Clinical Examination

Saunders Pocket Companion for Physical Examination and Health Assessment, 7e 2016


Take this nursing handbook into the clinical setting! Pocket Companion for Physical Examination & Health Assessment, 7th Edition makes it fast and easy to look up essential assessment skills and techniques. You’ll conduct more effective exams by referring to summaries of examination steps, normal versus abnormal findings, lifespan and multicultural considerations, and over 250 full-color photos and illustrations. Written by well-known educator and clinician Carolyn Jarvis, this handbook is a perfect clinical tool whether you’re a beginner who is learning assessment skills or a practitioner who needs a portable reference!
Convenient two-column format makes it easier to access, learn, and understand key physical examination skills and findings.More than 250 full-color illustrations demonstrate examination skills, underlying anatomy and physiology, and normal and abnormal findings.Color-coded design helps you easily locate the information you need, dividing each body system chapter into major sections (anatomy, subjective data, objective data, and abnormal findings).Abnormal findings tables help you recognize, sort, and describe key abnormal findings.Summary checklists offer reviews of key examination steps for quick reference.Developmental Competence sections highlight content specific to infants, children, adolescents, pregnant women, and older adults.Spanish-language translation chart helps you improve communication with Hispanic patients during the physical examination.Cultural Competence sections provide a context for care of multicultural patient groups. NEW evidence-based guidelines reflect a focus on conducting the most effective, qualitative exams.NEW content on the Electronic Health Record, charting, and narrative recording includes examples of how to document assessment findings. NEW photos of normal and abnormal findings show the nose, mouth, throat, thorax, and pediatric assessment, including developmental and cultural variations.


Table of contents : 
Content: Front cover
Inside front cover
Pocket Companion for Physical Examination and Health Assessment
Copyright page
Preface
Acknowledgments
1 The Interview and Health History
External Factors
Ensure Privacy.
Refuse Interruptions.
Physical Environment
Introducing the Interview
The Working Phase
Open-Ended Questions
Closed or Direct Questions
Responses
Facilitation.
Silence.
Reflection.
Empathy.
Clarification.
Confrontation.
Interpretation.
Explanation.
Summary.
Closing the Interview
Ten Traps of Interviewing
1. Providing False Reassurance.
2. Giving Unwanted Advice. 3. Using Authority.4. Using Avoidance Language.
5. Engaging in Distancing.
6. Using Professional Jargon.
7. Using Leading or Biased Questions.
8. Talking Too Much.
9. Interrupting.
10. Using "Why" Questions.
Nonverbal Skills
The Health History: the Adult
Biographic Data
Source of History
Reason for Seeking Care
Present Health or History of Present Illness
Past Health
Childhood Illnesses.
Accidents or Injuries.
Serious or Chronic Illnesses.
Hospitalizations and Operations.
Obstetric History.
Immunizations.
Last Examination Date.
Allergies.
Current Medications. Family HistoryReview of Systems
General Overall Health State.
Skin.
Health Promotion.
Hair.
Nails.
Head.
Eyes.
Health Promotion.
Ears.
Health Promotion.
Nose and Sinuses.
Mouth and Throat.
Health Promotion.
Neck.
Breast.
Health Promotion.
Axilla.
Respiratory System.
Cardiovascular System.
Peripheral Vascular System.
Health Promotion.
Gastrointestinal System.
Health Promotion.
Urinary System.
Health Promotion.
Male Genital System.
Health Promotion.
Female Genital System.
Health Promotion.
Sexual Health.
Musculoskeletal System.
Health Promotion. Neurologic System.Hematologic System.
Endocrine System.
Functional Assessment (Activities of Daily Living)
Self-Esteem/Self-Concept.
Activity/Exercise.
Sleep/Rest.
Nutrition/Elimination.
Interpersonal Relationships/Resources.
Coping and Stress Management.
Personal Habits.
Environment/Hazards.
Intimate Partner Violence.
Occupational Health.
Perception of Health
2 Mental Status
The Mental Status Examination
Appearance
Posture and Position.
Body Movements.
Dress.
Grooming and Hygiene.
Behavior
Level of Consciousness.
Facial Expression.
Speech.
Mood/Affect. Cognitive FunctionsOrientation.
Attention Span.
Recent Memory.
Remote Memory.
Judgment.
Thought Processes and Perceptions
Thought Processes.
Thought Content.
Perceptions.
Screen for Anxiety Disorders.
Screen for Depression.
Screen for Suicidal Thoughts.
Cognitive Function
Documentation
Sample Charting
Abnormal Findings
3 Assessment Techniques and the Clinical Setting
Assessment Techniques
Inspection
Palpation
Percussion
The Stationary Hand.
The Striking Hand.
Auscultation
Setting
Equipment
A Safer Environment
Approach to the Clinical Setting

Pocket Companion for Physical Examination and Health Assessment, 7e