NURS 5220 Advanced Health Assessment Test
zr zr zr zr zr zr
1 Expanded Study Guide zr zr zr
Module 1 + Module 2: SOAP/Diagnostic Reasoning, Growth & Measurement, Skin, Head/Neck, Lymph, Eye
zr zr zr zr zr zr zr zr zr zr zr zr zr
s, ENT, Chest/Lungs, Heart, and Blood Vessels
zr zr zr zr zr zr
Includes a 100-question practice test with answers and rationales after each question
zr zr zr zr zr zr zr zr zr zr zr
Howzrtozrusezrthiszrguide:zrReadzrthezrblueprintzrfirst,zrthenzrstudyzreachzrbody-
systemzrsection.zrMemorizezrthezrexamzrsequence,zrnormalzrfindings,zrabnormalzrfindings,zrredzrflags,zrandzrlifespanzrvariations.zrAfterzreachzrse
ction,zrquizzryourselfzrbyzrcoveringzrthezr"rapidzrrecall"zrtables.zrFinishzrwithzrthezr100-questionzrpracticezrtest.
TestzrArea ActualzrTest Approx.zr%zrofzrExa PracticezrQszrinzrthiszr
zrQuestions m guide
SOAPzrandzrDiagnosticzrReasoning 8 12% 12
GrowthzrandzrMeasurement 2 3% 3
Skin,zrHair,zrandzrNails 8 12% 12
HeadzrandzrNeck 5 8% 8
LymphaticzrSystem 5 8% 8
Eyes 5 8% 8
Ear,zrNose,zrandzrThroat 10 15% 15
ChestzrandzrLung 10 15% 15
Heart 10 15% 15
BloodzrVessels 2 3% 4
Total 65 100% 100
Examzrpearl:zrThezrtestzriszrnotzropenzrbook.zrYourzrbestzrreturnzronzrstudyzrtimezriszrmemorizingzrpatterns:zrsubjectivezrvszrobjective,zrexam
sequence,zrnormalzrvszrabnormalzrfindings,zrandzrwhichzrabnormalzrfindingzrpointszrtozrwhichzrcondition.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
,1. Module 1 Foundations: SOAP, History, and Diagnostic Reasoning
zr zr zr zr zr zr zr
Subjective vs Objective Data
zr zr zr
Category Meaning Examples Testzrtrap
Subjective Whatzrthezrpatientzrstates,zrreports,zrfeels "Myzrchestzrhurts."zrPainzr8/10.zrNauseazr Painzrscorezriszrsubjectivezrevenzrth
,zrbelieves,zrorzrdescribes.zrSymptomszrli xz r 3zrdays.zrFamilyzrhistoryzrofzrMI.zrMedic oughzritzriszrazrnumber.zrItzriszrwhatzrth
vezrhere. ationzrusezrreportedzrbyzrpatient. ezrpatientzrsays.
Objective Whatzrthezrexaminerzrobserves,zrmeasur BPzr160/92.zrRRzr26.zrSpO2zr88%. Dozrnotzrputzrpatientzrquotes,
es,zrpalpates,zrpercusses,zrauscultates,zr Wheezingzrheard.zrRashzr4zrcmzrxzr3zrcm.zrC zrsymptom zrdescriptions, zro
orzrverifieszrwithzrdiagnostics. BCzrresult. rzrpatient-
reportedzrhistoryzrinzrObjecti
ve.
High-yieldzrtestzrtargets:
• Subjectivezr=zrsymptoms,zrpatientzrstatements,zrCC,zrHPI,zrPMH,zrFH,zrSH,zrROS.
• Objectivezr=zrphysicalzrexam,zrvitalzrsigns,zrobservedzrbehavior,zrmeasurements,zrlabs,zrimaging,zrdiagnosticzrresults.
• Assessmentzr=zrdiagnosis,zrworkingzrdiagnosis,zrdifferentials,zrrule-outs,zrriskzrfactors,zrhealthzrmaintenancezrneeds.
• Planzr=zrtests,zrtreatments,zreducation,zrreferrals,zrfollow-up,zrandzrhealthzrmaintenance.
