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BRIEF CONTENTS

UNIT 1 Foundations for Health Assessment

1. Importance of Health Assessment, 1
2. Interviewing Patients to Obtain a Health History, 8
3. Techniques and Equipment for Physical Assessment, 21
4. General Inspection and Measurement of Vital Signs, 37
5. Ethnic, Cultural, and Spiritual Considerations, 46
6. Pain Assessment, 54
7. Mental Health and Abusive Behavior Assessment, 65
8. Nutritional Assessment, 80

UNIT 2 Health Assessment of the Adult

9. Skin, Hair, and Nails, 97
10. Head, Eyes, Ears, Nose, and Throat, 136
11. Lungs and Respiratory System, 191
12. Heart and Peripheral Vascular System, 223
13. Abdomen and Gastrointestinal System, 264
14. Musculoskeletal System, 293
15. Neurologic System, 336
16. Breasts and Axillae, 366
17. Reproductive System and the Perineum, 386

UNIT 3 Health Assessment Across the Life Span

18. Developmental Assessment Throughout the Life Span, 439
19. Assessment of the Infant, Child, and Adolescent, 455
20. Assessment of the Pregnant Patient, 495
21. Assessment of the Older Adult, 515

UNIT 4 Synthesis and Application of Health Assessment

22. Conducting a Head-to-Toe Examination, 531
23. Documenting the Comprehensive Health Assessment, 538
24. Adapting Health Assessment to the Hospitalized Patient, 542

Appendixes
A. Health History Using Functional Health Patterns, 557
B. Conversion Tables, 559
C. Abbreviations, 560
D. Answer Key, 562

Glossary, 568

Illustration Credits, 576

References, 579
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Health Assessment
for Nursing Practice
5th Edition
Susan Fickertt Wilson, PhD, RN, CNE
Associate Professor
School of Nursing
College of Health
University of Alaska Anchorage
Anchorage, Alaska;
Emeritus Associate Professor
Harris College of Nursing and Health Sciences
Texas Christian University
Fort Worth, Texas

Jean Foret Giddens, PhD, RN, FAAN

Professor and Executive Dean
College of Nursing
University of New Mexico
Albuquerque, New Mexico
3251 Riverport Lane
St. Louis, Missouri 63043

HEALTH ASSESSMENT FOR NURSING PRACTICE ISBN: 978-0-323-09151-0

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996 by Mosby, Inc., an affiliate of Elsevier Inc.

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
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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).

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 medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
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contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
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Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To my daughter, Megan, for her continued love, patience, and support; and to
the faculty, colleagues, and students who have challenged me through the years.
SFW

To my husband, Jay, for his unconditional support; to my mentors

and role models for their guidance throughout my career; and
to our nursing students, the future of our profession.
JFG
ABOUT THE AUTHORS

Susan Fickertt Wilson has over 40 years of teaching Jean Foret Giddens is a professor and Executive Dean
experience, including 30 years teaching health assess- at the College of Nursing at the University of New
ment. She has cared for adult patients in critical care, Mexico in Albuquerque. Dr. Giddens earned a Bachelor
general care, and rehabilitation units. Dr. Wilson has of Science in Nursing from the University of Kansas, a
taught undergraduate and graduate students about the Master of Science in Nursing from the University of
care of patients in a variety of settings. This text is a Texas at El Paso, and a doctorate in Education and
synthesis of all she has learned about performing health Human Resource Studies from Colorado State Univer-
assessment and teaching health assessment, as well as sity. Dr. Giddens has been involved with nursing educa-
how to meet the challenges she knows students experi- tion since 1984. Her teaching experience includes
ence in learning health assessment. associate, baccalaureate, and master’s degree programs
in New Mexico, Texas, and Colorado. Her content areas
in nursing education include adult health nursing,
health assessment, nursing process, curriculum devel-
opment, and innovative educational strategies.

