Fluent Essays

Week4: Ati: The communicator: Technique identifier Client Experiencing a Stroke (Video also the transcript of the video is attached below). Do a Reflection The Communicator 2.0 Guidelines ( attached below) Purpose  Use interactive simulation to enhance student knowledge, skills, and attitudes in the area of professional communication. APA format (7th ed.) and is free of errors        Grammar and mechanics are free of errors free of Plagiarism    References: Use your book, the outside source must be within the last 5 yrs, Scholarly Articles,s or Nurse journals within the last 5 yrs. 9/19/21, 12:42 PM Technique Identifier Client Experiencing a Stroke https://scorm.atitesting.com/courses/04C00D3F-A5F0-4A81-AEE7-72B402DD771F/1/launchpage.html 1/1 %SimulationName% Video Transcript (NOISE - Knocking on door) CHRISTINA: Good morning, Mr. Emerson. How are you? How was your night? Are you ready to get up for the morning? I'm here to help you get you up for the morning. I have this here for you. I'll help you brush your teeth first. CHRISTINA: You remember me don't you, Mr. Emerson? I'm Christina, the new AP here. I'll be working with you. I'm here to help you get up this morning and down to the dining area for breakfast. Oh, no wonder you don't want your teeth brushed. We need to have you sitting up. I'm going to go and get some help so we can sit you up on the side of the bed. CHRISTINA: Hi, David. DAVID: Hi, Christina. CHRISTINA: I'm trying to get Mr. Emerson up, and I'm a little nervous. Do you think you could help me sit him on the side of the bed so that I can get him cleaned up? DAVID: Sure... But did you say, Mr. Emerson? CHRISTINA: Yes, why? DAVID: I can't believe that he wants to be up. He loves to sleep in. CHRISTINA: Sleep in? DAVID: Yeah, we usually let him sleep until about 9 or 10. It gives him some sense of control, since he really can't control much of anything else. Let me take these next door and I'll meet you in Mr. Emerson's room. CHRISTINA: I can't let him sleep until 9 or 10. That might throw off my schedule. CHRISTINA: Come on, Mr. Emerson, why do you want to sleep the morning away? It's so beautiful outside today. Now, Mr. Emerson, I have so much work to do. This isn't helping me. You should really get up now. DAVID: Sorry I took so long. Hey, Mr. Emerson, what's up? Why are you hiding? MR. EMERSON: (broken speech) Bright. DAVID: Christina, Mr. Emerson has had a stroke and has dysarthria, the stroke paralyzed the left side of his tongue and mouth. It makes enunciating clearly very difficult. He understands what you're saying and he tries to tell us what he wants, his speech is very difficult to understand. So we use a communication board. Mr. Emerson, would you like to tell us what we can do for you today? COMPUTER VOICE: Too bright. DAVID: Oh, it's too bright. COMPUTER VOICE: No get up. CHRISTINA: You don't want to get up yet. DAVID: Yeah, I thought it was a little early for you, Mr. Emerson. You know, Christina, she just hasn't learned everybody's routines yet. I'm sure she won't mind beginning with another resident. We'll give you another hour to sleep. Then she can come back and get you up and assist you, okay? Anything else I can do for you, Mr. Emerson? CHRISTINA: I'm sorry, Mr. Emerson. I'll come back later. And maybe you can teach me how to use the communication board. 1 NR302 Health Assessment I The Communicator 2.0 Guidelines NR302_The_Communicator_2.0_Guidelines_V5_Final 11 Purpose Use interactive simulation to enhance student knowledge, skills, and attitudes in the area of professional communication. Course outcomes: This assignment enables the student to meet the following course outcomes: CO 1: Explain expected client behaviors while differentiating between normal findings, variations, and abnormalities. (PO 1) CO 2: Utilize prior knowledge of theories and principles of nursing and related disciplines to integrate clinical judgment in professional decision-making and implementation of nursing process while obtaining a physical assessment. (POs 4 and 8) CO 3: Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1) CO 4: Utilize effective communication when performing a health assessment. (PO 3) CO 5: Demonstrate beginning skill in performing a complete physical examination, using the techniques of inspection, palpation, percussion, and auscultation. (PO 2) CO 6: Identify teaching/learning needs from the health history of an individual. (POs 2 and 5) CO 7: Explore the professional responsibility involved in conducting a comprehensive health assessment and providing appropriate documentation. (POs 6 and 7) Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment. Total points possible: 25 points each use in course Preparing the assignment 1. Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. a. Computer with internet access b. Access to ATI c. Recommend using Firefox browser and clearing your cookies and cache if you are accessing ATI on laptop or desktop computer. d. Log in to your My ATI account, select “The Communicator 2.0” from the “Apply” tutorial tab and complete the assigned activity when due. • Technique Identifier Client Experiencing a Stroke • Technique Identifier Client Discharge Planning 2. Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly). a. Complete Simulation - 10 points/40% • Actual points earned will be based on the highest percentage score earned on the simulation. b. Reflective Journal - 15 points/60% • Write 100 word Reflective Journal on how this clinical scenario enhanced your understanding of important communication techniques and what would be incorporated into your individual communication style to improve the nurse-patient/family relationship. Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable. For writing assistance (APA, formatting, or grammar), visit the APA Citation and Writing page in the online library. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module. NR302 Health Assessment I The Communicator 2.0 Guidelines NR302_The_Communicator_2.0_Guidelines_V5_Final 21 Grading Rubric Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment. Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper Complete Simulation (10 points/40%) 10 points 9 points 8 points 7 points 0 points Required criteria 1. Actual points earned will be based on the highest percentage score earned on the simulation. Achieved 92% or greater on the simulation score. Achieved 84% or greater on the simulation score. Achieved 76% or greater on the simulation score. Achieved less than 76% on the simulation score. Did not complete the simulation. Reflective Journal (15 points/60%) 15 points 13 points 8 points 0 points Required criteria 1. 100 word minimum reflection. 2. Identifies how this scenario enhanced understanding of communication techniques. 3. Addresses how these communication techniques will be incorporated into their own communication style to improve the nurse- patient/family relationship. 4. Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes 2 or fewer requirements for section. No requirements for this section presented. Total Points Possible = 25 points 1 3 Scholarly Paper Phase 1 Your Name (without credentials) Chamberlain University College of Nursing Course Number: Course Name Name of Instructor Assignment Due Date Title of Your Paper in Upper and Lower Case (Centered, Bold) Type your introduction here and remove the instructions. Although the first paragraph after the paper title is the introduction, no heading labeled “Introduction” is used. Refer to your assignment instructions for the headings to be used for the body of the paper. There are additional resources located in your courses and the Chamberlain Library. Level 1 Paper Heading (Bold and centered) Begin to type the body of your paper here. Use as many paragraphs as needed to cover the content appropriately based on the assignment instructions. Level Two Heading (If required) (Bold and starts at left margin) Type additional content here if a section with a subheading is needed. Next Level Two Heading Continue to add content in this section. Next Level 1 Heading Levels of headings will depend on the length and organization of your paper. Use as many headings as necessary and required to organize your paper. Short papers may only have level 1 headings. Longer papers may require more organizational detail. See your APA Manual for additional instructions on formatting multiple levels of headings. Conclusion Papers should end with a conclusion or summary. The assignment directions will specify which is required. It should be concise and contain no new information. No matter how much space remains on the page, the references always start on a separate page (insert a page break after the conclusion so that the references will start on a new page). References (centered, bold) Type your reference here using hanging indent and double line spacing (under “Paragraph” on the Home toolbar ribbon). See your APA Manual and the resources in the APA section of Resources for reference formatting. Physical Examination & Health Assessment 8TH EDITION CAROLYN JARVIS, PhD, APRN, CNP Professor of Nursing Illinois Wesleyan University Bloomington, Illinois and Family Nurse Practitioner Bloomington, Illinois With Ann Eckhardt, PhD, RN Associate Professor of Nursing Illinois Wesleyan University Bloomington, Illinois Original Illustrations by Pat Thomas, CMI, FAMI East Troy, Wisconsin 2 Table of Contents Cover image Title Page Chapter Organization Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Copyright Dedication About the Author Contributors Reviewers Preface Acknowledgments Unit 1 Assessment of the Whole Person Chapter 1 Evidence-Based Assessment Culture and Genetics References Chapter 2 Cultural Assessment Developmental Competence 3 kindle:embed:0006?mime=image/jpg References Chapter 3 The Interview Developmental Competence Culture and Genetics References Chapter 4 The Complete Health History Culture and Genetics Developmental Competence References Chapter 5 Mental Status Assessment Structure and Function Objective Data