SOLUTIONS MANUAL For Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis; Ann by ACADEMIAMILL

SOLUTIONS MANUAL Manual for ForSolution Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis; Ann L. Eckhardt Jarvis Physical Examination and Health Assessment, 9th Edition Chapter1-32

TEACH FOR NURSES LESSON PLAN Chapter 01: Evidence-Based Assessment CHAPTER OBJECTIVES 1. Discuss the role of assessment as the starting point of all models of clinical reasoning.

2. Discuss the use of the nursing process in clinical judgment. 3. Differentiate between novice, proficient, and expert practitioner. 4. Describe the use of critical thinking in sound diagnostic reasoning and clinical judgment. 5. Differentiate first-level, second-level, third-level priority, and collaborative problems. 6. Use a conceptual framework to guide nursing practice. 7. Contrast medical diagnosis with nursing diagnosis. 8. Discuss the expanded concept of health and relate it to the process of data collection. 9. Relate the patient situation to the amount of data collected. 10. Relate the patient age and health status to the frequency of health assessment. 11. Consider life cycle and cross-cultural factors when performing a health assessment. 12. Discuss the importance of high-level assessment skills.

STUDENT RESOURCES

understand

      

Textbook Chapter 01 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS in text



Assessment—Point of Entry in an Ongoing Process

lesson focus

     

Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Actions Evaluate Outcomes

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

Next-Generation NCLEX™ (NGN)–Style Case Studies for Jarvis: Physical Examination & Health Assessment (Evolve) PowerPoint Presentations (Evolve) Image Collection (Evolve) Learning Activities (below) Discussion Topics (below) Conversion Guide (Evolve)

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

Content Focus

Content Highlights

ASSESSMENT—POINT OF ENTRY IN AN ONGOING PROCESS

Define the techniques for collecting subjective and objective data and the other relative material needed for the database.

Diagnostic Reasoning

Explain abductive, inductive, and deductive reasoning and the importance of validating your information.

Clinical Judgment and the Diagnostic Process

EVIDENCE-BASED ASSESSMENT COLLECTING FOUR TYPES OF PATIENT DATA Complete (Total Health) Database Focused or ProblemCentered Database

Give examples of the differences in the level of competency of the novice and the proficient nurse. Explain how the repetitive use of these skills will develop the multidimensional process. Consider first-level, second-level, and third-level priority problems and provide examples of each in conjunction with patient scenarios. Give examples of techniques previously used that research has deemed either unnecessary or detrimental to the patient. Name some of the many variables that make up EBP. Discuss why there is such a gap between research and implementation. Discuss how the organization of assessment data (the database) varies, depending on the conceptual model used. Explain how the compilation of all this information will influence the outcome of the patient’s treatment.

Follow-Up Database Emergency Database

Bring in clinical documentation with examples of focused data and give a demonstration on how this data could have been collected.

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Learning Activities

Resources

Activity: Using an age-specific chart for periodic health examination, have students identify a patient and design a recommended frequency of health visits and preventive services, as well as health promotion activities for that individual patient. Clinical Activity: Using available problems, have students identify the four major components of diagnostic reasoning that should be followed for each problem. Discussion Topic: Discuss the nursing process as a linear versus a circular process.

 Figure 1.2  Table 1.1

• Figure 1.4 Discussion Topic: Have advanced practice students • Table 1.1 discuss barriers they have encountered with implementing evidence-based practice (EBP) in their health care facilities. Clinical Activity: Using patient records at clinical agencies associated with the school of nursing, have students review the available database as part of the evaluation step of the nursing process. Group Activity: Break the students into pairs and have one student act as the patient who has come into the ED with an urgent issue, and have the other student act as the nurse who is assessing and entering information into the Emergency Database. Provide the “patient” with a condition or symptoms and evaluate the questions asked by the “nurse” to get to the information efficiently and effectively.

Relate your experience of an emergency department situation that required quick assessment, discuss issues that interfered with obtaining the pertinent

TEACHING STRATEGIES Content Focus

COMPREHENSIVE HEALTH CARE GENETICS AND ENVIRONMENT

Content Highlights information, and explain how these issues were overcome. Give an example of how health care has expanded over the past 10 years. Give some examples of cultural and genetic differences and how they affect the medical profession.

Learning Activities 



Discuss the social determinants of health. 

Resources

Online Activity: Have students access the Guide to Clinical Preventive Services online. Have them choose a section to read and report on the information that can be found in this guide. Research Activity: Discuss the demographics of the area in which you live. Have students develop a list of appropriate cross-cultural considerations for the ethnic groups in the area. Journal Activity: In their online journal, ask the students to evaluate which social determinants of health are applicable to them and how these determinants have affected or will affect them.

IN-CLASS/ONLINE CASE STUDY M. G. is a 62-year-old man with diabetes, diagnosed 3 years ago, who presents to the outpatient diabetes clinic for a routine preventive checkup. Subjective Data Complains of occasional dizziness when rising in morning Follows 1600-calorie diabetic diet Married with two grown children Retired construction worker Goes to the gym three times a week Objective Data Vital signs: T 37 P 118 R 18 BP 120/68 Glucose reading: 96 Weight: 165

Height: 5 feet, 8 inches Questions 1. What type of assessment should the nurse perform on this patient? 2. What prevention level is this visit? 3. What other prevention levels should be included in this patient’s care? 4. What step-by-step approach should the nurse take to identify and resolve this patient’s problem? 5. What interventions might be included in the plan of care for this patient? Answers 1. The type of health assessment performed by the nurse is also driven by patient need. A problem-focused assessment involves a history and examination that are limited to a specific problem. A follow-up assessment should be done at the next visit to be sure the problem has resolved. 2. This patient is involved in tertiary prevention. Tertiary prevention applies to patients who have been diagnosed with a disease and involves teaching them how best to manage the disease. 3. As part of this patient’s plan of care, he will most likely be advised to receive vaccinations. Vaccinations protect against disease and are considered primary prevention. More advanced-level learners need to know that diabetic patients are at increased risk for heart disease, peripheral vascular disease, and target organ damage; therefore, secondary prevention also is warranted. Secondary prevention involves screening patients in an effort to detect disease early and to prevent complications from the disease. 4. The nursing process is a systemic approach to identifying and resolving a patient’s problems; it includes assessment, diagnosis, outcome identification, planning, implementation, and evaluation. 5. Assess the patient’s diet and glucose reading throughout the day. Encourage a snack at bedtime to prevent dizziness. Report symptoms to provider. Teach the signs and symptoms of hypoglycemia and actions to control hypoglycemic episodes.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data o Comprehensive Health Care  Teamwork and Collaboration/Professional Identity

 

o Assessment—Point of Entry in an Ongoing Process Evidence-Based Practice/Spirit of Inquiry o Evidence-Based Assessment Informatics/Nursing Judgment o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Clinical Judgment o Exemplar: Assessment—Point of Entry in an Ongoing Process THEME: Care Competencies  Concept: Communication o Exemplar: Assessment—Point of Entry in an Ongoing Process  Concept: Technology and Informatics o Exemplar: Assessment—Point of Entry in an Ongoing Process o Exemplar: Collecting Four Types of Patient Data  Concept: Evidence o Exemplar: Evidence-Based Assessment

BSN ESSENTIALS  

Essential III: Scholarship for Evidence-Based Practice o Evidence-Based Assessment Essential IV: Information Management and Application of Patient Care Technology o Assessment—Point of Entry in an Ongoing Process

 

o Collecting Four Types of Patient Data Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o Comprehensive Health Care Essential IX: Baccalaureate Generalist Nursing Practice o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data o Comprehensive Health Care

2021 AACN ESSENTIALS DOMAINS   

Domain 1: Knowledge for Nursing Practice o Assessment—Point of Entry in an Ongoing Process Domain 2: Person-Centered Care o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data Domain 8: Information and Healthcare Technologies o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 



Domain 2: Roles/Responsibilities o Assessment—Point of Entry in an Ongoing Process o Collecting Four Types of Patient Data o Comprehensive Health Care Domain 3: Interprofessional Communication o Assessment—Point of Entry in an Ongoing Process

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN

Chapter 02: Cultural Assessment CHAPTER OBJECTIVES 1. 2. 3. 4. 5. 6. 7. 8.

Describe the basic characteristics of culture and the steps to cultural competence. Describe the concept of heritage consistency. Explain the concept of ethnicity. Discuss the influence of religion and spirituality on health and illness perception. Discuss areas of potential cultural conflicts between nurses and patients of different ethnic groups. Discuss components of the health belief system and their influence on health practices and illness expressions. Examine the sources that influence the culture and beliefs the student embraces. Provide care that reflects an acceptance of the patient as a unique individual.

STUDENT RESOURCES

understand

      

Textbook Chapter 02 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus DEMOGRAPHIC PROFILE OF THE UNITED STATES IMMIGRATION

SOCIAL DETERMINANTS OF HEALTH Health Care Disparities Among Vulnerable Populations

Content Highlights In comparison with the population of the United States, show the demographic diversity of your university and how it has changed in the past 10 years. Review the terms and categories of the immigrant populations and their impact on the health care field. Review Healthy People 2030 for the determinants of health and the interventions that can help eliminate health disparities. Ask for student input for additional useful interventions.

National Cultural and Linguistic Standards

Discuss the social determinants of health for the populations mentioned in this section. Choose several issues noted and examine the reasons for the disparities among populations.

CULTURE-RELATED

Give examples of how health care workers need to learn to communicate with and without interpreters. Discuss how the degree of an individual’s involvement

Learning Activities 



Resources

Activity: Have the students take a walk through the health care facility, noting the different cultures represented. Online Activity: Search for the statistics on the demographics in your area.  Figure 2.3

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Activity: Ask students to visit two different types of health care facilities and determine their policies and procedures about serving culturally diverse populations. Online Activity: Recommend online reading material for health care workers that explains what diseases are more frequent in certain cultures and ethnic groups. Have the students report on the items they have read.



Activity: Assign each student a particular culture or

 Table 2.1

TEACHING STRATEGIES Content Focus CONCEPTS RELIGION AND SPIRITUALITY

Content Highlights

Learning Activities

in his or her culture influences the individual’s medical treatment.

religion. Ask the student to research how that culture would influence decisions about medical treatment.

Resources

Discuss the four basic characteristics of culture, explaining your own culture according to these characteristics. Explain and contrast the processes of assimilation, acculturation, and biculturalism and discuss whether these are positive or negative processes. Discuss how certain religious beliefs may influence decisions about medical care.

HEALTH-RELATED BELIEFS AND PRACTICES Healing and Culture Beliefs About Causes of Illness Traditional Treatments and Folk Healers DEVELOPMENTAL COMPETENCE

Explain to the students that knowing, understanding, and accepting one’s own background helps a person better understand the views of others. Explain that understanding certain beliefs and practices sometimes gives insight into the cause and effect of a person’s symptoms and into the individual’s way of describing those symptoms. Find a documentary about the yin–yang theory to have the students watch in class. Ask several Asian students who are not normally in the class to attend this period, watch the documentary with the class, and respond to both the documentary and class questions. Invite an older recent immigrant to speak to the class about the adjustment that has been necessary in order to begin life anew in the United States.

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Discussion Topic: How do various religious, cultural, and spiritual beliefs affect the patient’s perception of (1) how he or she will relate the symptoms to the caregiver and (2) the care the patient receives? How will this influence the diagnosis? Small Group Activity: Give each student a paper that states a particular problem or disease. Make sure several students are given the same problem. The problem can be psychological, emotional, or physical. Without revealing the problem or disease, have each student describe to his or her group the symptoms that might be seen and have the rest of the group attempt to diagnose the condition. After an appropriate period, have the student reveal the problem. Then discuss the different ways the students explained the symptoms of the same problem.

 Figure 2.7  Figure 2.8

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 



BECOMING A CULTURALLY SENSITIVE PRACTITIONER COMPLETING A CULTURAL ASSESSMENT Cultural Self-Assessment

Learning the various steps and gaining cultural experience help the practitioner understand the many factors involved in cultural care.



Discuss sensitivity and appropriate actions for the many aspects of cultural care. Compare the terms culturally sensitive, culturally appropriate, and culturally competent.



Cultural Assessment Spiritual Assessment

Review the questions necessary to determine an individual’s background. Discuss what other questions or concerns might arise from the answers obtained from the questionnaire.

Online Activity: Investigate the website for the National Center for Complementary and Alternative Medicine at www.nccam.nih.gov. Consider the information on clinical trials about alternative therapies. Discussion Topic: Have students canvas their own community and locate businesses that specialize in products or services for certain cultures. Discuss findings in class. Activity: Have students look into their community for various community groups that serve as resources for specific cultural groups. Invite representatives to share their organization’s goals with the class. Activity: Ask students to use the Heritage Assessment tool in Figure 2.8 to interview a person on campus who is from a different cultural group than they are. Have students report back to the class. Small Group Activity: Divide the class into small groups. Have each group develop questions that may be used during a heritage assessment. Major topics that may be considered include the following: o Self-reported race and ethnicity o Religious beliefs and practices o Roles in the family or significant others o Verbal and nonverbal communication patterns, including primary language o Environmental influences o Beliefs and practices regarding food o Beliefs and practices regarding health and illness o Attitudes toward pain and the expression of pain o Use of traditional healers o Methods of treating illnesses o Cultural taboos o Culture-bound syndromes

Resources

IN-CLASS/ONLINE CASE STUDY The home care nurse is seeing a 68-year-old Vietnamese woman for an initial visit. The patient was discharged from the hospital with a diagnosis of congestive heart failure (CHF). The home health nurse notices the patient’s blood pressure is elevated, and the patient has a productive cough. The patient speaks very little English. However, the patient’s daughter is present and able to interpret. The nurse completes a full health assessment, including a review of medications, and notes that the patient was prescribed a diuretic and a beta-blocker to regulate blood pressure. The daughter shares with the nurse that her mother does not like taking medications and chooses to take herbal remedies instead. Upon assessment, the patient’s vital signs are T 98.6 P 76 R 20 BP 160/80, 02 saturation 94%. The patient’s lungs are positive for scattered rhonchi in the upper bases, clear in the lower bases, rhonchi clears with cough. The patient’s heart rate is regular with no audible mummers, +2 edema bilateral in the lower extremities. The patient denies pain. 1. Based on the information presented by the patient’s daughter, what is the most likely cause of the elevated blood pressure, edema, and rhonchi? Answer: The daughter stated that her mother does not like using medications and prefers to use herbal remedies. It is likely that this patient is not taking the prescribed medications, as evidenced by the clinical presentation and the patient’s preference for natural remedies and has developed pulmonary edema. Rationale: Wide cultural variation exists in the manner in which certain symptoms and disease conditions are perceived, diagnosed, labeled, and treated. People from Asian cultures may believe that illness is caused by an upset in the balance of “yin and yang” and are likely to turn to herbal remedies, acupuncture, moxibustion, or cupping for health restoration. 2. What interventions should the nurse incorporate into the plan of care for this patient? Answer: Perform a health beliefs and practices assessment to determine which beliefs and home remedies the patient is currently using and the frequency of use. Assess the patient’s knowledge of the prescribed medications. Rationale: The patient may be using remedies that can interfere with or take the place of the prescribed medications. It is important for the nurse to check for interactions among prescribed medications and herbal remedies. It is important to be aware of the existence of traditional folk practices and to include this as part of the assessment. It is also important to understand the patient’s knowledge level of the prescribed medications. 3. What steps does the nurse need to take to become culturally competent?

