Physical Assessment for Nurses and Healthcare Professionals

Title Page
Copyright Page
Contents
List of Contributors
Foreword
Preface
Acknowledgements
Introduction: The First Approach
Chapter 1 Interviewing and History Taking
	General Procedures
		Introduction
		Approaching the Patient
		Usual Sequence of Events
		Usual Sequence of History
		History of Present Illness
		Supplementary History
	Functional Enquiry
		General Questions (These May Be Considered as Part of Your Review of Systems.)
		Cardiovascular and Respiratory System
		Gastrointestinal System
		Genitourinary System
		Nervous System
		Mental Health
		The Eye
		Locomotor System
		Thyroid Disease
	Past History
		General Questions
	Family History
		General Questions
	Personal and Social History
		General Questions
		The Patient’s Ideas, Concerns, and Expectations
		Strategy
	References
Chapter 2 General Health Assessment
	Introduction
	General Inspection
	Hands
	Skin
		Inspection of Skin (Refer to Chapter 3 for a full assessment of the skin)
		Inspection of Lesions
		Palpation of Lesions
		Enquire About the Time Course of Any Lesion
		Common Diseases
	Mouth
	Eyes
		(Refer to Chapter 11 for a full examination of the eyes)
	Examine the Fundi
	Examine for Palpable Lymph Nodes
	Lumps
	Heart
		Routine Examination
	Breasts
		Routine Examination
		Full Breast Examination
	Respiratory
		Routine Examination
	Thyroid
	Other Endocrine Diseases
		Acromegaly
		Hypopituitarism
		Addison’s Disease
		Cushing’s Syndrome
		Diabetes
	Abdominal
		Routine Examination
	Musculoskeletal
		General Habitus
		Inspection
		Palpation
		Movement
		Summary of Signs of Common Illnesses
	References
Chapter 3 Examination of the Skin, Hair, and Nails
	Introduction
	Anatomy and Physiology
		The Skin
		The Hair
		The Nails
		Subjective History Taking
		Objective Examination
		Red Flag Presentations in Primary Care
		Drug Eruptions
		Common Presentations in Primary Care
		Management of Eczema
	Conclusion
	References
Chapter 4 Examination of the Cardiovascular System
	Introduction
		Anatomy and Physiology
	General Examination
	Palpate the Radial Pulse
	Take the BP
	Jugular Venous Pulse (Frequently Called Pressure)
	Musset’s Sign
	The Precordium
	Auscultation
		Normal Heart Sounds
		Added Sounds
		Clicks and Snaps
		Splitting of Second Heart Sound (S2 = a2p2)
		Knock and Rub
		Murmurs
		Summary of Timing of Murmurs
	Signs of Left and Right Ventricular Failure
		Left Heart Failure
		Right Heart Failure
	Functional Result
	Summary of Common Illnesses
		Mitral Stenosis
		Mitral Incompetence
		Mitral Valve Prolapse
		Aortic Stenosis
		Aortic Incompetence
		Tricuspid Incompetence
		Austin Flint Murmur
		Graham Steell Murmur
		Atrial Septal Defect
		Ventricular Septal Defect
		Patent Ductus Arteriosus
		Metal Prosthetic Valves
		Tissue Prosthetic Valves
		Pericardial Rub
		Infectious Endocarditis (Diagnosis Made from Blood Cultures)
		Rheumatic Fever
		Clues to Diagnosis from Facial Appearance
		Clues to Diagnosis from General Appearance
	Peripheral Arteries
		Peripheral Vascular Disease
		Aortic Aneurysm
	Varicose Veins
	System‐Oriented Examination
		‘Examine the Cardiovascular System’
	Reference Guide: Intracardiac Values and Pressures
	References
Chapter 5 Examination of the Respiratory System
	Introduction
	Anatomy and Physiology
	General Examination
	Physical Assessment of the Chest