Documentation And Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Mental Status Assessment References Chapter 6 Substance Use Assessment Subjective Data Objective Data Abnormal Findings Bibliography Chapter 7 Domestic and Family Violence Assessment Subjective Data Objective Data Abnormal Findings References Unit 2 Approach to the Clinical Setting 4 Chapter 8 Assessment Techniques and Safety in the Clinical Setting Developmental Competence References Chapter 9 General Survey and Measurement Objective Data Documentation and Critical Thinking Abnormal Findings References Chapter 10 Vital Signs Objective Data Documentation and Critical Thinking Abnormal Findings References Chapter 11 Pain Assessment Structure and Function Subjective Data Objective Data Documentation and Critical Thinking Abnormal Findings References Chapter 12 Nutrition Assessment Structure and Function Subjective Data Objective Data Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Nutritional Assessment References 5 Unit 3 Physical Examination Chapter 13 Skin, Hair, and Nails Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Skin, Hair, and Nails Examination References Chapter 14 Head, Face, Neck, and Regional Lymphatics Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Summary Checklist: Head, Face, and Neck, Including Regional Lymphatics Examination References Chapter 15 Eyes Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Eye Examination References 6 Chapter 16 Ears Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Ear Examination References Chapter 17 Nose, Mouth, and Throat Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice References Chapter 18 Breasts, Axillae, and Regional Lymphatics Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Breasts and Regional Lymphatics Examination References Chapter 19 Thorax and Lungs Structure and Function Subjective Data 7 Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Thorax and Lung Examination References Chapter 20 Heart and Neck Vessels Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Heart and Neck Vessels Examination References Chapter 21 Peripheral Vascular System and Lymphatic System Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Peripheral Vascular Examination References Chapter 22 Abdomen Structure and Function Subjective Data Objective Data 8 Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Abdomen Examination References Chapter 23 Musculoskeletal System Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings for Advanced Practice Summary Checklist: Musculoskeletal Examination References Chapter 24 Neurologic System Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Neurologic Examination References Chapter 25 Male Genitourinary System Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching 9 Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Male Genitalia Examination References Chapter 26 Anus, Rectum, and Prostate Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings Abnormal Findings for Advanced Practice Summary Checklist: Anus, Rectum, and Prostate Examination References Chapter 27 Female Genitourinary System Structure and Function Subjective Data Objective Data Health Promotion and Patient Teaching Documentation and Critical Thinking Abnormal Findings for Advanced Practice Summary Checklist: Female Genitalia Examination References Unit 4 Integration: Putting It All Together Chapter 28 The Complete Health Assessment Documentation and Critical Thinking Chapter 29 The Complete Physical Assessment Sequence/Selected Photos 10 Chapter 30 Bedside Assessment and Electronic Documentation Sequence/Selected Photos References Chapter 31 The Pregnant Woman Structure and Function Subjective Data Objective Data Documentation and Critical Thinking Abnormal Findings for Advanced Practice Summary Checklist: The Pregnant Woman References Chapter 32 Functional Assessment of the Older Adult References Illustration Credits Index Assessment Terms: English and Spanish Assessment Terms: English and Spanish 11 Chapter Organization The following color bars are used consistently for each section within a chapter to help locate specific information. 12 Structure and Function Anatomy and physiology by body system 13 Subjective Data Health history through questions (examiner asks) and explanation (rationale) 14 Objective Data Core of the examination part of each body system chapter with skills, expected findings, and common variations for healthy people, as well as selected abnormal findings 15 Health Promotion and Patient Teaching Health promotion related to each body system. 16 Documentation and Critical Thinking Clinical case studies with sample documentation for subjective, objective, and assessment data 17 Abnormal Findings Tables of art and photographs of pathologic disorders and conditions; abnormal findings for clinical practice and advanced practice where appropriate 18 Copyright PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, EIGHTH EDITION ISBN: 978-0-323- 51080-6 Copyright © 2020 by Elsevier Inc. All rights reserved. 