Answer: Cultural competence involves several steps, including (1) understanding one’s own heritage on the basis of cultural values, beliefs, attitudes, and practices relevant to health and illness; (2) identifying the meaning of health to the other person, keeping in mind that different groups may have different definitions of health; (3) understanding the health care delivery system; (4) being knowledgeable about the social backgrounds of patients; and (5) being familiar with the language spoken by patients and the resources available to help with interpretation. Rationale: Understanding his or her own culture helps the nurse understand and appreciate other cultures. Assessing the patient’s heritage assists the nurse in providing care that is customized to the patient’s needs. Customizing the plan of care helps ensure adherence to the prescribed regimen. 4. What interventions can the nurse include to provide care that reflects an acceptance of the patient’s health and illness beliefs and practices? Answer: Provide access to interpretation services for all patients with limited English proficiency. Provide written communication in both English and the patient’s native language. Thoroughly document the patient’s heritage assessment on the medical record. Provide education in lay terms to ensure understanding, especially regarding prescription drug information. Research the herbal remedies the patient is using to determine the benefits and risks of those remedies. If not contraindicated with the prescriptions, the patient may have more compliance with continuing the herbal remedies than the prescriptions. Rationale: Providing interpretation services respects the patient’s right to understand the plan of care. Providing written communication serves as a reference when patients are discharged. Documenting the heritage assessment in the medical record is important for collaborating with other health professionals; it also ensures that the patient is not being asked the same questions more than once. Willingness to adjust the plan of care to meet the patient’s belief system will ensure better compliance with medical interventions as well as provide patient-centered care.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Immigration o Social Determinants of Health o Culture-Related Concepts o Health-Related Beliefs and Practices o Developmental Competence o Becoming a Culturally Sensitive Practitioner o Completing a Cultural Assessment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH CARE RECIPIENT CONCEPTS THEME: Personal Preferences  Concept: Culture o Exemplar: Immigration o Exemplar: Culture-Related Concepts o Exemplar: Health-Related Beliefs and Practices  Concept: Spirituality o Exemplar: Religion and Spirituality PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Health Care Delivery  Concept: Health Disparities o Exemplar: Social Determinants of Health THEME: Care Competencies  Concept: Communication o Exemplar: Social Determinants of Health

BSN ESSENTIALS   

Essential VII: Clinical Prevention and Population Health o Developmental Competence Essential VIII: Professionalism and Professional Values o Becoming a Culturally Sensitive Practitioner Essential IX: Baccalaureate Generalist Nursing Practice o Immigration

o o

Culture-Related Concepts Completing a Cultural Assessment

2021 AACN ESSENTIALS DOMAINS 

  

Domain 2: Person-Centered Care o Culture-Related Concepts o Health-Related Beliefs and Practices o Developmental Competence o Completing a Cultural Assessment Domain 3: Population Health o Immigration Domain 9: Professionalism o Becoming a Culturally Sensitive Practitioner o Completing a Cultural Assessment Domain 10: Personal, Professional, and Leadership Development o Developmental Competence

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES  

Domain 1: Values/Ethics o Becoming a Culturally Sensitive Practitioner o Completing a Cultural Assessment Domain 2: Roles/Responsibilities o Immigration o Developmental Competence

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

CHAPTER OBJECTIVES 2. 3. 4. 5. 6. 7. 8. 9.

Demonstrate the ability to establish the parameters for a health interview. State the factors that affect communication. Describe the phases of an interview. Use the outlined communication techniques appropriately to gather data. State the 10 traps of interviewing. Discuss the meaning of common nonverbal modes of communication. Modify communication techniques as indicated by each patient’s developmental stage, special needs, or cultural practices. Discuss working with and without an interpreter to overcome communication barriers.

STUDENT RESOURCES

understand

      

Textbook Chapter 03 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

THE PROCESS OF COMMUNICATION

Exhibit several different behaviors that can affect an interview.

Sending

Using examples, demonstrate why nonverbal communication is more honest, at times, than verbal communication.

Receiving Internal Factors

Learning Activities 



Give examples of how putting nonverbal communication into context can be used as a tool.

Resources

Activity: Encourage the students to record in some way Table 3.1 an interview with a patient. After reviewing the recording, have the students offer information about what they discovered about their interview personal and process. Online Activity: Assign students to watch a television or Internet news broadcast and identify the verbal and nonverbal interview responses used by the news correspondent and the interviewee.

External Factors Dress Note-Taking

TECHNIQUES OF COMMUNICATION

Review the four internal factors interviewers should cultivate. Prepare a slide show of proper and improper settings for an interview. Emphasize the importance of external factors and of making the proper first impression. Approach the class using proper and improper interviewing techniques. Ask students how they felt and how these feelings might affect an interview.

Introducing the Interview Give examples of the appropriate use of open-ended



Small Group Activity: Divide the students into “patient” Table 3.2 Table 3.3 and “practitioner” pairs. Assign the “patients” various actions to perform during the interview, such as crying, Figure 3.5 avoiding eye contact, and so on. Alternately, assign the “practitioners” various actions, such as those illustrated

TEACHING STRATEGIES Content Focus The Working Phase

Content Highlights

Learning Activities

and closed-ended questions. Discuss the nine types of verbal responses. Review Figure 3.4 and Table 3.2.

in the “10 traps.” Have them present a portion of the interview and ask the class to identify the problems illustrated.

Open-Ended Questions Closed or Direct Questions Verbal Responses— Assisting the Narrative Ten Traps of Interviewing Nonverbal Skills Closing the Interview DEVELOPMENTAL COMPETENCE Interviewing the Parent or Caregiver Stages of Cognitive Development COMMUNICATING WITH DIFFERENT AGES The Infant (Birth to 12 Months) The Toddler (12 to 36 Months) The Preschooler (3 to 6 Years)

Resources

Hand out a paper with a list of the 10 traps of interviewing. Have the students make their own list of examples of harmful behavior. Give each student an emotion or a physical symptom to convey to the class nonverbally to see whether the class can identify it. Explain the importance of closing the interview with an agreement between the interviewer and the patient on the patient’s state of health. Point out that when a parent is interviewed, he or she may be distracted or biased when trying to share information. Coach the students to be aware of complicated family relationships. Review Table 3.4 and have students lead the discussion with suggestions on how to interview patients within each level of development. Bring in assessment equipment and demonstrate how an interviewer needs extra time to explain its use to the curious preschooler. Children ages 7 to 12 years are able to aid in the interview, with the parents’ help. Give the students examples of how to speak to this age group, demonstrating how to ask the child a question while at the same time inviting additional information from the parent.



Discussion Topic: Have students discuss unusual ways they effectively and successfully navigated interviews with patients of all ages.



Discussion Topic: Ask the students to share experiences of when they were younger and visited their health care provider. Were there practitioners whom they liked who were good at communication, and were there ones who created anxiety during their visit?

Table 3.4 Figure 3.6

TEACHING STRATEGIES Content Focus

Content Highlights

The School-Age Child (7 to 12 Years)

Discuss the pitfalls of interviewing adolescents, such as treating them like children, assuming they are familiar with a physical examination, or making remarks that can be construed as judgmental.

Learning Activities

Resources

The Adolescent The Older Adult

INTERVIEWING PEOPLE WITH SPECIAL NEEDS Hearing-Impaired People Acutely Ill People People Under the Influence of Illicit Drugs or Alcohol

List the skills needed for interviewing the older adult, such as the patience to listen and observe and showing consideration for various physical limitations. Impress upon the students the importance of avoiding “elder speak.” Inform the students of the needs of hearing-impaired people and the signs by which to recognize the symptoms. Make a list of the various forms of communication available. Invite an interpreter from an agency that provides services for the deaf to speak to the class about the necessity of accurate interpretation for hearing-impaired patients.



 Identify the difficulties of gathering information about an acutely ill person. Discuss the importance of conciseness, prioritization, and clarification.

Online Activity: Assign a student to a patient with special needs and have the student identify facilitators used to overcome barriers to communication. Using the Internet, have the students identify community resources available to assist the patient. What resources are available in the facility or in the community? Is there an expense involved? Small Group Activity: Pair up students and have them practice an interview, with one student asking personal questions and the other deciding how and which questions to answer.

Personal Questions Sexually Aggressive People Crying Anger Threats of Violence

Make the students aware of the dangers involved in interviewing extremely intoxicated patients; demonstrate how to ask the proper questions. Give examples of how to redirect a patient’s personal questions back to himself or herself without giving too much personal information. Review the various ways to set boundaries to keep all parties comfortable.

Anxiety

Clinical Illustration

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Reinforce the importance of the interviewer maintaining compassion while still getting the necessary information.

INTERVIEWING PEOPLE WITH DISTINCT NEEDS Cultural Considerations on Gender Sexual Orientation and Gender Identity Working With (and Without) an Interpreter Health Literacy: Ensuring We Are Understood Tools for Determining Literacy What Can You Do? COMMUNICATING WITH OTHER PROFESSIONALS

Make the students aware of the assistance available to them should they feel threatened or unsafe during an interview. Discuss when and how to use assistance. Review the mannerisms of various cultures and discuss how they can alter the interview. Provide the students with health history forms from various random health care providers in the area. Have them analyze the forms and suggest changes to account for all sexual orientations. Emphasize the sensitivity needed for an interview that includes sexual orientation. Explain how some questions may need to be altered by the interviewer. Invite both an interpreter and an adult who speaks limited English to discuss with the class the difficulties associated with access to proper health care because of language barriers. Encourage students to ask questions. Review Tables 3.5, 3.6, and 3.7.



Discussion Topic: Ask the students to volunteer any cultural communication practices they might use that differ from the mainstream norm. Online Activity: Have students investigate the website www.languageline.com for information about interpretation services. Small Group Activity: Assign students to small groups and have them create a health literacy questionnaire to give to family or friends. Have the questionnaire include an illness scenario that requires choices of health specialists, treatments, or tests. Have the students bring the completed questionnaires in to class and discuss the results.

Open lines of communication are necessary when caring for patients in any health care setting. Review Table 3.8.

Standardized Communication

Table 3.5 Table 3.6 Table 3.7

Table 3.8

IN-CLASS/ONLINE CASE STUDY Emily, a 3-year-old toddler, presents to the pediatrician’s office for her yearly physical examination. Her mother and 6-month-old brother accompany her. Emily’s brother was seen first for immunizations and a checkup, and now it is Emily’s turn for an exam and immunization check. The nurse notes that Emily’s immunizations are up to date (she received the pneumonia vaccine in the fall, as well as her yearly flu shot). Emily’s mother reports that her daughter is doing well in preschool and has had no illnesses since the last visit. Vital signs are T 98.6 P 122 R 20 BP 90/40. Emily is clinging to her mother; she is visibly upset, crying, and shouting, “Please don’t let them give me boo boo shot!” 1. How should the nurse proceed with the health interview? Answer: The nurse should consider that the child may be upset because she just witnessed her brother receiving immunizations. The nurse should proceed by using short, simple sentences with a concrete explanation of what procedure will be done in the office this visit. Reassure the child that no “boo boo shots” will occur at this visit. Proceed with the visit when the child is calm and allow the mother to hold the child while doing the exam. Rationale: If the nurse uses words that are unfamiliar or uses analogies, the preschooler may respond by misinterpreting or having animistic thinking about unfamiliar objects. For example, the child may imagine that the needle that her brother received was a bee and can sting her. Reassuring the child and allowing the parent to hold the child will likely decrease the child’s anxiety. 2. What factors may affect communication with this patient? Answer: In a two-person interaction, there are usually two roles, sender and receiver. During the exchange of information, both individuals engage in both verbal and nonverbal communication. When the patient is a child, the nurse must build a rapport with two people—the child and the parent. Another factor to consider is the child’s level of language development. The parent will provide most of the data needed for the visit. Provide the child with toys to play with while obtaining the history from the parent. Rationale: Ensuring that the child is included in the interview helps establish trust, but ignoring the child will likely cause the child anxiety. Providing toys serves as a distraction for the child while the parent completes the interview. 3. What are the three phases of the interview process? Answer: The first phase is the introduction phase. The second phase is the working phase. The third phase is the closing of the interview. Rationale: During the first phase, the health care provider introduces the interview. The working phase is the data-gathering phase, and both open-ended and closed-ended questions are used. Closing the interview is important because it signals that the interview is ending and gives the person one last chance to share concerns or self-expression. Be sure to provide a brief summary of what was learned during the interview.

