Table Of Content

S E I D E L ’ S G U I D E T O P H YS I C A L E X A M I N AT I O N A N I N T E R P R O F E S S I O N A L A P P R O A C H 9 TH EDITION JANE W. BALL, DrPH, RN, CPNP BARRY S. SOLOMON, MD, MPH Trauma Systems Consultant Associate Professor of Pediatrics American College of Surgeons Assistant Dean for Student Affairs Gaithersburg, Maryland Division of General Pediatrics and Adolescent Medicine JOYCE E. DAINS, DrPH, JD, RN, The Johns Hopkins University FNP-BC, FNAP, FAANP School of Medicine Professor and Director Advanced Practice Baltimore, Maryland Nursing ROSALYN W. STEWART, MD, MS, MBA Department of Nursing The University of Texas MD Anderson Cancer Associate Professor of Pediatrics and Medicine Center Departments of Pediatrics and Internal Houston, Texas Medicine The Johns Hopkins University JOHN A. FLYNN, MD, MBA, MEd School of Medicine Clinical Director and Professor of Medicine Baltimore, Maryland Division of General Internal Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland 3251 Riverport Lane St. Louis, Missouri 63043 SEIDEL’S GUIDE TO PHYSICAL EXAMINATION: ISBN: 978-0-323-48195-3 AN INTERPROFESSIONAL APPROACH Copyright © 2019 by 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. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/ permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2015, 2011, 2006, 2003, 1999, 1995, 1991, and 1987. Library of Congress Cataloging-in-Publication Data Names: Ball, Jane (Jane W.), author. | Dains, Joyce E., author. | Flynn, John A. (Physician), author. | Solomon, Barry S., author. | Stewart, Rosalyn W., author. Title: Seidel’s guide to physical examination : an interprofessional approach/ Jane W. Ball, Joyce E. Dains, John A. Flynn, Barry S. Solomon, Rosalyn W. Stewart. Other titles: Guide to physical examination Description: Ninth edition. | St. Louis, Missouri : Mosby, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017041250 | ISBN 9780323481953 (hardcover : alk. paper) Subjects: | MESH: Physical Examination—methods | Medical History Taking–methods Classification: LCC RC76 | NLM WB 205 | DDC 616.07/54—dc23 LC record available at https://lccn.loc.gov/2017041250 Executive Content Strategist: Lee Henderson Director, Content Development: Laurie Gower Content Development Specialist: Heather Bays Marketing Manager: Becky Ramsaroop Publishing Services Manager: Jeff Patterson Book Production Specialist: Carol O’Connell Design Direction: Brian Salisbury Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 About the Authors Jane W. Ball, DrPH, RN, CPNP Jane W. Ball graduated from The Johns Hopkins Hospital director, she provided support to two School of Nursing and subsequently received her master’s federal programs: Emergency Medical and doctoral degrees in public health from The Johns Services for Children and the Trauma- Hopkins University Bloomberg School of Public Health. Emergency Medical Services Systems She began her nursing career as a pediatric nurse and Program. Dr. Ball serves as a consultant pediatric nurse practitioner in The Johns Hopkins Hospital. to the American College of Surgeons’ Since completing her public health degrees, she has held Committee on Trauma to help states many positions that enable her to focus on improving the improve their trauma care systems. She healthcare system for children and adults, such as serving also serves as a consultant to Children’s National Medical as the chief of Child Health for the Commonwealth of Center supporting the development of a project to expand Pennsylvania Department of Health, Assistant Professor resources for the care of injured children. She is also the at the University of Texas at Arlington School of Nursing, author of several pediatric nursing textbooks. Dr. Ball was and executive director of the Emergency Medical Services recognized as a distinguished alumnus of The Johns for Children National Resource Center based at Children’s Hopkins University in 2010. National Medical Center in Washington, DC. As the center Joyce E. Dains, DrPH, JD, RN, FNP-BC, FNAP, FAANP As a board-certified family nurse practitioner with doctorates and Baylor College of Medicine. She in both public health and law, Joyce E. Dains has had a has been instrumental in the education rich and productive career in education and clinical practice. of nursing students, nurse practitioners, She graduated as valedictorian from the New England Baptist medical students, and other healthcare Hospital School of Nursing in Boston and subsequently professionals. As a family nurse prac- earned a baccalaureate degree in nursing from Boston titioner, she has maintained