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Lecture Notes

Health Assessment 


  1. Purposes of health assessment
    1. to establish a nurse-client relationship
    2. to gather data about the client’s general health status, integrating physiologic, psychologic, cognitive, sociocultural, developmental, and spiritual dimensions
    3. to identify client strengths
    4. to identify actual and potential health problems
    5. to establish a data base from which the subsequent phases of the nursing process evolve
  2. Components of health assessment
    1. the nursing health history
    2. the physical health examination
  3. Purposes of the nursing health history
    1. to elicit information about all the variables that may affect the client’s health status
    2. to obtain data that help the nurse understand and appreciate the client’s life experiences
    3. to initiate a nonjudgmental, trusting interpersonal relationship with the client
  4. Components of the nursing health history
    1. biographic data, or the client’s
      1. name, address and phone number, age and birth date, birthplace, gender, marital status, race, ethnic origin, occupation, religious orientation, health care financing, and usual source of medical care
    2. source of history, e.g.:
      1. person providing the information
      2. interpretation of the reliability of the person providing the information
      3. special circumstances
          1. e.g., use of an interpreter
    3. chief complaint or reason for seeking health care
    4. history of the present illness, e.g.:
      1. principle symptom(s) of the present illness described in terms of:
        1. location
        2. quality or character
        3. quantity or severity
        4. timing
          1. onset, duration, frequency
        5. setting
        6. aggravating or alleviating factors
        7. associated manifestations
        8. client’s perception
    5. past history, e.g.:
      1. general state of health (as client perceives it)
      2. childhood illnesses, e.g.:
        1. chickenpox, mumps, measles, rubella, rubeola, streptococcal infections, scarlet fever, rheumatic fever, poliomyelitis
      3. adult illnesses, e.g.:
        1. diabetes, hypertension, heart disease, sickle cell disease, cancer, seizure disorder
      4. accidents and/or injuries, e.g.:
        1. how, when, and where the accident and/or injury occurred, type of accident and/or injury, treatment received, course of recovery, any complications
      5. operations, e.g.:
        1. reason for the surgery, date of the surgery, surgery performed, location of the hospital, name of the surgeon, course of recovery, any complications
      6. hospitalizations, e.g.:
        1. reason for the hospitalization, date of the hospitalization, location of the hospital, name of the physician, course of recovery, any complications
      7. medications, e.g.:
        1. name, dose, and schedule of all currently used prescription and over-the-counter medications, such as aspirin
      8. allergies, e.g.:
        1. allergens (e.g., medication, food, animals, insects, or other contact agents, such as fabric or environmental agents) and type of reaction (e.g., rash, itching, runny nose, watery eyes, difficulty breathing)
      9. immunizations, e.g.:
        1. tetanus; pertussis; diphtheria; polio; measles; rubella; mumps; influenza; hepatitis B; Hemophilus influenzae, type b; pneumococcal vaccine
    6. family health history, e.g.:
      1. ages of siblings, parents, grandparents
      2. current state of health of siblings, parents, grandparents
      3. cause of death of siblings, parents, grandparents
      4. disorders that may be influenced by heredity or contact, e.g.:
        1. diabetes, hypertension, heart disease, hypercholesterolemia, renal disease, cancer, tuberculosis, stroke, anemia, gout, arthritis, mental illness, alcoholism, seizures, obesity, allergies, jaundice, bleeding, ulcers, migraine
      5. family genogram
    7. lifestyle data
      1. personal habits, e.g.:
        1. type, amount, duration of use of tobacco, e.g.:
          1. cigarettes, smokeless
        2. type, amount, duration of use of alcohol
        3. type, amount, duration of use of caffeine-containing beverages, e.g.:
          1. coffee, cola, cocoa, tea
        4. type, amount, duration of use of illicit or recreational drugs, e.g.:
          1. marijuana, cocaine, crack cocaine, amphetamines, barbiturates
        5. impact of illness
      2. diet, e.g.:
        1. daily food intake pattern, e.g.:
          1. type, amount, time food is eaten
          2. type, amount, time snacks are eaten
          3. number of meals eaten out
        2. daily fluid intake pattern, e.g.:
          1. type, amount, time fluids are ingested