4. What communication techniques would be appropriate for gathering the data needed to complete the health history? Answer: Facilitation, silence, reflection, empathy, clarification, confrontation, interpretation, explanation, and summary each could be used with the parent and child in this interview. Rationale: Each technique may elicit a different response from the patient or child. The perspective shifts from the patient to the health care provider with the last four. Each has a role in the interview process. However, practice is required to use each effectively and to move smoothly from one response to another.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Techniques of Communication o Communicating with Different Ages o Interviewing People with Distinct Needs  Teamwork and Collaboration/Professional Identity o Communicating with Other Professionals  Informatics/Nursing Judgment o The Process of Communication



o Exemplar: The Process of Communication o Exemplar: Techniques of Communication o Exemplar: Table 3.2 Examiner’s Verbal Responses o Exemplar: Table 3.3 Nonverbal Behaviors of the Interviewer o Exemplar: Communicating with Different Ages o Exemplar: Interviewing People with Special Needs o Exemplar: Interviewing People with Distinct Needs o Exemplar: Communicating with Other Professionals Concept: Technology and Informatics o Exemplar: The Process of Communication

HEALTH CARE RECIPIENT CONCEPTS THEME: Attributes and Resources  Concept: Development o Exemplar: Table 3.4 Stages of Cognitive Development

BSN ESSENTIALS   



Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o The Process of Communication Essential IV: Information Management and Application of Patient Care Technology o The Process of Communication Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o The Process of Communication o Techniques of Communication o Interviewing People with Special Needs o Interviewing People with Distinct Needs o Communicating with Other Professionals Essential VIII: Professionalism and Professional Values o Developmental Competence o Communicating with Other Professionals

2021 AACN ESSENTIALS DOMAINS



 

Domain 2: Person-Centered Care o Techniques of Communication o Interviewing People with Special Needs o Interviewing People with Distinct Needs Domain 8: Information and Healthcare Technologies o The Process of Communication Domain 9: Professionalism o The Process of Communication o Techniques of Communication o Developmental Competence o Interviewing People with Distinct Needs o Communicating with Other Professionals

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 3: Interprofessional Communication o The Process of Communication o Techniques of Communication o Interviewing People with Distinct Needs o Communicating with Other Professionals

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 04: The Complete Health History CHAPTER OBJECTIVES 10. State the purpose of the complete health history. 11. List the categories of information contained in a health history.

12. Describe the data or information that must be gathered for each category of a health history. 13. Describe the eight critical characteristics included in the summary of each patient symptom. 14. Relate developmental care during a health history for a child or older adult. STUDENT RESOURCES

understand

      

Textbook Chapter 04 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

THE HEALTH HISTORY— THE ADULT

Discuss the importance of using the patient’s terminology when recording the reason for seeking care versus making a diagnosis. Demonstrate how to narrow down the patient discussion to focus on the most pressing problem.



Differentiate between signs and symptoms. Provide the students with a short list and have them divide the list into two rows of signs and symptoms. Review the eight critical characteristics and the mnemonic PQRSTU.



Biographic Data

Learning Activities



Source of History Reason for Seeking Care Present Health or History of Present Illness Past Health

Give examples of how information from the past may affect the current diagnosis.

Family History Additional Questions for Immigrants GENETICS AND ENVIRONMENT

Bring in the family health history questionnaire given to patients and discuss how this information can assist in the diagnosis. Giving examples of the subjective data versus objective data under each one of the categories might assist the student on how to interview the patient.



Figure 4.4 Activity: Have students bring in a family history questionnaire from their institution or doctor and compare them. Small Group Activity: Have students use the above questionnaires and obtain a health history from each other. Online Activity: Have students search the Internet for health assessment documents and analyze them. Discussion Topic: Have students identify interviewing techniques that were most helpful in obtaining the data and those that were least helpful. Activity: Assign each student to construct a genogram for the classmate interviewed or for his or her own family. Activity: Assign students to write, in one paragraph, their own perceptions of health. Then have them ask a patient (or family member) for his or her perceptions of health. Students should then compare their personal perceptions with the perceptions of those they interviewed.

Review of Systems Functional Assessment (Including Activities of Daily Living)

Resources

Because some of the questions in this area are personal, ask the students how they would broach the subject with the patient. Emphasize the importance of recording both the presence and absence of symptoms.

Perception of Health Bring in the questionnaire and sample charts of

TEACHING STRATEGIES Content Focus

DEVELOPMENTAL COMPETENCE Children

Content Highlights

Learning Activities

several patients. Have students study them to see how others have arrived at some of their conclusions. Discuss the CAGE alcohol screening questionnaire. Point out various situations in which a child’s parent may bias the results of the examination or may contradict what the interviewer may be actually seeing. Discuss the importance of including information about the mother’s pregnancy.

Discussion Topic: Have students discuss ways to make an adolescent more comfortable during an assessment.

Resources

Figure 4.16

The Adolescent Review the HEEADSSS method of interviewing, noting the gradual progression from simple questions to more intense, personal questions.

IN-CLASS/ONLINE CASE STUDY J.P. is a 75-year-old retired factory worker who is being seen in the home setting for a yearly health assessment provided by his insurance company. Subjective Data No complaints at this time Enrolled in Silver Sneakers Eats out much of the time Widowed Has one daughter who lives in another state Retired automotive parts factory worker Drives to and from activities Objective Data Vital signs: T 37 P 80 R 18 BP 140/68 Weight: 200

Weight: 5 feet, 6 inches Questions 1. How should the nurse proceed with the interview portion of the assessment? 2. What are the components necessary to complete the interview? 3. Develop a problems list for subjective findings. 4. Develop a problems list for objective findings. 5. What teaching should the nurse consider from the problems list? 6. What interventions might be included in the plan of care for this patient? Answers 1. The interview consists of three phases: introduction, discussion, and summary. To begin the introduction phase, the nurse introduces himself or herself and informs the patient about his or her role in the patient’s care. 2. After the introduction phase, the nurse enters the discussion phase. During this phase the nurse collects the health history by facilitating a discussion regarding various aspects of the patient’s health in order to detect disease early and prevent complications. The summary phase of the interview is a time for closure. Summarize with patients the main points and emphasize data that have implications for health promotion, disease prevention, or resolving their health problems. 3. Subjective problems include the following: widower with daughter in another state, so the patient may not have support; eats out much of the time; assess what types of food eaten; retired factory worker in automotive parts, so assess for asbestos exposure; assess for physical and cognitive impairments regarding safety, hearing, vision, and accidents while driving. 4. Objective problems include the following: blood pressure high and overweight. 5. Teaching plan from problems list might include diet and exercise routine. Inquire about how often patient goes to Silver Sneakers (a program for seniors to keep active). Assess patient’s daily routine and activities. Simple meal preparation would reduce the amount of time patient eats out. Ask how often patient sees family and friends. Assess patient’s use of medications: taking a blood pressure medication? 6. Interventions include notifying provider of elevated blood pressure and scheduling a follow-up appointment with provider; teaching patient the signs and symptoms of congestive heart failure; giving patient information on diet and exercise and on other programs available for seniors in the community; identifying community resources for seniors that provide meals, socialization, and exercise; and assisting the patient in making healthier food choices when eating out by asking about favorite meals and restaurants.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o The Health History—The Adult o Developmental Competence  Informatics/Nursing Judgment o Developmental Competence

BSN ESSENTIALS 

Essential IX: Baccalaureate Generalist Nursing Practice o The Health History—The Adult o Developmental Competence



Domain 2: Person-Centered Care o The Health History—The Adult o Developmental Competence

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o The Health History—The Adult o Developmental Competence

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 05: Mental Status Assessment CHAPTER OBJECTIVES 15. Define the behaviors that are considered in an assessment of a person’s mental status. 16. Describe relevant developmental care related to the mental status examination. 17. State the purpose of a mental status examination. 18. List the four components of mental status assessment. 19. Complete a Mini-Mental State Examination. 20. Discuss developmental care for infants, children, and aging adults.

STUDENT RESOURCES

understand

      

Textbook Chapter 05 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS

in text



Objective Data

lesson focus



Recognize Cues

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

DEFINING MENTAL STATUS

Have the students review the assessment list in this section and share what they would ask to determine the level of functioning for each.

DEVELOPMENTAL COMPETENCE

Show a chart with the ages and the emotional and cognitive development of a child.

Infants and Children

Have the students make a list of the different variables that may affect the information they receive from older adults; have them explain how to deal with these variables.

Learning Activities

 

The Aging Adult

GENETICS AND ENVIRONMENT

Explain how various illnesses can affect behavior and cognitive function even when not physically apparent. Examine genetic components that influence a person’s risk of developing mental illness and/or dementia.



Sexual and Gender Minority Considerations

COMPONENTS OF THE

Use segments of movies or other visual materials and

Discussion Topic: Discuss the difficulties encountered in assessing both young children and older adults. Online Activity: Have students investigate several testing options for children and adolescents, including the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Compare the validity and thoroughness of these and other checklists or tests.



Online Activity: Have students go online and investigate peer-reviewed health articles about connections between mental health/behavioral issues and lack of food security during WWII. How did a child’s lack of food and care affect their adulthood and even their children’s physical and mental health? Activity: Have students shadow a psychiatric nurse in

Resources

TEACHING STRATEGIES Content Focus MENTAL STATUS EXAMINATION OBJECTIVE DATA Appearance Behavior

Content Highlights

Learning Activities

ask students to describe the mental status of the personality portrayed, using A, B, C, and T for the segment viewed. Some suggestions for movies might include The Over the Hill Gang with George Burns for viewing older adults, Forrest Gump for educationally challenged individuals, Rain Man for a psychiatric disorder, Terms of Endearment for anger, and A Beautiful Mind for a psychiatric disorder (schizophrenia).

either an outpatient or inpatient setting. Instruct them to write a short paper on their observations, including but not limited to the following: o The nurse’s attitude and demeanor toward the patient o Questions asked that clearly revealed the extent of the problem o Suggestions from the nurse about documentation o The nurse’s experience in the psychiatric field Discussion Topic: If they are willing, ask students to discuss their experiences with depressed friends or family members. As they read the chapter, what warning signs do they see in retrospect? Group Activity: Have student pairs try the Four Unrelated Words Test. Give each pair of students a separate list of words and use the lists to test for recall as described in the text.



Cognitive Functions Thought Processes and Perceptions

Discuss the four main headings of a mental status assessment and why they are placed in a particular sequence. 

Judgment Supplemental Mental Status Examination DEVELOPMENTAL COMPETENCE

Show the students two photos: one of a person with a neat, well-groomed appearance and the other with a disheveled appearance. Have students compare the photos and make assumptions based on appearance. Review the listed behaviors and other behaviors the instructor has encountered. Discuss how nonverbal behaviors are also considered.

Infants and Children The Aging Adult

Show results of various screenings that are both positive and negative for disturbed thought processes. Discuss suicidal ideation and warning signs. Explain the cause and symptoms of aphasia. Obtain input from the class on variables that might show a lack of judgment.

Resources

IN-CLASS/ONLINE CASE STUDY A.P. is a 73-year-old woman who presents to the women’s health clinic for an annual physical examination. She states that she is having difficulty sleeping and has been having panic attacks for the past year, since the death of her son. Subjective Data Lives with husband Daughter, age 50 years, lives nearby Had a son, age 52 years, who died in the past year from a drug overdose Objective Data Vital signs: T 37 P 80 R 18 BP 140/68 Weight: 140 Height: 5 feet, 5 inches Questions 1. On which components of the health history should the nurse focus the mental health exam? 2. What specific observations should the nurse make with regard to mental status? 3. Why is it important to obtain a thorough past medical history for this patient? 4. What specific questions should the nurse consider asking when obtaining the past medical history? 5. What specific questions should the nurse ask regarding the panic attacks? 6. Create a problems list from the data provided. 7. What teaching and nursing interventions should be included in the plan of care for this patient? Answers 1. During the health history, the nurse notices and compares the patient’s appearance, behavior, and cognitive functions with the characteristics of a healthy personality. The thought processes should also be assessed. Data collection begins when the nurse first sees the patient and will include verbal and nonverbal data. 2. Observations the nurse should make include the following:  Is the patient dressed appropriately for the weather?  Does her mood seem appropriate?  Is the affect (emotional state) appropriate?  What is the patient’s body posture and position?  Is the patient relaxed or moving frequently?

 Is the patient slumped over and looking at the ground with a sad facial expression or walking erect with a brisk step and a smiling face?  What is the patient’s tone of voice?  Does she talk in a monotone or in a happy, expressive tone?  Does the patient’s conversation flow in a logical or meaningful sequence? It is important for the nurse to obtain a thorough past medical history to assess previous coping strategies and identify the person’s previous problems. This will assist the nurse in providing a baseline for interviewing and determine whether this patient has previous experience with mental health disorders. In addition, the nurse will gain insight into previous coping strategies to determine whether these strategies were effective or whether other strategies are needed to deal with this patient’s grief process. The nurse should include the following in the past medical history: In the past, have you experienced any behaviors that could indicate a mental health problem? If yes, describe your experience. How have you coped in the past with this disorder? Are those coping strategies still working for you? Include the CAGE test to assess for substance abuse. Assess the use of sleep aids or medications taken to control anxiety. The nurse should focus the assessment on the anxiety and include the following questions as part of the assessment: Over the past 2 weeks: Have you had difficulty concentrating or making decisions? Have you been preoccupied or forgetful? Are you able to fall asleep and stay asleep without difficulty? Have you noticed a change in the amount of energy you have (fatigue)? Have you been more irritable than usual? Do your muscles seem tense? Do you feel a tightening in your throat? The problems list includes the following:  Anxiety: Related to the grieving process  Depression: This patient is having panic attacks, which contribute to depression. Gender is a risk factor. Women are at risk for depression 2:1 over men.  Insomnia: A depressed mood can interrupt sleep habits.  Appetite: May decrease or increase The nurse should include assessing and providing interventions for stressors that contribute to this patient’s anxiety, depression, and grieving process. The patient suffered the recent loss of a family member. Inquire about other stressors, such as money, intimate relationships, and employment problems. The nurse may take this opportunity to teach patients alternative ways to react to their stress. These may include relaxation techniques, physical exercise, or journaling. When patients describe difficulty dealing with stress, they can be referred to agencies for care and support.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing



o Objective Data Informatics/Nursing Judgment o Components of the Mental Status Examination

BSN ESSENTIALS 

Essential IV: Information Management and Application of Patient Care Technology o Components of the Mental Status Examination

2021 AACN ESSENTIALS DOMAINS  

Domain 2: Person-Centered Care o Developmental Competence Domain 9: Professionalism o Developmental Competence

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Developmental Competence

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 06: Substance Use Assessment CHAPTER OBJECTIVES 21. Identify current statistics related to alcohol use and abuse. 22. Identify risk factors associated with increased alcohol use. 23. Identify current statistics related to drug use and abuse. 24. Incorporate the use of alcohol and drug abuse tools into the assessment of patients in the health care environment. 25. Identify and assess substance abuse in individuals across the life span.

