,CONTENTS
1 The Interview and Health History, 1
2 Mental Status, 9
3 Assessment Techniques and the Clinical Setting, 15
4 General Survey, Measurement, Vital Signs, and Pain
Assessment, 21
5 Skin, Hair, and Nails, 33
6 Head, Face, and Neck, Including Regional Lymphatics, 53
7 Eyes, 61
8 Ears, 79
9 Nose, Mouth, and Throat, 89
10 Breasts and Axillae, Including Regional Lymphatics, 103
11 Thorax and Lungs, 115
12 Heart and Neck Vessels, 131
13 Peripheral Vascular System and Lymphatics, 149
14 Abdomen, 161
15 Musculoskeletal System, 177
16 Neurologic System, 199
17 Male Genitourinary System, 225
18 Female Genitourinary System, 237
19 Anus, Rectum, and Prostate, 253
20 Integration of the Complete Physical Examination, 261
21 Bedside Assessment and Electronic Health Recording, 273
ILLUSTRATION CREDITS, 283
BIBLIOGRAPHY, 285
,POCKET COMPANION FOR
Physical
Examination
& Health
Assessment
,This page intentionally left blank
, CAROLYN JARVIS, PhD, APN, CNP
Professor of Nursing
School of Nursing
Illinois Wesleyan University
Bloomington, Illinois
and
Family Nurse Practitioner
Bloomington, Illinois
POCKET COMPANION FOR
Physical
Examination
& Health
Assessment
7
Seventh Edition
Original Illustrations by Pat Thomas, CMI, FAMI
East Troy, Wisconsin
Assessment Photographs by Kevin Strandberg
Professor of Art
Illinois Wesleyan University
Bloomington, Illinois
,3251 Riverport Lane
St. Louis, Missouri 63043
POCKET COMPANION FOR PHYSICAL EXAMINATION AND
HEALTH ASSESSMENT, SEVENTH EDITION ISBN: 978-0-323-26537-9
Copyright © 2016 by Elsevier, Inc. All rights reserved.
Copyright © 2012, 2008, 2004, 2000, 1996, 1993 by Saunders, an affiliate of 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).
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).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the
safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability 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.
International Standard Book Number: 978-0-323-26537-9
Executive Content Strategist: Lee Henderson
Content Development Manager: Laurie Gower
Senior Content Development Specialist: Heather Bays
Publishing Services Manager: Deborah L. Vogel
Senior Project Manager: Jodi M. Willard
Design Direction: Julia Dummitt
Printed in the United States of America
Last digit is the print number:
9 8 7 6 5 4 3 2 1
, P R E FA C E
The seventh edition of Pocket Com- room in the Pocket Companion for
panion for Physical Examination and theories, principles, or detailed expla-
Health Assessment is designed for two nations, students using the Pocket
groups—those who need a practical Companion as a beginning text must
clinical reference and those acquiring have a thorough didactic presentation
beginning assessment skills. of assessment methods as well as
First, the Pocket Companion is tutored practice.
intended as an adjunct to Jarvis’ The Pocket Companion, 7th
Physical Examination and Health edition, is revised and updated to
Assessment, 7th edition. The Pocket match the revision of the parent
Companion is a memory prompt text, Physical Examination and Health
for those who have studied physical Assessment, 7th edition, including
assessment and wish to have a many new examination photos,
reminder when in the clinic. The abnormal findings photos, and full-
Pocket Companion has all the essen- color art. The following tables of
tials—health history points, exam Abnormal Findings are also new to
steps for each body system, normal the 7th edition:
versus abnormal findings, heart • Anxiety Disorders
sounds, lung sounds, neurologic • Common Sites of Referred Abdom
checks. The Pocket Companion is inal Pain
useful when you forget a step in the • Abnormalities Affecting Multiple
exam sequence, when you wish to be Joints
sure your assessment is complete, • Abnormal Postures
when you need to review the findings • Abnormalities of the Anal Region
that are normal versus abnormal, or A new section on the Electronic
when you are faced with an unfamil- Health Record has been integrated
iar technique or a new clinical area. Its into Chapter 21, Bedside Assessment
portable size and binding make it of the Hospitalized Adult. This sec-
perfect for a lab coat pocket or com- tion outlines charting, and narrative
munity health bag. recording provides examples of how
Second, the Pocket Companion, to document assessment findings.
