Physical Examination and Health Assessment 8th Edition

Book 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 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-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.