vi
 CONTRIBUTORS AND CONSULTANTS

Clinical Reasoning Special Consultant Case Studies, Review Questions

for previous editions Maria E. Lauer, MSN, RN, CNE
Christine A. Tanner, PhD, RN Instructor, School of Nursing
A.B. Youmans-Spaulding Distinguished Professor Thomas Edison State College
Oregon Health & Science University Trenton, New Jersey
School of Nursing
Portland, Oregon PowerPoint Slides
Darlene D. Brink, MSN, RN, CCM, NE-BC
Chapter 20 Manager, Resource Center
Joanne Bartram, RN, MSN, FNP Sentara Healthcare
Clinical Educator, Family Nurse Practitioner Virginia Beach, Virginia
University of New Mexico
Albuquerque, New Mexico Test Bank
Susan Fickertt Wilson, PhD, RN, CNE
Carolyn Montoya, RN, MSN, PNP Associate Professor
Academic Coordinator, Advanced Practice School of Nursing
Concentrations College of Health
University of New Mexico University of Alaska Anchorage
Albuquerque, New Mexico Anchorage, Alaska;
Emeritus Associate Professor
Special thanks to the Chamberlain College of Nursing Harris College of Nursing and Health Sciences
in St. Louis, Missouri, for providing a state-of-the-art Texas Christian University
facility in which to take several of the photos for the Fort Worth, Texas
fifth edition. Their hospitality and collaboration were
most appreciated. Test Bank Review
Anne F. Meyer, RN, MS, FNP-BC
Ancillary Writers Instructor, Nursing Department
Case Studies Fitchburg State University
Scharmaine Lawson-Baker, DNP, FNP-BC Fitchburg, Massachusetts
Family Health Nurse Practitioner
Associate Professor, School of Nursing
Southern University
Baton Rouge, Louisiana

vii
REVIEWERS

Anthony J. Brunello, RN, MS, TNS, PHRN Pamela Newland, RN, PhD
Clinical Leader and Stroke Coordinator Assistant Professor
Cardiovascular Services School of Nursing
Provena St. Mary’s Hospital Southern Illinois University Edwardsville
Kankakee, Illinois Edwardsville, Illinois

Sharon M. Forney, MSN, RN, MSHCA Kit Sebrey Schafer, DNP, BSN, MSN, NP
Faculty Clinical Associate Professor
Associate Degree Nursing School of Nursing
North Central Texas College Purdue University
Gainesville, Texas West Lafayette, Indiana

Rebecca A. Fountain, PhD, RN Mary Shelkey, PhD, ARNP

Assistant Professor Post-Doctoral Fellow
College of Nursing School of Nursing
University of Texas at Tyler Biobehavioral Nursing and Health Systems
Tyler, Texas University of Washington
Seattle, Washington
Colleen J. Hewes, DC, MSN, RN
Director of Nursing Programs Donna Walls, PhD, RN
Nursing Associate Clinical Professor
Lake Washington Technical College Nursing
Kirkland, Washington Texas Woman’s University
Dallas, Texas

viii
 PREFACE

If a teacher is indeed wise, he does not bid you Considerations; Pain Assessment; Mental Health and Abusive
enter the house of his wisdom, but rather leads Behavior Assessment; and Nutritional Assessment.
you to the threshold of your own mind. Unit 2, entitled Health Assessment of the Adult, is organized
KAHLIL GIBRAN The Prophet by body system. Several chapters in Unit 2 begin with a
Concept Overview that features concepts in the context of
Following this teaching we have revised this text Health health assessment. These concepts include pain, oxygenation,
Assessment for Nursing Practice to retain the strong features perfusion, tissue integrity, motion, sensory perception, and
and add others. The underlying principles of the previous intracranial regulation. The concept and interrelated con-
editions are steadfast. As with the previous editions, the fifth cepts are shown along with an explanation of how these con-
edition is based on the assumption that every patient—from cepts are linked.
neonate to older adult—is an interactive, complex being who
Each chapter includes a review of Anatomy and Physiology.
is more than a collection of his or her parts. Each patient’s
This is found at the beginning of the chapter because physical
health status depends on the interactions of physiological,
assessment techniques allow the student to answer the ques-
psychological, sociocultural, and spiritual factors. These
tion, “How does this patient’s anatomy and physiology
interactions occur within their physical environments (what
compare with that expected for his or her age-group and
they eat, drink, and breathe; what type of activity and work
ethnic group?”
they participate in and where they live), their social environ-
ments and health beliefs (friends, family, and support systems; The Health History section instructs the student on history
when and how they seek health care), and their internal envi- data to collect by providing sample questions to ask patients
ronments (what they eat and drink, how they sleep, and how along with the reasons for asking those questions. The text
often they exercise). below each question describes the variances that the student
may find. Included in the Health History section are headings
As faculty, we are challenged with several responsibilities
for Present Health Status, Past Medical History, Family
toward our students:
History, Personal and Psychosocial History, and Problem-
1. Demonstrate caring and compassion when we interact
Based History. Descriptions of how to assess patients with
with patients to act as role models for students.
special needs and how to teach patients to improve their
2. Help students become knowledgeable and skilled in his-
health and reduce their risk for illness or injury are retained
tory-taking and physical assessment.
from the fourth edition.
3. Model for students as well as teach them how to be objec-
tive and nonjudgmental. The Examination section begins with a table that outlines
4. Assist students to mobilize their resources to apply health procedures performed routinely and in special circumstances
assessment knowledge and skills to patients of all ages and or in advanced practice. A list of the appropriate Equipment
from a multitude of cultures and ethnic groups. needed for these procedures is included in the table.
This section sequentially guides the student in the techniques
We know that students will need this content for the remain-
routinely performed during the physical assessment of an
der of their professional lives. This textbook is a toolbox of
adult, telling what to do, how to do it, and what to expect.
information and techniques. As a wise teacher, you lead stu-
Photographs are provided to enhance learning. The subse-
dents to the threshold.
quent section describes the examination procedures per-
formed in special circumstances or in advanced practice. The
ORGANIZATION indication for performing each procedure is followed by
expected and abnormal findings. The left column, Proce-
Health Assessment for Nursing Practice is organized into four
dures and Techniques with Expected Findings, details the
units to assist students and faculty efficiently to find their
techniques of the assessment and the expected findings, and
areas of interest. Unit 1, entitled Foundations for Health
the right column describes Abnormal Findings. When appli-
Assessment, provides a strong foundation for students, cov-
cable, a section on Patients with Situational Variations may
ering issues pertinent to nursing practice with all age-groups,
include examinations of patients who are hearing impaired
such as Importance of Health Assessment, Interviewing to
or paralyzed.
Obtain a Health History, Techniques and Equipment for Physi-
cal Assessment, and General Inspection and Vital Signs. Also The Clinical Application and Clinical Reasoning section at
included are chapters on Ethnic, Cultural, and Spiritual the end of each chapter contains Review Questions, and