7th edition, is an independent primer For those times when readers need
of basic assessment skills. It is well detailed coverage of a particular tech-
suited to programs offering a begin- nique or finding, it is easily found
ning assessment course covering well through numerous cross-references
people of all ages. The Pocket Com- to pages in Physical Examination and
panion has the complete steps to Health Assessment, 7th edition.
perform a health history and physical As you thumb through the Pocket
examination on a well person. It Companion, note these features:
includes pertinent developmental • Health history and exam steps are
content for pediatric, pregnant, and concise yet complete.
aging adult patients. Although the • Method of examination is clear,
description of each exam step is stated orderly, and easy to follow.
concisely, there is enough informa- • Abnormal findings are described
tion given to study and learn exam briefly in a column adjacent to the
techniques. However, since there is no normal range of findings.
v
,vi PREFACE
• Sample charting is now included • Selected artwork from Physical
in all applicable chapters, illus Examination and Health Assess-
trating the documentation of ment, 7th edition, illustrates the
findings. pertinent anatomy.
• Tables are presented at the end of
chapters to fully illustrate impor-
tant information. ACKNOWLEDGMENTS
• Selected Cultural Competence I am grateful to those on the team at
information highlights this Elsevier who worked on the Pocket
important aspect of a health Companion. My thanks extend to
assessment. Lee Henderson, Executive Content
• Developmental Competence con- Strategist; Laurie Gower, Content
tent includes age-specific infor- Development Manager; Heather Bays,
mation for pediatric, pregnant, Senior Content Development Special-
and aging adult groups. ist; and Jodi Willard, Senior Project
• Summary checklists for each Manager, for their patient and atten-
chapter form a cue card of exam tive monitoring of every step in the
steps to remember. production of the Pocket Companion.
• Integration of the complete physi- Carolyn Jarvis
cal examination is presented in
Chapter 20.
, CHAPTER 1
The Interview and
Health History
The health history is important in There are three phases to each inter-
beginning to identify the person’s view: an introduction, a working
health strengths and problems and as phase, and a termination (or closing).
a bridge to the next step in data col-
lection, the physical examination.
The health history collects subjec- INTRODUCING THE INTERVIEW
tive data, what the person says about Address the patient using his or her
himself or herself. This is the first and surname. Introduce yourself and state
best chance that a person has to tell your role in the agency (if you are a
you what he or she perceives his or her student, say so). If you are gathering
health state to be. a complete history, give the reason for
this interview.
EXTERNAL FACTORS
Ensure Privacy. Aim for geo- THE WORKING PHASE
graphic privacy—a private room. If The working phase is the data-
geographic privacy is not available, gathering phase. It involves your
the “psychological privacy” afforded questions to the patient and your
by curtained partitions may suffice as responses to what he or she has said.
long as the person feels sure that no There are two types of questions:
one can overhear the conversation or open-ended and closed (or direct).
interrupt. Each type has a different place and
Refuse Interruptions. You need function in the interview.
this time to concentrate and establish
rapport.
Open-Ended Questions
An open-ended question asks for nar-
Physical Environment rative information. It states the topic
• Set the room temperature at a to be discussed, but only in general
comfortable level. terms. Use it to begin the interview,
• Provide sufficient lighting. to introduce a new section of ques-
• Reduce noise. tions, and whenever the person intro-
• Remove distracting objects. duces a new topic. Examples are,
• Maintain the distance between “Tell me why you have come here
you and the patient at 4 to 5 feet today” and “What brings you to the
(twice an arm’s length). hospital?”