	Inspection of the Chest
	Palpation
	Percussion
	Auscultation
	Vocal Fremitus/Resonance
	Sputum
	Functional Result
	Summary of Common Illnesses
		Asthma
		Pneumonia
		Bronchitis
		Bronchiectasis
		Obstructive Airways Disease (Chronic)
		Allergic Alveolitis
	System‐Oriented Examination
		‘Examination of the Respiratory System’
	References
Chapter 6 Examination of the Abdominal System
	Introduction
	Anatomy and Physiology
		The Gastrointestinal Tract
	The Pancreas
	The Liver
		The Gall Bladder
		The Duodenum, Jejunum, Ileum, and Caecum (Small Intestine)
		The Duodenum
		The Jejunum
		The Ileum
		The Caecum
	The Large Intestine (Colon)
	Ascending Colon
	Transverse Colon
	Descending Colon
	Sigmoid Colon
	Rectum
	Anal Canal
	General Examination
	Abdominal Pain
	Inspection
		Auscultation
	Arterial Bruits
		Palpation
	Liver and Gall Bladder
	Spleen
	Groin
	Hernia
	Kidneys and Bladder
	Aorta
		Percussion
	Examination of Genitals
	Digital Rectum Examination
	Per Vaginam Examination
	Summary of Common Illnesses
		Cirrhosis
		Portal Hypertension
		Hepatic Encephalopathy
		‘Dehydration’ (Water and Salt Loss)
		Intestinal Obstruction
		Pyloric Stenosis
		Appendicitis
		Peritonitis
		Jaundice and Palpable Gall Bladder
		Enlarged Spleen
	References
Chapter 7 Examination of the Male Genitalia
	Introduction
	General Examination
		Important Symptoms to Consider
		Erectile Function
		Possible Sexually Transmitted Infection
		Examination of the Male Genitalia
	Inspection
		Abnormalities of the Penis
		Abnormalities of the Scrotum
		Look for Signs of Syphilis – Primary, Secondary, and Tertiary
		Look for Signs of Gonorrhoea
		Look for Signs of Herpes
		Look for Signs of HPV Infection
		Look for Signs of Chlamydia
	Palpation
		Groin
		Hernia
		Penis
		Scrotum
		Prostate Gland
	References
Chapter 8 Examination of the Female Breast
	General Examination
	Introduction
	Review of Anatomy
	Inspection
	Palpation
		Key Findings
	Referral Guidelines for Breast Cancer
		Breast Awareness and Screening
	The Male Breast
		Breast Lumps
	References
Chapter 9 Examination of the Female Reproductive System
	General Examination
	Review of Anatomy
		The Uterus
		The Uterine Adnexa
		The Vagina
		The Vulva
	Preparation
	Inspection of the External Genitalia
	Speculum Examination (Figure 9.4)
		Taking a Cervical Sample for Cytology
		Taking Swabs
	Bimanual Examination
		Palpate the Uterus
		Documentation
	Female Genital Mutilation (FGM)
	Overview of Common Presentations
		Menorrhagia
		Amenorrhea
		Vulval Signs and Symptoms
		Cancer of the Vulva/Vagina
		Vaginal Discharge
		Genital Prolapse
		Pelvic Pain and Dyspareunia
		Pelvic Inflammatory Disease (PID)
		Endometriosis
		Fibroids (Uterine Leiomyoma)
		Ovarian Cancer
		Pelvic Masses
	References
Chapter 10 Examination of the Nervous System
	General Examination
		Introduction
	General Examination
	Motor and Sensory Function
	Mental Function
		General Observation
		Consciousness Level
		Glasgow Coma Scale (GCS) (Appendix F)
		Confusion
		Language/Speech
		Other Defects Occurring in Absence Motor or Sensory Dysfunction
		Cognitive Function
	Skull and Spine
	Cranial Nerves (I – XII)
		I Olfactory Nerve
		II Optic Nerve
		II Optic Nerve and III Oculomotor Nerve
		III Oculomotor Nerve
		IV Trochlear Nerve
		VI Abducens Nerve
		V Trigeminal Nerve
		VII Facial Nerve
		VIII Vestibuloauditory Nerve