a clinical College, graduating magna cum laude; a master’s degree practice in a variety of primary care in nursing from Case Western Reserve University; and settings. She is currently at the Uni- a doctorate in public health from the University of versity of Texas MD Anderson Cancer Center where she Texas–Houston. She also completed a post-graduate nurse is Director for Advanced Practice Nursing, a family nurse practitioner program at the Texas Woman’s University. She practitioner in the Cancer Prevention Center, and chair, ad earned her law degree at the University of Houston and interim, for the Department of Nursing. Dr. Dains is a practiced law for a brief period. In addition to her current Fellow of the American Association of Nurse Practitioners position, Dr. Dains has been in clinical practice, teaching, and is the recipient of other distinguished honors, including and leadership positions at major universities and medical election to the National Academies of Practice. Dr. Dains institutions including the Ohio State University, the Uni- is also the author of Elsevier’s Advanced Health Assessment versity of Texas-Houston, the Texas Woman’s University, and Clinical Diagnosis in Primary Care. John A. Flynn, MD, MBA, MEd John A. Flynn completed his undergraduate work at Boston Office of Johns Hopkins Physicians, College, graduating magna cum laude with a bachelor’s as well as the Associate Dean and degree in mathematics. He attended medical school at the Executive Director of the Clinical University of Missouri–Columbia where he was recognized Practice Association. He holds the in 2004 with the “Outstanding Young Alumni” award. Dr. John A. Flynn Professorship in Medi- Flynn completed his internship and residency at The Johns cine. Dr. Flynn also serves as the Hopkins University School of Medicine, followed by a medical director of the spondyloarthri- fellowship in rheumatology, and was selected to serve as tis program at The Johns Hopkins University and is the an assistant chief of service for the Longcope Firm of the co-director of the Primary Care Consortium. He is a Osler Medical Service. Dr. Flynn also completed a master’s founding member of the Vivien T. Thomas College within degree in business administration at The Johns Hopkins The Johns Hopkins University School of Medicine Colleges University. Dr. Flynn is currently the Vice President of the Advisory Program. Dr. Flynn is a Fellow with the American iii iv About the Authors College of Rheumatology and a Diplomat of the American editor of Cutaneous Medicine: Cutaneous Manifestations of Board of Rheumatology, as well as a Fellow to the American Systemic Disease and the first and second editions of the College of Physicians. Dr. Flynn holds memberships in the Oxford American Handbook of Clinical Medicine. Dr. Flynn’s American College of Physicians, the American College of clinical interest is arthritis and his research interests include Rheumatology, the Spondyloarthritis Research and Treat- ambulatory education, the delivery of ambulatory care in ment Network, and the Group for Research and Assessment an academic setting, and the care of patients with of Psoriasis and Psoriatic Arthritis. He has served as an spondyloarthritis. s r o h t Barry S. Solomon, MD, MPH u A e Barry S. Solomon graduated from the University of Penn- director of The Johns Hopkins Chil- h t sylvania School of Medicine and completed his residency dren’s Center Harriet Lane Clinic, Dr. t u at the Children’s Hospital of Pittsburgh. He subsequently Solomon has developed a nationally o b completed a fellowship in general academic pediatrics at recognized and award-winning model A The Johns Hopkins University School of Medicine, during for delivering family-centered care in which time he received a master of public health degree an urban pediatric primary care setting. from The Johns Hopkins University Bloomberg School of Many of the clinic’s patients and fami- Public Health. Barry is currently an associate professor of lies experience significant social and pediatrics in the Division of General Pediatrics and Ado- financial challenges associated with living in poverty. In lescent Medicine in the School of Medicine. His clinical collaboration with hospital and community partners, sup- work, research, teaching, and advocacy efforts relate to ported by philanthropic organizations, Dr. Solomon has addressing the social and emotional needs of urban youth brought an array of wrap-around services to the clinic. and caregivers through educational curricula, clinic-based Programming includes an on-site safety resource center, interventions, and