Nursing Health Assessment: a best practice approach

1559 Pages·2019·124.325 MB·English

by  Jensen, Sharon

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Third edition
Copyright © 2019 Wolters Kluwer.
Copyright © 2015 Wolters Kluwer Health. Copyright 2011© Wolters Kluwer Health | Lippincott Williams &
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Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Jensen, Sharon, 1955- author.
Title: Nursing health assessment : a best practice approach/Sharon Jensen, MN, RN, Assistant Professor,
Chaminade University, Honolulu, Hawaii.
Description: Third edition. | Philadelphia : Wolters Kluwer Health, [2019] |
Includes index.
Identifiers: LCCN 2018032854 | eISBN 9781496358431 | VST 9781496358417
Subjects: LCSH: Nursing assessment—Methodology—Case studies. | Medical
history taking—Methodology—Case studies. | Periodic health
examinations—Methodology—Case studies.
Classification: LCC RT48 .C355 2019 | DDC 616.07/5--dc23
LC record available at https://lccn.loc.gov/2018032854
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any
warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of
each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions,
medication history, laboratory data and other factors unique to the patient. The publisher does not provide
medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the
publisher, are solely responsible for the use of this work including all medical judgments and for any resulting
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diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment
options should be made and healthcare professionals should consult a variety of sources. When prescribing
medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s
package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects
and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered
is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable
law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter
of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.
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INSPIRATION
“The most important practical advice that can be given to nurses is to teach them what to observe.”
(Florence Nightingale, Notes on nursing: What it is, and what it is not, 1860)
We truly hope that this text lays out real-life situations so that nurses understand the importance of
observation, with subjective and objective assessment as the process on which all nursing is based.
DEDICATION
To the students, whose effort and ability allow me the privilege of serving as a guide and mentor
during their education.
To my parents, Jack and Gwen Erickson, who instilled in me my strong work ethic and
understanding of community.
Thank you to my siblings, Mike Erickson, Kathy Keithly, Alan Erickson, and their families, who have
supported me during this process.
To honor my children, Anna and Chris Megrey, and Eric Jensen, for their care.
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CONTRIBUTORS
CONTRIBUTORS TO THE THIRD EDITION*
Kandice S. Bowman, RN, MSN, PNP, CPNP
Instructor
Division of Pediatric Otolaryngology
Oregon Health and Science University
Portland, Oregon
Chapter 14: Ear Assessment for Advanced and Specialty Practice
Yvonne D’Arcy, MS, APN-C, CNS, FAANP
Pain Management and Palliative Care Nurse Practitioner
Ponte Vedra Beach, Florida
Chapter 6: Pain Assessment
Monica Deshpande, MSN, FNP
Instructor
Division of Pediatric Otolaryngology
Oregon Health and Science University
Portland, Oregon
Chapter 14: Ear Assessment for Advanced and Specialty Practice
Jessica E. Gay, MSN, RNC-MNN
Clinical Assistant Professor
University of Kansas School of Nursing
Kansas City, Kansas
Chapter 25: Pregnant Woman
Nan M. Gaylord, PhD, RN, CPNP-PC
Professor
College of Nursing
University of Tennessee
Knoxville, Tennessee
Chapter 27: Children and Adolescents
Jane Leach, PhD, RN
Associate Professor
Wilson School of Nursing
Midwestern State University
Wichita Falls, Texas
Chapter 26: Newborns and Infants
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Kari Magill, BSN, RN, CNOR
Retinal Service Lead, Operating Rooms
Kellogg Eye Center
Michigan Medicine
Ann Arbor, Michigan
Chapter 13: Eye Assessment for Advanced and Specialty Practice
Amy Metteer-Storer, MSN, RN
Assistant Professor
Department of Nursing
Cedar Crest College
Allentown, Pennsylvania
Chapter 2: The Health History and Interview
Chapter 18: Peripheral Vascular and Lymphatic Assessment
Jessica Nishikawa, DNP, NP-c
Nurse Practitioner
Straub Medical Center
Honolulu, Hawaii
Chapter 28: Older Adults
Barbara L. Parker, MS, FNP, CNM
Clinical Associate Professor
University of Kansas Medical Center
Kansas City, Kansas
Chapter 25: Pregnant Woman
Demetrius J. Porche, DNS, PhD, ANEF, FACHE, FAANP, FAAN
Dean and Professor
School of Nursing
Louisiana State University Health–New Orleans
New Orleans, Louisiana
Chapter 23: Male Genitalia and Rectal Assessment
Diane Marie Schadewald, DNP, MSN, WHNP, FNP
Clinical Associate Professor
College of Nursing
University of Wisconsin–Milwaukee
Milwaukee, Wisconsin
Chapter 24: Female Genitalia and Rectal Assessment
Debra Lee Servello, DNP, APRN, AGACNP-BC
Associate Professor and Chair
School of Nursing
Rhode Island College
Providence, Rhode Island
Mindy Stites, MSN, APRN, CCNS, ACNS-BC, CCRN
Chapter 5: Vital Signs and General Survey
Chapter 17: Heart and Neck Vessels Assessment
Chapter 20: Abdominal Assessment
Chapter 30: Head-to-Toe Assessment of the Adult
Franz H. Vergara, PhD, DNP, RN, ONC, CCM
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Nurse Educator
Department of Central Nursing Administration
The Johns Hopkins Hospital
Baltimore, Maryland
Chapter 21: Musculoskeletal Assessment
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Mary Viergutz, RN, MSN, JD
Former Director
Healthcare Risk Management
Milwaukee, Wisconsin
Chapter 10: Cultural Assessment
Chapter 29: Assessment of the Hospitalized Adult
Margaret A. Wallace, RN, FNP, CORLN
Nurse Practitioner
Department of Otolaryngology
Washington University School of Medicine
St. Louis, Missouri
Chapter 15: Nose, Sinuses, Mouth, and Throat
Yvette D. Wilson, MSN, APRN-CNS, CCRN
Clinical Nurse Specialist/Doctoral Candidate
Burn Intensive Care, Surgical Intensive Care and Burn Wound Unit
Johns Hopkins Bayview Medical Center
Baltimore, Maryland
Chapter 11: Skin, Hair, and Nails Assessment
CONTRIBUTORS TO THE SECOND EDITION
Laura A. Blue, RN, MSN-Ed
Instructor
University of Hawai’i at Manoa, School of Nursing & Dental Hygiene
Honolulu, Hawaii
Chapter 3: Techniques of Assessment and Safety
Margie Bridges, MN, ARNP-BC, RNC-OB
Perinatal Clinical Nurse Specialist
University of Washington
Seattle, Washington
Chapter 26: Newborns and Infants
Ruth Chaplen, RN, DNP, ACNS-BC, AOCN
Associate Professor of Nursing
Rochester College, School of Nursing
Rochester Hills, Michigan
Chapter 16: Thorax and Lung Assessment
Yvonne D’Arcy, MS, APN-C, CNS, FAANP
Pain Management and Palliative Care
Nurse Practitioner
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