. EXAMINATION OF THE MUSCULOSKELETAL SYSTEM
  2956. INSPECT and PALPATE the spine, extremities, and joints.
  2957. ABNORMAL FINDINGS
  2958. Fig. 21-3 Lordosis during pregnancy.
  2959. EXAMINATION OF THE NEUROLOGIC SYSTEM
  2960. EXAMINE the client for neurologic changes.
  2961. ABNORMAL FINDINGS
  2962. EXAMINATION OF THE ABDOMEN
  2963. INSPECT the abdomen for surface characteristics and fetal movement.
  2964. ABNORMAL FINDINGS
  2965. Fig. 21-4 Linea nigra on abdomen.
  2966. PALPATE the abdomen for fetal movement and uterine contraction.
  2967. MEASURE the fundus for height.
  2968. ABNORMAL FINDINGS
  2969. Fig. 21-5 Measuring fundal height.
  2970. Fig. 21-6 Changes in fundal height during pregnancy. Weeks 1 through 12, the uterus is within the pelvis. Weeks 36 through 40, fundal height drops as the fetus begins to engage in the pelvis (lightening).
  2971. AUSCULTATE the abdomen for fetal heart sounds.
  2972. ABNORMAL FINDINGS
  2973. Fig. 21-7 Auscultating fetal heart tones with a fetoscope.
  2974. PALPATE fetal position for fetal lie and presentation, position, and attitude.
  2975. ABNORMAL FINDINGS
  2976. Fig. 21-8 Leopold’s maneuvers. A, First maneuver. Place hand(s) over fundus and identify the fetal part. B, Second maneuver. Use the palmar surface of one hand to locate the back of the fetus. Use the other hand to feel the irregularities such as hands and feet. C, Third maneuver. Use thumb and third finger to grasp presenting part over the symphysis pubis. D, Fourth maneuver. Use both hands to outline the fetal head. With a head presenting deep in the pelvis, only a small portion may be felt.