innovations in primary care delivery. mental health services for children and adolescents, a For many years he worked closely with colleagues in the maternal mental health clinic, parenting groups, and a Women and Children’s Health Policy Center in the Bloom- help desk to connect families with community resources berg School of Public Health on the Dyson Community (Health Leads©). Dr. Solomon is also an active clinical Pediatrics Training Initiative National Evaluation, a longi- teacher and research mentor to medical students, residents, tudinal study assessing the impact of integrating community- fellows, and junior faculty interested in addressing social based experiences and child advocacy skills into residency determinants of health through primary care redesign. His training. Dr. Solomon has a joint appointment in the academic career and personal mission have been centered Department of Health, Behavior and Society in the Bloom- on providing high-quality, family-centered primary care, berg School of Public Health, where he conducts research while training new generations of health professioals to with faculty in the Center for Injury Research and Policy become advocates for vulnerable populations. to prevent childhood injury. For the past 10 years, as medical Rosalyn W. Stewart, MD, MS, MBA Rosalyn W. Stewart began her career at the University of and practice of medicine. She is associ- Texas Medical Branch where she earned her medical degree ate director of the Longitudinal and subsequently completed her combined internal medi- Ambulatory Clerkship, a clinical clerk- cine–pediatrics residency and a master of science degree ship devoted to primary care and in preventive medicine. She is currently an associate profes- systems of health practice. She focuses sor in internal medicine and pediatrics at The Johns Hopkins her efforts on assembling a cadre of University and is also a member of the faculty in the excellent teachers, training the very best Bloomberg School of Public Health and The Johns Hopkins students of medicine in continuity of School of Nursing. She completed a master of business patient care, and developing new curricula for the education administration degree with an emphasis on health care. of the best clinicians. Her goal is to create physician leaders She practices both general internal medicine and general who will serve as primary care systems–level change agents pediatrics. Her academic focus is on medical education, and will provide effective, longitudinal, comprehensive, primary care, and health disparities. She holds many posi- coordinated, person-focused care for the underinsured tions centered on these interests and has been recognized inner-city patient. for her ability to carry forth the Osler philosophy, discipline, Reviewers Susan M. Beidler, PhD, MBE, APRN, FAANP Dian Colette Davitt, RN, PhD Department of Nursing Professor Emeritus Briar Cliff University Department of Nursing Sioux City, Iowa Webster University St. Louis, Missouri Craig S. Boisvert, DO Professor and Chair of Clinical Sciences Lucinda Drohn, RN, MSN West Virginia School of Osteopathic Medicine School of Nursing Lewisberg, West Virginia Liberty University Lynchburg, Virginia Diane Bridge, EdS, RN, MSN School of Nursing Jason Ferguson, BPA, AAS NREMT-Paramedic Liberty University EMS Program Head Lynchburg, Virginia Central Virginia Community College Lynchburg, Virginia Amber B. Carriveau, DNP, FNP-BC MSN Program Renee Fife, MSN, CPNP Bellin College Professor Emeritus Green Bay, Wisconsin College of Nursing Purdue University Northwest Laura H. Clayton, RN, PhD, CNE Hammond, Indiana Department of Nursing Education Shepherd University Sarah J. Flynn, MD, MPhil Shepherdstown, West Virginia Darwin College University of Cambridge Shirlee Cohen, MPH, ANP-BC, NPP, CCRN Cambridge, England DNP Candidate College of Nursing Rebecca A. Fountain, RN, PhD University of New Mexico Assistant Professor Albuquerque, New Mexico College of Nursing and Health Sciences University of Texas at Tyler Tonya A Collado, RN, MSN Tyler, Texas St. Elizabeth School of Nursing University of Saint Francis Brian Garibaldi, MD Lafayette, Indiana Pulmonary and Critical Care Medicine Department of Medicine Amy Culbertson, DNP, MSN, BSN, FNP Johns Hopkins University Assistant Professor Baltimore, Maryland School of Nursing & Health Sciences Georgetown University Deanna Hanisch, MA Washington, District of Columbia Office of Information Technology Johns Hopkins University Pamela Darby, RN, MSN, ACNS-BC, FNP-C Baltimore, Maryland Clinical Instructor Department of Nursing Alicia C. Henning, RN, BSN, SANE