SOAP Note Structure
zr zr
SOAPzrElement Whatzrbelongszrthere Commonzrexamples
Szr-zrSubjective Chiefzrconcern,zrHPI,zrROS,zrPMH,zrmedications,zrallergies,zr "Coughzrforzr4zrdays."zrReportszrfever.zrDenieszrchestzrpa
familyzrhistory,zrsocialzrhistory,zrpatientzrgoalszrandzrconcerns. in.zrSmokerzrxzr20zryears.
Ozr-zrObjective Generalzrsurvey,zrvitals,zrphysicalzrexamzrfindings,zrobjectivezr Tzr101.3zrF,zrHRzr112,zrcrackleszrRLL,zrCXRzrinfiltrate.
measurements,zrlabs,zrimaging,zrscreeningzrresults.
Azr-zrAssessment Bestzrexplanationzrforzrthezrpatientzrdata,zrdifferentials,zrrule Community-
-outs,zrclinicalzrimpression,zrhealthzrrisks. acquiredzrpneumoniazrvszrviralzrbronchitis;zrdehydrationzrri
sk.
Pzr-zrPlan Diagnostics,zrtherapeutics,zreducation,zrreferrals,zrsafetyzrinst CXR,zrCBC,zrantibioticszrifzrindicated,zrhydration,zrreturnzrp
ructions,zrfollow-upzrinterval,zrprevention. recautions,zrfollow-upzrinzr48zrhours.
Examzrpearl:zrSOAPzriszrbothzrazrthinkingzrprocesszrandzrazrdocumentationzrformat.zrAzrgoodzrSOAPzrnotezrshouldzrtellzrazrchronologicalzrstoryzran
d
showzrwhyzrthezrassessmentzrandzrplanzrmatchzrthezrdata.
Building the History
zr zr
• Startzrwithzridentifierszrandzrchiefzrconcern,zrthenzrmovezrintozrHPI,zrPMH,zrfamilyzrhistory,zrpersonal/socialzrhistory,zrandzrROS.
• Chiefzrconcernzrshouldzrbezrinzrthezrpatient'szrownzrwordszrandzrshouldzrfocuszrthezrvisit.
• HPIzriszrsymptomzranalysis.zrItzrtellszrthezrstoryzrofzrthezrpresentzrproblemzrstartingzrfromzrthezrlastzrtimezrthezrpatientzrfeltzrwell.
• Usezropen-endedzrquestionszrfirst,zrthenzrdirectzrquestions.zrAvoidzrleadingzrquestions.
• Verifyzrandzrsummarizezrwhatzryouzrheardzrbeforezrmovingzron.
History Purpose Exampleszrofzrwhatzrtozrask
zrArea
CC Reasonzrforzrseekingzrcare,zrusuallyzrbriefzr "Whatzrbringszryouzrinzrtoday?"zr"Whatzriszrbotheringzryouzrthezrmost?"
andzrinzrpatientzrwords.
HPI Analyzezrcurrentzrproblemzrandzrdifferentia Onset,zrlocation,zrduration,zrcharacter,zraggravatingzrfactors,zrrelievingzrfactors,zrtiming/tr
tezrpossiblezrcauses. eatments,zrseverity,zrassociatedzrsymptoms.
PMH Identifyzrpriorzrconditionszrandzrriskzrfac Medications,zrallergieszrandzrreactions,zrimmunizations,zrsurgeries,zrhospitalizations,zrtra
tors. nsfusions,zradult/childhoodzrillness,zrscreeningzrtests.
FH Identifyzrgenetic/familialzrpatterns. Threezrgenerations;zragezrandzrhealth/deathzrofzrrelatives;zrcancerszrbeforezragezr50;zrMI,zr
HTN,zrdiabetes,zrstroke,zrthyroid,zrasthma.
SH Identifyzrlifestyle,zrenvironmental,zrand Occupation,zrexposures,zrhousing,zrsafety,zrtobacco,zralcohol,zrdrugs,zrmilitaryzrhistory,zrt
zraccess-to-carezrrisks. ravel,zrsexualzrhistory,zrspirituality,zrfinances,zraccesszrtozrcare.
ROS Inventoryzrsymptomszrsystem-by- General,zrskin,zrHEENT,zrlymph,zrchest/lungs,zrheart,zrGI,zrGU,zrMSK,zrneuro,zrpsych.
systemzrandzridentifyzroverlooked
zrproblems.