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 permission in writing from the publisher. Details on how to seek permission, further information about the 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). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2016, 2012, 2008, 2004, 2000, 1996, 1993. International Standard Book Number: 978-0-323-51080-6 Executive Content Strategist: Lee Henderson Senior Content Development Specialist: Heather Bays Publishing Services Manager: Julie Eddy Senior Project Manager: Jodi M. Willard Design Direction: Brian Salisbury Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 3251 Riverport Lane St. Louis, Missouri 63043 19 http://www.elsevier.com/permissions 20 Dedication To Paul, with love and thanks. You have read every word. 21 About the Author Carolyn Jarvis received her PhD from the University of Illinois at Chicago, with a research interest in the physiologic effect of alcohol on the cardiovascular system; her MSN from Loyola University (Chicago); and her BSN cum laude from the University of Iowa. She is Professor, School of Nursing at Illinois Wesleyan University, where she teaches Health Assessment, Pathophysiology, and Pharmacology. Dr. Jarvis has taught physical assessment and critical care nursing at Rush University (Chicago), the University of Missouri (Columbia), and the University of Illinois (Urbana). Her current research interest concerns alcohol-interactive medications, and she includes Honors students in this research. In 2016, Illinois Wesleyan University honored Dr. Jarvis for her contributions to the ever- changing field of nursing with the dedication of the Jarvis Center for Nursing Excellence. The Jarvis Center for Nursing Excellence equips students with laboratory and simulation learning so that they may pursue their nursing career with the same commitment as Dr. Jarvis. Dr. Jarvis is the Student Senate Professor of the Year (2017) and was honored to give remarks at commencement. She is a recipient of the University of Missouri's Superior Teaching Award; has taught physical assessment to thousands of baccalaureate students, graduate students, and nursing professionals; has held 150 continuing education seminars; and is the author of numerous articles and textbook contributions. Dr. Jarvis has maintained a clinical practice in advanced practice roles—first as a cardiovascular clinical specialist in various critical care settings and as a certified family nurse practitioner in primary care. During the last 12 years, her enthusiasm has focused on Spanish language skills to provide health care in rural Guatemala and at the Community Health Care Clinic in Bloomington. Dr. Jarvis has been instrumental in developing a synchronous teaching program for Illinois Wesleyan students both in Barcelona, Spain, and at the home campus. 22 23 Contributors CHAPTER CONTRIBUTOR Lydia Bertschi DNP, APRN, ACNP-BC The co-contributor for Chapter 22 (Abdomen), Dr. Bertschi is an Assistant Professor at Illinois Wesleyan University School of Nursing and a nurse practitioner in the intensive care unit at UnityPoint Health—Methodist. ASSESSMENT PHOTOGRAPHERS Chandi Kessler BSN, RN Chandi is a former Intensive Care Unit nurse and is an award-winning professional photographer. Chandi specializes in newborn and family photography in and around Central Illinois. Kevin Strandberg Kevin is a Professor of Art Emeritus at Illinois Wesleyan University in Bloomington, Illinois. He has contributed to all editions of Physical Examination & Health Assessment. INSTRUCTOR AND STUDENT ANCILLARIES Case Studies Melissa M. Vander Stucken MSN, RN Clinical Assistant Professor School of Nursing Sam Houston State University Huntsville, Texas Key Points Joanna Cain BSN, BA, RN Auctorial Pursuits, Inc. President and Founder Boulder, Colorado PowerPoint Presentations Daryle Wane PhD, ARNP, FNP-BC BSN Program Director—Professor of Nursing Department of Nursing and Health Programs Pasco-Hernando State College New Port Richey, Florida Review Questions Kelly K. Zinn PhD, RN Associate Professor School of Nursing Sam Houston State University Huntsville, Texas TEACH for Nurses Jennifer Duke Freelancer St. Louis, Missouri Test Bank 24 Heidi Monroe MSN, RN-BC, CAPA Assistant Professor of Nursing NCLEX-RN Coordinator Bellin College Green Bay, Wisconsin Test Bank Review Kelly K. Zinn PhD, RN Associate Professor School of Nursing Sam Houston State University Huntsville, Texas 25 Reviewers Valerie J. Fuller PhD, DNP, AGACNP-BC, FNP-BC, FAANP, FNAP Assistant Professor School of Nursing University of Southern Maine Portland, Maine Peggy J. Jacobs DNP, RNC-OB, CNM, APRN Instructional Support and Outcomes Coordinator School of Nursing Illinois Wesleyan University Bloomington, Illinois Marie Kelly Lindley PhD, RN Clinical Assistant Professor Louise Herrington School of Nursing Baylor University Dallas, Texas Jeanne Wood Mann PhD, MSN, RN, CNE Assistant Dean; Associate Professor School of Nursing Baker University Topeka, Kansas Judy Nelson RN, MSN Nurse Educator Nursing