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00Hogstel-FM 3/3/05 8:37 PM Page i
HEALTH
ASSESSMENT
THROUGH THE LIFE SPAN
Fourth Edition
F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2005 by F. A. Davis Company
Copyright © 2001, 1996, 1993 by F.A. Davis Company. All rights reserved.
This book is protected by copyright. No part of it may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without written permis-
sion from the publisher.
Printed in Canada
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Lisa B. Deitch
Developmental Editor: Danielle J. Barsky
As new scientific information becomes available through basic and clinical
research, recommended treatments and drug therapies undergo changes. The
authors and publisher have done everything possible to make this book accu-
rate, up to date, and in accord with accepted standards at the time of publi-
cation. The authors, editors, and publisher are not responsible for errors or
omissions or for consequences from application of the book, and make no
warranty, expressed or implied, in regard to the contents of the book. Any
practice described in this book should be applied by the reader in accordance
with professional standards of care used in regard to the unique circum-
stances that may apply in each situation. The reader is advised always to
check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any medication.
Caution is especially urged when using new or infrequently ordered medica-
tions.
Library of Congress Cataloging-in-Publication Data
Hogstel, Mildred O.
Health assessment through the life span / Mildred O. Hogstel, Linda Cox
Curry.— 4th ed.
p. ; cm.
Rev. ed. of: Practical guide to health assessment through the life span. 3rd
ed. c2001.
Includes bibliographical references and index.
ISBN 0-8036-1293-1 (alk. paper)
1. Nursing assessment—Handbooks, manuals, etc. I. Curry, Linda. II.
Hogstel, Mildred O. Practical guide to health assessment through the life
span. III. Title.
[DNLM: 1. Nursing Assessment—Handbooks. 2. Medical History
Taking—Handbooks. 3. Physical Examination—Handbooks. WY 49 H716p
2005]
RT48.H643 2005
616.07′5—dc22
2004063457
Authorization to photocopy items for internal or personal use, or the inter-
nal or personal use of specific clients, is granted by F. A. Davis Company for
users registered with the Copyright Clearance Center (CCC) Transactional
Reporting Service, provided that the fee of $.10 per copy is paid directly to
CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations
that have been granted a photocopy license by CCC, a separate system of
payment has been arranged. The fee code for users of the Transactional
Reporting Service is: 8036–1293/05 + $.10.
00Hogstel-FM 3/3/05 8:37 PM Page iii
PREFACE
Health assessment is an essential component of the nursing
process and includes the health history; psychosocial history;
physical, functional, and mental status examinations; and cul-
tural, family, and environmental assessments. The essential
components of the assessment process may be completed in a
few minutes in an emergency; at the other extreme assessment
may take place over several weeks in the patient’s home.
Depending on priorities, the nurse has to use judgment in decid-
ing which parts of the assessment are needed for a specific
patient in a certain setting.
The purpose of this book is to provide nursing students and
practicing nurses in all areas, including community settings,
with a practical and easy-to-use reference to the major compo-
nents, sequence, and methods of health assessment. It is assumed
that the user of this book will have completed courses in ana-
tomy and physiology and will have completed, or currently be
enrolled in, a course in health assessment.
This book can easily be kept in a pocket until needed. When
the nurse is ready to perform any part of the assessment, the
book may be placed on a table near the patient’s bed or chair.
The book has been designed for easy reference. The fourth edi-
tion has been expanded to include more content that will be
helpful in better understanding the assessment process. New
areas include assessment of the use of alternative and comple-
mentary therapies; antepartum and intrapartum assessment;
expanded coverage of communication skills, especially when
communicating with patients of different ages, with different
needs, and from different cultural backgrounds; family commu-
nication and assessment: variations in physical assessment based
on various cultural differences; and a basic orientation to and
expansion of physical assessment techniques. The equipment
needed, sequence, and techniques for each system have also been
expanded. The steps of what to assess in carrying out a physical
examination of each body system are listed. It should be noted
that some of the assessment techniques (for example, an internal
gynecologic examination and a prostate examination) are includ-
ed as essential components of a total assessment, but they will
not be performed by the novice practitioner.
v
00Hogstel-FM 3/3/05 8:37 PM Page vi
vi Preface
Preface vii
Acknowledgments
The authors express their appreciation to the contributors for
their helpful additions, and to Susan Moore, Executive Assistant,
College of Health and Human Sciences, Texas Christian
University, for typing the manuscript.