Angelo State University Member of American College of Forensic Examiners San Angelo, Texas Member of International Association of Forensic Nurses Breckenridge Memorial Hospital Hardinsburg, Kentucky v vi Reviewers Nancy J. Kern, EdD, MSN, FNP-C, AGPCNP-C, APRN Susan D. Rymer, RN, MSN School of Nursing Assistant Professor Spalding University School of Nursing Louisville, Kentucky Bellin College Green Bay, Wisconsin Pamela L King, PhD, MSN, FNP, PNP Marlene Sefton, PhD, APRN, FNP-BC School of Nursing Spalding University Clinical Assistant Professor Louisville, Kentucky College of Nursing, Department of Health System Sciences Rs Carla Lynch, BSN, MS University of Illinois at Chicago e w Clinical Assistant Professor of Nursing Chicago, Illinois e vi School of Nursing e The University of Tulsa Pamella Stockel, RN, PhD, CNE R Tulsa, Oklahoma Associate Professor of Nursing Loretto Heights School of Nursing Duane F. Napier, RN, MSN Regis University Captio Department of Nursing Denver, Colorado The University of Charleston Ruthann Taylor, MS, CRNP, NP-C, AGPCNP-BC, GCNS- Charleston, West Virginia BC, OCN, CME Grace M. Nteff, DNP, MS, BSN Passan School of Nursing School of Nursing Wilkes University Clayton State University Wilkes-Barre, Pennsylvania Morrow, Georgia Karen Vanbeek, MSN, CCNS Elizabeth Oakley, DHSc, MSPT Assistant Professor of Nursing Department of Physical Therapy School of Nursing Andrews University Bellin College Berrien Springs, Michigan Green Bay, Wisconsin Natacha Pierre, DNP, FNP-BC Joy Turner Washburn, RN, EdD, WHNP-BC Health Systems Sciences Department Kirkhof College of Nursing University of Illinois at Chicago College of Nursing Grand Valley State University Chicago, Illinois Allendale, Michigan Kristin Ramirez, RN, MSN, ACNS-BC Lynn Wimett, EdD, MS, BSN Assistant Clinical Professor of Nursing Professor of Nursing Department of Nursing Loretto Heights School of Nursing Angelo State University Regis University San Angelo, Texas Denver, Colorado Anita K. Reed, RN, MSN John Zampella, MD Department Chair Adult and Community Health Department of Dermatology Practice New York University Remington, Indiana New York, New York Susan K. Rice, RN, PhD, CPNP, CNS Professor College of Nursing University of Toledo Toledo, Ohio Preface Seidel’s Guide to Physical Examination: An Interprofessional specific body systems and body parts, with each chapter Approach was a landmark text when first published, in divided into four major sections: part because of the interprofessional team of nurse practi- • Anatomy and Physiology tioner and physician authors. The use of interprofessional • Review of Related History authors has continued through all editions, and the current • Examination and Findings team of nurse practitioner and physician authors brings the • Abnormalities strengths of their respective disciplines to help students of all Each of these sections begins with consideration of the health disciplines learn to conduct a patient-centered inter- adult patient and ends, when appropriate, with variations view and perform a physical examination. This text is written for infants, children, and adolescents; pregnant persons; primarily for students beginning their careers as a healthcare older adults; and individuals with disabilities. professional. To help you get organized, each chapter starts with a The core message of the book is that patients are our preview of physical examination components discussed. central focus and must be served well. Learning how to The Anatomy and Physiology sections begin with the take a history and perform a physical examination is neces- physiologic basis for the interpretation of findings, as well sary, but does not provide a full understanding of your as the key anatomic landmarks to guide physical examina- patients. The relationship with your patients and the tion. The Review of Related History sections detail a specific development of trust most often begins with conversation. method of inquiry when a system or organ-related health Patients will more comfortably share personal and sensitive issue is discovered during the interview or examination. information when you develop a rapport and build trust. The Examination and Findings sections list needed equip- Such a relationship helps you obtain reliable information ment and then describe in detail the procedures for the enabling you to serve your patients well. You are, after all, examination and the expected findings. These sections learning the stories of individuals with unique experiences encourage you to develop an approach and sequence that and cultural heritage, and