ix
x PREFACE

answers are provided in Appendix D. Case Studies give sub- SUMMARY OF SPECIAL FEATURES
jective and objective data about a patient and ask the student
to use clinical reasoning skills to answer questions. Answers • Updated Health Promotion for Evidence-Based Practice
for these questions are included in Appendix D to facilitate boxes outline new Healthy People 2020 objectives and
self-study. include thorough discussions of recommendations for
health promotion and reducing risk.
Health Promotion for Evidence-Based Practice boxes • The Examination section in each body system chapter has
outline new Healthy People 2020 objectives and include thor- a table that outlines procedures performed routinely, in
ough discussions of recommendations for health promotion special circumstances, or in advanced practice.
and reducing health risks. These special feature boxes follow • Advanced Practice Skills are distinguished from basic
the Health History section so that data are collected at the skills and are identified with a special icon. This feature
time of history taking. The Common Problems and Condi- bridges the gap between undergraduate and advanced
tions section toward the end of each chapter has been practice education. Advanced content is denoted with a
updated. It now includes Risk Factors boxes for disorders in symbol to highlight this material for advanced practice
each body system to remind students to discuss these behav- students without being obtrusive for undergraduate
iors with patients to help them maintain health and reduce students.
the risk of disease. The areas of risk factor identification and • Special Risk Factors boxes are found at the beginning of
health promotion are unique to this text. These areas indicate each Common Problems and Conditions section in the
our commitment to not only teaching students how to gather body system chapters and highlight information specific to
data from patients and examine their bodies to detect health various body systems and disorders.
and disease, but also to teaching students how to attain and • Unique and revised Clinical Reasoning: Thinking Like a
maintain a higher level of health. Special Ethnic, Cultural, Nurse boxes walk students through the thought process of
and Spiritual Variations boxes throughout the body systems how an experienced nurse or nurse practitioner makes
chapters contain racial, cultural, and religious variations the decisions and includes examples of how experts notice,
nurse should consider when assessing patients. interpret, and respond to clinical situations.
• Frequently Asked Questions boxes answer common ques-
Unit 3, entitled Health Assessment Across the Life Span,
tions students have as they are learning health assessment.
begins with an overview of growth and development and
These “FAQs” appear throughout Unit 2.
continues with chapters on Assessment of the Infant, Child,
• Near the end of each chapter is a section on Clinical Appli-
and Adolescent; Assessment of the Pregnant Patient; and Assess-
cation and Clinical Reasoning. Included are the Case
ment of the Older Adult. These chapters describe how to indi-
Studies and Review Questions, and answers to these exer-
vidualize the examination for patients of different ages and
cises are provided in Appendix D to help students evaluate
in pregnancy. Each chapter includes a box that lists the dif-
their learning.
ferences in anatomy and physiology pertinent to those
• New Quality Improvement Competencies for Nurses
patients. Health history and examination follow along with
tables provide assessment related to selected Quality and
procedures and techniques and expected and abnormal find-
Safety Education for Nurses (QSEN) competencies, includ-
ings. The Common Problems and Conditions section toward
ing patient-centered care, teamwork and collaboration,
the end of each chapter has been retained in these chapters
safety, and informatics.
as they pertain to the patients described.
• Reformatted Ethnic, Cultural, and Spiritual Variations
Unit 4, entitled Synthesis and Application of Health Assess- boxes anticipate the unique needs of a multicultural patient
ment, contains Conducting a Head-to-Toe Examination, Doc- population.
umenting the Comprehensive Health Assessment, and Adapting
Health Assessment to the Hospitalized Patient (new to the fifth
edition). These chapters provide guidelines and photographs TEACHING AND LEARNING AIDS
for combining the body system assessments into one compre- The Evolve website for this book contains extensive student
hensive examination, for communicating the findings to and instructor resources and can be accessed at http://evolve.
other health care professionals, and for adapting the compre- elsevier.com/Wilson/assessment. This dynamic educational
hensive assessment to patients in a hospitalized setting. component allows students and faculty to access the most
current information and resources for further study and
A Glossary at the end of the book provides definitions to
research. The comprehensive Evolve Instructor Resources
enhance student comprehension of key concepts and terms.
include TEACH for Nurses, a resource that ties together every
Chapters were updated and revised based on feedback from chapter resource necessary for the most effective class presen-
both faculty and students. Consider each chapter a different tations. TEACH for Nurses incorporates objectives, key terms,
type of tool from the toolbox. Collectively they provide all nursing curriculum standards (including QSEN, BSN Essen-
that students need to perform a comprehensive health tials, and Concepts), student and instructor chapter resources,
assessment. in-class/online case studies, and teaching strategies consisting
 PREFACE xi