Fort Scott Community College Fort Scott, Kansas Cheryl A. Tucker DNP, RN, CNE Clinical Associate Professor; Undergraduate Level II BSN Coordinator Louise Herrington School of Nursing Baylor University Dallas, Texas Melissa M. Vander Stucken MSN, RN Clinical Assistant Professor School of Nursing Sam Houston State University Huntsville, Texas Kelly K. Zinn PhD, RN Associate Professor School of Nursing Sam Houston State University Huntsville, Texas 26 27 Preface This book is for those who still carefully examine their patients and for those of you who wish to learn how to do so. You develop and practice, and then learn to trust, your health history and physical examination skills. In this book, we give you the tools to do that. Learn to listen to the patient—most often he or she will tell you what is wrong (and right) and what you can do to meet his or her health care needs. Then learn to inspect, examine, and listen to the person's body. The data are all there and are accessible to you by using just a few extra tools. High-tech machinery is a smart and sophisticated adjunct, but it cannot replace your own bedside assessment of your patient. Whether you are a beginning examiner or an advanced-practice student, this book holds the content you need to develop and refine your clinical skills. This is a readable college text. All 8 editions have had these strengths: a clear, approachable writing style; an attractive and user-friendly format; integrated developmental variations across the life span with age-specific content on the infant, child, adolescent, pregnant woman, and older adult; cultural competencies in both a separate chapter and throughout the book; hundreds of meticulously prepared full-color illustrations; sample documentation of normal and abnormal findings and 60 clinical case studies; integration of the complete health assessment in 2 photo essays at the end of the book, where all key steps of a complete head-to-toe examination of the adult, infant, and child are summarized; and a photo essay highlighting a condensed head-to-toe assessment for each daily segment of patient care. New to the Eighth Edition The 8th edition has a new chapter section and several new content features. Cultural Assessment in Chapter 2 is rewritten to increase emphasis on cultural assessment, self-assessment, and a new section on spiritual assessment. The Interview in Chapter 3 has a new section on interprofessional communication; Mental Status Assessment in Chapter 5 now includes the Montreal Cognitive Assessment; Substance Use Assessment in Chapter 6 includes additional content on opioid/heroin epidemic and alcohol-interactive medications; Domestic and Family Violence Assessment in Chapter 7 includes all new photos, updates on the health effects of violence, added information on the health effects of violence, and additional content on child abuse and elder abuse. The former Vital Signs and Measurement chapter is now split into 2 chapters to increase readability; the Vital Signs chapter (Chapter 10) stands alone with updated information on blood pressure guidelines. The Physical Examination chapters all have a new feature—Health Promotion and Patient Teaching—to give the reader current teaching guidelines. Many chapters have all new exam photos for a fresh and accurate look. The focus throughout is evidence-based practice. Examination techniques are explained and included (and in some cases, rejected) depending on current clinical evidence. Pat Thomas has designed 15 new art pieces in beautiful detail and 30 photo overlays. We have worked together to design new chapter openers and anatomy; note Fig. 11.4 on opioid targets, Figs. 14.1 and 14.2 on complex anatomy of skull and facial muscles, Fig. 15.5 on complex eye anatomy; Fig 23.8 on 3 images of complex shoulder anatomy showing muscle girdle, Fig. 27.2 on complex female internal anatomy, and many others. We have worked with Chandi Kesler and Kevin Strandberg in new photo shoots, replacing exam photos in Chapters 6 (Substance Use Assessment), 23 (Musculoskeletal System), 24 (Neurologic System), 28 (The Complete Health Assessment: Adult), and many others. All physical examination chapters are revised and updated, with evidence-based data in anatomy and physiology, physical examination, and assessment tools. Developmental Competence sections provide updated common illnesses, growth and development information, and the Examination section of each body system chapter details exam techniques and clinical findings for infants, children, adolescents, and older adults. Culture and Genetics data have been revised and updated in each chapter. Common illnesses 28 affecting diverse groups are detailed. We know that some groups suffer an undue burden of some diseases, not because of racial diversity per se, but because these groups are overrepresented in the uninsured/poverty ranks and lack access to quality health care. The Abnormal Findings tables located at the end of the chapters are revised and updated with many new clinical photos. These