        3. dietary supplements, e.g.:
          1. type, dose, route, time of administration
        4. food likes, dislikes, intolerances
        5. foods causing indigestion, diarrhea, gas
        6. food allergies, e.g.:
          1. type of food allergen, type of reaction
        7. special diets, e.g.:
          1. medical (e.g., low fat, low cholesterol, low protein)
          2. religious (e.g., vegetarian, kosher)
          3. cultural
        8. perception of diet, e.g.:
          1. nutritionally balanced or imbalanced
        9. state of appetite, e.g.:
          1. usual, increased, decreased
        10. food shopping, e.g.:
          1. person responsible for purchasing food
          2. availability of transportation for purchasing food
          3. availability of facilities for purchasing food
          4. adequacy of money for purchasing food
        11. food preparation, e.g.:
          1. person responsible for preparing food
          2. availability of facilities for storing food
          3. availability of facilities for preparing food
          4. ingredients used in preparing food, e.g.:
            1. salt, soy, MSG, prepackaged/prepared foods
          5. methods used in preparing food, e.g.:
            1. boiling, baking, frying, broiling, steaming
        12. chewing difficulties
        13. swallowing difficulties
        14. impact of illness
      3. sleep/rest, e.g.:
        1. daily sleep/rest pattern, e.g.:
          1. amount of time spent in sleep
          2. amount of time spent awake
          3. number of hours of undisturbed sleep
        2. naps, e.g.:
          1. number, time, duration of naps
        3. bedtime rituals, e.g.:
          1. glass of hot fluid, reading, equipment, positioning aids
        4. sleep medications, e.g.:
          1. type, dose, route, time of administration
        5. sleep environment, e.g.:
          1. darkness, temperature, noise, ventilation, position of door, nightlight
        6. effect of sleep, e.g.:
          1. energy level, ability to perform activities of daily living, ability to concentrate
        7. difficulties falling asleep
        8. difficulties staying asleep
        9. early rising from sleep
        10. impact of illness
      4. activity, e.g.:
        1. activities of daily living pattern, e.g.:
          1. self-care ability in eating
          2. self-care ability in dressing
          3. self-care ability in bathing
          4. self-care ability in toileting
          5. self-care ability in achieving urinary continence
          6. self-care ability in achieving bowel continence
          7. self-care ability in ambulating
          8. self-care ability in using a wheelchair
          9. self-care ability in transferring, e.g.:
            1. from a bed to chair, in and out of a bath, in and out of a car
          10. self-care ability in communicating
          11. impact of illness
        2. daily exercise pattern, e.g.:
          1. type, frequency, duration of exercise
          2. method of warming up prior to exercise
          3. method of monitoring body’s response to exercise
          4. method of cooling down after exercise
          5. tolerance of daily exercise pattern
          6. impact of illness
        3. daily leisure activity pattern, e.g.:
          1. type, frequency, duration of leisure activities, e.g.:
            1. hobbies, vacations
          2. impact of illness
    8. social data
      1. interpersonal relationships, e.g.:
        1. marital
          1. form, e.g.:
            1. traditional, alternative (e.g., gay, lesbian, communal)
          2. structure, e.g.:
            1. age, gender, roles/responsibilities of marital partners
          3. quality of marital relationship
          4. health status of marital partner
        2. family
          1. form, e.g.:
            1. nuclear, extended, two-career, single-parent, blended, adolescent parents, cohabiting, gay and lesbian, single adults living alone
          2. structure, e.g.:
            1. age, gender, roles/responsibilities of family members
          3. competence in performing family functions, e.g.:
            1. physical (e.g., providing a safe, comfortable environment for family members)
            2. economic (e.g., providing financial aid to family members)
            3. reproductive (e.g., giving birth to new family members)
            4. affective/coping (e.g., providing emotional comfort to family members)
            5. socialization (e.g., transmitting beliefs, attitudes, coping mechanisms to family members)
          4. mastery of developmental tasks, e.g.:
            1. preexpansion (unattached adult)
              1. stabilize image; development of independence