of student activities, online activities, and discussion topics. Evolve Student Resources include animations, case studies,
The ExamView Test Bank has been updated and includes content updates, examination techniques, lab guides, key
approximately 650 test questions. Also included is a compre- points, heart and lung sounds, review questions, skills check-
hensive Image Collection, which contains hundreds of full- lists, and video clips.
color images that can be imported into the PowerPoint
Visit http://evolve.elsevier.com/Wilson/assessment to access
Lecture Slides for use in classroom lectures. Audience
these resources.
Response Questions and Case Studies are also provided for
the PowerPoint lecture slides.
This page intentionally left blank
CONTENTS

UNIT 1 Techniques of Physical Assessment, 23

Inspection, 23
Foundations for Health Assessment Palpation, 23
Percussion, 24
C HAPTER 1 Auscultation, 24
Patient Positioning, 25
Importance of Health Assessment, 1 Equipment Used During the Examination, 25
Components of Health Assessment, 1 Thermometer, 25
Health History, 1 Stethoscope, 27
Physical Examination, 1 Equipment to Measure Blood Pressure, 28
Documentation of Data, 1 Pulse Oximeter, 29
Types of Health Assessment, 2 Scale, 30
Context of Care, 2 Visual Acuity Charts, 30
Patient Need, 3 Ophthalmoscope, 31
Nurse Expertise, 3 Otoscope, 31
Clinical Reasoning and Judgment, 4 Penlight, 32
Data Organization, 4 Ruler and Tape Measure, 32
Data Analysis, Interpretation, and Clinical Judgment, 4 Nasal Speculum, 32
Health Promotion and Health Protection, 5 Tuning Fork, 33
Percussion, or Reflex, Hammer, 33
Doppler, 33
C HAPTER 2
Goniometer, 33
Interviewing Patients to Obtain a Health Calipers for Skinfold Thickness, 34
History, 8 Vaginal Speculum, 34
Audioscope, 35
The Interview, 8
Monofilament, 35
Phases of the Interview, 8
Transilluminator, 35
Communication Skills for Interviewing, 9
Wood’s Lamp, 36
The Physical Setting, 9
Magnification Device, 36
Professional Behavior, 10
Patient-Related Variables, 10
The Art of Asking Questions, 10
CHAPTER 4
Types of Questions to Ask, 11
Techniques That Enhance Data Collection, 11 General Inspection and
Techniques That Diminish Data Collection, 12 Measurement of Vital Signs, 37
Managing Awkward Moments During an Interview, 12
General Inspection, 37
Challenges to the Interview, 12
Physical Appearance and Hygiene, 37
The Health History, 13
Body Structure and Position, 37
Types of Health Histories, 13
Body Movement, 37
Components of the Health History, 14
Emotional and Mental Status and
Alternative Health History Formats, 19
Behavior, 38
AGE-RELATED VARIATIONS, 19
Measurement of Vital Signs, Height,
and Weight, 38
C HAPTER 3 Temperature, 38
Techniques and Equipment for Heart Rate, 39
Respiratory Rate, 40
Physical Assessment, 21 Blood Pressure, 40
Infection Control Practices, 21 Oxygen Saturation, 43
Hand Hygiene, 21 Pain, 43
Personal Protective Equipment, 21 Weight, 43
Latex Allergy, 21 Height, 44
Patient Care Equipment, 22 AGE-RELATED VARIATIONS, 44
xiii
xiv CONTENTS