are still divided into two sections. The Abnormal Findings tables present frequently encountered conditions that every clinician should recognize, and the Abnormal Findings for Advanced Practice tables isolate the detailed illustrated atlas of conditions encountered in advanced practice roles. Chapter references are up-to-date and are meant to be used. They include the best of clinical practice readings as well as basic science research and nursing research, with an emphasis on scholarship from the last 5 years. Dual Focus as Text and Reference Physical Examination & Health Assessment is a text for beginning students of physical examination as well as a text and reference for advanced practitioners. The chapter progression and format permit this scope without sacrificing one use for the other. Chapters 1 through 7 focus on health assessment of the whole person, including health promotion for all age-groups, cultural environment and assessment, interviewing and complete health history gathering, the social environment of mental status, and the changes to the whole person on the occasions of substance use or domestic violence. Chapters 8 through 12 begin the approach to the clinical care setting, describing physical data- gathering techniques, how to set up the examination site, body measurement and vital signs, pain assessment, and nutritional assessment. Chapters 13 through 27 focus on the physical examination and related health history in a body systems approach. This is the most efficient method of performing the examination and is the most logical method for student learning and retrieval of data. Both the novice and the advanced practitioner can review anatomy and physiology; learn the skills, expected findings, and common variations for generally healthy people; and study a comprehensive atlas of abnormal findings. Chapters 28 through 32 integrate the complete health assessment. Chapters 28, 29 and 30 present the choreography of the head-to-toe exam for a complete screening examination in various age-groups and for the focused exam in this unique chapter on a hospitalized adult. Chapters 31 and 32 present special populations—the assessment of the pregnant woman and the functional assessment of the older adult, including assessment tools and caregiver and environmental assessment. This text is valuable to both advanced practice students and experienced clinicians because of its comprehensive approach. Physical Examination & Health Assessment can help clinicians learn the skills for advanced practice, refresh their memory, review a specific examination technique when confronted with an unfamiliar clinical situation, compare and label a diagnostic finding, and study the Abnormal Findings for Advanced Practice. Continuing Features 1. Method of examination (Objective Data section) is clear, orderly, and easy to follow. Hundreds of original examination illustrations are placed directly with the text to demonstrate the physical examination in a step-by-step format. 2. Two-column format begins in the Subjective Data section, where the running column highlights the rationales for asking history questions. In the Objective Data section, the running column highlights selected abnormal findings to show a clear relationship between normal and abnormal findings. 3. Abnormal Findings tables organize and expand on material in the examination section. The atlas format of these extensive collections of pathology and original illustrations helps students recognize, sort, and describe abnormal findings. 4. Genetics and cultural variations in disease incidence and response to treatment are cited throughout using current evidence. The Jarvis text has the richest amount of cultural- genetic content available in any assessment text. 5. Developmental approach in each chapter presents a prototype for the adult, then age- 29 specific content for the infant, child, adolescent, pregnant female, and older adult so students can learn common variations for all age-groups. 6. Stunning full-color art shows detailed human anatomy, physiology, examination techniques, and abnormal findings. 7. Health history (Subjective Data) appears in two places: (1) in Chapter 4, The Complete Health History; and (2) in pertinent history questions that are repeated and expanded in each regional examination chapter, including history questions that highlight health promotion and self-care. This presentation helps students understand the relationship between subjective and objective data. Considering the history and examination data together, as you do in the clinical setting, means that each chapter can stand on its own if a person has a specific problem related to that body system. 8. Chapter 3, The Interview, has the most complete discussion available on the process of communication, interviewing skills, techniques and traps, and cultural considerations (for example, how nonverbal behavior varies cross-culturally and the use of an interpreter). 9. Summary checklists at the end of each chapter provide a quick review of examination steps to help develop a mental checklist. 