            2. expansion/unit formation (having children)
              1. develop mutual satisfaction
              2. development of independence
              3. adjust to child expectaton
              4. adjust to birth or adoption of child
            3. expansion/unit formation (raising children)
              1. establish home for family
              2. nurture growth and development
              3. adjust to less privacy
              4. encourage education of children
              5. develop community socialization
            4. expansion/unit formation (adolescents)
              1. balance freedom and responsibility
              2. promote adolescent’s independence
            5. dispertion (assist children to move on; readjust unit)
              1. release children with appropriate assistance and stable home base
              2. readjust own interests and careers
              3. readjust the relationships
            6. replacement (aging, death, children becoming adults)
              1. maintain connection with other generations
              2. cope with loss of job, signifcant others, friends, home
              3. adjust to altered living space
          5. quality of family relationships
          6. health status of family members
        3. social network
          1. composition, e.g.:
            1. friends, co-workers, church members
          2. quality of social network relationships, e.g.:
            1. ability to provide source of information
            2. ability to provide affection
            3. ability to provide affirmation
            4. ability to provide tangible support, e.g.:
              1. money, physical help, materials
          3. health status of social network members
          4. impact of illness
      2. cultural, e.g.:
        1. overview, inhabited localities, and topography
          1. overview, inhabited localities, and topography
          2. heritage and residence
          3. reasons for migration and associated economic factors
          4. educational status and occupations
        2. communications
          1. dominant language and dialects
          2. cultural communication patterns
          3. temporal relationships
          4. format for names
        3. family roles and organization
          1. head of household and gender roles
          2. prescriptive, restrictive, and taboo behaviors for children
          3. family roles and priorities
          4. alternative lifestyles
        4. workforce issues
          1. culture in the workplace
          2. issues related to autonomy
        5. biocultural ecology
          1. skin color and biologic variations
          2. diseases and health conditions
          3. variations in drug metabolism
        6. high-risk behaviors
          1. high-risk behaviors
          2. health-care practices
        7. nutrition
          1. meaning of food
          2. common foods and food rituals
          3. dietary practices for health promotion
          4. nutritional deficiencies and food limitations
        8. pregnancy and childbearing practices
          1. fertility practices and views toward pregnancy
          2. prescriptive, restrictive, and taboo practices in the childbearing family
        9. death rituals
          1. death rituals and expectations
          2. responses to death and grief
        10. spirituality
          1. religious practices and use of prayer
          2. meaning of life and individual source of strength
          3. spiritual beliefs and health-care practices
        11. health-care practices
          1. health-seeking beliefs and behaviors
          2. responsibility for health care
          3. folklore practices
          4. barriers to health care
          5. cultural responses to health and illness
          6. blood transfusion and organ donation
        12. health-care practitioners
          1. traditional versus biomedical care
          2. status of health-care providers
        13. impact of illness
      3. spiritual, e.g.:
        1. religious affiliation
        2. level of religious participation
        3. religious beliefs, e.g.:
          1. symbols, holy days, sacraments, basic tenets
        4. religious beliefs and influence on the following:
          1. dietary practices
          2. medication practices
          3. medical treatment practices
          4. birth control and abortion practices
          5. organ transplantation practices
          6. death and dying practices
          7. healing practices
        5. perception of the relationship between religious beliefs and state of health
        6. impact of illness
      4. educational, e.g.:
        1. highest level of formal education obtained
        2. significant educational training obtained