C HAPTER 5 Problem-Based History, 68

Ethnic, Cultural, and Spiritual Depression, 68
Anxiety, 70
Considerations, 46 Altered Mental Status, 70
Ethnic, Cultural, and Spiritual Awareness, 46 Alcohol Abuse, 71
Develop Cultural Competence, 49 Drug Abuse, 72
Avoid Stereotyping, 49 Interpersonal Violence, 73
Develop a Template for Assessment, 50 EXAMINATION, 74
Personal and Psychosocial History, 51 Routine Techniques, 74
Notice the Patient’s Surroundings, 52 AGE-RELATED VARIATIONS, 75
Remember…, 52 COMMON PROBLEMS AND CONDITIONS, 76
Major Depression, 76
Bipolar Disorder, 76
C HAPTER 6 Schizophrenia, 76
Pain Assessment, 54 Anxiety Disorders, 77
Anxiety, 77
CONCEPT OVERVIEW, 54
Obsessive-Compulsive Disorder, 77
Cognitive and Cultural Influences on Pain Perception, 55
Substance Abuse Disorders, 77
Types of Pain, 55
Alcohol Withdrawal Syndrome, 77
Standards for Pain Assessment, 56
Drug Intoxication, 77
ANATOMY AND PHYSIOLOGY, 57
Delirium and Dementia, 77
Pain Process, 57
Delirium, 77
Pain Threshold and Pain Tolerance, 58
Dementia, 77
HEALTH HISTORY, 58
General Health History, 58
Present Health Status, 58 CHAPTER 8
Problem-Based History, 59 Nutritional Assessment, 80
Onset, 59
ANATOMY AND PHYSIOLOGY, 80
Location, 59
Macronutrients, 80
Duration, 59
Micronutrients, 81
Characteristics, 59
Water, 81
Aggravating Factors, 59
HEALTH HISTORY, 82
Related Symptoms, 59
General Health History, 82
Treatment by the Patient, 59
Present Health Status, 82
Severity, 61
Past Health History and Family History, 82
Response to Pain, 61
Personal and Psychosocial History, 82
Pain Reassessment, 62
Problem-Based History, 83
Assessing Pain of Patients Who Cannot Communicate, 62
Weight Loss, 83
EXAMINATION, 62
Weight Gain, 83
Routine Techniques: Pain, 62
Difficulty Chewing or Swallowing, 83
AGE-RELATED VARIATIONS, 63
Loss of Appetite or Nausea, 84
Assessment of Dietary Intake, 85
C HAPTER 7 EXAMINATION, 85
Mental Health and Abusive Routine Techniques: Nutrition, 86
Special Circumstances or Advanced Practice: Nutrition, 90
Behavior Assessment, 65 AGE-RELATED VARIATIONS, 94
ANATOMY AND PHYSIOLOGY, 65 COMMON PROBLEMS AND CONDITIONS, 94
HEALTH HISTORY, 67 Obesity, 94
General Health History, 67 Hyperlipidemia, 94
Present Health Status, 67 Protein-Calorie Malnutrition (PCM), 95
Past Health History, 67 Eating Disorders, 95
Family History, 67
Personal and Psychosocial History, 67
 CONTENTS xv

