Mosby’s Expert Physical Exam Handbook: Rapid Inpatient and Outpatient Assessments

393 Pages·2008·8.349 MB·English

by  Frances Donovan Monahan, Mosby

QUICK-REFERENCE GUIDE TO IMPORTANT ASSESSMENT
INFORMATION, CONT.
CULTURAL
CONSIDERATIONS ANATOMY REVIEWS
Chapter 1: 1, 2 Structures of the Skin, Hair, and
Chapter 3: 38, 57, 59, 63 Nails, 56
Chapter 4: 80 Structures of the Head and Neck, 67
Chapter 5: 106, 125 Parts of the Brain, 71
Chapter 6: 137 Intraocular Structures, 101
Chapter 8: 233, 234 Structures of the Ear, 121
Structures of the Thorax, 131
Structures of the Upper Extermities,
LIFESPAN
196
CONSIDERATIONS
Structures of the Abdominal Region,
Chapter 2: 35
226
Chapter 3: 45, 48, 50, 58, 60, 63
Structures of the Lower Extremities,
Chapter 4: 75, 88
275
Chapter 5: 104, 105, 106, 124, 128
Chapter 6: 135, 136, 143, 157, 158
Chapter 7: 203, 204
Chapter 8: 241, 243, 261, 267 DISORDER CLOSE-UPS
Chapter 11: 316 Hypertension, 43
Hyperthyroidism, 85
Meningitis, 97
Diabetes Mellitus, 111
ACTION STATS
Breast Cancer, 145
Responding to Anaphylaxis, 79
Pneumonia, 151
Responding to Acute Angle-Closure
Heart Failure, 169
Glaucoma, 115
Myocardial Infarction, 172
Responding to Airway Obstruction,
Angina Pectoris, 176
192
Bronchitis, 184
Responding to Intravenous Fluid
Emphysema, 189
Extravasation, 222
Asthma, 193
Responding to Gastrointestinal
Rheumatoid Arthritis, 216
Bleeding, 247
Cerebrovascular Accident, 220
Responding to Acute Intestinal
Peptic Ulcer Disease, 253
Obstruction, 257
Cholecystitis, 254
Responding to Acute Arterial
Acquired Immunodeficiency
Occlusion, 301
Syndrome, 262
Chronic Venous Insufficiency, 279
Gout, 295
Thrombophlebitis, 296
.
:
To access your Student Resources, visit the web address below:
http://evolve.elsevier.com/Mosby/expertexam/
Evolve Student Learning Resources for Mosby’s Expert
Physical Exam Handbook: Rapid Inpatient and Outpatient
Assessments, 3rd edition, offer the following features:
(cid:115)(cid:0) PDA-Downloadable Expert Exam Checklists
Great for use in practice, exam techniques are outlined for
each body region and are printable or downloadable to
your PDA.
(cid:115)(cid:0) Chief Complaints: Focused Assessment Checklists
Quick-access, bulleted lists provide focused guidelines for
exploring chief complaints.
(cid:115)(cid:0) Assessment Animations
Detailed animations show structure and function of various
body regions—helpful for rapid physical e xamination and
assessment.
(cid:115)(cid:0) Heart and Lung Sounds
Become familiar with 27 cardiac and respiratory audio
clips provided for review or further study.
http://evolve.elsevier.com/Mosby/expertexam/
Mosby’s