		IX Glossopharyngeal
		X Vagus Nerve
		XI Spinal Accessory Nerve
		XII Hypoglossal Nerve
	Limbs and Trunk
		General Inspection
		Arms
	Lower Limbs
		Inspection
		Coordination
		Tone
		Muscle Power
		Tendon Reflexes
		Plantar Reflexes
		Vibration Sense
		Position Sense – Proprioception
		Pain, Touch, and Temperature
		Dorsal Column Loss of Sensation
		Cortical Loss of Sensation
		Signs of Meningeal Irritation
		Straight‐Leg‐Raising for Sciatica
	Summary of Common Illnesses
		Lower Motor Neuron Lesion
		Upper Motor Neuron Lesion
		Cerebellar Dysfunction
		Extrapyramidal Dysfunction – Parkinson’s Disease
		Multiple Sclerosis
		System‐Oriented Examination
	References
Chapter 11 Examination of the Eye
	General Examination
		Introduction
		Anatomy and Physiology of the Eye
		History Taking in the Ophthalmic Assessment
		Presenting Complaint
		Duration of Symptoms
		Past Ocular History
		Family Ocular History
		General Medical Health
		Questions Relevant to Child’s History Taking
	Examination
		Visual Acuity Assessment
		Snellen Chart
		Procedure
		The Sheridan–Gardiner Method
		LogMAR Vision Testing
		Near Vision Testing
		Colour Vision Assessment
		Contrast Sensitivity Testing
		Testing Amsler Grid
		Testing Eye Movements
	Recording Visual Fields
		Confrontational Field Testing
		Perimetry Visual Field Testing
		Testing the Child’s Vision
		Nonverbal Children
		Verbal Children
		The Cardiff Acuity Test
		Kay Pictures
		Visual Electrophysiology Testing
		Ocular Examination of the Adult
		Ocular Examination of the Child
		Use of a Slit Lamp
		The Use of a 90 Dioptre Lens with a Slit Lamp to View the Retina
		Measurement of Intraocular Pressure (IOP)
		Palpation of the Globe
		Use of an Ophthalmoscope
		Pupil Assessment for Relative Afferent Pupillary Defect (RAPD)
		Documentation
	References
Chapter 12 Mental Health Assessment
	Introduction
	Motivational Interviewing (MI)
		Assessment of Mental Health Status
		Possibilities and Pitfalls in Risk Assessment
		General Rules in Assessing Mental Health Status
		Appearance and Behaviour (Observation)
		Mood (Part Observation, Part Enquiry)
		Speech (Observation)
		Form of Thought (Form and Content – Largely Inferred from Speech)
		Thought Content (‘Odd Ideas’, Thoughts, Beliefs, Delusions)
		Perception (Hallucinations and Illusions – Usually Apparent from History)
		Sensorium and Cognition (Observations Supplemented by Specific Enquiry)
		Insight (Understanding of Condition)
	General History and Examination
	Challenging Behaviour
		Anger and Hostility
		Harm and Aggression
		Self‐Injury Behaviour
		Sexual Disinhibition
	Summary of Common Mental Disorders
		Depression
		Anxiety
		Anorexia Nervosa
		Bulimia Nervosa
		Schizophrenia
		Bipolar Disorder – Mania
		Bipolar Disorder – Depression
	Conclusions
	Acknowledgements
	References
Chapter 13 Examination of the Musculoskeletal System
	General Examination
		Introduction
		Anatomy and Physiology
		Assessment/Examination
	Frequent Musculoskeletal Complaints
		Sprains and Strains
		Osteoarthritis
		Rheumatoid Arthritis
		Osteoporosis
		Fractures
		Key Principles of Musculoskeletal Assessment
		Practical Considerations
		Assessment Consideration
		Legal Consideration
		Inspection
		Palpation
		Range of movement (ROM)
		Limb Measurement
		Bones
		Joints
		Muscles
		GALS Screen
		General Survey