our interaction with them involves is comfortable for you and, also for the patient. In some far more than the sum of body parts and systems. The art chapters advanced examination procedures are described and skills involved in history taking and the physical for use in specific circumstances or when specific conditions examination are common to all of us, regardless of our exist. Sample documentation of findings conclude these particular health profession. sections. You will note that the terms “normal” and “abnormal” are avoided whenever possible to describe findings because, in our view, these terms suggest a value judgment Organization that may or may not prove valid with experience and The achievement of a constructive relationship with a additional information. The Abnormalities sections provide patient begins with your mastery of sound history taking an overview of diseases and associated problems relevant and physical examination. Chapter 1 offers vital “getting to to the particular system or body part. The Abnormalities know you” guidelines to help you learn about the patient sections include tables clearly listing pathophysiology in as the patient learns about you. Chapter 2 stresses that one column and patient subjective and objective data in “knowing” is incomplete without the mutual understanding another column for selected conditions. Full-color photos of cultural backgrounds and differences. Chapter 3 gives an and illustrations are often included. overview of examination processes and the equipment you Chapter 24 details the issues relevant to the sports will need. participation evaluation. Chapter 25 provides guid- Chapter 4 assists with the process of analyzing the ance for integrating examination of all body systems information collected during the history and physical into an organized sequence and process. Chapter 26 examination, and using clinical reasoning to support deci- provides guidelines for the change in standard exami- sion making and problem solving. Chapter 5 provides nation approaches in emergency and life-threatening guidance on recording the information collected into the situations. This information is only a beginning and is patient’s written or electronic health record with particular intended to be useful in your clinical decision making. emphasis on the Problem Oriented Medical Record (POMR) You will need to add other resources to your base of and the use of SOAP (Subjective findings, Objective findings, knowledge. Assessment, and Plan). The appendices and companion Evolve website content Chapters 6 through 8 introduce important elements of provide clinical tools and resources to document observa- assessment: vital signs and pain; mental status; and growth, tions or problems and complete the physical examination, development, and nutrition. Chapters 9 through 23 discuss preserving a continuous record. vii viii Preface Special Features gay, bisexual, and transgender patients has been integrated into several chapters. The basic structure of the book—with its consistent chapter • The emergency or life-threatening situations chapter organization and the inclusion of special considerations has been updated. sections for infants, children, adolescents, pregnant persons, • The sports participation chapter includes recommenda- and older adults—facilitates learning. tions for assessing and managing patients with sports- • Differential Diagnosis Tables—a hallmark of this text— related concussions. appear throughout the text. • Evidence-Based Practice in Physical Examination boxes Our Ancillary Package are reminders that our clinical assessment—as much as possible—should be supported by research. Seidel’s Physical Examination Handbook is a concise, pocket- e • Risk Factors boxes highlight modifiable and nonmodifi- sized companion for clinical experiences. It summarizes, c a able risk factors for a variety of conditions. reinforces, and serves as a quick reference to the core content f e r • Functional Assessment boxes help students to consider of the textbook. P specific physical problems and to evaluate their effect Student Laboratory Manual for Seidel’s Guide to on patient function. Physical Examination is a practical printed workbook that • Patient Safety boxes offer guidance about ways to helps readers integrate the content of the textbook and promote patient safety during the physical examination ensure content mastery through a variety of engaging or about patient education that supports safe practices exercises. at home. Instructor Resources on the companion Evolve website • Sample Documentation boxes at the end of each