  2977. TABLE 21-3 Fetal Assessment Terms
  2978. EXAMINATION OF THE GENITALIA
  2979. INSPECT the external and internal genitalia for general appearance and discharge.
  2980. ABNORMAL FINDINGS
  2981. PALPATE the cervix to determine length (effacement) and dilation.
  2982. ABNORMAL FINDINGS
  2983. Fig. 21-9 Measurement of cervical length (effacement) and dilation.
  2984. EXAMINATION OF THE RECTUM AND ANUS
  2985. INSPECT and PALPATE the anus and rectum.
  2986. ABNORMAL FINDINGS
  2987. COMMON PROBLEMS & CONDITIONS
  2988. ABRUPTIO PLACENTAE
  2989. PLACENTA PREVIA
  2990. Fig. 21-10 Abruptio placentae. Premature separation of normally implanted placenta.
  2991. Fig. 21-11 Types of placenta previa after onset of labor. A, Complete, or total. B, Incomplete, or partial.
  2992. HYDRAMNIOS (POLYHYDRAMNIOS)
  2993. PREGNANCY-INDUCED HYPERTENSION (PIH)
  2994. PREMATURE RUPTURE OF MEMBRANES
  2995. CLINICAL APPLICATION & CLINICAL REASONING
  2996. REVIEW QUESTIONS
  2997. SAMPLE DOCUMENTATION
  2998. SUBJECTIVE DATA
  2999. OBJECTIVE DATA
  3000. CASE STUDY
  3001. Interview Data
  3002. Examination Data
  3003. CLINICAL Reasoning
  3004. INTERACTIVE ACTIVITIES
  3005. CHAPTER 22 Assessment of the Older Adult
  3006. ANATOMY & PHYSIOLOGY
  3007. BOX 22-1 SELECTED ANATOMIC AND PHYSIOLOGIC CHANGES ASSOCIATED WITH OLDER ADULTS
  3008. Mental health
  3009. Sleep
  3010. Integument System
  3011. Head, Eyes, Ears, Nose, and Throat
  3012. Respiratory System
  3013. Cardiovascular System
  3014. Gastrointestinal System
  3015. Musculoskeletal System
  3016. Neurologic System
  3017. Reproductive System
  3018. Female Genitourinary System
  3019. Male Genitourinary System
  3020. Breast
  3021. HEALTH HISTORY
  3022. RISK FACTORS Older Adult
  3023. Falls
  3024. Malnutrition in Older Adults
  3025. GENERAL HEALTH HISTORY
  3026. Present Health Status
  3027. Past Health History
  3028. Family History
  3029. Personal and Psychosocial History
  3030. Personal Status
  3031. Family and Social Relationships
  3032. Functional Ability
  3033. BOX 22-2 ACTIVITIES OF DAILY LIVING ASSESSMENT
  3034. Sleep
  3035. Mental Health
  3036. Environment
  3037. Review of Systems
  3038. Head, Eyes, Ears, Nose, and Throat
  3039. Fig. 22-1 Yesavage Geriatric Depression Scale, Short Form.
  3040. BOX 22-3 HEARING HANDICAP INVENTORY FOR THE ELDERLY—SCREENING VERSION (HHIE-S)
  3041. Respiratory System
  3042. Cardiovascular System
  3043. Gastrointestinal System
  3044. Urinary System
  3045. Musculoskeletal System
  3046. Reproductive System
  3047. BOX 22-4 RISK OF FALLS ASSESSMENT TOOL
  3048. Fall Assessment Scoring System
  3049. EXAMINATION
  3050. OVERVIEW: THE OLDER ADULT PHYSICAL EXAMINATION
  3051. VITAL SIGNS AND BASELINE MEASUREMENTS
  3052. Temperature
  3053. Heart and Respiratory Rates
  3054. Blood Pressure
  3055. Pain
  3056. Height and Weight
  3057. Normal and Abnormal Findings
  3058. Fig. 22-2 Hands of older adult. Note prominent veins and thin appearance of the skin.
  3059. EXAMINATION OF THE SKIN, HAIR, NAILS
  3060. Procedure and Techniques
  3061. Normal and Abnormal Findings
  3062. Skin
  3063. Fig. 22-3 Solar lentigo (liver spots). Brown macules that appear in chronically sun-exposed areas.
  3064. Hair
  3065. Fig. 22-4 Multiple seborrheic keratosis lesions on the trunk.
  3066. Fig. 22-5 Multiple skin tags.
  3067. Nails