Memoryzrhook:zrHPIzr=zrthezrstoryzrofzrthiszrproblem.zrPMH/FH/SHzr=zrthezrriskzrbackground.zrROSzr=zrsystemzrinventory.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
, HPI Symptom Analysis
zr zr
Variable Whatzritzrmeans Example
Timing/onset Whenzritzrstarted,zrsuddenzrvszrgradual,zrduration,zrfrequen Startedzrsuddenlyzr2zrhourszrago;zroccurszrdailyzrafterzrbreakf
cy,zrconstantzrvszrintermittent. ast.
Location Exactzrsite,zrgeneralizedzrvszrlocalized,zrradiation. Substernalzrpainzrradiatingzrtozrleftzrarm.
Quality Naturezrofzrsymptom. Sharp,zrdull,zrsqueezing,zrthrobbing,zrburning,zrstabbing,zrco
licky.
Quantity/severity Magnitudezrandzreffectzronzrfunction. Painzr8/10;zrhadzrtozrstopzrdriving.
Setting Context,zrtriggers,zractivity,zrexposure,zrenvironment,zrmech Afterzrclimbingzrstairs;zrafterzrsickzrcontact;zrafterzrfall.
anism.
Aggravating/alleviating Whatzrmakeszrbetterzrorzrworse. Worsezrwithzrexertion;zrbetterzrwithzrrestzrorzrbelching.
Associatedzrfactors Symptomszrthatzrcomezrwithzrthezrchiefzrconcern. Nausea,zrdiaphoresis,zrfever,zrrash,zrphotophobia.
Examzrpearl:zrPertinentzrpositiveszrsupportzrazrdiagnosis.zrPertinentzrnegativeszrhelpzrlowerzrazrdiagnosiszronzrthezrdifferential.zrBothzrarezrneeded
inzrgoodzrdiagnosticzrreasoning.
Diagnostic Reasoning Process
zr zr
1. Createzrazrdifferentialzrdiagnosiszrlist:zrallzrreasonablezrpossibilitieszrforzrthezrchiefzrconcern.
2. AskzrmorezrfocusedzrquestionszrusingzrthezrsevenzrHPIzrvariables.
3. Sortzrpertinentzrpositiveszrandzrpertinentzrnegativeszrforzreachzrpossiblezrdiagnosis.
4. Assignzrprobabilityzrbasedzronzrclusters,zrtrends,zrtimezrcourse,zrexposures,zrfamily/seasonalzrpatterns,zrandzrriskzrfactors.
5. Usezrthezrphysicalzrexamzrtozrsupportzrorzrweakenzrdiagnoses.
6. Orderzrtestszronlyzrwhenzrthezrresultzrwillzrhelpzrrulezrin,zrrulezrout,zrorzrguidezraction.
7. Choosezrthezrassessment/diagnosiszrthatzrbestzrexplainszrthezrhistoryzrpluszrphysicalzrfindings.
High-yieldzrtestzrtargets:
• Redzrflagzr=zrfindingzrsuggestingzrazrseriouszrconditionzrneedingzrurgentzrevaluation.
• Pathognomoniczr=zrfindingzrsozrcharacteristiczritzrpointszrstronglyzrtozronezrdiagnosis.
• Rulingzroutzriszraszrimportantzraszrrulingzrin.
• Avoidzrthezrbiaszrtrap:zrdozrnotzrlabelzrthezrpatientzrorzrclosezryourzrmindzrtoozrearly.
• Commonzrthingszrcommonlyzrhappen,zrbutzralwayszrconsiderzrthezrbadzrstuff.
2. Growth, Measurement, Vital Signs, and Pain
zr zr zr zr zr
Temperature
• Bodyzrtemperaturezriszrregulatedzrbyzrthezrhypothalamus.
• Feverzrresponse/pyrexiazriszrtriggeredzrbyzrendogenouszrpyrogenszrandzrprostaglandins.
• Thezrbodyzrgenerateszrheatzrthroughzrshiveringzrandzrvasoconstriction.
• Thezrbodyzrcoolszrthroughzrvasodilationzrandzrevaporationzrofzrperspiration.
• Expectedzrtemperaturezrrange:zr97.2zrFzrtozr99.9zrFzr(36.2zrCzrtozr37.7zrC).