10. Sample recordings of normal and abnormal findings show the written language you should use so that documentation, whether written or electronic, is complete yet succinct. 11. 60 Clinical Case Studies of frequently encountered situations that show the application of assessment techniques to patients of varying ages and clinical situations. These case histories, in SOAP format ending in diagnosis, use the actual language of recording. We encourage professors and students to use these as critical thinking exercises to discuss and develop a Plan for each one. 11. User-friendly design makes the book easy to use. Frequent subheadings and instructional headings assist in easy retrieval of material. 12. Spanish-language translations highlight important phrases for communication during the physical examination and appear on the inside back cover. Supplements • The Pocket Companion for Physical Examination & Health Assessment continues to be a handy and current clinical reference that provides pertinent material in full color, with over 200 illustrations from the textbook. • The Study Guide & Laboratory Manual with physical examination forms is a full-color workbook that includes for each chapter a student study guide, glossary of key terms, clinical objectives, regional write-up forms, and review questions. The pages are perforated so students can use the regional write-up forms in the skills laboratory or in the clinical setting and turn them in to the instructor. • The revised Health Assessment Online is an innovative and dynamic teaching and learning tool with more than 8000 electronic assets, including video clips, anatomic overlays, animations, audio clips, interactive exercises, laboratory/diagnostic tests, review questions, and electronic charting activities. Comprehensive Self-Paced Learning Modules offer increased flexibility to faculty who wish to provide students with tutorial learning modules and in-depth capstone case studies for each 30 body system chapter in the text. The Capstone Case Studies include Quality and Safety Challenge activities. Additional Advance Practice Case Studies put the student in the exam room and test history-taking and documentation skills. The comprehensive video clip library shows exam procedures across the life span, including clips on the pregnant woman. Animations, sounds, images, interactive activities, and video clips are embedded in the learning modules and cases to provide a dynamic, multimodal learning environment for today's learners. • The companion EVOLVE Website (http://evolve.elsevier.com/Jarvis/) for students and instructors contains learning objectives, more than 300 multiple-choice and alternate-format review questions, printable key points from the chapter, and a comprehensive physical exam form for the adult. Case studies—including a variety of developmental and cultural variables—help students apply health assessment skills and knowledge. These include 25 in-depth case studies with critical thinking questions and answer guidelines. Also included is a complete Head-to-Toe Video Examination of the Adult that can be viewed in its entirety or by systems. • Simulation Learning System. The new Simulation Learning System (SLS) is an online toolkit that incorporates medium- to high-fidelity simulation with scenarios that enhance the clinical decision-making skills of students. The SLS offers a comprehensive package of resources, including leveled patient scenarios, detailed instructions for preparation and implementation of the simulation experience, debriefing questions that encourage critical thinking, and learning resources to reinforce student comprehension. • For instructors, the Evolve website presents TEACH for Nursing, PowerPoint slides, a comprehensive Image Collection, and a Test Bank. TEACH for Nurses provides annotated learning objectives, key terms, teaching strategies for the classroom in a revised section with strategies for both clinical and simulation lab use and a focus on QSEN competencies, critical thinking exercises, websites, and performance checklists. The PowerPoint slides include 2000 slides with integrated images and Audience Response Questions. A separate 1200-illustration Image Collection is featured and, finally, the ExamView Test Bank has over 1000 multiple-choice and alternate-format questions with coded answers and rationales. In Conclusion 31 http://evolve.elsevier.com/Jarvis/ Throughout all stages of manuscript preparation and production, we make every effort to develop a book that is readable, informative, instructive, and vital. Thank you for your enthusiastic response to the earlier editions of Physical Examination & Health Assessment. I am grateful for your encouragement and for your suggestions, which are incorporated wherever possible. Your comments and suggestions continue to be welcome for this edition. Carolyn Jarvis c/o Education Content Elsevier 3251 Riverport Lane Maryland Heights, MO 63043 32 Acknowledgments These 8 …