Examina- (http:/evolve.elsevier.com/Seidel) include an extensive tion and Findings section model good documentation electronic image collection and a PowerPoint lecture slide practice. collection that includes integrated animations, case studies, and a series of audience response questions. In addition, TEACH provides learning objectives, key terms, nursing New to This Edition curriculum standards, content highlights, teaching strate- The entire book has been thoroughly updated for this gies, and case studies. Also available on the Evolve website edition. This includes the replacement of illustrations of are two thoroughly revised Test Banks, in ExamView® abnormal findings with updated photos and the use of new format, which faculty can use to create customized exams full-color photos and drawings to replace one- and two-color for medical, allied health, or nursing programs. Together illustrations in the eighth edition. There are approximately these resources provide the complete building blocks needed 1200 illustrations in addition to the numerous tables and for course preparation. boxes that have traditionally given readers easy access to Student Resources on the companion Evolve website information. Among the many changes: include a wide variety of activities, including audio clips • Evidence-Based Practice in Physical Examination boxes of heart, lung, and abdominal sounds; video clips of selected have been thoroughly updated. These boxes focus on examination procedures; animations depicting content and the ongoing need to incorporate recent research into processes; 270 NCLEX-style review questions; and download- clinical practice and decision making. able student checklists and key points. • Clinical Pearls boxes have been updated and revised. Also available is the thoroughly revised and expanded • The Abnormalities section is now in two columns to online course library titled Health Assessment Online, which better show the relationship between the summary is an exhaustive multimedia library of online resources, of the pathophysiology and patient data, both subjec- including animations, video clips, interactive exercises, tive and objective, associated with the condition or quizzes, and much more. Comprehensive self-paced learning disorder. modules offer flexibility to faculty or students, with tutorial • The Techniques and Equipment chapter includes updated learning modules and in-depth capstone case studies for recommendations for Standard Precautions. each body system chapter in the text. Available for individual • The Recording Information: Documentation chapter has student purchase or as a required course supplement, been revised to add a focus on electronic health records Health Assessment Online unlocks a rich online learning and recording information electronically. experience. • The Growth, Measurement, and Nutrition chapter, This edition is also available on Elsevier eBooks on integrates two separate chapters to better demonstrate VitalSource. Easy-to-use, interactive features let you make the interdependence of nutrition, growth, and health. highlights, share notes, run instant searches, and much • Updated cancer screening controversies and summary more. You can access your eBook online through Evolve evidence are included in the abdomen, breast, and or with apps for PC, Mac, iOS, Android, and Kindle Fire. prostate chapters. The existing physical examination video series com- • Information about sensitive and respectful approaches prises 14 examination videos, each of which features an to history taking and physical examination of lesbian, examination of a specific body system with animations and Preface ix illustration overlays to demonstrate examination techniques Acknowledgments in greater depth, and a fifteenth “Putting It All Together” video that shows a head-to-toe examination of an adult The ninth edition of our textbook is possible only because of along with appropriate life span variations. The series the professionalism and skills of so many others who really includes three special topics: Effective Communication and know how to fashion a book and its ancillaries so that it is Interviewing Skills, Physical Examination of the Hospitalized maximally useful to you. First, there are those instructors Patient, and Putting It All Together: Physical Examination and students who have so thoughtfully and constructively of the Child. All 18 videos in this video series are offered offered comment over the years. Improvements in content in two formats: streaming (online) and networkable (for and style are often the results of their suggestions. institutional