  3068. EXAMINATION OF THE HEAD, EYES, EARS, NOSE, AND THROAT
  3069. Neck
  3070. Procedure and Technique
  3071. Normal and Abnormal Findings
  3072. Eyes and Vision
  3073. Normal and Abnormal Findings
  3074. Fig. 22-6 Sebaceous hyperplasia.
  3075. Fig. 22-7 Arcus senilis (a gray-white circle around the limbus).
  3076. Fig. 22-8 Ectropion.
  3077. Fig. 22-9 Entropion.
  3078. Ears and Hearing
  3079. Normal and Abnormal Findings
  3080. Mouth
  3081. Normal and Abnormal Findings
  3082. BOX 22-5 HEARING LOSS STATISTICS IN MIDDLE-AGE ADULTS, OLDER ADULTS, AND OLD-OLD ADULTS
  3083. EXAMINATION OF THE RESPIRATORY SYSTEM
  3084. Normal and Abnormal Findings
  3085. EXAMINATION OF THE CARDIOVASCULAR SYSTEM
  3086. Normal and Abnormal Findings
  3087. EXAMINATION OF THE ABDOMEN AND GASTROINTESTINAL SYSTEM
  3088. Normal and Abnormal Findings
  3089. EXAMINATION OF THE MUSCULOSKELETAL SYSTEM
  3090. Normal and Abnormal Findings
  3091. EXAMINATION OF THE NEUROLOGIC SYSTEM
  3092. Normal and Abnormal Findings
  3093. EXAMINATION OF THE BREASTS
  3094. BOX 22-6 FUNCTIONAL ASSESSMENT: TINETTI BALANCE AND GAIT ASSESSMENT TOOL
  3095. Normal and Abnormal Findings
  3096. EXAMINATION OF THE REPRODUCTIVE SYSTEM AND PERINEUM
  3097. Female Exam
  3098. Procedure and Techniques
  3099. Normal and Abnormal Findings
  3100. Male Exam
  3101. Normal and Abnormal Findings
  3102. Perianal Examination
  3103. Procedure and Techniques
  3104. Normal and Abnormal Findings
  3105. COMMON PROBLEMS & CONDITIONS
  3106. MACULAR DEGENERATION
  3107. Fig. 22-10 Amsler grid used to evaluate central vision as occurs in macular degeneration; here showing visual changes caused by fluid leakage under the retina.
  3108. ANEMIA
  3109. URINARY INCONTINENCE
  3110. CLINICAL APPLICATION & CLINICAL REASONING
  3111. REVIEW QUESTIONS
  3112. SAMPLE DOCUMENTATION
  3113. SUBJECTIVE DATA
  3114. OBJECTIVE DATA
  3115. CASE STUDY
  3116. Interview Data
  3117. Examination Data
  3118. CLINICAL Reasoning
  3119. INTERACTIVE ACTIVITIES
  3120. CHAPTER 23 Conducting a Head-to-Toe Assessment
  3121. PERFORMING A HEALTH ASSESSMENT
  3122. BOX 23-1 EQUIPMENT FOR HEALTH EXAMINATION IN SUGGESTED ORDER OF USE
  3123. GUIDELINES FOR ADULT HEAD-TO-TOE EXAMINATION
  3124. Procedures
  3125. Assessment Data Collected in the General Survey During the History
  3126. Assess Vital Signs and Other Baseline Measurements
  3127. Examine Hands
  3128. Examine Head and Face
  3129. Examine Eyes
  3130. Examine Ears
  3131. Examine Nose, Mouth, and Oropharynx
  3132. Examine Neck
  3133. Examine Upper Extremities
  3134. Assess Posterior Chest
  3135. Assess Anterior Chest
  3136. Female Breasts
  3137. Male Breasts
  3138. All Clients
  3139. Assess Anterior Chest in Recumbent Position
  3140. Female Breasts
  3141. Assess Abdomen
  3142. Assess Lower Extremities
  3143. Assess Remaining Neurologic System
  3144. Assess Genitalia, Pelvic Region, and Rectum
  3145. Males
  3146. Females
  3147. INTERACTIVE ACTIVITIES
  3148. CHAPTER 24 Documenting the Health Assessment
  3149. HEALTH HISTORY
  3150. Biographic Data
  3151. Reason for Seeking Care
  3152. History of Present Illness
  3153. Present Health Status
  3154. Past Health History
  3155. Family History
  3156. Personal and Psychosocial History
  3157. Personal Status
  3158. Family and Social Relationships
  3159. Diet/Nutrition