• Feverzriszrgenerallyzrtemperaturezrgreaterzrthanzr100.4zrF;zraxillaryzrfeverzrthresholdzrmayzrbezrlower.
• Feverzrinzr0zrtozr90zrdayszrofzrlifezrneedszrimmediatezrevaluation.zrOverzr90zrdayszrwithzrtemperaturezr>105zrFzrneedszrevaluation.
Pulse, Respirations, and Blood Pressure
zr zr zr zr
Vitalzrsign Whatzritzrrepresents Keyzrexamzrpoints
Pulse Heartzrratezrgeneratedzrbyzrventricularzrcontr Apicalzrpulsezrpreferredzrinzrinfants/children.zrAssesszrrate,zrrhythm,zrcontour,zra
actionzrpushingzrazrpressurezrwavezrthroughzra mplitude.zrAdultzraveragezr60-
rteries. 100zrbpm.zrIrregularzrrhythm:zrcountzrfullzr60zrseconds.
Respiratoryzrrate Ventilationzrpatternzrcreatedzrbyzrdiaphragm/i Adultzrnormalzr12-
ntercostalzrmusclezractivity. 20zrbreaths/min.zrAssesszrworkzrofzrbreathing:zrretractions,zrnasalzrflaring,zrstri
dor,zrgrunting.zrTachypneazr=zrfasterzrthanzrnormal;zrbradypneazr=zrslowerzrth
anzrnormal.
Bloodzrpressure Peripheralzrmeasurezrofzrcardiovascularzrfu Systoliczr=zrventricularzrcontraction;zrdiastoliczr=zrperipheralzrresistancezrdurin
nction;zrforcezrofzrbloodzragainstzrarterialzrwall. gzrrelaxation.zrPulsezrpressurezr=zrsystoliczrminuszrdiastolic.zrUsezrproperzrcuf
fzrsize.zrRoutinezrBPzrbeginszraroundzragezr3.
Memoryzrhook:zrPulsezrpressurezr=zrtopzrnumberzrminuszrbottomzrnumber.zrExample:zr120/80zr=zrpulsezrpressurezr40.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
zr zr zr zr zr zr
1 Expanded Study Guide zr zr zr
Module 1 + Module 2: SOAP/Diagnostic Reasoning, Growth & Measurement, Skin, Head/Neck, Lymph, Eye
zr zr zr zr zr zr zr zr zr zr zr zr zr
s, ENT, Chest/Lungs, Heart, and Blood Vessels
zr zr zr zr zr zr
Includes a 100-question practice test with answers and rationales after each question
zr zr zr zr zr zr zr zr zr zr zr
Howzrtozrusezrthiszrguide:zrReadzrthezrblueprintzrfirst,zrthenzrstudyzreachzrbody-
systemzrsection.zrMemorizezrthezrexamzrsequence,zrnormalzrfindings,zrabnormalzrfindings,zrredzrflags,zrandzrlifespanzrvariations.zrAfterzreachzrse
ction,zrquizzryourselfzrbyzrcoveringzrthezr"rapidzrrecall"zrtables.zrFinishzrwithzrthezr100-questionzrpracticezrtest.
TestzrArea ActualzrTest Approx.zr%zrofzrExa PracticezrQszrinzrthiszr
zrQuestions m guide
SOAPzrandzrDiagnosticzrReasoning 8 12% 12
GrowthzrandzrMeasurement 2 3% 3
Skin,zrHair,zrandzrNails 8 12% 12
HeadzrandzrNeck 5 8% 8
LymphaticzrSystem 5 8% 8
Eyes 5 8% 8
Ear,zrNose,zrandzrThroat 10 15% 15
ChestzrandzrLung 10 15% 15
Heart 10 15% 15
BloodzrVessels 2 3% 4
Total 65 100% 100
Examzrpearl:zrThezrtestzriszrnotzropenzrbook.zrYourzrbestzrreturnzronzrstudyzrtimezriszrmemorizingzrpatterns:zrsubjectivezrvszrobjective,zrexam
sequence,zrnormalzrvszrabnormalzrfindings,zrandzrwhichzrabnormalzrfindingzrpointszrtozrwhichzrcondition.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
,1. Module 1 Foundations: SOAP, History, and Diagnostic Reasoning
zr zr zr zr zr zr zr
Subjective vs Objective Data
zr zr zr
Category Meaning Examples Testzrtrap
Subjective Whatzrthezrpatientzrstates,zrreports,zrfeels "Myzrchestzrhurts."zrPainzr8/10.zrNauseazr Painzrscorezriszrsubjectivezrevenzrth
,zrbelieves,zrorzrdescribes.zrSymptomszrli xz r 3zrdays.zrFamilyzrhistoryzrofzrMI.zrMedic oughzritzriszrazrnumber.zrItzriszrwhatzrth
vezrhere. ationzrusezrreportedzrbyzrpatient. ezrpatientzrsays.