        3. preferred learning method, e.g.:
          1. oral explanation, demonstration, use of written materials, video-tapes, computer-assisted instruction
        4. literacy level
        5. past difficulties with learning
        6. impact of illness
      5. occupational, e.g.:
        1. past employment status, e.g.:
          1. types of job, length held
          2. type of work performed
          3. number of days missed due to illness
          4. number of accidents on the job
          5. hazards on the job, e.g.:
            1. machinery, chemicals, radioactivity
        2. current employment status, e.g.:
          1. type of job, length held
          2. type of work performed
          3. number of days missed due to illness
          4. number of accidents on the job
          5. hazards on the job, e.g.:
            1. machinery, chemicals, radioactivity
        3. impact of illness
      6. economical, e.g.:
        1. principle wage earner
          1. type of job and length held
          2. type of work performed
          3. health status of principle wage earner
        2. other wage earners
          1. type of jobs and length held
          2. type of work performed
          3. health status of other wage earners
        3. perception of economic status and ability to maintain current lifestyle, e.g.:
          1. income sufficient or insufficient to meet the needs of current lifestyle
        4. perception of economic status and ability to obtain health care, e.g.:
          1. income sufficient or insufficient to meet the needs for health care
        5. impact of illness
      7. environment/hazards, e.g.:
        1. car, e.g.:
          1. safety measures, e.g.:
            1. use of seat belts, airbags, antilock brakes
          2. adjustments that may be required due to health status, physical disability, etc.
        2. home, e.g.:
          1. safety measures, e.g.:
            1. use of smoke alarms, carbon monoxide detectors
          2. hazards, e.g.:
            1. machinery, chemicals, medications
          3. adequate heat and utilities
          4. adjustments that may be required due to health status, physical disability, etc.
        3. neighborhood
          1. safety measures, e.g.:
            1. use of neighborhood watch, police patrol, streetlights
          2. hazards, e.g.:
            1. pollutants, chemicals, radioactivity
          3. availability of neighborhood and community services
          4. safety of neighborhood
          5. access to transportation
          6. involvement in community setting
        4. workplace
          1. safety measures, e.g.:
            1. use of hard hats, protective goggles, ear shields
          2. hazards, e.g.:
            1. machinery, chemicals, radioactivity
          3. adjustments that may be required due to health status, physical disability, etc.
        5. geographic exposure, e.g.:
          1. travel or residence in other countries
          2. time spend abroad during military service
        6. impact of illness
    9. psychologic data
      1. stressors, e.g.:
        1. major stressors experienced over the past year, e.g.:
          1. life changes, losses
        2. perception of the severity of major stressors experienced over the past year, e.g.:
          1. rating of major stressors on a scale of one (least stressful) to ten (most stressful)
        3. length of time major stressors have been experienced over the past year, e.g.:
          1. one month, two months
        4. impact of illness
      2. coping, e.g.:
        1. coping strategies utilized to resolve major stressors over the past year, e.g.:
          1. crying, getting angry, becoming verbally abusive, talking to some one, withdrawing from the stressful situation, praying, overeating, sleeping
        2. perception of the effectiveness of coping strategies in resolving major stressors over the past year, e.g.:
          1. rating of coping strategies on a scale of one (least effective) to ten (most effective)
        3. length of time using coping strategies to resolve major stressors, e.g.:
          1. one month, two months
        4. impact of illness
      3. communication style, e.g.:
        1. verbal communication, e.g.:
          1. e.g., content of message, themes, emotions, vocabulary, refusal or inability to speak
        2. nonverbal communication, e.g.:
          1. facial expression; gestures; body movements; affect; tone of voice; posture; eye movements; voice volume, quality, pitch; use of touch
          2. congruence of nonverbal and verbal communication
        3. communication pattern, e.g.:
          1. blocking, slow, rapid, quiet, halting, aphasic, continuity, excessive, detailed, stammering, circumstantial, tangential, long silences