STUDENT RESOURCES

understand

      

Textbook Chapter 06 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

ALCOHOL USE AND ABUSE

Show a chart with the percentage of people who drink, the amount they drink, and a list of the medical complications.

DEFINING ILLICIT DRUG USE DIAGNOSING SUBSTANCE ABUSE GENETICS AND ENVIRONMENT Sexual and Gender Minority Considerations

DEVELOPMENTAL COMPETENCE Adolescents The Pregnant Woman

Learning Activities 

Give a list of illicit drugs with the ages and percentage of users. Review Table 6.2 and discuss the delicacy of asking questions and the possible physical signs of alcohol abuse. Discuss environmental factors that increase the risk or contribute to substance abuse. Ask several recovering users from NA or AA to come to class to discuss their environmental influences. Invite an adolescent drug counselor to speak to the class about the current trends in adolescent substance use and abuse. Discuss the types of programs available to adolescents in your area. Demonstrate the number of pregnant women who drink and discuss the potential adverse effects.

The Aging Adult Consider the 4P’s Plus questionnaire for women. List the factors that can increase the risks of alcohol use in older adults; explain why these factors are so difficult to detect.



Resources

Table 6.1 Activity: Discuss “red flags” of substance abuse that can be assessed by the nurse during the social Figure 6.2 Table 6.2 history assessment.  Activity: Assign students to groups of four and have them research one type of substance that currently is being abused by adolescents. Have them present their findings in class or at a postconference clinical. Community Activity: Ask the students to obtain permission and then attend an NA or AA meeting. Have them write a 2-page report on their experience.



Community Activity: Ask the students to contact and tour an adolescent substance abuse facility near them. What type of services do they offer? What outcome measurements do they use? Write a 2-page paper about your findings. Online activity: Ask the students to examine the connections between substance use and tobacco use. Have the students find examples in literature where one leads to the other, or have them examine articles online that discuss this connection and its circular process.

TEACHING STRATEGIES Content Focus SUBJECTIVE DATA Screening Women for Alcohol Problems Screening Aging Adults

Content Highlights Discuss the AUDIT test in Table 6.3. Pass out the TWEAK questions and the CAGE questions and discuss how they might cause the patient to be hesitant to answer truthfully. Explain how to get yes or no responses, rather than emotional responses, for the SMAST-G questionnaire.

OBJECTIVE DATA Discuss the definitions of intoxication, abuse, dependence, tolerance, and withdrawal. See Table 6.6.

Learning Activities 

Small Group Activity: Divide the class into small groups and have students role-play asking questions that may be necessary in assessing for substance abuse. Include situations in which alcohol abuse has caused many problems for the individual and family. Learners can use the CAGE assessment tool to determine the level of abuse.  Online Activity: Ask students to identify patient teaching websites that would be useful for patients and families who are victims of problems arising from substance abuse.  Discussion Topic: If they are willing, have students discuss their experiences with binge drinking, family alcoholism, or illicit drug use.

Resources Table 6.3 Table 6.4 Table 6.5 Table 6.6

IN-CLASS/ONLINE CASE STUDY The emergency department nurse is assessing a 38-year-old man who was in a motor vehicle accident. The patient was an unrestrained driver of the vehicle. The vehicle was traveling approximately 42 mph upon impact, the driver collided with the windshield and sustained a head injury. The patient is now stable, complaining of pain 9/10 in the head, neck, and shoulder region. Neurologic status: cranial nerves 2-12 intact; patient is awake, alert, and oriented; computed tomography scan was negative for hematoma or hemorrhage. Vital signs: T 97.5, P 68, R 16, BP 130/70. The patient is asking the nurse for pain medication; however, the nurse smells alcohol on the patient’s breath. Toxicology reports are pending. 1. Based on the information presented, what subjective data will assist the nurse in making a decision to treat this patient’s pain? Answer: Various screening tools are effective at differentiating between use and abuse of substances. Screening tools such as CAGE, AUDIT, SMAST, and the NIAA tools offer a general framework for assessment. Rationale: Screening tools are instruments that assist the nurse in obtaining data that can be quantified. Screening tools are considered valid instruments with a high degree of reliability for identifying substance abuse issues.

2. The nurse is teaching the patient about the standard amount of alcohol in various beverages. How would the nurse explain a standard drink in the United States? Answer: There is 1 oz of alcohol in a 12-oz beer and 1.5 oz of alcohol in a 1.5-oz glass of malt liquor. A mixed drink can have 1 to 3 oz of alcohol. Ask the patient to describe the glass or mug normally used for his drinks. Rationale: Many people do not know what constitutes a standard drink. Providing this information assists the patient in making an informed choice regarding alcohol consumption. The size of the glass used will give the nurse an understanding of the patient’s attitudes and perceptions regarding his drinking. 3. The laboratory findings showed evidence of chronic alcohol abuse. What risk factors are associated with this patient's alcohol use? Answer: In the general population, alcohol consumption of at least four standard drinks per day (each containing 12 g of alcohol) is associated with increased rates of death from cirrhosis and alcoholism. In men, it is also associated with increased rates of cancers of the mouth, esophagus, pharynx, and liver and with injuries and other external causes of death. Rationale: Risk factors increase with the amount of alcohol consumed. 4. What interventions should the nurse incorporate into the plan of care for this patient? Answer: Assess the patient’s social history using one of the screening tools outlined in the chapter. If the toxicology and lab reports show evidence of problem drinking, consider advising the patient of this. State the results of the studies and make a brief recommendation. For example, “You are drinking more than is medically safe. I strongly recommend that you quit, and I am willing to help.” Use FRAMES to provide intervention:  Feedback: Give feedback on the risks and negative consequences of substance use. Seek the patient’s reaction and listen.  Responsibility: Emphasize that the individual is responsible for making his or her own decision about his or her drug use.  Advice: Give straightforward advice on modifying drug use.  Menu of options: Give menus of options to choose from, fostering the patient’s involvement in decision making.  Empathy: Be empathic, respectful, and nonjudgmental.  Self-efficacy: Express optimism that the individual can modify his or her substance use if he or she chooses. Self-efficacy is one's ability to produce a desired result or effect. Rationale: The consequences of substance abuse are destructive. Although the patient may need a referral for treatment, the nurse can assist the patient in identifying the problem and the medical consequences of the abuse.

NURSING CURRICULUM STANDARDS



Patient-Centered Care/Human Flourishing o Subjective Data  Informatics/Nursing Judgment o Subjective Data

BSN ESSENTIALS  

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data Essential IX: Baccalaureate Generalist Nursing Practice o Subjective Data

 

Domain 2: Person-Centered Care o Subjective Data Domain 8: Information and Healthcare Technologies o Subjective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Subjective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 07: Family Violence and Human Trafficking CHAPTER OBJECTIVES 1. 2. 3. 4. 5. 6. 7. 8. 9.

Recognize health care professionals’ role as mandatory reporters of abuse. Discuss the health effects of violence. Describe the use of the Abuse Assessment Screen (AAS) when one is screening for intimate partner violence (IPV). Explain the aspects of assessment and history taking for suspected abuse. Describe the components of the physical examination of the known survivor of IPV or elder abuse and use correct forensic terminology. Examine the increasing problem of adolescent relationship violence. Discuss the importance of and procedures for both written and photographic documentation of IPV and elder abuse. Assess for the risk of homicide when working with suspected IPV cases. Determine what steps to take if a patient denies IPV but abuse is still suspected.

STUDENT RESOURCES

understand

      

Textbook Chapter 07 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS in text



Types of Violence

lesson focus

 

Recognize Cues Take Actions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus TYPES OF VIOLENCE Intimate Partner Violence Child Abuse and Neglect

Content Highlights Bring in case examples of the four types of intimate partner violence (IPV) that are defined by the Centers for Disease Control and Prevention (CDC). Review the definitions that the state statutes have incorporated.

Elder Abuse and Neglect Human Trafficking HEALTH EFFECTS OF VIOLENCE

Invite an RN who works with adolescents to speak to the class about the consequences of adolescent relationship violence she has observed. Discuss the ways technology factors into violence within this particular age group. Bring in a copy of the state reporting requirements for elder abuse and neglect. Review the list of forensic terminology of neglect and abuse in Table 7.1.

Learning Activities 

Activity: Have a guest speaker from one or more of the following organizations or groups speak to the class: o Social worker or case worker who works with IPV or elder abuse o Survivor of domestic violence or an adult survivor of child abuse o S.A.N.E. nurse from a local emergency department o Representative for a local shelter for battered and abused women and families o A specialist in forensic medicine who can show photographs of physical evidence of abuse o An attorney who specializes in elder law and cases of elder abuse and neglect

Resources

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Show pictures of various bruising, laceration, and cutaneous injuries that indicate abuse of children, women, and older adults. Discuss the chronic health and mental health problems that may be a result of violence.

GENETICS AND ENVIRONMENT Sexual and Gender Minority Considerations DOCUMENTATION

SUBJECTIVE DATA

Discuss recent incidences of abuse or neglect that have been reported in the news, noting how the reports fit the CDC definitions presented in this chapter. Review the risk factors among ethnic and racial minorities and discuss triggers that may be associated with these factors. Obtain information from a mental health provider, a social service provider, and a health care provider about the percentage of minority clients they serve. Bring in actual documentation of cases of abuse to give the students an example of verbatim reporting. Hand out a copy of your employer or institutional protocols for obtaining a history of abusive episodes. Emphasize that documentation must hold up in court. Discuss whether routine universal assessment for IPV is being performed in your area.



 

Intimate Partner Violence Elder Abuse and Neglect



Discuss various ways the students might pose the abuse assessment screen to uncomfortable victims. Invite input from students about how to tailor questions to patients of different ages.  Invite a social worker to discuss how to approach and acquire information from abuse victims.  Discuss the actions a nurse should take when an

Online Activity: The text states that there is “little research about the effectiveness of screening and prevention efforts among racial and ethnic minority women.” Ask the students to search online for any research that is available and report findings to the class. Online Activity: Have students go online and find documentation from cases of abuse to see how it matches up with the instructions in the text. Discuss in class. Discussion Topic: Discuss “red flags” of abuse and neglect that may be found during an assessment. Small Group Activity: Divide the class into small groups and have students role-play asking questions that may be necessary in assessing for abuse. Include situations in which abuse is suggested, as well as obvious abuse cases. Have students practice using the AAS tool. Activity: Ask the students how they would expand the four questions in this section to create a screening tool for adolescents. Online Activity: Access the website of the department in your state that oversees public health and human

Table 7.1

Figure 7.3

TEACHING STRATEGIES Content Focus

Content Highlights adolescent admits to currently being involved in a violent relationship.

Child Abuse and Neglect Human Trafficking

OBJECTIVE DATA Infants and Children

Discuss the steps to be taken if the health care provider suspects abuse in the cognitively challenged patient. Investigate the resources available to the patient. Discuss the questions that can be used for obtaining information from a child. Explain the importance of evaluating the developmental stage of the child in connection with the injury.

Learning Activities

Resources

services. Determine what services or assistance the agency provides to families caring for older adult members.



Online Activity: Ask the students to research a human trafficking organization online. What information do they provide to health care professionals to alert them to signs of human trafficking in their patients? What information is available for the average person? (Suggest ecpatusa.org, humantraffickingsearch.org, traffickinginstitute.org, among others.)

Present examples of both correct and incorrect documentation of the physical exam. Review Table 7.1 for correct forensic terminology. Give a slide show comparing normal childhood injuries with injuries caused by abuse.

Figure 7.4 Table 7.2 Table 7.3 Table 7.6

Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Figure 7.5

IN-CLASS/ONLINE CASE STUDY M.L. is a 15-year-old young woman who presents to the family planning clinic for her first visit. Before seeing the patient, the nurse reads through the initial paperwork and notes that the patient is requesting a pregnancy test and birth control counseling. The nurse calls the patient into the triage room and begins the initial interview and the sexual history assessment. When the nurse inquiries about the patient’s age of first sexual encounter, the patient becomes upset and starts to cry. The nurse consoles the patient and listens carefully as the patient describes how her father has been sexually abusing her since she was 5 years old. The patient explains that the abuse continues on a weekly basis. The patient

also shares that it has been 2 months since her last menstrual cycle, and she is worried that she may be pregnant. M.L. is in a monogamous relationship with her boyfriend of 1 year and is sexually active with this partner. 1. How should the nurse proceed with the screening and interview? Answer: Because this patient is a minor and, in a relationship, it is important for the nurse to assess and document prior abuse, including IPV, childhood physical and sexual abuse, and prior rapes of all kinds (stranger, date, intimate partner). The nurse should also use the Abuse Assessment Screen (AAS) to determine whether the patient is in an abusive relationship. Ensure that the patient is alone and not being controlled by a partner or parent. Rationale: Cumulative trauma can be associated with more severe mental and physical health problems. A victim may continue to seek abusive relationships because of poor self-esteem and lack of empowerment. Assessing the patient alone protects the patient and creates a safe environment. 2. M.L. answers yes to questions 1 through 3 on the AAS. How should the nurse proceed? Answer: The nurse should respond by stating, “Thank you for sharing. Can you tell me more about this?” The health care provider should convey a sense of concern and even distress about the violence and should emphasize that the abuse is not the woman’s fault. Assurance should also be given that the patient is in a safe place. The message that help is available should also be conveyed. Red flags of possible abuse are physical findings that are not consistent with the history provided by the patient. Rationale: If a woman answers yes to any of the AAS questions, a careful assessment is needed to discover how recent and how serious the abuse was. Sometimes more violence is uncovered as the assessment continues. It is important to intervene and provide resources to the patient. 3. What is the nurse's role in reporting the suspected abuse? Answer: The Joint Commission requires that all health care settings have policies and procedures in place to assess, document, and make referrals for all kinds of family violence, including child abuse. The Centers for Disease Control and Prevention (CDC) provides definitions for two types of intimate partner violence (IPV): physical or sexual violence and psychological or emotional abuse. As mandatory reporters of abuse, health care professionals need only have suspicion that abuse or neglect may have occurred. Rationale: IPV, child abuse, and elder abuse are important health problems that health care professionals must recognize and assess. Many nursing and medical organizations, such as the American Nurses Association and the American Medical Association, have developed policy statements recognizing the need for health care professionals to assess family violence. 4. How would the nurse proceed with the physical examination? Answer: Components of the physical examination include a complete head-to-toe visual examination. When the examination reveals physical findings, it is important to use correct basic medical forensic terminology. Bruising should be described specifically and photographed if possible.