• Arrange equal-status seating. Both
of you should be comfortably
seated at eye level. Avoid sitting Closed or Direct Questions
behind a desk or bedside table Closed or direct questions ask for spe-
placed so it looks like a barrier. cific information. They elicit a one- or
• Avoid standing. two-word answer, a “yes” or “no,” or a
1
1 The Interview and Health History, 1
2 Mental Status, 9
3 Assessment Techniques and the Clinical Setting, 15
4 General Survey, Measurement, Vital Signs, and Pain
Assessment, 21
5 Skin, Hair, and Nails, 33
6 Head, Face, and Neck, Including Regional Lymphatics, 53
7 Eyes, 61
8 Ears, 79
9 Nose, Mouth, and Throat, 89
10 Breasts and Axillae, Including Regional Lymphatics, 103
11 Thorax and Lungs, 115
12 Heart and Neck Vessels, 131
13 Peripheral Vascular System and Lymphatics, 149
14 Abdomen, 161
15 Musculoskeletal System, 177
16 Neurologic System, 199
17 Male Genitourinary System, 225
18 Female Genitourinary System, 237
19 Anus, Rectum, and Prostate, 253
20 Integration of the Complete Physical Examination, 261
21 Bedside Assessment and Electronic Health Recording, 273
ILLUSTRATION CREDITS, 283
BIBLIOGRAPHY, 285
,POCKET COMPANION FOR
Physical
Examination
& Health
Assessment
,This page intentionally left blank
, CAROLYN JARVIS, PhD, APN, CNP
Professor of Nursing
School of Nursing
Illinois Wesleyan University
Bloomington, Illinois
and
Family Nurse Practitioner
Bloomington, Illinois
POCKET COMPANION FOR
Physical
Examination
& Health
Assessment
7
Seventh Edition
Original Illustrations by Pat Thomas, CMI, FAMI
East Troy, Wisconsin
Assessment Photographs by Kevin Strandberg
Professor of Art
Illinois Wesleyan University
Bloomington, Illinois
,3251 Riverport Lane
St. Louis, Missouri 63043
POCKET COMPANION FOR PHYSICAL EXAMINATION AND
HEALTH ASSESSMENT, SEVENTH EDITION ISBN: 978-0-323-26537-9
Copyright © 2016 by Elsevier, Inc. All rights reserved.
Copyright © 2012, 2008, 2004, 2000, 1996, 1993 by Saunders, an affiliate of 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).
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).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the
safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability 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.
International Standard Book Number: 978-0-323-26537-9
Executive Content Strategist: Lee Henderson
Content Development Manager: Laurie Gower
Senior Content Development Specialist: Heather Bays
Publishing Services Manager: Deborah L. Vogel
Senior Project Manager: Jodi M. Willard
Design Direction: Julia Dummitt
Printed in the United States of America
Last digit is the print number:
9 8 7 6 5 4 3 2 1
, P R E FA C E
The seventh edition of Pocket Com- room in the Pocket Companion for
panion for Physical Examination and theories, principles, or detailed expla-
Health Assessment is designed for two nations, students using the Pocket
groups—those who need a practical Companion as a beginning text must
clinical reference and those acquiring have a thorough didactic presentation
beginning assessment skills. of assessment methods as well as
First, the Pocket Companion is tutored practice.
intended as an adjunct to Jarvis’ The Pocket Companion, 7th
Physical Examination and Health edition, is revised and updated to
Assessment, 7th edition. The Pocket match the revision of the parent
Companion is a memory prompt text, Physical Examination and Health
for those who have studied physical Assessment, 7th edition, including
assessment and wish to have a many new examination photos,
reminder when in the clinic. The abnormal findings photos, and full-
Pocket Companion has all the essen- color art. The following tables of
tials—health history points, exam Abnormal Findings are also new to
steps for each body system, normal the 7th edition:
versus abnormal findings, heart • Anxiety Disorders
sounds, lung sounds, neurologic • Common Sites of Referred Abdom
checks. The Pocket Companion is inal Pain
useful when you forget a step in the • Abnormalities Affecting Multiple
exam sequence, when you wish to be Joints
sure your assessment is complete, • Abnormal Postures
when you need to review the findings • Abnormalities of the Anal Region
that are normal versus abnormal, or A new section on the Electronic
when you are faced with an unfamil- Health Record has been integrated
iar technique or a new clinical area. Its into Chapter 21, Bedside Assessment
portable size and binding make it of the Hospitalized Adult. This sec-
perfect for a lab coat pocket or com- tion outlines charting, and narrative
munity health bag. recording provides examples of how
Second, the Pocket Companion, to document assessment findings.