UNIT 2 CHAPTER 10
Health Assessment of the Adult Head, Eyes, Ears, Nose, and Throat, 136
CONCEPT OVERVIEW, 136
C HAPTER 9 ANATOMY AND PHYSIOLOGY, 136
The Head, 137
Skin, Hair, and Nails, 97 The Eyes, 137
CONCEPT OVERVIEW, 97 External Ocular Structures, 137
ANATOMY AND PHYSIOLOGY, 97 Ocular Structures, 137
Skin, 98 Ocular Function, 138
Epidermis, 98 The Ear, 138
Dermis, 98 External Ear, 138
Subcutaneous Layer, 98 Middle Ear, 139
Appendages, 99 Inner Ear, 139
Hair, 99 The Nose, 139
Nails, 99 The Mouth and Oropharynx, 140
Eccrine Sweat Glands, 99 Oropharynx, 140
Apocrine Sweat Glands, 99 Neck, 141
Sebaceous Glands, 99 Larynx, 141
HEALTH HISTORY, 99 Thyroid Gland, 141
General Health History, 99 Cardiovascular Structures, 142
Present Health Status, 99 Lymph Nodes, 142
Past Medical History and Family History, 100 HEALTH HISTORY, 143
Personal and Psychosocial History, 100 General Health History, 143
Problem-Based History, 100 Present Health Status, 143
Skin, 100 Past Health History, 143
Hair, 101 Family History, 143
Nails, 101 Personal and Psychosocial History, 143
EXAMINATION, 102 Problem-Based History, 144
Routine Techniques, 103 Headache, 144
Special Circumstances or Advanced Practice, 110 Dizziness and Vertigo, 144
AGE-RELATED VARIATIONS, 120 Difficulty with Vision, 144
SITUATIONAL VARIATIONS, 121 Hearing Loss, 145
Patients with Limited Mobility (Hemiplegia, Paraplegia, Ringing in the Ears (Tinnitus), 145
Quadriplegia), 121 Earache, 145
Expected and Abnormal Findings (Skin), 121 Nasal Drainage/Nose Bleed, 145
COMMON PROBLEMS AND CONDITIONS, 123 Sore Throat, 146
Skin, 123 Mouth Lesions, 146
Hyperkeratosis, 123 EXAMINATION, 147
Dermatitis, 123 Routine Techniques: Head, 148
Lesions Caused by Viral Infection, 125 Special Circumstances or Advanced Practice:
Lesions Caused by Fungal Infections, 127 Head, 148
Lesions Caused by Bacterial Infections, 128 Routine Techniques: Eyes, 149
Lesions Associated with Arthropods, 128 Special Circumstances or Advanced Practice: Eye, 154
Malignant Neoplasia, 129 Routine Techniques: Ears, 160
Skin Lesions Caused by Abuse, 130 Special Circumstances or Advanced Practice: Ears, 162
Hair, 131 Routine Techniques: Nose, 169
Pediculosis (Lice), 131 Special Circumstances or Advanced Practice: Nose, 169
Alopecia Areata, 132 Routine Techniques: Mouth, 171
Hirsutism, 132 Special Circumstances or Advanced Practice:
Nails, 132 Mouth, 175
Onychomycosis, 132 Routine Techniques: Neck, 175
Paronychia, 132 Special Circumstances or Advanced Practice: Neck, 176
Ingrown Toenail, 133 Special Circumstances or Advanced Practice: Lymph
Nodes, 178
AGE-RELATED VARIATIONS, 180
COMMON PROBLEMS AND CONDITIONS, 181
xvi CONTENTS