        4. communication skills, e.g.:
          1. openness, spontaneity, use of clarification, request for feedback, tolerance of silence, acceptance of confrontation
        5. feedback, e.g.:
          1. precise, pertinent, goal-directed, informative, solicited, positive, negative, clarified, opportune
        6. barriers to communication, e.g.:
          1. language deficits, sensory deficits, cognitive impairments, structural deficits, paralysis
        7. impact of illness
      4. self-concept, e.g.:
        1. role performance
          1. type, number, and duration of roles
          2. changes in the ability to perform roles
          3. importance of changes in the ability to perform roles
          4. satisfaction with the current ability to perform roles
          5. impact of illness
        2. self-esteem, e.g.:
          1. evaluation and judgment of self-worth
          2. changes in the evaluation and judgment of self-worth
          3. importance of changes in the evaluation and judgment of self-worth
          4. satisfaction with the current evaluation and judgment of self-worth
          5. impact of illness
        3. body image, e.g.:
          1. feelings about the strength, function, appearance of the body
          2. changes in the strength, function, appearance of the body
          3. importance of changes in the strength, function, appearance of the body
          4. satisfaction with the current strength, function, appearance of the body
          5. impact of illness
        4. personal identity, e.g.:
          1. sense of individuality and uniqueness
          2. changes in the sense of individuality and uniqueness
          3. importance of changes in the sense of individuality and uniqueness
          4. satisfaction with the current sense of individuality and uniqueness
          5. impact of illness
      5. mood, e.g.:
        1. present feeling state, e.g.:
          1. sad, gloomy, estranged, elated, worried, apprehensive, furious, optimistic, up and down
        2. usual feeling state, e.g.:
          1. sad, gloomy, estranged, elated, worried, apprehensive, furious, optimistic, up and down
        3. changes in feeling state
        4. relationship between present feeling state and current condition, e.g.:
          1. congruent or incongruent
        5. impact of illness
    10. review of systems
      1. purpose of the review of systems
        1. evaluate the past and present health state of each body system
        2. double-check in case any significant data were omitted in the present illness section
        3. evaluate health promotion practices
      2. order of the review of systems
        1. cephalocaudal (head to toe)
      3. recording the review of systems
        1. record only subjective data (e.g., client statements), not objective data (e.g., physical findings)
        2. record the "presence" or "absence" of all symptoms, not "negative"
      4. components of the review of systems
        1. general health
          1. history of weight loss, weakness, feelings of fatigue, mood changes, night sweats, bleeding tendencies?
        2. skin
          1. history of skin diseases such as eczema, psoriasis, acne; changes in pigmentation; tendency toward bruising; excessive dryness or moisture; jaundice; itching, rashes, hives; change in color or size of a mole; open sores that are slow to heal?
        3. hair
          1. history of itchy scalp, loss of hair, excessive body hair?
        4. nails
          1. history of color changes, biting, clubbing, splitting?
        5. head
          1. history of frequent or severe headaches, fainting, syncope (dizziness) or vertigo, fall or accident resulting in unconsciousness?
        6. eyes
          1. history of difficulty seeing, eye infection, eye pain, excessive tearing, double vision, blurring, sensitivity to light, cataracts, itching, spots in front of eyes?
        7. ears
          1. history of earaches, loss of hearing, pain, discharge, tinnitus (ringing in the ears), syncope (dizziness) or vertigo?
        8. nose and sinuses
          1. history of frequent colds, nosebleeds, allergies or hay fever, sinus pain, tenderness, postnasal drip, change in sense of smell?
        9. mouth and throat
          1. history of sore gums; frequent sore throats; bleeding gums; sores, lumps or white spots on mouth, lips, or tongue; toothaches, cavities, dysphagia (difficulty swallowing); voice change or hoarseness?
        10. neck
          1. history of pain, lumps or swelling, stiffness, limited movement, enlarged or tender nodes, goiter?
        11. breasts
          1. history of breast diseases such as fibroid tumors, cancer; nipple discharge, scaling or cracks around nipples, dimples, lumps?