7th edition, is an independent primer For those times when readers need
of basic assessment skills. It is well detailed coverage of a particular tech-
suited to programs offering a begin- nique or finding, it is easily found
ning assessment course covering well through numerous cross-references
people of all ages. The Pocket Com- to pages in Physical Examination and
panion has the complete steps to Health Assessment, 7th edition.
perform a health history and physical As you thumb through the Pocket
examination on a well person. It Companion, note these features:
includes pertinent developmental • Health history and exam steps are
content for pediatric, pregnant, and concise yet complete.
aging adult patients. Although the • Method of examination is clear,
description of each exam step is stated orderly, and easy to follow.
concisely, there is enough informa- • Abnormal findings are described
tion given to study and learn exam briefly in a column adjacent to the
techniques. However, since there is no normal range of findings.
v
,vi PREFACE
• Sample charting is now included • Selected artwork from Physical
in all applicable chapters, illus Examination and Health Assess-
trating the documentation of ment, 7th edition, illustrates the
findings. pertinent anatomy.
• Tables are presented at the end of
chapters to fully illustrate impor-
tant information. ACKNOWLEDGMENTS
• Selected Cultural Competence I am grateful to those on the team at
information highlights this Elsevier who worked on the Pocket
important aspect of a health Companion. My thanks extend to
assessment. Lee Henderson, Executive Content
• Developmental Competence con- Strategist; Laurie Gower, Content
tent includes age-specific infor- Development Manager; Heather Bays,
mation for pediatric, pregnant, Senior Content Development Special-
and aging adult groups. ist; and Jodi Willard, Senior Project
• Summary checklists for each Manager, for their patient and atten-
chapter form a cue card of exam tive monitoring of every step in the
steps to remember. production of the Pocket Companion.
• Integration of the complete physi- Carolyn Jarvis
cal examination is presented in
Chapter 20.
, CHAPTER 1
The Interview and
Health History
The health history is important in There are three phases to each inter-
beginning to identify the person’s view: an introduction, a working
health strengths and problems and as phase, and a termination (or closing).
a bridge to the next step in data col-
lection, the physical examination.
The health history collects subjec- INTRODUCING THE INTERVIEW
tive data, what the person says about Address the patient using his or her
himself or herself. This is the first and surname. Introduce yourself and state
best chance that a person has to tell your role in the agency (if you are a
you what he or she perceives his or her student, say so). If you are gathering
health state to be. a complete history, give the reason for
this interview.
EXTERNAL FACTORS
Ensure Privacy. Aim for geo- THE WORKING PHASE
graphic privacy—a private room. If The working phase is the data-
geographic privacy is not available, gathering phase. It involves your
the “psychological privacy” afforded questions to the patient and your
by curtained partitions may suffice as responses to what he or she has said.
long as the person feels sure that no There are two types of questions:
one can overhear the conversation or open-ended and closed (or direct).
interrupt. Each type has a different place and
Refuse Interruptions. You need function in the interview.
this time to concentrate and establish
rapport.
Open-Ended Questions
An open-ended question asks for nar-
Physical Environment rative information. It states the topic
• Set the room temperature at a to be discussed, but only in general
comfortable level. terms. Use it to begin the interview,
• Provide sufficient lighting. to introduce a new section of ques-
• Reduce noise. tions, and whenever the person intro-
• Remove distracting objects. duces a new topic. Examples are,
• Maintain the distance between “Tell me why you have come here
you and the patient at 4 to 5 feet today” and “What brings you to the
(twice an arm’s length). hospital?”
• Arrange equal-status seating. Both
of you should be comfortably
seated at eye level. Avoid sitting Closed or Direct Questions
behind a desk or bedside table Closed or direct questions ask for spe-
placed so it looks like a barrier. cific information. They elicit a one- or
• Avoid standing. two-word answer, a “yes” or “no,” or a
1