Head and Neck, 181 Chronic Pulmonary Disease, 218

Headaches, 181 Asthma, 218
Hydrocephalus, 182 Emphysema, 219
Eyes, 182 Chronic Bronchitis, 219
External Eye, 182 Acute or Traumatic Conditions, 220
Internal Eye, 183 Pneumothorax, 220
Ears, 184 Hemothorax, 220
Foreign Body, 184 Other Pulmonary Conditions, 221
Infection, 184 Atelectasis, 221
Hearing Loss, 185 Lung Cancer, 221
Nose, 185
Epistaxis, 185 CHAPTER 12
Inflammation/Infection, 186
Mouth, 186
Heart and Peripheral Vascular System, 223
Inflammation/Infection, 186 CONCEPT OVERVIEW, 223
Lesions, 187 ANATOMY AND PHYSIOLOGY, 223
Neck, 187 The Heart and Great Vessels, 223
Thyroid Disorders, 187 Pericardium and Cardiac Muscle, 224
Lymphoma, 188 Blood Flow Through the Heart: The Cardiac Cycle, 224
Electric Conduction, 226
C HAPTER 11 Peripheral Vascular System, 227
Lymph System, 228
Lungs and Respiratory System, 191 HEALTH HISTORY, 228
CONCEPT OVERVIEW, 191 General Health History, 228
ANATOMY AND PHYSIOLOGY, 191 Present Health Status, 228
Structures Within the Thorax, 192 Past Health History, 229
External Thorax, 192 Family History, 229
Mechanics of Breathing, 193 Personal and Psychosocial History, 229
Topographic Markers, 194 Problem-Based History, 230
Anterior Chest Wall, 194 Chest Pain, 230
Lateral Chest Wall, 194 Shortness of Breath, 230
Posterior Chest Wall, 195 Cough, 232
HEALTH HISTORY, 195 Urinating During the Night, 232
General Health History, 195 Fatigue, 232
Present Health Status, 195 Fainting, 232
Past Health History, 197 Swelling of Extremities, 232
Family History, 197 Leg Cramps or Pain, 233
Personal and Psychosocial History, 197 EXAMINATION, 234
Problem-Based History, 198 Routine Techniques: General Appearance, 234
Cough, 198 Routine Techniques: Peripheral Vascular System, 234
Shortness of Breath, 199 Routine Techniques: Heart, 243
Chest Pain with Breathing, 199 Special Circumstances or Advanced Practice: Peripheral
EXAMINATION, 200 Vascular System, 252
Routine Techniques, 201 Special Circumstances or Advanced Practice: Heart, 257
Routine Techniques: Posterior Thorax, 202 AGE-RELATED VARIATIONS, 259
Routine Techniques: Anterior Thorax, 207 COMMON PROBLEMS AND CONDITIONS, 259
Special Circumstances or Advanced Practice: Posterior Cardiac Disorders, 259
Thorax, 208 Valvular Heart Disease, 259
Special Circumstances or Advanced Practice: Anterior Angina Pectoris, 259
Thorax, 213 Acute Coronary Syndrome, 259
AGE-RELATED VARIATIONS, 217 Heart Failure, 260
COMMON PROBLEMS AND CONDITIONS, 217 Infective Endocarditis, 261
Inflammation/Infection, 218 Pericarditis, 261
Acute Bronchitis, 218 Peripheral Vascular Disease, 261
Pneumonia, 218 Hypertension, 261
Tuberculosis, 218 Venous Thrombosis and Thrombophlebitis, 261
Pleural Effusion, 218 Aneurysm, 261
 CONTENTS xvii

C HAPTER 13 CHAPTER 14
Abdomen and Gastrointestinal Musculoskeletal System, 293
System, 264 CONCEPT OVERVIEW, 293
Peritoneum, Musculature, and Connective Tissue, 264 Motion, 293
Alimentary Tract, 264 ANATOMY AND PHYSIOLOGY, 293
Esophagus, 264 Skeleton, 293
Stomach, 264 Skeletal Muscles, 294
Small Intestine, 265 Joints, 294
Large Intestine (Colon) and Rectum, 266 Ligaments and Tendons, 294
Accessory Organs, 266 Cartilage and Bursae, 295
Liver, 266 Axial Skeleton and Supporting Structures, 295
Gallbladder, 266 Skull and Neck, 295
Pancreas, 266 Trunk and Pelvis, 295
Spleen, 266 Appendicular Skeleton and Supporting Structures, 295
Urinary Tract, 266 Upper Extremities, 295
Kidneys, 266 Lower Extremities, 297
Ureters, 266 HEALTH HISTORY, 300
Bladder, 266 General Health History, 300
Vasculature of the Abdomen, 267 Present Health Status, 300
HEALTH HISTORY, 267 Past Health History, 300
General Health History, 267 Family History, 300
Present Health Status, 267 Personal and Psychosocial History, 300
Past Health History, 267 Problem-Based History, 300
Family History, 267 Pain, 300
Personal and Psychosocial History, 268 Problems with Movement, 301
Problem-Based History, 268 Problems with Daily Activities, 301
Abdominal Pain, 268 EXAMINATION, 302
Nausea and Vomiting, 268 Routine Techniques: Musculoskeletal System, 303
Indigestion, 270 Examination of Specific Musculoskeletal Regions, 309
Abdominal Distention, 270 Special Circumstances or Advanced Practice:
Change in Bowel Habits, 270 Musculoskeletal System, 325
Yellow Discoloration of Eyes or Skin (Jaundice), 270 AGE-RELATED VARIATIONS, 330
Problems with Urination, 270 COMMON PROBLEMS AND CONDITIONS, 331
EXAMINATION, 271 Bones, 331
Routine Techniques: Abdomen, 272 Fracture, 331
Special Circumstances or Advanced Practice: Osteoporosis, 331
Abdomen, 276 Joints, 332
AGE-RELATED VARIATIONS, 287 Rheumatoid Arthritis, 332
COMMON PROBLEMS AND CONDITIONS, 287 Osteoarthritis, 332
Alimentary Tract, 288 Bursitis, 332
Gastroesophageal Reflux Disease, 288 Gout, 332
Hiatal Hernia, 288 Spine, 333
Peptic Ulcer Disease, 288 Herniated Nucleus Pulposus (HNP), 333
Crohn’s Disease, 288 Scoliosis, 333
Ulcerative Colitis, 288 Ligaments and Muscles, 333
Diverticulitis, 288 Carpal Tunnel Syndrome, 333
Hepatobiliary System, 289
Viral Hepatitis, 289 CHAPTER 15
Cirrhosis, 289
Cholecystitis with Cholelithiasis, 289
Neurologic System, 336
Pancreas, 290 CONCEPT OVERVIEW, 336
Pancreatitis, 290 ANATOMY AND PHYSIOLOGY, 337
Urinary System, 290 Central Nervous System, 337
Urinary Tract Infections, 290 Protective Structures, 337
Nephrolithiasis, 290 Cerebrospinal Fluid and Cerebral Ventricular System, 337
Brain, 337
xviii CONTENTS