E X P E R T
PHYSICAL
EXAM HANDBOOK
Rapid Inpatient and
Outpatient Assessments
3
Third Edition
Frances D. Monahan, PhD, RN, ANEF
Professor of Nursing
SUNY Rockland Community College
Suffern, New York
and
Consulting Faculty
Excelsior College
Albany, New York
11830 Westline Industrial Drive
St. Louis, Missouri 63146
Mosby’s Expert Physical Exam Handbook: ISBN: 978-0-323-05791-2
Rapid Inpatient and Outpatient Assessments
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted
in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission
in writing from the publisher. Permissions may be sought directly from Elsevier’s
Rights Department: phone: [phone] (US) or ([phone] (UK);
fax: [phone]; e-mail: [email protected]. You may also
complete your request on-line via the Elsevier website at http://www.elsevier.
com/permissions.
Notice
Knowledge and best practice in this field are constantly changing. As new
research and experience broaden our knowledge, changes in practice, t reatment
and drug therapy may become necessary or appropriate. Readers are advised
to check the most current information provided (i) on procedures featured
or (ii) by the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of the practitioner, relying on their
own experience and knowledge of the patient, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all
appropriate safety p recautions. To the fullest extent of the law, neither the
Publisher nor the Author assumes any liability for any injury and/or damage
to persons or property a rising out of or related to any use of the material
c ontained in this book.
The Publisher
Previous editions copyrighted 2005, 1997.
Library of Congress Cataloging in Publication Data
Monahan, Frances Donovan.
Mosby’s expert physical exam handbook: rapid inpatient and outpatient assessments/Frances D. Monahan.—
3rd ed.
p.; cm.
Rev ed. of: Mosby’s expert 10-minute physical examinations.
Includes index.
ISBN 978-0-323-05791-2 (pbk. : alk. paper) 1. Physical diagnosis—Handbooks, manuals, etc. 2. Nursing
diagnosis—Handbooks, manuals, etc. I. Mosby, Inc. II. Mosby’s expert 10-minute physical examinations.
III. Title.
[DNLM: 1. Physical Examination—Handbooks. 2. Nursing Assessment—Handbooks. WB 39 M734m 2009]
RC76.E97 2009
616.07’54—dc22 2008030802
Acquisitions Editor: Robin Carter
Developmental Editor: Deanna Davis
Publishing Services Manager: Deborah L. Vogel
Project Manager: Ann E. Rogers
Book Designer: Kimberly Denando
Printed in United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
This page intentionally left blank
REVIEWERS
Jody F. Agins, MSN, RNP, BC-FNP/GNP
Executive Director
Seminars for Healthcare Education, Inc
and
Family & Geriatric Nurse Practitioner
Evercare
Tucson, Arizona
Erin Bagshaw, RN, MSN, C-ANP
Owner/Practice Director
Northwest Nurse Practitioner Associates
Washington, DC
Tim J. Bristol, RN, PhD
Director of Nursing
Crown College
St. Bonifacius, Minnesota
Mary Ann Siciliano McLaughlin, MSN, RN
Nurse Educator
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
PREFACE
When you open this latest edition of Mosby’s Expert Physical Exam Handbook:
Rapid Inpatient and Outpatient Assessments, you’ll see a physical examination
book like no other. Packed with time-saving tips, this portable handbook
will help you to organize your physical examination so that you can move
through the examination quickly—and without missing critical findings. The
book’s organization allows you to rapidly find what you need, easily accessed
in either a hospital or clinical setting. Physical exam content is organized
by body region—for example, chest and back—rather than by body system,
an approach that provides an excellent method for conducting a thorough
examination. What’s more, the book will help you realize when to shift gears
and focus the examination on a critical sign or chief complaint.
HOW TO USE THIS BOOK
There are two ways to use this handbook and approach the physical examina-
tion. First, working methodically with a patient who is no immediate distress,
you can cover all areas of the body, picking up any abnormal findings. You can
pace yourself knowing you’ll need to spend extra time examining the areas
that reflect the patient’s recovery from a specific condition. You’ll find that
Chapters 1 through 9 provide you with detailed knowledge of how to examine
the major body regions. Chapter 10 then weaves together all aspects of a
head-to-toe examination, and Chapter 11 highlights key information to docu-
ment during the initial assessment and presents guidelines for documenting
findings for more than 20 selected conditions.
If you have quickly identified a chief complaint from your patient, you’ll
want to begin a focused, rapid assessment that addresses the most pressing
problem. That’s why throughout this book you’ve been given techniques
for isolating your patient’s chief complaint (such as chest pain, dyspnea, and
nausea), performing a focused assessment, and pinpointing its probable cause.
SPECIAL FEATURES
Several special features, signaled by quick-reference symbols within the text,
help speed you to important assessment information.
Disorder Close-Ups focus on the most common disorders encountered by
nurses today, listing their characteristic findings as well as complications.
Disorders include angina pectoris, asthma, diabetes mellitus, hypertension,
myocardial infarction, and many others.
Action STATs tell you exactly what to do if, during your examination, you
discover that your patient is in a potentially life-threatening situation.
Anatomy Reviews present detailed illustrations of major body parts and
organs.
Normal Findings summarize characteristic findings and acceptable
variations based on age, sex, and condition of the patient.
Interpreting Abnormal Findings help you analyze abnormal findings and
determine their causes.
viii Preface
Exam Tips feature time-saving pointers that make the examination faster
and easier—and more accurate.
Lifespan Considerations help you individualize exams for patients of
various ages and for those who are pregnant or lactating.
Cultural Considerations provide information on variations in findings and
transcultural considerations.
The step-by-step format is easy to follow and covers all aspects of physical
examination: inspection, palpation, percussion, and auscultation.
Chief complaints with interview questions and guidelines are provided for
focused assessments.
How-to tips on individualizing the physical exam for patients with s erious
illnesses, pain, or handicaps provide specific approaches for special situations.
NEW TO THIS EDITION
To keep you on the right track, we’ve packed even more information and
features into the third edition of Mosby’s Expert Physical Exam Handbook.
Updated content throughout provides you with the latest information on
assessment techniques, normal and abnormal findings, and the assessment of
patients with specific diseases and disorders.
Expert Exam Checklists throughout the book review the most important
steps to cover when examining patients.
Spanish-English Assessment Terms provide you with key assessment questions
and findings.
The dual-function table of contents now provides body systems cross-refer-
encing in addition to a body regions organization.
The new companion Evolve website offers easily accessible resources such as
heart and lung audio clips, highly detailed and clear exam animations, and
printable or PDA-downloadable versions of the Expert Exam Checklists. The
website can be accessed, free with your purchase of this book, at http://evolve.
elsevier.com/Mosby/expertexam/.
These added features have been selected, prepared, and reviewed with
your time constraints and patient-care needs in mind. The new and improved
Mosby’s Expert Physical Exam Handbook is a reference tool that no nurse should
be without.
CONTENTS
1 HEALTH HISTORY AND PHYSICAL EXAMINATION
REVIEW, 1
2 EXAMINING PATIENTS WITH SPECIAL NEEDS, 21
3 FIRST ENCOUNTER: A GENERAL SURVEY OF THE
PATIENT, 37
4 EXAMINING THE HEAD AND NECK, 66
Includes Neurologic System (Cranial Nerves)
5 EXAMINING THE EYES AND EARS, 100
6 EXAMINING THE CHEST AND BACK, 131
Includes Cardiac, Respiratory, Musculoskeletal, Upper Gastrointestinal,
and Renal Systems
7 EXAMINING THE UPPER EXTREMITIES, 196
Includes Musculoskeletal, Neurologic, Vascular, Integumentary, and
Lymphatic Systems
8 EXAMINING THE ABDOMINAL REGION, 225
Includes Lower Gastrointestinal and Reproductive Systems
9 EXAMINING THE LOWER EXTREMITIES, 274
Includes Musculoskeletal, Vascular, and Integumentary Systems
10 PUTTING IT ALL TOGETHER, 305
11 DOCUMENTING YOUR FINDINGS ACCURATELY, 314