  3160. Functional Ability
  3161. Mental Health
  3162. Personal Habits
  3163. Health Promotion Activities
  3164. Environment
  3165. Review of Systems
  3166. General Symptoms
  3167. Integumentary System
  3168. HEENT
  3169. Breasts
  3170. Cardiovascular System
  3171. Respiratory System
  3172. Gastrointestinal System
  3173. Urinary System
  3174. Musculoskeletal System
  3175. Neurologic System
  3176. Reproductive System
  3177. PHYSICAL EXAMINATION
  3178. General Survey
  3179. Skin, Hair, Nails
  3180. Head
  3181. Eyes
  3182. Ears
  3183. Nose and Sinuses
  3184. Mouth and Throat
  3185. Neck
  3186. Chest and Lungs
  3187. Breasts
  3188. Heart
  3189. Peripheral Vascular
  3190. Abdomen
  3191. Musculoskeletal
  3192. Neurologic
  3193. Gynecologic
  3194. PROBLEM LIST
  3195. NURSING DIAGNOSES
  3196. INTERACTIVE ACTIVITIES
  3197. Back Matter
  3198. APPENDIX A North American Nursing Diagnosis Association (NANDA) Nursing Diagnoses
  3199. APPENDIX B Health History Using Functional Health Patterns
  3200. APPENDIX C Conversion Tables
  3201. TABLE C-1 Length
  3202. TABLE C-2 Weight
  3203. TABLE C-3 Temperature: Fahrenheit and Celsius Equivalents in the Body Temperature Range
  3204. APPENDIX D Abbreviations
  3205. Symbols:
  3206. APPENDIX E Answer Key
  3207. Chapter 1
  3208. REVIEW QUESTIONS
  3209. Case Study 1
  3210. Case Study 2
  3211. Chapter 2
  3212. REVIEW QUESTIONS
  3213. Chapter 3
  3214. REVIEW QUESTIONS
  3215. Case Study
  3216. Chapter 4
  3217. REVIEW QUESTIONS
  3218. Chapter 5
  3219. REVIEW QUESTIONS
  3220. Chapter 6
  3221. REVIEW QUESTIONS
  3222. Case Study
  3223. Chapter 7
  3224. REVIEW QUESTIONS
  3225. Case Study
  3226. Chapter 8
  3227. REVIEW QUESTIONS
  3228. Case Study
  3229. Chapter 9
  3230. REVIEW QUESTIONS
  3231. Case Study
  3232. Chapter 10
  3233. REVIEW QUESTIONS
  3234. Case Study
  3235. Chapter 11
  3236. REVIEW QUESTIONS
  3237. Case Study
  3238. Chapter 12
  3239. REVIEW QUESTIONS
  3240. Case Study
  3241. Chapter 13
  3242. REVIEW QUESTIONS
  3243. Case Study
  3244. Chapter 14
  3245. REVIEW QUESTIONS
  3246. Case Study
  3247. Chapter 15
  3248. REVIEW QUESTIONS
  3249. Case Study
  3250. Chapter 16
  3251. REVIEW QUESTIONS
  3252. Case Study
  3253. Chapter 17
  3254. REVIEW QUESTIONS
  3255. Case Study
  3256. Chapter 18
  3257. REVIEW QUESTIONS
  3258. Case Study
  3259. Chapter 19
  3260. REVIEW QUESTIONS
  3261. Case Study
  3262. Chapter 20
  3263. REVIEW QUESTIONS
  3264. Case Study
  3265. Chapter 21
  3266. REVIEW QUESTIONS
  3267. Case Study
  3268. Chapter 22
  3269. REVIEW QUESTIONS
  3270. Case Study
  3271. Glossary
  3272. A
  3273. B
  3274. C
  3275. D
  3276. E
  3277. F
  3278. G
  3279. H
  3280. I
  3281. J
  3282. K
  3283. L
  3284. M
  3285. N
  3286. O
  3287. P
  3288. R
  3289. S
  3290. T
  3291. U
  3292. V
  3293. W
  3294. X
  3295. Illustration Credits
  3296. References
  3297. Chapter 1
  3298. Chapter 2
  3299. Chapter 3
  3300. Chapter 4
  3301. Chapter 5
  3302. Chapter 6
  3303. Chapter 7
  3304. Chapter 8
  3305. Chapter 9
  3306. Chapter 10
  3307. Chapter 11
  3308. Chapter 12
  3309. Chapter 13
  3310. Chapter 14
  3311. Chapter 15
  3312. Chapter 16
  3313. Chapter 17
  3314. Chapter 18
  3315. Chapter 19
  3316. Chapter 20
  3317. Chapter 21
  3318. Chapter 22

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