The patient must grant permission before photographs are taken. Baseline laboratory tests may be necessary. As the patient’s advocate, consider testing for sexually transmitted infections. Rationale: A complete examination assists in obtaining evidence for sexual and physical abuse. Using medical forensic terminology assists the nurse in communicating with the health care team. The definitions provide a means for defining objective findings and documenting findings in objective terms. Photographs also provide objective documentation and can be used as evidence. 5. How should the nurse document the abuse? Answer: It is important to use correct basic medical forensic terminology. Photographs may be necessary, as well as documentation of detailed, nonbiased progress notes and the use of injury maps. It is critical to document exceptionally poignant statements made by the victim that identify the reported perpetrator and severe threats of harm made by the reported perpetrator. It may be necessary to include obscenities and curses with verbatim documentation. In cases of sexual abuse, use the exact terms an abused patient may use to describe sexual organs or sexually assaultive behaviors. Rationale: Using medical forensic terminology assists the nurse in communicating with the health care team. The definitions provide a means for defining objective findings and documenting findings in objective terms. Photographs also provide objective documentation and can be used as evidence. Documenting the patient’s words can be extremely useful in future court proceedings.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Types of Violence o Subjective Data  Teamwork and Collaboration/Professional Identity o Types of Violence  Safety/Nursing Judgment o Types of Violence  Informatics/Nursing Judgment o Documentation o Subjective Data

NURSING CONCEPTS

The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Maladaptive Behavior  Concept: Interpersonal Violence o Exemplar: Types of Violence o Exemplar: Health Effects of Violence PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Health Care Delivery  Concept: Health Disparities o Exemplar: Genetics and Environment THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Documentation o Exemplar: Subjective Data  Concept: Communication o Exemplar: Types of Violence THEME: Health Care Infrastructures  Concept: Health Care Law o Exemplar: Subjective Data

BSN ESSENTIALS  

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Types of Violence Essential IV: Information Management and Application of Patient Care Technology o Documentation o Subjective Data

   

Essential V: Healthcare Policy, Finance, and Regulatory Environments o Types of Violence Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o Types of Violence Essential VII: Clinical Prevention and Population Health o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Subjective Data

2021 AACN ESSENTIALS DOMAINS    

Domain 2: Person-Centered Care o Types of Violence o Subjective Data Domain 3: Population Health o Types of Violence o Genetics and Environment Domain 5: Quality and Safety o Types of Violence Domain 8: Information and Healthcare Technologies o Documentation o Subjective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES  

Domain 1: Values/Ethics o Types of Violence Domain 2: Roles/Responsibilities o Types of Violence o Subjective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 08: Assessment Techniques and Safety in the Clinical Setting CHAPTER OBJECTIVES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Describe the use of inspection as a physical examination technique. Describe the use of palpation as a physical examination technique. Relate the parts of the hands to palpation techniques used in assessment. Differentiate between light, deep, and bimanual palpation. Describe the use of percussion as a physical examination technique. Describe direct and indirect percussion. Identify the components of a percussion note. Describe the use of auscultation as a physical examination technique. Identify the equipment needed for the screening physical examination. Discuss appropriate infection control measures used to prevent spread of infection. Discuss developmental care needed for patients.

STUDENT RESOURCES

understand

      

Textbook Chapter 08 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

CULTIVATING YOUR SENSES

Give examples of how your own personal technical skills have improved over time and with experience.

Inspection

Have students inspect one another and give results, comparing them with the instructor’s results.

Learning Activities 

Palpation Percussion Auscultation

Bring in a volunteer for a hands-on experience of this technique. Have students practice on each other to discover how different parts of the hands are best suited for different factors.



Resources

Activity: Obtain two large foam cups with lids. Fill one Table 8.1 Table 8.2 with water or sand. Leave the other empty. Have students percuss the tops of the two cups. Although the Figure 8.4 Figure 8.8 sounds are exaggerated, this allows students to begin Figure 8.9 to differentiate between the sound heard over an airfilled organ and that heard over a solid organ. It also allows the instructor to observe the percussion technique of the student. Activity: Have students practice listening to heart sounds with both the bell and the diaphragm of their

TEACHING STRATEGIES Content Focus SETTING EQUIPMENT A Clean Field

Content Highlights Using a volunteer, demonstrate the location of organs, the differing sounds, and the density of structures. Let students practice and critique their process. Discuss the four components of sound and vibrations. Bring in a stethoscope for demonstration. Ask students to bring in their own stethoscope and discuss their reasons for choosing that particular one.

Learning Activities



Resources

stethoscopes. Ask them to write down the differences they perceive when listening to the same sound with both devices. Small Group Activity: Asking students to work in pairs, have them listen to each other’s breath sounds, first with the shirt off and then with the shirt on. Have them compare the differences in sound quality. Online Activity: Have students access the following website to listen to and become familiar with heart sounds: http://www.easyauscultation.com/heartsounds.aspx.

Give examples of how various distractions can affect an interview. Bring in equipment to allow the students hands-on training.

A SAFER ENVIRONMENT Handwashing

Explain that in various settings, there is no designated place for equipment; however, as long as clean and used pieces of equipment are separated, that is sufficient. Review the precautions in Table 8.2, emphasizing the ease with which nurses sometimes become desensitized to the thought of infection.



 Personal Protective Equipment

THE CLINICAL SETTING General Approach

Reassure students that experience is the best teacher and relate some of your own embarrassing experiences and how you dealt with them.



Figure 8.11 Discussion Topic: Discuss Standard Precautions and Table 8.3 infection control methods for the protection of both the patient and the examiner. Online Activity: Have students access online articles about hospital-acquired infections. Choose one and write a 1-page summary and a 1-page reaction paper, including how the infections mentioned could have been prevented. Activity: Arrange for each student to observe a physical Table 8.4 examination performed by an experienced practitioner.  Group Activity: Have students do mock exams of one another and describe any uncomfortable

TEACHING STRATEGIES Content Focus

Content Highlights

Hands On

Learning Activities

Resources

feelings they have. Provide input on how they can overcome those feelings.

DEVELOPMENTAL COMPETENCE

Discuss developmental care needed for patients across the lifespan.

The Infant

Discuss ways that you have used to make young patients more comfortable.

The Toddler The Preschool Child The School-Age Child The Adolescent The Aging Adult The Sick Person

IN-CLASS/ONLINE CASE STUDY P.P. is a 32-year-old man who presents to the occupational health clinic for a physical before beginning employment at a local hospital. The patient is in good health, has no complaints of pain, and exercises on a daily basis. His body mass index is 23.4; the physical exam is unremarkable; and vital signs are T 97.5, P 68, R 16, and BP 120/60. The patient is to begin work after obtaining physical clearance. Labs and immunization reports are pending. The nurse is preparing to perform the physical examination. 1. How does the nurse prevent the spread of infection and implement infection control measures? Answer: As the examiner enters the room, he or she should wash his or her hands in the patient’s presence. Standard precautions are used for all patients, and transmission-based precautions are used with patients who have documented or suspected transmitted infections. Designate “clean” and “used” areas for handled equipment. All equipment carried by the examiner should be cleaned with alcohol between patients.

Rationale: The single most important step to decrease the risk of microorganism transmission is thorough handwashing after physical contact with patients or body fluids. A stethoscope and other equipment can become a common vehicle for transmission of infection 2. What physical examination techniques should the nurse use for inspection? Answer: While conducting an inspection, the provider uses the patient’s body as his or her own control to determine symmetry between the right and left sides of the body. Perform the inspection in a well-lighted room. Rationale: Inspection is critical observation of the patient in a systematic, deliberate manner that begins as a general survey the moment the practitioner meets the patient. It is the first technique used in the performance of a physical assessment. Good lighting; adequate exposure; and, at times, the use of special instruments aid in the completion of a good inspection. 3. What physical examination techniques should the nurse use for palpation? Answer: Fingertips for fine tactile discrimination. Grasp with the thumb and fingers to determine the position, shape, and consistency of an organ or mass. Temperature is best determined with the dorsa (back) of the hands and fingers. Vibration is assessed with the base of the fingers (metacarpophalangeal joints) or ulnar surface of the hand. Palpitation is used to assess temperature, moisture, change in size, vibrations, pulsations, rigidity or spasticity, crepitation, presence of lumps or masses, and the presence of tenderness or pain may also be found. Rationale: Palpitation uses fingertips, grasping actions, and the dorsa of the fingers and hands as well as the base of the fingers. Palpitation follows and confirms points noted during inspection. Palpation applies the sense of touch to assess texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or opacity, crepitation, presences of lumps or masses, and presence of tenderness or pain. 4. What physical examination techniques should the nurse use for percussion? Answer: Percussion is used to assess underlying structures. Percussion is used most frequently to assess the thorax and abdomen. Direct percussion, most commonly used to assess the adult sinuses and thorax of an infant, is the technique of striking the finger or hand directly against the body. With indirect percussion, the examiner’s interphalangeal joint is placed firmly against the patient’s skin with the remainder of the hand lifted off the skin. The middle finger of the dominant hand is used as the striking force (plexor). The striking finger, using the action of the wrist, hits directly at right angles to the stationary finger on the portion in contact with the skin surface. Rationale: Percussion is the technique of striking a part of the body with short, sharp taps of the fingers. The location, size, position, and density of the underlying organs can be assessed by the change in percussion sounds elicited. The sounds are assessed for amplitude, pitch, quality, and duration. To elicit the best tones and to avoid pain, short fingernails are a must. 5. What physical examination techniques should the nurse use for auscultation? Answer: Auscultation (listening to sounds produced by the body) is done with both the unassisted sense of hearing and with special instruments, usually a stethoscope. Sounds heard with the ear alone include speech, percussion tones, difficult breathing, coughing, and loud abdominal sounds. The stethoscope should always be put on bare skin, not over clothing.

Rationale: The examiner listens for the presence or absence of sound and the quality of sound heard. Areas most commonly assessed with a stethoscope are the heart, blood vessels, lungs, and abdomen. Because the stethoscope does not amplify sound but rather blocks out extraneous room sounds, a quiet environment is required. Auscultation through clothing creates artifactual sounds and muffling.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o The Clinical Setting

BSN ESSENTIALS 

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety

 

o Table 8.2 Essential VIII: Professionalism and Professional Values o The Clinical Setting Essential IX: Baccalaureate Generalist Nursing Practice o Developmental Competence

2021 AACN ESSENTIALS DOMAINS    

Domain 1: Knowledge for Nursing Practice o Cultivating Your Senses o Developmental Competence Domain 2: Person-Centered Care o The Clinical Setting Domain 5: Quality and Safety o Table 8.2 Domain 10: Personal, Professional, and Leadership Development o The Clinical Setting

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Cultivating Your Senses o The Clinical Setting

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 09: General Survey and Measurement CHAPTER OBJECTIVES

1. 2. 3.

List the information considered in each of the four areas of a general survey: physical appearance, body structure, mobility, and behavior. Discuss measurement of weight and height. Discuss relevant developmental care in relation to a general survey.

STUDENT RESOURCES

understand

      

Textbook Chapter 09 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus OBJECTIVE DATA THE GENERAL SURVEY Physical Appearance

Content Highlights

Learning Activities

Have a volunteer unknown to the students stand up before the class. Using the tables for range of findings, have students give their observations of physical appearance, body structure, mobility, and behavior, citing reasons for their opinions.



While explaining how to properly measure weight, height, body mass, and waist circumference, discuss the various maladies that would cause drastic fluctuations in these measurements from one visit to the next.



Group Activity: Have each student observe a peer and document findings as a “general assessment.” Activity: In the clinical setting, assign students to write a general survey description of a patient.

Resources Figure 9.3

Body Structure Mobility Behavior MEASUREMENT Weight Height Body Mass Index Waist Circumference DEVELOPMENTAL COMPETENCE



Activity: Have students calculate their own BMI using the formula. Discuss other ways that BMI is calculated. Discussion Topic: Discuss how some patients might be embarrassed or anxious about their measurements and how they can be made to feel more comfortable with this process and information.

Explain why it is important to weigh at the same time of day. Examine the reasons for increased risk of type 2 diabetes because of waist circumference. Discuss some unusual observations that may occur because of age.

Table 9.1

TEACHING STRATEGIES Content Focus Infants and Children The Aging Adult

Content Highlights Discuss the extra time it takes for a full assessment of both a child and an older adult. Consider ways to make the assessment progress smoothly and efficiently.

IN-CLASS/ONLINE CASE STUDY L.G. is a 5-year-old boy who is being seen in the pediatric clinic for a yearly physical examination. Subjective Data Patient is accompanied by parent (mother) Mother states child takes no medications and is healthy Patient attends preschool Plays T-ball No smokers in house Lives with mother and father Objective Data Vital signs: T 37 P 124 R 12 BP 104/64 Weight: 35 lb Height: 52 inches Immunizations: Up to date Questions 1. What should the nurse include in the general inspection of this patient? 2. What observations are important regarding physical appearance and hygiene? 3. How should a 5-year-old child be assessed? 4. What teaching is appropriate for this age group?

Learning Activities

Resources

Answers 1. General inspection requires attention to detail and provides clues regarding possible problems the patient may be experiencing. 2. The physical appearance includes a variety of observations about the patient, including general appearance, age, skin, and hygiene. Consider the patient’s general appearance. Are there any immediately obvious findings (e.g., tremors or facial drooping)? Does the patient appear close to his or her stated age? Notice the color and condition of the patient’s skin: Chapped lips? Chewed fingernails? Are there any variations in color, or are any lesions obvious? What is the general hygiene of the patient? Is the patient clean and well groomed? Does the patient have a disheveled appearance? Are any odors detected: body odor, smoke, bad breath? Does the child have loose teeth? Has the child lost teeth? Is there evidence of poor oral hygiene? Assess interaction with the mother to determine bonding. 3. The nurse may have to alter the way in which the exam is done. For example, a 5-year-old child may want to play with the assessment equipment. Also, the child may want to sit on the parent’s lap. Assess the child’s range of motion and motor skills by observing child at play if possible. 4. The child may need immunizations to enroll in school. Assessment and teaching should include the following: Car—booster seat, riding in the back seat Information—knows address and phone number Water safety—child should be taught about water safety Stranger danger Bicycle safety, wears helmet Reading to child Developmental milestones Dental care Gun and weapon safety

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Developmental Competence

NURSING CONCEPTS

BSN ESSENTIALS 

Essential IX: Baccalaureate Generalist Nursing Practice o Developmental Competence

2021 AACN ESSENTIALS DOMAINS  

Domain 1: Knowledge for Nursing Practice o Developmental Competence Domain 2: Person-Centered Care o The General Survey

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o The General Survey

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 10: Vital Signs CHAPTER OBJECTIVES 1. 2. 3. 4.

