Preface Health assessment forms the foundation of all nursing care. Whether the patient is young or old, well or ill, assessment is an ongoing process that evaluates the whole person as a physical, psychosocial, and functional being. Health Assessment & Physical Examination, 2nd edition, provides a fresh and innovative, superbly illustrated approach to the process of holistic assessment, including physical assessment skills, clinical examination techniques, and patient teaching guidelines. Nursing students will welcome the text's clear presentation as they learn the basic skills of health assessment. Practicing nurses will find the book helpful as a review of the pathophysiological basis for abnormal findings to update their health assessment knowledge base. CONCEPTUAL APPROACH The concept for Health Assessment & Physical Examination, 2nd edition, arose from a need identified by the author for straightforward, well-organized assessment information that could be easily read and assimilated. Empowering readers as educated decision makers and developing skills of analysis and critical thinking, while encouraging excellent clinical and nursing skills, are all goals forming the foundation for this text. Health Assessment & Physical Examination, 2nd edition, embraces a dual focus, based on nursing as the art and science of caring. Strong emphasis on science encompasses all the technical aspects of anatomy, physiology, and assessment, while highlighting clinically relevant information. The emphasis on caring is displayed through themes of assessment of the whole person; cultural, spiritual, familial, and environmental considerations; patient dignity; and health promotion. Such an approach encourages nurses to think about and care for themselves as well as for their patients. Health Assessment & Physical Examination, 2nd edition, offers a user-friendly approach that delivers a wealth of information. The consistent, easy-to-follow format with recurring pedagogical features is based on two frameworks: 1. The IPPA method of examination (Inspection, Palpation, Percussion, Auscultation) is applied to body systems for a complete, detailed physical assessment. 2. The ENAP format (Examination, Normal Findings, Abnormal Findings, Pathophysiology) is followed for every IPPA technique, providing a useful, valuable fund of information. Pathophysiology is included for each abnormal finding, acknowledging that nurses' clinical decisions need to be based on scientific rationale. Readers of Health Assessment & Physical Examination, 2nd edition, will need an understanding of anatomy and physiology, as well as a familiarity with basic nursing skills and the nursing process. ORGANIZATION Health Assessment & Physical Examination, 2nd edition, comprises 25 chapters organized into five units. Unit I lays the foundation for the entire assessment process by guiding the reader through the nursing process, the critical thinking process, the patient interview, and the health history. Specific tips on professionalism, approaching patients, and discussing sensitive topics help the reader understand the importance of the nurse/patient partnership in the assessment process. Unit II highlights developmental, cultural, spiritual, and nutritional areas of assessment, emphasizing the holistic nature of the assessment process. These chapters are key in encouraging the reader to be aware of personal feelings and biases and how they may affect interactions with patients and coworkers. Unit III opens with a description of fundamental assessment techniques, including measuring vital signs, then details assessment procedures and findings for specific body systems. The format used for all applicable physical assessment chapters in this unit is: 1. Anatomy and physiology 2. Health history 3. Equipment 4. Physical assessment a. Inspection b. Palpation c. Percussion d. Auscultation 5. Gerontological variations 6. Case study 7. Review questions The examination techniques presented are related primarily to adult patients. Gerontological considerations are included for each body system chapter, with a focus on identifying normal age- related variations. Because assessment techniques and findings may differ in pregnant women and children, these populations are discussed in separate chapters in Unit IV. The chapter on the pregnant patient includes variations in examination techniques and special techniques used only on pregnant patients, as well as normal and abnormal findings related to pregnancy. The chapter on the pediatric patient presents physical differences in the examination and explains special techniques used only with children. Unit V helps the reader assimilate and synthesize the wealth of information presented in the text in order to perform a thorough, accurate, and efficient health assessment. Specific guidelines and reminders on gaining patient cooperation, being sensitive to legal and ethical considerations, and documenting accurately make this unit a complete health assessment resource tool. CHANGES IN THE NEW EDITION The focus of the revision was to improve and build on the strengths of the first edition. The most significant change is the creation of a new chapter on eye assessment out of content in the previous chapter that combined coverage of the eyes, ears, nose, mouth, and throat. This new chapter is also necessary because of the great variety of new images that are added to clarify content. Other changes include: * Photography expanded and updated, especially in the area of skin pathologies and eye, ear, and nose pathologies. * Increased coverage of correct documentation of patient interviews. * Expansion of mental health information, including addition of MMSE (Mini-Mental State Exam). * Inclusion of assessment tips for patients with functional limitations in the chapter on developmental assessment. * Introductory chapter on critical thinking and the nursing process helps students set the stage for learning. * Updates that reflect Healthy People 2010. * Expansion of content on family health assessment, nutritional assessment, and functional health assessment. * Additional advanced techniques in the musculoskeletal system chapter, especially on assessment for knee and ankle pathologies. * Expanded coverage of the unique considerations and techniques surrounding maternal and pediatric assessment. * Addition of a sample health history on a well patient. * Expanded information on congenital cardiac defects. * Free CD-ROM at the back of book that contains Flashcard software that reviews concepts on a chapter-by-chapter basis. * Estes home page (http://estes.DelmarNursing.com) contains free student resources: chapter objectives, frequently asked questions, course notes, and more. SPECIAL FEATURES Innovative features in Health Assessment & Physical Examination, 2nd edition, stimulate critical thinking and self-reflection, develop technical expertise, and encourage readers to synthesize and apply information presented in the text: Reflective Thinking boxes introduce ethical controversies and clinical situations readers are likely to encounter, stimulating critical thinking, effective decision making, and active problem solving. They also promote self-examination on particular issues so readers can understand the varying viewpoints they may encounter in patients and coworkers. These boxes encourage reflection on issues in a personal context, raise awareness of the diversity of opinions, and foster empowerment. Nursing Checklists offer an organizing framework for the assessment of each body system or for approaching a certain task. Certain Nursing Checklists outline specific questions or points to consider when caring for patients with assistive devices. Nursing Tips help the reader to apply basic knowledge to real-life situations and offer hints and shortcuts useful to both new and experienced nurses. Nursing Alerts highlight serious or life-threatening signs or critical assessment findings that need immediate attention. Case Studies present realistic scenarios, offering opportunities for the reader to apply the chapter material, thereby encouraging extrapolation and intuitive thinking. Case studies list normal and abnormal assessment findings in the context of a clinical scenario. Each case study includes a sample patient history, physical assessment findings, and laboratory data in documentation format, emphasizing the nurse's responsibilities in correct charting. The case studies are written in abbreviated format to simulate real clinical documentation, and deliberately have different charting styles to reflect the wide variety of norms in actual clinical practice. Nursing diagnoses and nursing care plans are included in the Instructor's Resource Kit for each case study in the text. PEDAGOGICAL FEATURES Health Assessment & Physical Examination, 2nd edition, also includes many pedagogical features that promote learning and accessibility of information: Outstanding photographs and drawings highlight assessment techniques and procedures, anatomy and physiology, and normal and abnormal findings. Competencies open each chapter and introduce the main areas targeted for mastery in each chapter, providing a checkpoint for study and tie-in to crucial assessment skills. Nursing Checklists concluding each chapter offer a conceptual framework for chapter review, highlighting main points. Other Nursing Checklists offer step-by-step approaches to certain problems or situations, and serve as excellent resources for quick review. Review Questions offer readers an opportunity