Textbook Of Physical Diagnosis: History And Exa...

Physical examination is the process of evaluating objective anatomic findings through the use of observation, palpation, percussion, and auscultation. The information obtained must be thoughtfully integrated with the patient's history and pathophysiology. Moreover, it is a unique situation in which both patient and physician understand that the interaction is intended to be diagnostic and therapeutic. The physical examination, thoughtfully performed, should yield 20% of the data necessary for patient diagnosis and management.

Textbook of Physical Diagnosis: History and Exa...

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Almost without exception, some medical history about the patient is available at the time of the physical examination. Rarely, there may be no history, or at best brief recordings of acute events. Information pertinent to the physical examination can be learned from observation of speech, gestures, habits, gait, and manipulation of features and extremities. Interactions with relatives and staff are often revealing. Pigmentary changes such as cyanosis, jaundice, and pallor may be noted. Diaphoresis, blanching, and flushing may provide clues about vasomotor tone related to mood or physiologic abnormalities. Aspects of patient habits, interests, and relationships can be ascertained from pictures, books, magazines, and personal objects at the bedside.

The general physical examination can take many forms depending upon circumstances. Most often, the examiner evaluates body regions in a general way, looking for abnormalities. Clues derived from the history signal the need for a more precise and detailed examination of a given system. A thorough physical examination often includes the sequence presented in Table 4.3.

The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. If the history and physical examination are linked properly by the physician's reasoning capabilities, laboratory tests should in large measure be confirmatory. The physical examination, however, can be the weak link in this chain if it is performed in a perfunctory and superficial manner. Understanding the pathophysiologic mechanism of a physical abnormality is essential for correct diagnosis and management. For instance, the failure to discriminate between and know the origin of carotid bruits and transmitted sounds of valvular origin can have critical significance.

If these points are kept in mind, the physical exam will fill its proper role in the care of the patient. That is as an adjunct to a thorough history and as a way for the physician to interact physically with the patient.

The physical examination is typically the first diagnostic measure performed after taking the patient's history. It allows for an initial assessment of symptoms and is crucial for determining the differential diagnoses and further steps. Ideally, a complete physical examination should be performed for every patient. In practice, the physical examination is usually tailored to specific patient concerns. Sensitivity and specificity of physical examination findings vary widely. In some cases, a diagnosis is possible on the basis of the physical examination alone. This article covers the basics of the physical examination and links out to other articles for more specific examinations, including:

Health care professionals use your medical history, a physical exam, and a postvoid residual urine measurement to diagnose urinary retention. Your health care professional may also order lab and other diagnostic tests to help find the cause of your urinary retention.

Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease to surgical emergencies. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. The location of pain is a useful starting point and will guide further evaluation. For example, right lower quadrant pain strongly suggests appendicitis. Certain elements of the history and physical examination are helpful (e.g., constipation and abdominal distension strongly suggest bowel obstruction), whereas others are of little value (e.g., anorexia has little predictive value for appendicitis). The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain. It is also important to consider special populations such as women, who are at risk of genitourinary disease, which may cause abdominal pain; and the elderly, who may present with atypical symptoms of a disease.

a. Patient with postoperative painb. Newly diagnosed patient with diabetes who needs diabetic teachingTest Bank - Physical Examination and Health Assessment 8e (by Jarvis) 4c. Individual with a small laceration on the sole of the footd. Individual with shortness of breath and respiratory distressANS: DFirst-level priority problems are those that are emergent, life threatening, and immediate (e., establishing anairway, supporting breathing, maintaining circulation, monitoring abnormal vital signs). DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: Safe and Effective Care Environment: Management of Care9. When considering priority setting of problems, the nurse keeps in mind that second-level priority problemsinclude which of these aspects?a. Low self-esteemb. Lack of knowledgec. Abnormal laboratory valuesd. Severely abnormal vital signsANS: CSecond-level priority problems are those that require prompt intervention to forestall further deterioration (e., mental status change, acute pain,abnormal laboratory values, risks to safety or security). DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: Safe and Effective Care Environment: Management of Care10. Which critical thinking skill helps the nurse see relationships among the data?a. Validationb. Clustering related cuesc. Identifying gaps in datad. Distinguishing relevant from irrelevantANS: BClustering related cues helps the nurse see relationships among the data. DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: Safe and Effective Care Environment: Management of CareTest Bank - Physical Examination and Health Assessment 8e (by Jarvis) 511. The nurse knows that developing appropriate nursing interventions for a patient relies on theappropriateness of the __________ diagnosis.a. Nursingb. Medicalc. Admissiond. CollaborativeANS: AAn accurate nursing diagnosis provides the basis for the selection of nursing interventions to achieve outcomesfor which the nurse is accountable. The other items do not contribute to the development of appropriate nursinginterventions. DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: Safe and Effective Care Environment: Management of Care12. The nursing process is a sequential method of problem solving that nurses use and includes which steps?a. Assessment, treatment, planning, evaluation, discharge, and follow-upb. Admission, assessment, diagnosis, treatment, and discharge planningc. Admission, diagnosis, treatment, evaluation, and discharge planningd. Assessment, diagnosis, outcome identification, planning, implementation, and evaluationANS: DThe nursing process is a method of problem solving that includes assessment, diagnosis, outcomeidentification, planning, implementation, and evaluation. DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: Safe and Effective Care Environment: Management of Care13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is having difficultybreathing. How should the nurse prioritize these problems?a. Breathing, pain, and sleepb. Breathing, sleep, and painc. Sleep, breathing, and painTest Bank - Physical Examination and Health Assessment 8e (by Jarvis) 6d. Sleep, pain, and breathingANS: AFirst-level priority problems are immediate priorities, remembering the ABCs (airway, breathing, andcirculation), followed by second-level problems, and then third-level problems. DIF: Cognitive Level: Analyzing (Analysis)MSC: Client Needs: Safe and Effective Care Environment: Management of Care14. Which of these would be formulated by a nurse using diagnostic reasoning?a. Nursing diagnosisb. Medical diagnosisc. Diagnostic hypothesisd. Diagnostic assessmentANS: CDiagnostic reasoning calls for the nurse to formulate a diagnostic hypothesis; the nursing process calls for anursing diagnosis. DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: General15. Barriers to incorporating EBP include:a. Nurses lack of research skills in evaluating the quality of research studies.b. Lack of significant research studies.c. Insufficient clinical skills of nurses.d. Inadequate physical assessment skills.ANS: AAs individuals, nurses lack research skills in evaluating the quality of research studies, are isolated from othercolleagues who are knowledgeable in research, and often lack the time to visit the library to read research. Theother responses are not considered barriers. DIF: Cognitive Level: Understanding (Comprehension)MSC: Client Needs: General16. What step of the nursing process includes data collection by health history, physical examination, andinterview? 041b061a72