Describe various routes of temperature measurement and special considerations for each route. Describe the qualities considered when one assesses the pulse. Describe the appropriate procedure for assessing normal respirations. Describe the relationships among the terms blood pressure, systolic pressure, diastolic pressure, pulse pressure, and mean arterial pressure (MAP). 5. List the factors that affect blood pressure. 6. Relate the use of a blood pressure cuff of improper size to the possible findings that may be obtained.

STUDENT RESOURCES

understand

      

Textbook Chapter 10 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS

in text



List any in-text resources for clinical judgment (boxes; case studies; review questions; chapter sections; etc.)

lesson focus

     

Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Actions Evaluate Outcomes

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus OBJECTIVE DATA

Content Highlights Using a volunteer, demonstrate the proper use of the various temperature measurement devices. Discuss

Learning Activities 

Discussion Topic: Discuss infection control practices in relation to measuring vital signs.

Resources Table 10.1 Figure 10.3

TEACHING STRATEGIES Content Focus VITAL SIGNS

Content Highlights why the rectal temperature measures higher and what things affect normal temperatures.

Learning Activities 

Temperature Pulse Respirations

After demonstrating the proper procedure for taking a pulse, have students try it on each other. Discuss bradycardia and tachycardia, and rate, rhythm, and force. Examine why females, after puberty, have a slightly faster rate than males.



Blood Pressure DEVELOPMENTAL COMPETENCE Infants and Children The Aging Adult

Demonstrate how to include counting respirations in with counting radial pulses without making the patient aware. Discuss Table 10.1. Bring in the various sizes of cuffs used on adults and infants. With the aid of a model or movie, demonstrate the many ways to obtain blood pressure and what information the blood pressure relates. Discuss the factors that affect a person’s blood pressure. Review Tables 10.2 and 10.3.

Activity: Have variously sized sphygmomanometers available. Have students take pressure on the same person using inappropriately sized cuffs and note the difference in readings obtained. Also, have students compare blood pressures taken directly on an arm and over clothing such as a sweater or sweatshirt. Group Activity: After students have obtained a baseline assessment on each other, designate some students as “patients” and other students as “nurses.” Have the “patients” perform an activity that will alter vital signs, such as rapidly climbing stairs, jumping in place, or drinking hot or cold fluids; have the “nurses” repeat the assessment. Note how long it takes for the vital signs to return to baseline.

Bring in a doll to demonstrate how to collect general information on an infant.

ADDITIONAL TECHNIQUES Measurement of Oxygen Saturation

Visit an older adult care facility to observe the changes in the body with aging. Demonstrate the use of a pulse oximeter with both finger and earlobe probes.



Online Activity: Have the students watch several YouTube videos of the additional techniques listed in this section. Have them discuss and critique in class.

Demonstrate the use of a Doppler ultrasonic flowmeter.

Electronic Vital Signs Monitor

Resources Figure 10.4 Figure 10.5 Figure 10.6 Table 10.2 Table 10.3

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

The Doppler Technique

IN-CLASS/ONLINE CASE STUDY L.G. is a 5-year-old boy who is being seen in the pediatric clinic for a yearly physical examination. Subjective Data Patient is accompanied by parent (mother) Mother states child takes no medications and is healthy Patient attends preschool Plays T-ball No smokers in house Lives with mother and father Objective Data Vital signs: T 37 P 124 R 12 BP 104/64 Weight: 35 lb Height: 52 inches Immunizations: Up to date Questions 5. What baseline indicators are necessary for this patient? 6. Are the vital signs within normal limits? Why or why not? 7. How should a 5-year-old child be assessed? Answers 5. Baseline indicators of a patient’s health status include the measurement of vital signs (temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation), height, and weight. Assessing the presence of pain is also considered standard baseline data to be

Resources

collected on all patients and is often included with assessment of vital signs. This patient has presented for an annual physical examination; therefore, inspection, palpation, auscultation, and percussion will all be used. 6. Vital signs are within normal limits. 7. The nurse may have to alter the way in which the exam is done. For example, a 5-year-old child may want to play with the assessment equipment. Also, the child may want to sit on the parent’s lap. Assess the child’s range of motion and motor skills by observing child at play if possible.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Developmental Competence  Informatics/Nursing Judgment o Vital Signs



Concept: Technology and Informatics o Exemplar: Vital Signs

BSN ESSENTIALS   

Essential IV: Information Management and Application of Patient Care Technology o Vital Signs Essential V: Healthcare Policy, Finance, and Regulatory Environments o Developmental Competence Essential IX: Baccalaureate Generalist Nursing Practice o Developmental Competence

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o Developmental Competence Domain 8: Information and Healthcare Technologies o Vital Signs Domain 10: Personal, Professional, and Leadership Development o Additional Techniques

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Developmental Competence

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 11: Pain Assessment CHAPTER OBJECTIVES

1. 2. 3. 4. 5. 6. 7. 8. 9.

Define pain. Discuss the function of nociception and the patient’s sensation of pain. Differentiate the different types of pain. Compare acute and chronic pain. Describe developmental care as well as cross-cultural and gender considerations regarding pain. Describe the initial pain assessment. Compare available pain assessment tools. Compare acute and chronic pain behaviors (nonverbal behaviors of pain). Describe the physical changes that may occur because of poorly controlled pain.

STUDENT RESOURCES

understand

      

Textbook Chapter 11 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS

in text

  

Initial Pain Assessment Table 11.1 PQRST Method of Pain Assessment Pain Assessment Tools

lesson focus

   

Recognize Cues Analyze Cues Take Actions Evaluate Outcomes

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus NEUROANATOMIC PATHWAY

Content Highlights Explain the nociceptive and neuropathic processes.

Learning Activities 

Resources

Discussion Topic: Have students discuss their memories Figure 11.1 Figure 11.2 of the worst pain they have experienced and what

TEACHING STRATEGIES Content Focus NOCICEPTIVE PAIN

Content Highlights

Learning Activities

Give examples of a type of trauma or injury and the corresponding sensations that the Aδ fiber and the C fiber would transmit to the central nervous system.

Resources

relieved it.

Figure 11.3

Discussion Topic: Start a discussion of different methods used to relieve pain. Emphasize nonpharmacologic strategies used to relieve pain. Online Activity: Have students research methods of pain relief used in different cultures. They can either interview persons from different cultures or use the Internet to find information. Online Activity: Have students find a recent scholarly article on fetal pain. Discuss their findings in class.

Figure 11.4

Activity: Have students use different pain assessment tools to rate pain, both while in the clinical setting and

Table 11.1 Figure 11.5

NEUROPATHIC PAIN Review the four phases of nociception.

SOURCES OF PAIN TYPES OF PAIN

Because neuropathic pain is sometimes difficult to detect, give examples of a patient’s history to aid in a diagnosis. Review visceral, deep somatic, cutaneous, and referred pain and explain the sources of each type of pain.



 DEVELOPMENTAL COMPETENCE The Aging Adult

Explain the differences between acute, persistent (chronic), and breakthrough pain. Discuss also the subcategories of pain: incident, malignant, and nonmalignant.

Gender and Sex Differences

Give examples of pain that may be undetected in preverbal infants.

GENETICS AND ENVIRONMENT

Discuss the older adult’s perception of pain, which might alter the person’s reporting of pain.

The Opioid Epidemic

Suggest that students read the Human Genome Project and the findings about pain perception.

SUBJECTIVE DATA

Invite three people who are around the same age but from different cultures to discuss with the class their perceptions of and reactions to pain. Ask them to examine the reasons for the differences among them. Discuss why the subjective report is the most reliable indicator of pain. Emphasize that only the patient can



TEACHING STRATEGIES Content Focus

Content Highlights

INITIAL PAIN ASSESSMENT

accurately report levels of pain and the nurse cannot compare pain among patients.

Learning Activities when at home with family and friends.

Resources Figure 11.6

PAIN ASSESSMENT TOOLS Tools for Infants and Children

Give students the list of questions in the Initial Pain Assessment, the Brief Pain Inventory, and the shortform McGill Pain questionnaire. Ask how they would alter these questions to obtain specific information. Invite a guest speaker from a local pain management specialist group to discuss the challenges of their chosen practice.

OBJECTIVE DATA

Review the Oucher scale and any other forms of pain ratings for children. Show a video of normal and abnormal joints and explain some of the complications.

JOINTS MUSCLES AND SKIN ABDOMEN NONVERBAL BEHAVIORS OF PAIN

Demonstrate how to test for location and extent of altered sensation. Give examples of nonverbal communications that signal pain.



Online Activity: Instruct students to search the Internet Table 11.2 Figure 11.8 for community resources for pain management. Figure 11.9 Figure 11.10 Table 11.3 Table 11.4 Table 11.5

Give further examples of variables causing or affecting acute pain.

Acute Pain Behaviors Chronic (Persistent) Pain Behaviors DEVELOPMENTAL COMPETENCE

From your experience, give examples of other behaviors that indicate chronic pain. Solicit student input from the students’ own personal or familial experiences. Review the tips for using CRIES. Emphasize that assessing pain requires close observation and minimal

TEACHING STRATEGIES Content Focus Infants

Content Highlights

Learning Activities

distractions. Discuss how sometimes it is necessary to pause, be still, and observe.

The Aging Adult Explain the behavioral cues that aid in detecting hidden pain. Review the PAINAD scale.

IN-CLASS/ONLINE CASE STUDY J.P. is a 15-year-old African American adolescent who was diagnosed with sickle cell disease 3 years ago. J.P. presents to the emergency department with pain related to sickle cell crisis. Subjective Data Pain level is an 8/10 location = bilateral legs, described as deep muscle pain Student in 10th grade, honor roll student On the track team Lives with mother and father Objective Data Vital signs: T 37 P 80 R 18 BP 140/68 Weight: 140 Height: 5 feet, 6 inches Questions 6. What other assessments should be included for this patient? 7. Identify the various types of pain. 8. What type of pain does this patient describe? 9. What standards of assessing pain will be applied to this patient’s plan of care? 10. What teaching should the nurse consider from the problems list? 11. What interventions should be included in the plan of care for this patient?

Resources

Answers 1. Assess hydration status, stress level, presence of infection, activity level, what pain relief measures the patient has tried, and what measures have been successful in the past. Assess nonverbal signs of pain. Assess pain level after medication administration to ensure the patient’s comfort. Assess legs for discoloration, swelling, and ability to move. Rationale: Dehydration, stress, and infection can trigger sickle cell crisis. The patient’s past experience with pain and pain relief will allow the most appropriate pain relief. Nonverbal signs may include rocking, bracing, rubbing, and sleeping. Inspect painful areas for discoloration, swelling, masses, and mobility. 26.

Types of pain include acute, persistent (also called chronic), nociceptive, and neuropathic.

Rationale: Nociceptive pain is caused by tissue damage, and neuropathic pain is caused by abnormal processing of the pain message. Acute pain is short term and self-limiting due to an injury. Persistent pain is pain lasting for more than 6 months.

27. This patient has nociceptive, acute, and deep somatic pain. Rationale: Acute pain has a recent onset (less than 6 months) and results from tissue damage, is usually self-limiting, and ends when the tissue heals. The pain appears to be nociceptive. Nociceptive pain arises from stimulation of somatic structures, such as bone, joint, muscle, skin, and connective tissue or from stimulation of visceral organs, such as the gastrointestinal tract or pancreas. Deep somatic pain is a result of ischemia in the blood vessels caused by sickle cell crisis. 4. The standards include (1) initial assessment and regular reassessment of pain, taking into account personal, cultural, spiritual, and ethnic beliefs; (2) education of all relevant health care personnel in pain assessment and management; and (3) education of patients and families regarding their roles in managing pain and the potential limitations and side effects of pain. Rationale: Ethnic groups and genders may be treated differently for pain due to disparity of pain management. Lack of knowledge may cause the patient to not adhere to pain control methods. 5. The teaching plan from the problems list might include the patient’s diet and exercise routine. Inquire about how often the patient exercises. Rest and hydration are key factors for preventing sickle cell crisis. Rationale: Infection, dehydration, and stress can trigger a sickle cell crisis. Good hydration, nutrition, and vaccinations will decrease the risk of crisis.

6. Interventions should include being assertive with pain management, assessing and addressing hydration status, identifying family supports for the patient in this crisis, incorporating culturally sensitive care, and identifying support groups for sickle cell disease. Assess the patient’s immunization record to make sure immunizations are up to date. Encourage good handwashing and disease prevention. Assess patient’s stress level and coping abilities. Rationale: Appropriate pain management will decrease the stress of the pain. Infection, dehydration, and stress can trigger a sickle cell crisis. Good hydration, nutrition, and vaccinations will decrease the risk of crisis.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Types of Pain o Developmental Competence o Subjective Data o Table 11.1 o Pain Assessment Tools  Informatics/Nursing Judgment o Objective Data



Concept: Pain o Exemplar: Neuroanatomic Pathway o Exemplar: Nociceptive Pain o Exemplar: Neuropathic Pain o Exemplar: Sources of Pain o Exemplar: Types of Pain o Exemplar: Developmental Competence o Exemplar: Subjective Data o Exemplar: Table 11.1 o Exemplar: Pain Assessment Tools o Exemplar: Objective Data o Exemplar: Nonverbal Behaviors of Pain o Exemplar: Table 11.2

HEALTH CARE RECIPIENT CONCEPTS THEME: Personal Preferences  Concept: Culture o Exemplar: Genetics and Environment PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Clinical Judgment o Exemplar: Initial Pain Assessment o Exemplar: Table 11.1 PQRST Method of Pain Assessment o Exemplar: Pain Assessment Tools

BSN ESSENTIALS  

Essential IV: Information Management and Application of Patient Care Technology o Objective Data Essential IX: Baccalaureate Generalist Nursing Practice o Types of Pain o Developmental Competence

o o o

Subjective Data Table 11.1 Pain Assessment Tools

2021 AACN ESSENTIALS DOMAINS 

 

Domain 2: Person-Centered Care o Types of Pain o Developmental Competence o Subjective Data o Table 11.1 o Pain Assessment Tools Domain 8: Information and Healthcare Technologies o Objective Data Domain 10: Personal, Professional, and Leadership Development o Subjective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Types of Pain o Developmental Competence o Subjective Data o Pain Assessment Tools o Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 12: Nutrition Assessment

CHAPTER OBJECTIVES 28. Define nutritional status. 29. Describe the unique nutritional needs for various developmental periods throughout the life cycle. 30. Describe the role cultural heritage and values may play in an individual’s nutritional intake. 31. State the purposes of a nutritional assessment. 32. Describe the components of a nutritional assessment. 33. Discuss the strengths and limitations of the methods used for collecting current dietary intake. 34. Use anthropometric measures and laboratory data to assess the nutritional status of patients. 35. Use nutritional assessment in the provision of health care and for health promotion. STUDENT RESOURCES

understand

      

Textbook Chapter 12 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

DEFINING NUTRITIONAL STATUS

Discuss how being overweight during childhood can increase the risk not only of being overweight in adulthood but also of acquiring health issues.

