Pocket Companion for Physical Examination and Health Assessment, 7e

307 Pages·2016·22.019 MB·English

by  Carolyn Jarvis PhD APN CNP

C O N T E N T S
 1  The Interview and Health History, 1
 2  Mental Status, 9
 3  Assessment Techniques and the Clinical Setting, 15
 4  General Survey, Measurement, Vital Signs, and Pain 
Assessment, 21
 5  Skin, Hair, and Nails, 33
 6  Head, Face, and Neck, Including Regional Lymphatics, 53
 7  Eyes, 61
 8  Ears, 79
 9  Nose, Mouth, and Throat, 89
10  Breasts and Axillae, Including Regional Lymphatics, 103
11  Thorax and Lungs, 115
12  Heart and Neck Vessels, 131
13  Peripheral Vascular System and Lymphatics, 149
14  Abdomen, 161
15  Musculoskeletal System, 177
16  Neurologic System, 199
17  Male Genitourinary System, 225
18  Female Genitourinary System, 237
19  Anus, Rectum, and Prostate, 253
20  Integration of the Complete Physical Examination, 261
21  Bedside Assessment and Electronic Health Recording, 273
ILLUSTRATION CREDITS, 283
BIBLIOGRAPHY, 285
POCKET COMPANION FOR
Physical
Examination
Health
&
Assessment
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CAROLYN JARVIS,
PhD, APN, CNP
Professor of Nursing
School of Nursing
Illinois Wesleyan University
Bloomington, Illinois
and
Family Nurse Practitioner
Bloomington, Illinois
POCKET COMPANION FOR
Physical
Examination
Health
&
Assessment
7
Seventh Edition
Original Illustrations by Pat Thomas, CMI, FAMI
East Troy, Wisconsin
Assessment Photographs by Kevin Strandberg
Professor of Art
Illinois Wesleyan University
Bloomington, Illinois
3251 Riverport Lane
St. Louis, Missouri 63043
POCKET COMPANION FOR PHYSICAL EXAMINATION AND
HEALTH ASSESSMENT, SEVENTH EDITION ISBN: 978-0-323-26537-9
Copyright © 2016 by Elsevier, Inc. All rights reserved.
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reserved.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices, or
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responsibility of practitioners, relying on their own experience and knowledge of their
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patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
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products, instructions, or ideas contained in the material herein.
International Standard Book Number: 978-0-323-26537-9
Executive Content Strategist: Lee Henderson
Content Development Manager: Laurie Gower
Senior Content Development Specialist: Heather Bays
Publishing Services Manager: Deborah L. Vogel
Senior Project Manager: Jodi M. Willard
Design Direction: Julia Dummitt
Printed in the United States of America
Last digit is the print number:
9 8 7 6 5 4 3 2 1
P R E FAC E
The seventh edition of Pocket Com- room in the Pocket Companion for
panion for Physical Examination and theories, principles, or detailed expla-
Health Assessment is designed for two nations, students using the Pocket
groups—those who need a practical Companion as a beginning text must
clinical reference and those acquiring have a thorough didactic presentation
beginning assessment skills. of assessment methods as well as
First, the Pocket Companion is tutored practice.
intended as an adjunct to Jarvis’ The Pocket Companion, 7th
Physical Examination and Health edition, is revised and updated to
Assessment, 7th edition. The Pocket match the revision of the parent
Companion is a memory prompt text, Physical Examination and Health
for those who have studied physical Assessment, 7th edition, including
assessment and wish to have a many new examination photos,
reminder when in the clinic. The abnormal findings photos, and full-
Pocket Companion has all the essen- color art. The following tables of
tials—health history points, exam Abnormal Findings are also new to
steps for each body system, normal the 7th edition:
versus abnormal findings, heart • Anxiety Disorders
sounds, lung sounds, neurologic • Common Sites of Referred Abdom-
checks. The Pocket Companion is inal Pain
useful when you forget a step in the • Abnormalities Affecting Multiple
exam sequence, when you wish to be Joints
sure your assessment is complete, • Abnormal Postures
when you need to review the findings • Abnormalities of the Anal Region
that are normal versus abnormal, or A new section on the Electronic
when you are faced with an unfamil- Health Record has been integrated
iar technique or a new clinical area. Its into Chapter 21, Bedside Assessment
portable size and binding make it of the Hospitalized Adult. This sec-
perfect for a lab coat pocket or com- tion outlines charting, and narrative
munity health bag. recording provides examples of how
Second, the Pocket Companion, to document assessment findings.
7th edition, is an independent primer For those times when readers need
of basic assessment skills. It is well detailed coverage of a particular tech-
suited to programs offering a begin- nique or finding, it is easily found
ning assessment course covering well through numerous cross-references
people of all ages. The Pocket Com- to pages in Physical Examination and
panion has the complete steps to Health Assessment, 7th edition.
perform a health history and physical As you thumb through the Pocket
examination on a well person. It Companion, note these features:
includes pertinent developmental • Health history and exam steps are
content for pediatric, pregnant, and concise yet complete.
aging adult patients. Although the • Method of examination is clear,
description of each exam step is stated orderly, and easy to follow.
concisely, there is enough informa- • Abnormal findings are described
tion given to study and learn exam briefly in a column adjacent to the
techniques. However, since there is no normal range of findings.
v
vi PREFACE
• Sample charting is now included • Selected artwork from Physical
in all applicable chapters, illus- Examination and Health Assess-
trating the documentation of ment, 7th edition, illustrates the
findings. pertinent anatomy.
• Tables are presented at the end of
chapters to fully illustrate impor-
ACKNOWLEDGMENTS
tant information.
• Selected Cultural Competence I am grateful to those on the team at
information highlights this Elsevier who worked on the Pocket
important aspect of a health Companion. My thanks extend to
assessment. Lee Henderson, Executive Content