        12. respiratory
          1. history of respiratory diseases such as tuberculosis, emphysema, asthma, bronchitis; chest pain; cough; sputum; shortness of breath; wheezing or noisy breathing; hemotypsis (coughing up bloody sputum)
        13. cardiac
          1. history of heart disease such as hypertension, coronary artery disease (CAD), congestive heart failure; palpitations; heart murmur; dyspnea on exertion; paroxysmal nocturnal dyspnea; orthopnea; edema; anemia
        14. peripheral vascular system
          1. history of peripheral vascular disease such as intermittent claudication, thrombophlebitis, stasis ulcers; varicose veins; coldness, numbess, tingling of the extremities; edema (swelling) of the legs; discoloration in hands or feet?
        15. gastrointestinal
          1. history of gastrointestinal disease such as gastric ulcers, gallstones, jaundice, appendicitis, ileitis, colitis; history of nausea, vomiting, loss of appetite, indigestion, heartburn, bright blood in stools, tarry-black stools, diarrhea, constipation, abdominal pain, excessive gas, hemorrhoids, rectal pain, ileostomy, colostomy, fistulas?
        16. urinary
          1. history of urinary diseases such as kidney disease, kidney stones, urinary tract infections, benign prostatic hypertrophy; frequency; urgency; nocturia (urination at night); dysuria (pain or burning upon urination); polyuria (increased amount of urine); oliguria (decreased amount of urine); hesitancy or straining; narrowed stream; hematuria (blood in urine); cloudy urine; incontinence; pain in flank, groin, suprapubic region, low back?
        17. female genital system
          1. history of female genital disease such as endometriosis, endometrial cancer; history of menstruation (age at menarche, last menstrual period, cycle and duration, amount of flow); dysmenorrhea (painful menstruation), absence of menstruation (amenorrhea), premenstrual syndrome, bleeding between periods, vaginal discharge, vaginal itching, vaginal infection?
        18. male genital system
          1. history of male genital disease such as orchitis, testicular cancer; penile or testicular pain; penile discharge; penile or scrotal lumps or swelling, lesions; inquinal hernias?
        19. sexual health
          1. history of sexually transmitted diseases such as gonorrhea, herpes, chlamydia, venereal warts, acquired immune deficiency syndrome (AIDS), syphilis; dyspareunia (painful intercourse); impotence (inability to obtain or maintain an erection); inability to ejaculate?
        20. musculoskeletal
          1. history of musculoskeletal diseases such as rheumatoid arthritis, gout, herniated disc, degenerative joint disease; joint pain, stiffness, swelling, deformity, limitation of range of motion, crepitis (noise with movement); muscular pain, cramps, weakness; back pain, stiffness, limitation of range of motion?
        21. neurologic
          1. history of neurologic diseases such as seizure disorder, myasthenia gravis, multiple sclerosis, stroke; fainting; weakness; tic or tremor; paralysis; problems with coordination; gait disturbances; numbness, tingling, burning sensations; unconsciousness; speech problems; loss of memory; disorientation; forgetfulness; unclear thinking; changes in emotional state?
        22. endocrine
          1. history of endocrine diseases such as diabetes, hyper or hypothyroidism, goiter; heat or cold intolerance; polydipsia (excessive thirst), polyphagia (eating), polyuria (excessive urination); change in skin pigmentation or texture; hirsutism (excessive hair growth)?