Learning Activities  

OBESITY DEVELOPMENTAL COMPETENCE

Review infant and child growth rates, the advantages of breastfeeding, and the necessity for appropriate fat intake for children younger than 2 years of age.

 

Infants and Children Adolescence

Examine the increased requirements for protein, calcium, and iron. Discuss the concern some adolescents feel because of the typical increase in body weight.

Discussion Topic: Discuss the impact of economic factors and living situation on food choices. Discussion Topic: Assign students to examine the nutritional value of the foods available in local fast-food establishments. Discussion Topic: Discuss food-drug interactions that must be included in patient teaching. Activity: Ask students to share any of the cultural practices their families follow regarding nutrition and meals.

Pregnancy and Lactation Adulthood

Discuss in more detail the lifestyle factors that influence the development of serious chronic illnesses.

The Aging Adult GENETICS AND ENVIROMENT

Review several medications taken by aging adults that affect nutrient absorption.

Resources

TEACHING STRATEGIES Content Focus Culture and Nutrition DIETARY PRACTICES OF SELECTED CULTURAL GROUPS TYPES OF NUTRITIONAL ASSESSMENT

Content Highlights Familiarize students with some of the questions necessary to obtain information on food preparation, unusual food consumption, and fasting. Discuss some religious dietary practices that are not listed in Table 12.1.

Demonstrate the difficulties with the 24-hour recall method by having the students recall their diets of the past 24 hours.

Learning Activities



SUBJECTIVE DATA Additional History for Infants and Children Additional History for the Adolescent Additional History for the Pregnant Woman Additional History for the Aging Adult

Have students answer the examiner’s questions about their own nutrition and discuss the results. Discuss how easy it is to snack and not recall correct amounts or to eat bites of things without considering the accumulating calories. Examine the risk factors for infants to become obese adults.

 



Give examples of how to speak to the adolescent when asking such personal questions. Give examples of any foods that may be harmful to pregnant women. Discuss factors that affect the eating habits of aging adults. Examine how to encourage healthy eating habits for this population.

 

Resources

Table 12.1 Online Activity: Have the students go online and research their assigned religious or cultural group and present to the class the information they’ve learned about the dietary practices of the group. Online Activity: Have students access the more detailed report of the 2020-2025 Dietary Guidelines at www.health.gov/dietaryguidelines. Read the overview about the development process of the 2025-2030 Dietary Guidelines. Discuss in class. Online Activity: Have students search the Internet for dietary assessment instruments. Activity: Using the nutritional assessment forms provided in the text, have students complete a screening and comprehensive nutritional assessment of a peer. Activity: Using the charting formats of the clinical agencies used by the school, have students document the results of the previous screening or assessment and other relevant data. Activity: Assign students to examine frozen and prepackaged food for nutritional value. Activity: Have nursing students visit a grammar school or high school and assess the school lunch program in relation to the USDA dietary guidelines. Is good nutrition provided? Do they have suggestions for change? Are food machines in the school? If so, evaluate choices. (Consider: do the children have enough time to eat? Are the hot food lines long and/or slow? Is it easier to grab chips from the machine than to wait in line?)

TEACHING STRATEGIES Content Focus OBJECTIVE DATA ANTHROPOMETRIC MEASURES

Content Highlights Review Tables 12.2 to 12.6 for clinical signs of nutritional deficiencies and abnormalities.

Learning Activities

Resources



Activity: Have students measure frame size for two or three volunteers the professor provides.

Table 12.2



Activity: Have students analyze the laboratory tests results for several patients. Discuss the problems they find.

Table 12.3 Table 12.4 Table 12.5 Table 12.6

Demonstrate the three derived weight measures. With the help of a volunteer and using the formula, find the body mass index. Bring in Lange or Harpenden skinfold calipers and demonstrate their use. Allow students to practice. Get a volunteer to demonstrate how to properly obtain a skinfold thickness measurement and mid– upper arm circumference. Explain DEXA and BIA. Demonstrate how to measure the arm span to obtain height.

SERIAL ASSESSMENT

Bring in calipers to demonstrate how to obtain frame size. Review the routine lab tests and the normal and abnormal findings seen for each one. Review the four major types of malnutrition (Table 12.3). Discuss the cardinal features of a successful long-term weight loss plan. Examine the most difficult feature of a weight loss plan and discuss how to overcome it.

IN-CLASS/ONLINE CASE STUDY C.M. is an 89-year-old woman who presents with her daughter to the provider’s office. The daughter is concerned because her mother has not been eating well. Subjective Data PMH: HTN, Hypothyroid 24-hour diet recall reveals approximately 1100-calorie intake Lives alone, daughter nearby Does not drive Daughter shops Patient cooks light meals Objective Data Vital signs: T 37 P 72 R 12 BP 104/64 Weight: 105 lb Weight last visit, 3 months ago: 115 lb Height: 5 feet, 1 inch Medications: metoprolol 12.5 mg per day, Synthroid 0.75 mg per day Oral mucosa dry, gums bleeding, dentures loose Poor skin turgor Questions 1. Develop a problems list from the objective and subjective data. 2. What nursing diagnoses can be derived from the problems list? 3. What should be included in the plan of care? 4. Calculate the patient’s body mass index. 5. How many calories a day does this patient need to maintain her current weight? 6. What laboratory studies would help determine the patient’s nutritional status? Answers 1. The problems list includes the following:  Poor skin turgor  Loose-fitting dentures

  

Bleeding gums Weight loss, 10 lb Low caloric intake

2. The two main diagnoses at this time are imbalanced nutrition: less than body requirements and impaired skin integrity. The ill-fitting dentures may be contributing to imbalanced nutrition as well. 3. The plan of care should include having the patient follow up with a dentist to have her dentures realigned; planning meals that include higher calorie options; following up in 1 month to be sure the patient is gaining weight; increasing fluid intake; monitoring for signs and symptoms of dehydration, such as urinary tract infections; monitoring for changes in level of consciousness; and monitoring for increased skin breakdown or turgor. If the patient is not gaining weight, follow-up will be needed to rule out organic causes. The plan of care should also assess cognitive function to make sure C.M. is remembering to eat and can safely heat her food. (1) Body mass index is 19.8; however, it was 21.7, both of which are normal. (2) This patient needs at least 1200 calories per day to maintain her weight (http://www.mayoclinic.com/health/caloriecalculator/NU00598). (3) This patient needs a thyroid level check to be sure the thyroid is not malfunctioning. Also, keep in mind that protein calorie malnutrition (PCM) refers to the state of inadequate protein and calorie intake. PCM is the most common form of undernutrition and can result from poor or limited food intake, wasting disease (e.g., cancer), malabsorption syndromes, endocrine imbalances, and poor living conditions. Labs would include the following:  Serum albumin: 3.5-5.0 g/dL or 35-50 g/L (SI units)  Prealbumin: 15-36 mg/dL or 150-360 mg/L (SI units)  Hemoglobin and hematocrit  Blood glucose: 70 to 105 mg/dL or 3.9 to 5.8 mmol/L (SI units)  Lipid profile

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Developmental Competence o Genetics and Environment o Dietary Practices of Selected Cultural Groups o Types of Nutritional Assessment Copyright © 2024 Elsevier, Inc. All rights reserved.



o Subjective Data o Objective Data o Serial Assessment Informatics/Nursing Judgment o Types of Nutritional Assessment o Subjective Data o Objective Data o Serial Assessment

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9etextbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Defining Nutritional Status o Exemplar: Obesity o Exemplar: Developmental Competence o Exemplar: Genetics and Environment o Exemplar: Types of Nutritional Assessment o Exemplar: Subjective Data o Exemplar: Objective Data o Exemplar: Serial Assessment HEALTH CARE RECIPIENT CONCEPTS THEME: Personal Preferences  Concept: Culture o Exemplar: Genetics and Environment

Exemplar: Dietary Practices of Selected Cultural Groups

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Developmental Competence THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Types of Nutritional Assessment o Exemplar: Subjective Data o Exemplar: Objective Data o Exemplar: Serial Assessment

BSN ESSENTIALS  



Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o Genetics and Environment Essential IV: Information Management and Application of Patient Care Technology o Types of Nutritional Assessment o Subjective Data o Objective Data o Serial Assessment Essential IX: Baccalaureate Generalist Nursing Practice o Developmental Competence o Types of Nutritional Assessment

2021 AACN ESSENTIALS DOMAINS 



Domain 2: Person-Centered Care o Developmental Competence o Genetics and Environment o Types of Nutritional Assessment Domain 8: Information and Healthcare Technologies o Types of Nutritional Assessment

o o o

Subjective Data Objective Data Serial Assessment

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Types of Nutritional Assessment

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 13: Skin, Hair, and Nails CHAPTER OBJECTIVES 1. 2. 3. 4. 5. 6. 7.

Relate the anatomic structures of the skin to its functions. Describe the significant differences between the skin of the very young, the older adult, and the healthy adult. Cite examples of health care implications presented by skin alterations. Describe the differentiation between normal and abnormal skin color for various ethnic groups. State the significance of skin tone changes. Complete an assessment of hair, skin, and nails using appropriate technique for all developmental stages. Incorporate health promotion concepts when performing an assessment of the hair, skin, and nails.

STUDENT RESOURCES

understand

      

Textbook Chapter 13 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus SKIN

Content Highlights Figure 13.1 displays the three layers of skin. Examine the composition of each layer.

Epidermis Dermis Subcutaneous Layer Hair Sebaceous Gland Sweat Glands

Learning Activities 

Activity: Using a copy of the picture of the skin provided in the text, have students label the structures of the skin.

Review the basal cell layer, the horny cell layer, and the three sources of skin color. Figure 13.1 shows the nerves, sensory receptors, blood vessels, and glands. Explain how collagen prevents the skin from tearing. Describe adipose tissue and its use in the body. Review the shaft, bulb matrix, and arrector pili. Include the two types of hair, vellus and terminal.

Resources Figure 13.1 Figure 13.2

TEACHING STRATEGIES Content Focus Nails

FUNCTION OF THE SKIN DEVELOPMENTAL COMPETENCE

Content Highlights

Learning Activities

Discuss how sebum oil lubricates the skin and hair, connecting the excess production during puberty to adolescent acne. Examine the two types of sweat glands and their functions. Demonstrate the protective and adaptive qualities of the skin.



Group Activity: Simulate erythema. Working in pairs or trios, have each student slap his or her left hand and compare its tone with that of the right hand. Students may need especially good lighting to note the difference between the two hands, but there will be a noticeable difference. This exercise underscores the need for good lighting. A change will occur regardless of each student’s basic skin color. This is one way to teach students how to assess for the phlebitis that may be associated with intravenous lines.



Small Group Activity: Assign students to prepare a presentation on the use of sunscreen that is directed toward adolescents or designed for a group of new mothers. Be sure they explain the differences in the SPF of various products.

Examine how the eccrine sweat glands are not fully functional in infants and children.

Infants and Children The Pregnant Woman The Aging Adult GENETICS AND ENVIROMENT

SUBJECTIVE DATA Additional History for Infants and Children Additional History for the Adolescent Additional History for the Aging Adult

Discuss the skin’s reaction to increase metabolism during pregnancy. Discuss what factors affect the hair and skin of the aging adult. Explain what part melanin plays in skin color and show photos of skin conditions such as keloids, pseudofolliculitis, and melasma. Choose one of the questions in this section and elaborate on both problems and solutions for the subject matter. Discuss the importance of sun protection for children of all ages. Bring in an aging adult volunteer for a brief examination by the students. Have them focus on foot care and skin conditions associated with chronic diseases.

Resources

TEACHING STRATEGIES Content Focus

OBJECTIVE DATA INSPECT AND PALPATE THE SKIN

Content Highlights

Discuss how to integrate the skin examination into the complete physical examination and the regional examination; cover Table 13.1.

Learning Activities



 Discuss figures 13.3 and 13.4, which give examples of common benign pigmented areas. Table 13.2 gives specific clues for assessment concerning widespread color change, pallor, and erythema.

Resources

Online Activity: Have students search the Internet for a skin assessment instrument. Have them critique the instrument for completeness. Activity: In the clinical area, assign students to patients from various ethnic groups and have them complete an assessment, including the submission of a completed history and description of findings. Students might complete this assignment singly or in pairs.

Figure 13.3 Figure 13.4 Figure 13.5 Figure 13.7 Figure 13.8 Figure 13.10



Figure 13.11 Figure 13.12 through Figure 13.32 Table 13.1 Table 13.2 Table 13.3 Table 13.4

Explain the difference between hypothermia and hyperthermia and how they affect the skin. Show a picture of very thin, shiny skin (atrophic). Ask a volunteer to demonstrate mobility and turgor. Cherry (senile) angiomas may be seen in Figure 13.8. Discuss what creates these angiomas. Table 13.7 shows pattern injury, hematoma, and contusions.