Objective Whatzrthezrexaminerzrobserves,zrmeasur BPzr160/92.zrRRzr26.zrSpO2zr88%. Dozrnotzrputzrpatientzrquotes,
es,zrpalpates,zrpercusses,zrauscultates,zr Wheezingzrheard.zrRashzr4zrcmzrxzr3zrcm.zrC zrsymptom zrdescriptions, zro
orzrverifieszrwithzrdiagnostics. BCzrresult. rzrpatient-
reportedzrhistoryzrinzrObjecti
ve.
High-yieldzrtestzrtargets:
• Subjectivezr=zrsymptoms,zrpatientzrstatements,zrCC,zrHPI,zrPMH,zrFH,zrSH,zrROS.
• Objectivezr=zrphysicalzrexam,zrvitalzrsigns,zrobservedzrbehavior,zrmeasurements,zrlabs,zrimaging,zrdiagnosticzrresults.
• Assessmentzr=zrdiagnosis,zrworkingzrdiagnosis,zrdifferentials,zrrule-outs,zrriskzrfactors,zrhealthzrmaintenancezrneeds.
• Planzr=zrtests,zrtreatments,zreducation,zrreferrals,zrfollow-up,zrandzrhealthzrmaintenance.
SOAP Note Structure
zr zr
SOAPzrElement Whatzrbelongszrthere Commonzrexamples
Szr-zrSubjective Chiefzrconcern,zrHPI,zrROS,zrPMH,zrmedications,zrallergies,zr "Coughzrforzr4zrdays."zrReportszrfever.zrDenieszrchestzrpa
familyzrhistory,zrsocialzrhistory,zrpatientzrgoalszrandzrconcerns. in.zrSmokerzrxzr20zryears.
Ozr-zrObjective Generalzrsurvey,zrvitals,zrphysicalzrexamzrfindings,zrobjectivezr Tzr101.3zrF,zrHRzr112,zrcrackleszrRLL,zrCXRzrinfiltrate.
measurements,zrlabs,zrimaging,zrscreeningzrresults.
Azr-zrAssessment Bestzrexplanationzrforzrthezrpatientzrdata,zrdifferentials,zrrule Community-
-outs,zrclinicalzrimpression,zrhealthzrrisks. acquiredzrpneumoniazrvszrviralzrbronchitis;zrdehydrationzrri
sk.
Pzr-zrPlan Diagnostics,zrtherapeutics,zreducation,zrreferrals,zrsafetyzrinst CXR,zrCBC,zrantibioticszrifzrindicated,zrhydration,zrreturnzrp
ructions,zrfollow-upzrinterval,zrprevention. recautions,zrfollow-upzrinzr48zrhours.
Examzrpearl:zrSOAPzriszrbothzrazrthinkingzrprocesszrandzrazrdocumentationzrformat.zrAzrgoodzrSOAPzrnotezrshouldzrtellzrazrchronologicalzrstoryzran
d
showzrwhyzrthezrassessmentzrandzrplanzrmatchzrthezrdata.
Building the History
zr zr
• Startzrwithzridentifierszrandzrchiefzrconcern,zrthenzrmovezrintozrHPI,zrPMH,zrfamilyzrhistory,zrpersonal/socialzrhistory,zrandzrROS.
• Chiefzrconcernzrshouldzrbezrinzrthezrpatient'szrownzrwordszrandzrshouldzrfocuszrthezrvisit.
• HPIzriszrsymptomzranalysis.zrItzrtellszrthezrstoryzrofzrthezrpresentzrproblemzrstartingzrfromzrthezrlastzrtimezrthezrpatientzrfeltzrwell.