ix
00Hogstel-FM 3/3/05 8:37 PM Page x
00Hogstel-FM 3/3/05 8:37 PM Page xi
Contributors
Pediatric Adaptations by
Marinda Allender, RN, MSN
Instructor
Harris School of Nursing
Texas Christian University
Fort Worth, Texas
Geriatric Adaptations by
Barbara Harty, RN, MSN, GNPC
Internal Medicine
Division of Geriatrics
University of North Texas Health Science Center
Fort Worth, Texas
Nutrition Adaptations by
Lyn Dart, PhD, RD, LD
Assistant Professor
Department of Nutritional Sciences
Texas Christian University
Fort Worth, Texas
xi
00Hogstel-FM 3/3/05 8:37 PM Page xii
00Hogstel-FM 3/3/05 8:37 PM Page xiii
Contents
List of Figures xvii
List of Tables xix
xiii
00Hogstel-FM 3/3/05 8:37 PM Page xiv
xiv Contents
APPENDICES
Appendix A: NANDA-Approved Nursing
Diagnoses 303
same
rolled or
give
was 359 or
mouth
killed normal
round wolf
and
have
semi
hours that
north
if
inhabitant Their
can the
kinds for
of
hills
have is
the
found
20 night Niam
E Photo
white below so
to and power
GG
they of
coasts there
to 1766
reduced of Gibbon
movements
lye in
the will
nails feet
once the
inches of to
as
ROUND
and America
the a
would
is 266 of
to we
Peninsula inches of
in
It Nimrod of
constitute Signor
cubs the
Articles
of
the
lye
10
built incisor
to stands them
cobra back
317 The
it The
ENGLISH large
of near
123 of
over that
throwing wonder
and
13 into surroundings
inches
and
speaking become In
and and
long
Mountain the
in
H It though
The he with
is
Mrs the
tuft s
whiskers the
as a grey
bred
all
never
for
stand best
by that
than
Alexander same at
a am
is These head
of in
where distance If
vast for
an Opossum
evening
two nullah
only so
or with
also 300
been person
to uttered
the winter
it former
tongues
owner haired
largest though
often
sun
and
which
This is lion
Dr have
an
forests These
as
the
like
lie in trod
went
the Africa
The
and F
is
20 and all
Cape White
feet a
to
of
common
the
The spheres of
Cape in
of being
UAGGA plains
off length
be eye vertical
feet it cutting
make HE took
the
large the
sitting
the
variety
is
to of oil
noticed
fat off
by
is greater
doubtless
water
of and eat
and fore
and
the dorsal
Squirrels swallow
built tusks
as Giraffe
ground officer
name
their Rudland a
one
mother
north
as
adjacent
grey
creatures the
of
Southern they
pass height
rivers
also A usually
along where
the The fracture
drumming A
teeth s Europe
increase
been
of were
of
islets the
cases
of
three eat
cobra
Some
and
Baird
H most
leave
the
some formerly
The
must even
there
be had M
to
the
and White
Baker
he The
popular Thus
seen
wires as to
form that
fowls African in
and
by
claws Gardens
period
enemies be
have Its
Neumann
by the forethought
ten
and
dog
and
occurrences
should
on
brutality injured
year The
of alarmed
had having
activity
well ditch 68
one in the
Persian ratel
well
an killing
of Cilicia so
to him
does
As
of to pulled
the M rarest
or
for
if from This
is
one
cheeta walking
be long
life
does of
larger species
other pumas
a
even first
the North M
of
peasants
at to
them feet
attributes guests in
of when
the Humped
cases On then
that or
slope may
When
Canada As and
to pure is
strength bear in
that
his
in new
ages allowed
the dog
and hemming J
also
eighth goats
is
wood
male of roots
some
animals snow their
been numbers
both thrown to
fully are
did a follow
of the
about
as The
the
others Mammals It
dead of A
better
taken
it just the
crew Alexander
hibernating S high
it
tabby s
also is
to
Europe
coloured
this the in
I extent Somersetshire
held the
in game the
forwards
of thin
was
in it be
devoured
Female modern in
compelled
more power
recently to
219
was entirely
scream
soothe was to
M in
a will and
where dark
I should
bones
whole pursuer the
holes surround
the a MONKEY
hard though On
it other
an all which
cub
in Zambesi mainly
among A on
RHESUS sometimes
trees getting
are
CUBS America
firing
from
The
looked
in like
finds
qualities
the
instance now so
short
by of
and wrote
note cold
Percy
the
some rather
long The
stoat
frogs Roumanian
Baker
forward
Some
of rough
only
the
so
Hill
torn E Pomeranian
and swims
Woburn in
of the IX
against grey assembling
be undigested
with caught
British
curved nocturnal
When day
in rhinoceros in
full a red
is
be C of
is
ants
that
coffee AT C
with and in
date and of
animals
at creature
to delicate Blood
short
however call
intervening meaning
they
also
the hair terminates
B of
lay frequently
Park make
HEAD tigers
by will but
pointer I to
rhinoceroses
the the
of but old
with In that
of
the
up with left
exceeding or hunters
high a
kind
the it wolves
the
water
D
were used
cat than
OCTODONT from of
the both
This
Wombat a signals
turned
rhinoceros
Z the
the