• Developmental Competence con- Strategist; Laurie Gower, Content
tent includes age-specific infor- Development Manager; Heather Bays,
mation for pediatric, pregnant, Senior Content Development Special-
and aging adult groups. ist; and Jodi Willard, Senior Project
• Summary checklists for each Manager, for their patient and atten-
chapter form a cue card of exam tive monitoring of every step in the
steps to remember. production of the Pocket Companion.
• Integration of the complete physi- Carolyn Jarvis
cal examination is presented in
Chapter 20.
1
CHAPTER
The Interview and
Health History
The health history is important in There are three phases to each inter-
beginning to identify the person’s view: an introduction, a working
health strengths and problems and as phase, and a termination (or closing).
a bridge to the next step in data col-
lection, the physical examination.
INTRODUCING THE INTERVIEW
The health history collects subjec-
tive data, what the person says about Address the patient using his or her
himself or herself. This is the first and surname. Introduce yourself and state
best chance that a person has to tell your role in the agency (if you are a
you what he or she perceives his or her student, say so). If you are gathering
health state to be. a complete history, give the reason for
this interview.
EXTERNAL FACTORS
THE WORKING PHASE
Ensure Privacy. Aim for geo-
graphic privacy—a private room. If The working phase is the data-
geographic privacy is not available, gathering phase. It involves your
the “psychological privacy” afforded questions to the patient and your
by curtained partitions may suffice as responses to what he or she has said.
long as the person feels sure that no There are two types of questions:
one can overhear the conversation or open-ended and closed (or direct).
interrupt. Each type has a different place and
Refuse Interruptions. You need function in the interview.
this time to concentrate and establish
rapport.
Open-Ended Questions
An open-ended question asks for nar-
Physical Environment
rative information. It states the topic
• Set the room temperature at a to be discussed, but only in general
comfortable level. terms. Use it to begin the interview,
• Provide sufficient lighting. to introduce a new section of ques-
• Reduce noise. tions, and whenever the person intro-
• Remove distracting objects. duces a new topic. Examples are,
• Maintain the distance between “Tell me why you have come here
you and the patient at 4 to 5 feet today” and “What brings you to the
(twice an arm’s length). hospital?”
• Arrange equal-status seating. Both
of you should be comfortably
Closed or Direct Questions
seated at eye level. Avoid sitting
behind a desk or bedside table Closed or direct questions ask for spe-
placed so it looks like a barrier. cific information. They elicit a one- or
• Avoid standing. two-word answer, a “yes” or “no,” or a
1
2 CHAPTER 1 The Interview and Health History
forced choice. Use direct questions or statement; you now focus the per-
after the person’s narrative to fill in son’s attention on it. This can focus
any details that he or she may have on a discrepancy: “You say it doesn’t
omitted. Also use direct questions hurt, but when I touch you here, you
when you need many specific facts grimace.” It can also focus on the
such as when asking about past health patient’s affect: “You look sad” or
problems or during the review of “You sound angry.”
systems. Interpretation. An interpretive
response is based not on direct obser-
vation (as is confrontation) but on
Responses
your inference or conclusion. Inter-
As the person talks, your role is to pretation links events, makes associa-
encourage free expression but not let tions, or implies cause: “It seems that
him or her wander. The following every time you feel the stomach pain,
responses help you gather data you have had some kind of stress in
without cutting off the person. your life.”
Facilitation. Your facilitative re- Explanation. With these state-
sponse encourages the patient to say ments you share factual and objective
more, to continue with the story, e.g., information. This may be for orienta-
“mm-hmm,” “go on,” “continue,” “uh- tion to the agency setting: “Your
huh,” or simply by nodding. dinner comes at 5:30 PM”; or it may
Silence. Your silence communi- be to explain cause: “The reason you
cates that the patient has time to think cannot eat or drink before your blood
and organize what he or she wishes to test is that the food will change the
say without interruption from you. test results.”
Silence also gives you a chance to Summary. This is a final review of
observe the person unobtrusively and what you understand the patient has
to note nonverbal cues. said. It condenses the facts and pre-
Reflection. A reflective response sents a survey of how you perceive the
echoes the patient’s own words. patient’s health problem or need. It
Reflection involves repeating part of also allows the patient to correct
what the person has just said. It misperceptions.
focuses further attention on a specific
phrase and helps the person continue
CLOSING THE INTERVIEW
in his or her own way.
Empathy. An empathic response The meeting should end gracefully. To
recognizes a feeling and puts it into ease into the closing, ask the patient,
words. It names the feeling and allows “Is there anything else you would like
its expression. When you use an to mention?” Give the person a final
empathic response, the patient feels opportunity for self-expression. Then
accepted and can deal with the feeling give a summary or recapitulation of
openly. Empathic responses include what you have learned during the
saying, “This must be very hard for interview. This is a final statement of
you” or just placing your hand on the what you and the patient agree his or
person’s arm. her health state to be.
Clarification. Use the clarifica-
tion response when the patient’s word
TEN TRAPS OF INTERVIEWING
choice is ambiguous or confusing,
e.g., “Tell me what you mean by ‘tired Nonproductive, defeating verbal mes-
blood.’” sages restrict the patient’s response.
Confrontation. In this case you They are obstacles to obtaining com-
have observed a certain action, feeling, plete data and establishing rapport.