• Usezropen-endedzrquestionszrfirst,zrthenzrdirectzrquestions.zrAvoidzrleadingzrquestions.
• Verifyzrandzrsummarizezrwhatzryouzrheardzrbeforezrmovingzron.
History Purpose Exampleszrofzrwhatzrtozrask
zrArea
CC Reasonzrforzrseekingzrcare,zrusuallyzrbriefzr "Whatzrbringszryouzrinzrtoday?"zr"Whatzriszrbotheringzryouzrthezrmost?"
andzrinzrpatientzrwords.
HPI Analyzezrcurrentzrproblemzrandzrdifferentia Onset,zrlocation,zrduration,zrcharacter,zraggravatingzrfactors,zrrelievingzrfactors,zrtiming/tr
tezrpossiblezrcauses. eatments,zrseverity,zrassociatedzrsymptoms.
PMH Identifyzrpriorzrconditionszrandzrriskzrfac Medications,zrallergieszrandzrreactions,zrimmunizations,zrsurgeries,zrhospitalizations,zrtra
tors. nsfusions,zradult/childhoodzrillness,zrscreeningzrtests.
FH Identifyzrgenetic/familialzrpatterns. Threezrgenerations;zragezrandzrhealth/deathzrofzrrelatives;zrcancerszrbeforezragezr50;zrMI,zr
HTN,zrdiabetes,zrstroke,zrthyroid,zrasthma.
SH Identifyzrlifestyle,zrenvironmental,zrand Occupation,zrexposures,zrhousing,zrsafety,zrtobacco,zralcohol,zrdrugs,zrmilitaryzrhistory,zrt
zraccess-to-carezrrisks. ravel,zrsexualzrhistory,zrspirituality,zrfinances,zraccesszrtozrcare.
ROS Inventoryzrsymptomszrsystem-by- General,zrskin,zrHEENT,zrlymph,zrchest/lungs,zrheart,zrGI,zrGU,zrMSK,zrneuro,zrpsych.
systemzrandzridentifyzroverlooked
zrproblems.
Memoryzrhook:zrHPIzr=zrthezrstoryzrofzrthiszrproblem.zrPMH/FH/SHzr=zrthezrriskzrbackground.zrROSzr=zrsystemzrinventory.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
, HPI Symptom Analysis
zr zr
Variable Whatzritzrmeans Example
Timing/onset Whenzritzrstarted,zrsuddenzrvszrgradual,zrduration,zrfrequen Startedzrsuddenlyzr2zrhourszrago;zroccurszrdailyzrafterzrbreakf
cy,zrconstantzrvszrintermittent. ast.
Location Exactzrsite,zrgeneralizedzrvszrlocalized,zrradiation. Substernalzrpainzrradiatingzrtozrleftzrarm.
Quality Naturezrofzrsymptom. Sharp,zrdull,zrsqueezing,zrthrobbing,zrburning,zrstabbing,zrco
licky.
Quantity/severity Magnitudezrandzreffectzronzrfunction. Painzr8/10;zrhadzrtozrstopzrdriving.
Setting Context,zrtriggers,zractivity,zrexposure,zrenvironment,zrmech Afterzrclimbingzrstairs;zrafterzrsickzrcontact;zrafterzrfall.
anism.
Aggravating/alleviating Whatzrmakeszrbetterzrorzrworse. Worsezrwithzrexertion;zrbetterzrwithzrrestzrorzrbelching.
Associatedzrfactors Symptomszrthatzrcomezrwithzrthezrchiefzrconcern. Nausea,zrdiaphoresis,zrfever,zrrash,zrphotophobia.
Examzrpearl:zrPertinentzrpositiveszrsupportzrazrdiagnosis.zrPertinentzrnegativeszrhelpzrlowerzrazrdiagnosiszronzrthezrdifferential.zrBothzrarezrneeded
inzrgoodzrdiagnosticzrreasoning.
Diagnostic Reasoning Process
zr zr
1. Createzrazrdifferentialzrdiagnosiszrlist:zrallzrreasonablezrpossibilitieszrforzrthezrchiefzrconcern.
2. AskzrmorezrfocusedzrquestionszrusingzrthezrsevenzrHPIzrvariables.
3. Sortzrpertinentzrpositiveszrandzrpertinentzrnegativeszrforzreachzrpossiblezrdiagnosis.
4. Assignzrprobabilityzrbasedzronzrclusters,zrtrends,zrtimezrcourse,zrexposures,zrfamily/seasonalzrpatterns,zrandzrriskzrfactors.