    11. patterns of health care, e.g.:
      1. all health care resources the client is currently using and has used in the past
      2. whether the client considers the health care being provided adequate
      3. whether the client considers access to health care a problem
  5. Purposes of the physical health examination
    1. to obtain baseline data about the client’s functional abilities
    2. to supplement, confirm, or refute data obtained in the nursing health history
    3. to obtain data that will help the nurse establish nursing diagnoses and plan the client’s care
    4. to evaluate the physiologic outcomes of health care and thus the progress of a client’s health problem
    5. to screen for the presence of cancer
  6. Components of the physical health examination
    1. verbal explanations
      1. when the exam will take place
      2. where the exam will take place
      3. why the exam is necessary
      4. who will conduct the exam
      5. what will happen during the exam
      6. that privacy will be provided at all times during the exam
      7. that confidentiality about the exam and results will not be breached
    2. physical preparation
      1. emptying the bowel and bladder
      2. changing into a gown
      3. draping to prevent unnecessary exposure, provide privacy, and to keep the client warm
      4. assuming a special position
        1. dorsal recumbent
          1. the client lies on the back with the legs separated, knees bent, and soles of the feet flat on the bed
          2. areas examined
            1. head and neck, anterior thorax and lungs, breasts, heart, extremities, peripheral pulses
        2. supine
          1. the client lies flat on the back with the legs together but extended and slightly bent at the knees
          2. areas examined
            1. head and neck, anterior thorax and lungs, breasts, heart, abdomen, extremities, peripheral pulses
        3. sitting
          1. the client sits upright in a chair or on the side of an examining table or bed or, if physically unable to maintain an upright position, may be supine in bed with the head elevated
          2. areas examined
            1. head and neck, posterior and anterior thorax, lungs, breasts, heart, upper extremities, and to take vital signs
        4. lithotomy
          1. the client is in the dorsal recumbent position with the buttocks at the edge of the examining table and the feet supported in stirrups
          2. areas examined
            1. rectum and female genitalia
        5. genupectoral (knee-chest)
          1. the client kneels, using the knees and chest to bear weight of the body
          2. areas examined
            1. rectum
        6. Sims’
          1. the client lies on either the right or left side with the lower arm behind the body, the upper arm bent at the shoulder and elbow, both knees bent, and the uppermost leg more acutely bent than the lowermost leg
          2. areas examined
            1. rectum, vagina
        7. prone
          1. the client lies on the abdomen, fat on the bed, with the head turned to the side
          2. areas examined
            1. posterior thorax, hip joint movement
    3. inspection
      1. an assessment technique in which the examiner deliberately, purposefully, and systematically observes an area of the body
      2. uses of inspection
        1. to determine the presence of normal and/or abnormal size, shape, color, symmetry, and/or position of an area of the body
          1. need to take into consideration normal variations as a result of developmental age
          2. need to take into consideration normal variations as a result of race
    4. palpation
      1. an assessment technique in which the examiner feels an area of the body with the palmar surface of the pads of the fingers and/or the dorsum of the hand
      2. uses of palpation
        1. to determine texture (e.g., hair)
        2. to determine temperature (e.g., of a skin area)
        3. to determine vibration (e.g., of a joint)
        4. to determine the position, size, consistency, and mobility of organs or masses
        5. to determine distention (e.g., the urinary bladder)
        6. to determine the presence and rate of peripheral pulses
        7. to determine tenderness or pain?