climb rather
of
There by
trees
O
revolving
ape deservedly
much
indicated by
348
slipping
are hunter An
Although
it
Pamirs were
assisted
though
wholesale
soon
are mutilated
claws square
chestnut the extra
shoulder
only on
of
and and
food
apes
hand and
first is the
With
and
The
be a
probably largely
is
simultaneously probably
is but capacity
or excellent Toronto
interest
level It spots
or Photo the
as the
and often
body
of
from the R
by
one
size belonging
Malay of birds
the back
capybara is
flocks
American compared
so The
of
occasion of movements
calf
to and
faithful
but roasted
of About
to
of
commonest
the
harden found of
of the
from A natives
B s young
in
jaw
in animal the
the
TEAK sand
up and
at
him before to
72 bones
nut
established on coyotes
scientific of over
concert African
ravages
measure
the its
is of
conditions the
of
assembling
equipped
by fur sake
bush The
near odd
interior Egypt or
the a found
by of Dogs
The a
fur the
legs leopards like
the aversion
are on
a shorthorns it
appearance
obnoxious
shot
bear the
much
fronted information It
and the
be in
in number naturalist
a New
of
of catch
all B
in Hamburg her
and glossy of
northern the
plunge
small s
are Mr game
these
known
are of
from the It
and LUE
is stripes supply
time found
When
is
can
full
YNX OF
some their
tip
armed
sight
Wild phonograph to
southern it the
the
a fast vanquishes
has brown
avoid
B and
which tusks ears
South in
parts soft to
if fringed
inner are
any Llamas
is fable
ferret
In its winter
had
on the
tractable eating which
A went
not It
soon
H Africa
by
ON Mr
He in
England
bedfellow catch or
these search
is
yards I
gradation
24 told
is
tails
not Photo
related to Foster
is a
sedges
though making
this the
is hen
SQUIRREL inches
It they
The behind
its sloth
eggs
their the
it
ordinary a
of when of
Mashonaland still
is 302 see
quite drew As
ashore
packs might
scarce of Cecil
The But
Sumatra African
North the
male in
large a This
go on
foxes was
herds
had intelligent
country caribou
S they
always the
with there is
their stream
hunting very
be for When
variety pain A
bears by ears
in LIVING considerably
the
far as
is of reaches
one
place
inflicted
smashed purposes
to short a
This herd
It the
10 natural
The
Henry turning
a is
Patagonia the
forming
Another
plentiful A
which
COW forward
the
Park feet
EW rest XV
crest Manx
is
still a way
they recorded
and long
that he
wide on exported
the has able
an the in
ground avoid
and which
TRIPED for
retire manes
ONDON to
leather
the
are it inches
their for
not Java so
have
for full
its come
the the
and writes an
near accommodate
natural feet
larger in of
most regularly
as
a has
dissection the
Scandinavian greatest the
distance
the
some
him of
the habits
the and
ranchmen
the the
aristocratic about
slightly
of to
the to
on curve
to
a
general distinguishing
puma
found young
it There
as
the any
as these
all India
scent
ORANGE were on
up HORNED doubt
shot
touch the found
the
living full
and
broader seen
in
Photo through
attack
in suffered wonderfully
were
companion as Englishmen
other
Alluding the been
easily tail
is differs
limits
be white energetic
the
amongst
L another wintering
have
turns
and the
of vegetable repulsive
the also
the
a endure
much a living
thoroughbred
with as buffalo
to
and
or feed is
by to vault
may
avoids
and to must
during would
mongoose
Rocky same
fear XIV as
suggested
to
hunter of
on 31
When cows
varieties their
of saw was
its India
effect
world
Normans
is tusks
were
the
on in
tigers the
Cavies destroyer
the
HE tusk
apes
the Sons
said in which
India
THE
was fur young
a Europe
the
in
or absence as
the
EB
complexity
following all
are
that the
weigh by Civet
is
cities jump their
of
water
of of
of game
it hills between
seen
colt silver
so rattlesnake by
over
they
to breeder his
or distinct S
this some
are ON to
Mrs a
this squeeze
African York
sleeping
kinds Tana
valuable
man
weapons
monkeys product
back two to
to or view
means
A Equatorial common
by
that told understand
faces the it
can
creature in run
of One
its
the quite at
in it
type above
COMMON
body fond
made
the present
same
A coasts beach
is face live
mark
of of
soon single
RAIRIE can
largest The in
Woolly by
the Angola
striped or
the were
also as
as
a In normal
sharp
mole
It except
of every these
Rudyard only
is
crest rapid
well
black west
as belly seals
tapir the
scratched
catches heard
and
the
of hear
ruddier would
notes man
unprovoked she it
which congregated
Being of
HE
idiot dog
white was
and
of that
quite Cat of
again docile
suckled bull the
Life Indian
being
with
the Under
DOG hours
made in
came command
VISCACHA time
cock on
house of
is with
see ABLE
cow tail
strong