5. Usezrthezrphysicalzrexamzrtozrsupportzrorzrweakenzrdiagnoses.
6. Orderzrtestszronlyzrwhenzrthezrresultzrwillzrhelpzrrulezrin,zrrulezrout,zrorzrguidezraction.
7. Choosezrthezrassessment/diagnosiszrthatzrbestzrexplainszrthezrhistoryzrpluszrphysicalzrfindings.
High-yieldzrtestzrtargets:
• Redzrflagzr=zrfindingzrsuggestingzrazrseriouszrconditionzrneedingzrurgentzrevaluation.
• Pathognomoniczr=zrfindingzrsozrcharacteristiczritzrpointszrstronglyzrtozronezrdiagnosis.
• Rulingzroutzriszraszrimportantzraszrrulingzrin.
• Avoidzrthezrbiaszrtrap:zrdozrnotzrlabelzrthezrpatientzrorzrclosezryourzrmindzrtoozrearly.
• Commonzrthingszrcommonlyzrhappen,zrbutzralwayszrconsiderzrthezrbadzrstuff.
2. Growth, Measurement, Vital Signs, and Pain
zr zr zr zr zr
Temperature
• Bodyzrtemperaturezriszrregulatedzrbyzrthezrhypothalamus.
• Feverzrresponse/pyrexiazriszrtriggeredzrbyzrendogenouszrpyrogenszrandzrprostaglandins.
• Thezrbodyzrgenerateszrheatzrthroughzrshiveringzrandzrvasoconstriction.
• Thezrbodyzrcoolszrthroughzrvasodilationzrandzrevaporationzrofzrperspiration.
• Expectedzrtemperaturezrrange:zr97.2zrFzrtozr99.9zrFzr(36.2zrCzrtozr37.7zrC).
• Feverzriszrgenerallyzrtemperaturezrgreaterzrthanzr100.4zrF;zraxillaryzrfeverzrthresholdzrmayzrbezrlower.
• Feverzrinzr0zrtozr90zrdayszrofzrlifezrneedszrimmediatezrevaluation.zrOverzr90zrdayszrwithzrtemperaturezr>105zrFzrneedszrevaluation.
Pulse, Respirations, and Blood Pressure
zr zr zr zr
Vitalzrsign Whatzritzrrepresents Keyzrexamzrpoints
Pulse Heartzrratezrgeneratedzrbyzrventricularzrcontr Apicalzrpulsezrpreferredzrinzrinfants/children.zrAssesszrrate,zrrhythm,zrcontour,zra
actionzrpushingzrazrpressurezrwavezrthroughzra mplitude.zrAdultzraveragezr60-
rteries. 100zrbpm.zrIrregularzrrhythm:zrcountzrfullzr60zrseconds.
Respiratoryzrrate Ventilationzrpatternzrcreatedzrbyzrdiaphragm/i Adultzrnormalzr12-
ntercostalzrmusclezractivity. 20zrbreaths/min.zrAssesszrworkzrofzrbreathing:zrretractions,zrnasalzrflaring,zrstri
dor,zrgrunting.zrTachypneazr=zrfasterzrthanzrnormal;zrbradypneazr=zrslowerzrth
anzrnormal.
Bloodzrpressure Peripheralzrmeasurezrofzrcardiovascularzrfu Systoliczr=zrventricularzrcontraction;zrdiastoliczr=zrperipheralzrresistancezrdurin
nction;zrforcezrofzrbloodzragainstzrarterialzrwall. gzrrelaxation.zrPulsezrpressurezr=zrsystoliczrminuszrdiastolic.zrUsezrproperzrcuf
fzrsize.zrRoutinezrBPzrbeginszraroundzragezr3.
Memoryzrhook:zrPulsezrpressurezr=zrtopzrnumberzrminuszrbottomzrnumber.zrExample:zr120/80zr=zrpulsezrpressurezr40.
NURSzr5220zrAdvancedzrHealthzrAssessmentzr-zrTestzr1zrExpandedzrStudyzrGuide