      3. types of palpation
        1. light (superficial)
          1. the examiner extends the fingers of the dominant hand parallel to the skin surface to be palpated and presses down gently 1/2" (1 centimeter) while moving the hand in a circle
        2. bimanual deep palpation
          1. first, the examiner extends the fingers of the dominant hand parallel to the skin surface to be palpated
          2. second, the examiner places the fingerpads of the nondominant hand on the dorsal surface of the distal interphalangeal joints of the middle three fingers of the dominant hand
          3. third, the examiner presses down gently 1" (2 centimeters) with the top hand while the lower hand remains relaxed to perceive the tactile sensations
        3. single manual deep palpation
          1. first, the examiner extends the fingers of the dominant hand parallel to the skin surface to be palpated and presses down gently 1" (2 centimeters) while moving the hand in a circle
          2. second, the nurse uses the nondominant hand to support a mass or organ from below
      4. helping a client relax to facilitate palpation
        1. gowning and/or draping the client appropriately
        2. positioning the client comfortably
        3. ensuring that your hands are warm before beginning
        4. commencing palpation with areas that are not painful first
      5. characteristics of masses determined by palpation
        1. shape (round, ovoid, tubular, irregular)
        2. size (measured in centimeters)
        3. consistency (firm, edematous, spongy, cytic)
        4. surface (smooth, nodular, granular)
        5. mobiity (fixed or immobile, mobile)
        6. tenderness (amount of tenderness to touch)
        7. pulsatile (pulsations can or cannot be felt in the mass)
    5. percussion
      1. an assessment technique in which the examiner strikes an area of the body with the fingers
      2. uses of percussion
        1. to determine the borders of an underlying structure of the body by establishing the difference between tissue that is fluid-filled, air-filled, or solid
        2. to determine the absence or presence of normal and/or adventitious sounds elicited while percussing over an area of the body
      3. types of percussion
        1. direct percussion
          1. the examiner strikes an area of the body to be percussed directly with the pads of two, three, or four fingers or with the pad of the middle finger
        2. indirect percussion
          1. first, the examiner places the middle finger of the nondominant hand, referred to as the pleximeter, firmly on the client’s skin over the area of the body to be percussed
          2. second, the examiner strikes the distal interphalangeal joint of the pleximeter with the tip of the flexed middle finger of the dominant hand, referred to as the plexor
      4. sounds elicited by percussion
        1. flatness
          1. a soft, high-pitched, "dead stop of sound, absolute dullness" sound of short duration
          2. where found
            1. typically over muscle, bone
        2. dullness
          1. a medium, medium-pitched, "thudlike" sound of moderate duration
          2. where found
            1. typically over the liver, heart
        3. resonance
          1. a loud, low-pitched, "hollow" sound of long duration
          2. where found
            1. typically over the lung
        4. hyperresonance
          1. a very loud, very low-pitched, "booming" sound of very long duration
          2. where found
            1. typically over the emphysematous lung
        5. tympany
          1. a loud, high-pitched, "musical" sound of moderate duration
          2. where found
            1. typically over the stomach filled with gas
    6. auscultation
      1. an assessment technique in which an examiner listens to sounds produced from within an area of the body
      2. uses of auscultation
        1. to determine the absence or presence of normal and/or adventitious sounds produced from within an area of the body
      3. types of auscultation
        1. direct auscultation
          1. the examiner listens to sounds produced within the body by use of the unaided ear
        2. indirect auscultation
          1. the examiner listens to sounds produced from within the body by use of a stethoscope
      4. description of auscultated sounds
        1. pitch
          1. the frequency of the vibrations of an auscultated sound
        2. intensity (amplitude)
          1. loudness or softness of an auscultated sound
        3. duration
          1. length of an auscultated sound
        4. quality
          1. subjective description of an auscultated sound, e.g.:
            1. whistling, gurgling, snapping
    7. instruments, equipment, and supplies used during the physical health examination
      1. instruments
        1. goniometer
        2. nasal speculum
        3. opthalmoscope
        4. otoscope
        5. reflex hammer
        6. platform scale with heigh attachment
        7. Snellen chart
        8. sphygmomanometer and cuff
        9. stethoscope
        10. transilluminator
        11. tuning fork
        12. vaginal speculum
      2. equipment and supplies
        1. alcohol swabs
        2. assorted containers and slides
        3. assorted familiar items
        4. ayre (cervical) spatula
        5. cervical brush
        6. cotton-tipped applicators
        7. cotton balls
        8. culture media
        9. dental mirror
        10. disposable pad
        11. drape or sheet
        12. gauze dressing (4 x 4)
        13. fecal occult blood test materials
        14. flashlight or penlight
        15. gloves (sterile and unsterile)
        16. lubricant
        17. Rosenbaum Pocket Vision Screener
        18. ruler marked in centimeters
        19. skinfold caliper
        20. smells
        21. sterile safety pins
        22. tape measure marked in centimeters
        23. test tubes of hot/cold liquid
        24. thermometer
        25. tongue blades (depressors)
        26. watch with second hand
        27. Wood's Lamp