purchase). While the authors have provided the content, it must be accessible to the reader. A textbook needs a style that ensures readability, and our partners at Elsevier have made e Our Core Values c that happen. Lee Henderson, our Executive Content Strate- a f e In the ninth edition of Seidel’s Guide to Physical Examination: gist, provided oversight and guidance with the eye of an r P An Interprofessional Approach, we have made every attempt experienced editor along with strategies to meet the changing to consider patients in all of their variety and to preserve environment of print and electronic publishing. The whole the fundamental messages explicit in earlier editions. These textbook revision is a demanding project requiring effective include the following: teamwork. Courtney Sprehe, Jennifer Hermes, and Saman- • Respect the patient. tha Dalton, our Content Development Specialists, maintained • Achieve the complementary forces of competence and professional skill and calm while obtaining chapter reviews, compassion. editing chapters, and moving the project forward. Heather • The art and skill essential to history taking and physical Bays did a spectacular job of keeping everything moving examination are the foundation of care; technologic with her qualitative eye for detail and design throughout. resources complement these processes. Brian Salisbury’s design is visually appealing and showcases • The history and physical examination are inseparable; the content. they are one. We also want to recognize the indispensable efforts of • The computer and technology compliments you. Your the entire marketing team led by Becky Ramsaroop, as well care and skills are what builds a trusting, fruitful relation- as the sales representatives, who make certain that our ship with the patient. message is honestly portrayed and that comments and • That relationship can be indescribably rewarding. suggestions from the field are candidly reported. Indeed, We hope that you will find this a useful text and that it will there are so very many men and women who are essential continue to serve as a resource as your career evolves. to the creation and potential success of our ninth edition, and we are indebted to each of them. The remarkable teaching tools we call the ancillaries Dedication need special attention. These are the laboratory manual, We dedicate the ninth edition of this text to two original handbook, TEACH, test banks, Health Assessment Online, authors, Henry M. Seidel, MD, and William Benedict, MD, and video series, all demanding an expertise—if they are who served on seven and six editions, respectively. Both to be useful—that goes beyond that of the authors. Frances physicians had academic appointments at The Johns Donovan Monahan offers hers for the laboratory manual. Hopkins University School of Medicine for decades and Joanna Cain offers hers for the Power Point slides, nursing made important contributions to patient care and medical test bank NCLEX review questions, student checklists, and student education in their specialties of pediatrics and key points; Jennifer Hermes offers hers for TEACH; and endocrinology/internal medicine, respectively. Frank Bregar offers his for the advanced practice test bank. As original authors they contributed greatly to the initial The careful attention to all asset development is text design as well as to its ongoing development. Both overseen by Jason Gonulsen. The development of Health Dr. Seidel and Dr. Benedict understood the importance of Assessment Online is led by Frances Donovan Monahan; communication, sensitivity, compassion, and connection Chris Lay; Nancy Priff, Glenn Harman, and Paul Trumbore’s with patients. This text was one of the earliest collabora- efforts are essential to the success of the video series. tions of a physician and nurse author team, in this case to And finally—our families! They are patient with our develop a text targeted to students of medicine, nursing, necessary absences, support what we do, and are unstinting and other allied health professions. The ability of these in their love. They have our love and our quite special thanks. physicians to mesh their visions with that of the nurse authors and to collaborate as an effective team allowed the Jane W. Ball, DrPH, RN, CPNP authors to shape this text and share important values with Joyce E. Dains, DrPH, JD, RN, FNP-BC, FNAP, FAANP students. John A. Flynn, MD, MBA, MEd This text was renamed in Henry Seidel’s honor for the Barry S. Solomon, MD, MPH eighth edition as Seidel’s Guide to Physical Examination. Rosalyn W. Stewart, MD, MS, MBA