Peripheral Nervous System, 341 Problem-Based History, 368

Cranial Nerves, 341 Breast Pain or Tenderness, 368
Spinal Nerves, 341 Breast Lump, 369
Reflex Arc, 342 Nipple Discharge, 369
Autonomic Nervous System, 343 Axillary Lumps or Tenderness, 369
HEALTH HISTORY, 343 Breast Swelling or Enlargement (Men), 370
General Health History, 343 EXAMINATION, 370
Present Health Status, 343 Routine Techniques: Female Breast Examination, 371
Past Health History, 344 Special Circumstances or Advanced Practice: Female
Family History, 344 Breast Examination, 374
Personal and Psychosocial History, 344 Routine Techniques: Male Breast Examination, 378
Problem-Based History, 344 AGE-RELATED VARIATIONS, 379
Headache, 344 SITUATIONAL VARIATIONS, 380
Dizziness, 344 Patients with a Mastectomy, 380
Seizures, 345 Benign Breast Disease, 381
Loss of Consciousness, 345 Fibrocystic Changes to the Breast, 381
Changes in Movement, 345 Fibroadenoma, 381
Changes in Sensation, 346 Ductal Ectasia, 381
Difficulty Swallowing (Dysphagia), 346 Intraductal Papilloma, 382
Difficulty Communicating (Dysphasia/Aphasia), 346 Breast Cancer, 382
EXAMINATION, 347 Invasive Breast Cancer, 383
Routine Techniques: Neurologic System, 347 Noninvasive Breast Cancer, 383
Special Circumstances or Advanced Practice: Cranial Other Breast Conditions, 383
Nerves, 351 Mastitis, 383
AGE-RELATED VARIATIONS, 361 Galactorrhea, 383
COMMON PROBLEMS AND CONDITIONS, 362 Gynecomastia, 384
Disorders of the Central Nervous System, 362
Multiple Sclerosis, 362
Meningitis, 362 CHAPTER 17
Encephalitis, 362 Reproductive System and the
Spinal Cord Injury, 362
Craniocerebral Injury (Head Injury), 363
Perineum, 386
Parkinson’s Disease, 363 ANATOMY AND PHYSIOLOGY, 386
Cerebrovascular Accident (Stroke), 363 Female Reproductive System, 386
Alzheimer’s Disease, 363 External Genitalia, 386
Disorders of Cranial Nerves, 363 Internal Structures, 387
Trigeminal Neuralgia, 363 Menstrual Cycle, 389
Bell’s Palsy, 363 Menopause, 390
Disorders of Peripheral Nerves, 363 Male Reproductive System, 390
Myasthenia Gravis, 363 Internal Structures, 390
Guillain-Barré Syndrome, 364 External Genitalia, 391
Rectum and Anus, 392
Rectum, 392
C HAPTER 16 Anal Canal and Anus, 392
HEALTH HISTORY, 393
Breasts and Axillae, 366 General Health History, 393
ANATOMY AND PHYSIOLOGY, 366 Present Health Status, 393
Female Breast, 366 Past Health History, 393
Lymphatic Network, 367 Family History, 393
Male Breast, 367 Personal and Psychosocial History, 393
HEALTH HISTORY, 368 Sexual History, 393
General Health History, 368 Obstetric History, 394
Present Health Status, 368 Menstruation, 394
Past Health History, 368 Pregnancy, 394
Family History, 368
Personal and Psychosocial History, 368
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