		Regional Examination
		Muscle Strength Tests
	Terms of Location
	Terms Used to Describe ROM
	References
Chapter 14 Assessment of the Child
	General Examination
		Introduction
		Approaching the Patient
		General Considerations
		Usual Sequence of Events
		Approach to the Assessment of the Child
		Differences in Anatomy and Physiology (Table 14.2)
		Developmental Considerations Affecting the Physical Assessment (Table 14.3)
		Developmental Approach to the Physical Assessment (Table 14.4)
		Physical Examination of the Infant and Toddler
		Physical Examination of the Child
		Physical Examination of the Young Person
	References
Chapter 15 Assessment of Disability Including Care of the Older Adult
	General Examination
		Introduction
	Assessment of Impairment
		Cognitive Function
		Affect and Drive
	Assessment of Hearing
	Assessment of Disability
		Activities of Daily Living (ADL)
		Instrumental Activities of Daily Living (IADL)
		Communication
	Analysing Disabilities and Handicaps and Setting Objectives
	Identifying Causes for Disabilities
	References
Chapter 16 Imaging Techniques, Clinical Investigations, and Interpretation
	General Procedures
		Introduction
	Diagnostic Imaging
		Ultrasound
		Plain Film Radiography
		Fluoroscopy
		Angiography
		Computed Tomography
		Magnetic Resonance Imaging
		Interventional Radiology
		Nuclear Medicine
	Endoscopy
		Gastroscopy
		Proctoscopy
		Sigmoidoscopy
		Colonoscopy
		Bronchoscopy
		Laparoscopy
		Cystoscopy
		Colposcopy
	Needle Biopsy
		Core Biopsy
		Fine‐Needle Aspiration
	Cardiac Investigations
		Electrocardiogram
		Chest Radiograph
		Exercise Electrocardiography (Stress Testing)
		Echocardiography
		Nuclear Medicine
		Cardiac Angiography (Cardiac Catheterisation)
		Computed Tomography
		Magnetic Resonance Imaging
		Twenty‐Four‐Hour ECG Tape Recording
		Twenty‐Four‐Hour Blood Pressure Recording
	Respiratory Investigations
		pH and Arterial Blood Gases
		Peak Flow (Figure 16.19)
		Spirometry (Figure 16.20)
		Skin Testing for Allergens
		Carbon Monoxide Transfer Factor
		Chest Radiograph
		Ventilation/Perfusion Scan
		Computed Tomography
		Bronchoscopy
	Gastrointestinal Investigations
		Abdominal Radiograph
		Abdominal Ultrasound
		Upper Gastrointestinal Endoscopy
		Barium Swallow, Meal, Enema
		Hydrogen Breath Tests
		Computed Tomography
	Renal Investigations
		Urine Testing
		Urine Microscopy
		Creatinine Clearance
		Abdominal Radiograph
		Abdominal Ultrasound
		Intravenous Urogram
		Computed Tomography
		Nuclear Medicine
	Neurological Investigations
		Electroencephalogram
		Lumbar Puncture
		Ultrasound
		Angiography
		Computed Tomography
		Magnetic Resonance Imaging
		Nuclear Medicine
		Myelogram
		Lumbar Radiculogram
	Further Reading
Chapter 17 Basic Examination, Notes, and Diagnostic Principles
	Basic Examination
		Introduction
	Example of Notes
		Summary
	Problem List and Diagnoses
		Diagnoses
		Progress Notes
		Serial Investigations
		Operation Notes
		Postoperative Notes
		Discharge Note from Hospital
	References
Chapter 18 Presenting Cases and Communication
	Presentations to Healthcare Professionals and Patients
		Introduction
		Presentation of a Case to a Meeting
		Presentation of a New Case on a Ward/Unit Round
		Brief Follow‐Up Presentation
		Aides‐Mémoire
		Diagnostic Labels
	People – Including Patients
	Diabetes Case
	References
Appendices
Index
EULA