INSPECT AND PALPATE THE HAIR INSPECT AND PALPATE THE NAILS DEVELOPMENTAL COMPETENCE

Review the steps taken to inspect a lesion and the proper technique for palpating and scraping. Use a volunteer to show how to inspect the hair for texture, distribution, lesions, or lice. Discuss care for both dandruff and lice.  Recruit volunteers to show examples of fingers and toenails of various shapes, consistency, and color. Figures 13.14 and 13.15 give examples of linear bands and what to look for when depressing the nail and

Discussion Topic: Have students share their family history of graying and any traits that they have noticed in themselves. Small Group Activity: Divide students into pairs or trios to complete a history, examination, and documentation of an examination of the hair, skin, and nails. One student may be the patient, one may conduct the examination, and one may read the text to guide the

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

checking for capillary refill. HEALTH PROMOTION AND PATIENT TEACHING

Using Figure 13.32, demonstrate how to do skin selfexamination. Using Figures 13.17 through 13.23, review the normal skin findings for infants. Explain that understanding and recognizing normal findings helps nurses more easily determine abnormal findings.



examiner. Rotate roles as time permits. Have paper rulers available so students can measure any lesions or marks found during the assessment. Activity: Provide a list of terms used in the inspection of hair, skin, and nails. The terms may be written on the blackboard, on an overhead projector, or on a handout. Have students describe each term (e.g., freckle, nevus, and birthmark).

Resources Table 13.5 Table 13.6 Table 13.7 Table 13.8 Table 13.9 Table 13.10 Table 13.11

Review examples of acne and blackheads in Figure 13.24, A and B. Discuss how to teach acne care to adolescents while making them aware that acne usually is a temporary condition. Discuss how in the aging adult, hair growth decreases and other coarse, unwanted hairs appear in annoying places.

IN-CLASS/ONLINE CASE STUDY J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on his right foot. He does not recall injuring his foot. Subjective Data Pain level is a 6/10 location = right foot, throbbing Works as a truck driver Objective Data Vital signs: T 37 P 80 R 14 BP 120/68 +2 edema great toe and second toe, right foot, warm to touch + pulses Copyright © 2024 Elsevier, Inc. All rights reserved.

+2 capillary refill Questions 1. What other assessments should be included for this patient? 2. From the readings, what is the most probable cause of the edema? 3. What are two known nursing diagnoses? 4. What would be included in the nursing care plan? 5. What interventions might be included in the plan of care for this patient? Answers 1. The assessment should include the onset, location, duration, characteristics, aggravating factors, related symptoms, treatment by the patient, and severity. 2. From the readings, cellulitis is a common cause of inflammation. Cellulitis is an acute streptococcal or staphylococcal infection of the skin and subcutaneous tissue. Cellulitis can occur at any age and can involve any skin area on the body. Clinical findings: The skin is red, warm to the touch, and tender and appears to be indurated. There may be regional lymphangitic streaks and lymphadenopathy. 3. Nursing diagnoses: infection and impaired skin integrity 4. The plan of care should include determining the cause of the inflammation. Interventions include pain management to reduce the swelling (anti-inflammatories, rest, ice, compression, and elevation). This patient will likely require antibiotics as well. 5. Interventions also include reinforcing the need to finish antibiotics, stressing the importance of seeking medical attention if the problem persists or gets worse, and following up with the provider in 2 weeks to be sure the infection has resolved.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Homeostasis and Regulation  Concept: Thermoregulation o Exemplar: Function of the Skin  Concept: Fluids and Electrolytes o Exemplar: Function of the Skin  Concept: Elimination o Exemplar: Function of the Skin THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: Function of the Skin PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS 

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data

 

o Objective Data Essential VII: Clinical Prevention and Population Health o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data Domain 10: Personal, Professional, and Leadership Development o Genetics and Environment

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Subjective Data o Objective Data o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN

Chapter 14: Head, Face, Neck, and Regional Lymphatics

CHAPTER OBJECTIVES 1. 2. 3. 4.

Describe the significant features of the head. Identify the structures and landmarks of the neck. Identify relevant developmental care for the head and neck. Incorporate health promotion concepts when performing an assessment of the head, face, and neck.

STUDENT RESOURCES

understan d

● ● ● ● ● ● ●

Textbook Chapter 14 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

● ●

in class

after class

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus STRUCTURE AND FUNCTION THE HEAD THE NECK

Content Highlights Make up a study guide for the students using only the pictures and lines from Figures 14.1 through 14.6 in the chapter. In addition to having them identify the bones, muscles, nodes, and so forth on paper, have them locate as many of them as possible on their own bodies. After all of these have been located, the students can discuss their function in the body.

Learning Activities ●

●

LYMPHATICS DEVELOPMENTAL COMPETENCE Infants and Children The Pregnant Woman The Aging Adult GENETICS AND ENVIRONMENT SUBJECTIVE DATA Additional History for Infants and Children

Discuss the locations of the lymph nodes, relating their function to why cancer is many times found in lymph nodes far from the original source. See Figure 14.7.

Figure 14.1 Figure 14.2 Figure 14.3 Figure 14.4 Figure 14.5 Figure 14.6 Figure 14.7 Figure 14.8

Show the differences between infants and children, especially the fontanels. Be sure to mention the lymphoid tissue growth rate and when the thyroid cartilage occurs. Show a picture of an older adult without teeth and discuss how this affects head shape. Discuss the types of headaches, causes, and treatments. Ask students for input about headaches they have experienced, and the causes and treatments.

Additional History for the Aging Adult

Examine the risks of alcohol and difficult birth delivery, both of which can cause head and facial deformities in infants.

OBJECTIVE DATA

Measure the heads of everyone in the class, demonstrating the wide range of sizes. Calculate an average head size for the class.

THE HEAD

Small Group Activity: Have students pair up. Then have them palpate the salivary glands, thyroid gland, location of the lymph nodes, and the anterior and posterior triangles of their partner’s neck. Also have them palpate their partner’s temporal artery and temporomandibular joint. Online Activity: Have students search the Internet for community resources available to patients with head and neck disorders. Have them design a resource book for patients.

Resources

●



Online Activity: Have students research headache treatments online. Have them focus especially on nontraditional or alternative treatments. Activity: Using the rationale for the examination questions presented in the text, create “headache case studies.” Provide a copy to a student who will play the role of patient. Instruct a student playing the role of examiner to interview the patient on the basis of “clues” provided by the patient. Activity: Using forms from clinical agencies used by the school, have students document the data obtained from the history and examination of the head and neck.

Figure 14.9 through 14.18

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 

Inspect and Palpate the Skull

Using a student volunteer, demonstrate how to inspect and palpate the skull.

Inspect the Face

Discuss the importance of symmetry in the facial structures.

Discussion Topic: Discuss difficulties the nurse might encounter when trying to examine infants and children.

Resources Tables 14.1 through 14.4

THE NECK Inspect and Palpate the Neck DEVELOPMENTAL COMPETENCE Infants and Children

Explain the importance of finding a sequence by which to inspect the lymph nodes. Discuss the importance of referring the patient to a doctor if the nurse cannot determine the cause of an enlarged lymph node. Bring in a doll or, if possible, a mother and infant or child. Demonstrate how to measure the head, evaluate symmetry, and perform the proper palpating technique.

The Pregnant Woman The Aging Adult

Find a picture of prolapse of the submandibular glands.

IN-CLASS/ONLINE CASE STUDY P.A. is a 72-year-old woman who presents to the family practice with her 40-year-old daughter. The daughter states that her mother has been confused lately and is complaining of a headache, shortness of breath, and a cough. The cough has been persistent for 6 days, and a fever developed 2 days ago. The patient states that she is bringing up yellow-green mucus and has a cough, which gets worse at night. Vital signs are T 100.5, P 88, R 16, and BP 110/55. Lungs are positive bilaterally for wheezing, positive egophony. A chest x-ray examination reveals consolidation indicative of bacterial pneumonia. Labs and culture results are pending for specific antigen. The nurse proceeds with the physical examination of the head, face, neck, and associated lymphatic system. 1. When performing a review of systems, the nurse obtains subjective data concerning the patient’s headache. What specific questions will assist the nurse in determining the cause of the headache?

Answer: Questions should include the following: Any unusually frequent or unusually severe headaches? When did the headache start? Is the pain localized on one side or all over? Is the pain mild, moderate, or severe? What types of activity bring on the headache? What relief measures are you using? Do they help with the pain? Rationale: Many conditions have a headache as a symptom, and a detailed history is important. The location of the headache is important because the examiner will be able to determine the type of headache. Associated and relieving factors can also help the examiner determine the cause of the pain and provide relief for it. 1. The nurse proceeds to palpate the lymph nodes. Which lymph nodes are located in the neck? Answer: ∙ Preauricular: in front of the ear ∙ Posterior auricular (mastoid): superficial to the mastoid process ∙ Occipital: base of the skull ∙ Submental: midline, behind the tip of the mandible ∙ Submandibular: halfway between the angle and the tip of the mandible ∙ Jugulodigastric: under the angle of the mandible ∙ Superficial cervical: overlying the sternomastoid muscle ∙ Deep cervical: deep under the sternomastoid muscle ∙ Posterior cervical: in the posterior triangle along the edge of the trapezius muscle ∙ Supraclavicular: just above and behind the clavicle, at the sternomastoid muscle Rationale: The examiner should be familiar with the direction of the drainage patterns of the system. The area proximal (upstream) to the location of the abnormal node is explored. Any deviations from normal findings may be indicative of an abnormality. When performing the physical examination, what objective data should the nurse inspect and palpate for the head and neck? Answer: The head is assessed for size, shape, lumps, and protrusions. Facial symmetry and features should also be assessed. The skull is a rigid, bony box that protects the brain and special sense organs; it includes the bones of the cranium and the face. Note the location of these bones: frontal, parietal, occipital, and temporal. The cervical vertebrae support the cranium. Fourteen facial bones also articulate at sutures, except the mandible, which has a movable joint, the temporomandibular joint, anterior to each ear. The neck should be assessed for symmetry, range of motion, and lymph nodes. Lymph nodes are assessed for tenderness and enlargement. The carotid arteries should be palpated. Rationale: Any deviations from normal findings may indicate an abnormality. In this case study, the patient has tender lymph nodes (swollen glands), which often present in acute infection or bacterial pneumonia. The temporal artery lies superior to the temporalis muscle and has a

palpable pulsation anterior to the ear. The sublingual and submandibular salivary glands are accessible to examination, but the parotid glands are not normally palpable. How might the physical examination vary given the patient’s age? Answer: In toddlers, the face appears small in relation to the skull. In older adults, the facial bones and orbits may appear more prominent; the lower face may look smaller if teeth have been lost. Rationale: In toddlers, the mandible and maxilla are small, and the nasal bridge is low, making the face seem small compared to the skull. As a person ages, the facial skin sags as a result of decreased elasticity, decreased subcutaneous fat, and decreased moisture in the skin.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES ●

Patient-Centered Care/Human Flourishing o Health Promotion and Patient Teaching ● Informatics/Nursing Judgment o Subjective Data o Objective Data

●

Concept: Pain o Exemplar: Genetics and Environment

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles ● Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching THEME: Care Competencies ● Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data

BSN ESSENTIALS ● ●

●

Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o Lymphatics Essential IV: Information Management and Application of Patient Care Technology o Health Promotion and Patient Teaching o Subjective Data o Objective Data Essential IX: Baccalaureate Generalist Nursing Practice o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS ● ●

Domain 1: Knowledge for Nursing Practice o Lymphatics Domain 2: Person-Centered Care o Health Promotion and Patient Teaching

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES ●

Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN

Chapter 15: Eyes CHAPTER OBJECTIVES 36. Identify the external anatomic features of the eye. 37. Describe the internal anatomy of the eye. 38. Name the functions of the ciliary body, the pupil, and the iris. 39. Describe the compartments of the eye. 40. Identify the structures viewed through the ophthalmoscope. 41. Define pupillary light reflex, fixation, and accommodation. 42. Identify age-related changes in the eye. 43. Discuss the three most common causes of decreased visual functioning in the older adult. 44. Incorporate health promotion concepts when performing an assessment of eyes.

STUDENT RESOURCES

understan d

apply

● ● ● ● ● ● ●

Textbook Chapter 15 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

●

Nursing Curriculum Standards (below)

in class

after class

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus STRUCTURE AND FUNCTION EXTERNAL ANATOMY INTERNAL ANATOMY VISUAL PATHWAYS AND VISUAL FIELDS VISUAL REFLEXES DEVELOPMENTAL COMPETENCE

Content Highlights Bring in an eye anatomy model and diagram to explain the external and internal structures of the eyes, the positioning and functions of the glands, and the muscle attachments.

●

Discuss the eye’s three concentric coats and explain why only two of them are accessible to examination.

●

Learning Activities

Resources

Activity: Obtain a diagram of the eye and optic nerve and have students label the structures. Small Group Activity: Have a small group of students give a PowerPoint presentation comparing an eye lens to a camera. Online Activity: Have students search the Internet for community resources available for patients with visual impairment and for visual assessment instruments.

Figures 15.1 through 15.8

Explain how light is refracted through the eye lens. Discuss how the retina transforms the light and how the nerve impulses travel to the visual fields. Demonstrate the papillary light reflex and explain direct and consensual reflexes, fixation, and accommodation.

Infants and Children The Aging Adult GENETICS AND ENVIRONMENT

Put together a chart showing vision development, from peripheral vision and lack of macular vision at birth to binocularity at 3 to 4 months and full development around age 8. Go over the causes and effects of presbyopia, cataract formation, glaucoma, and macular degeneration.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Discuss whether there are preventive measures one can take to slow these effects.

SUBJECTIVE DATA

Bring in photos showing the differences in the palpebral fissures. Review the questions important in an eye exam. Discuss medications that may affect the eyes.

●

Activity: Observe and assist as class members practice, one on one, asking questions to collect data for an eye examination.

Emphasize the importance of checking toys for possible eye safety hazards (safety checks typically focus on choking hazards). Reiterate the importance of regular eye exams for aging adults. Suggest ways to help with dry eyes.

Resources

TEACHING STRATEGIES Content Focus OBJECTIVE DATA TEST CENTRAL VISUAL ACTIVITY

Content Highlights Bring in the Snellen eye chart and with the help of a volunteer, demonstrate the techniques and equipment needed for an exam. Discuss both normal and abnormal findings. Explain the visual acuity fraction.



TEST VISUAL FIELDS INSPECT EXTRAOCULAR MUSCLE FUNCTION

Have one of the class members use the handheld Jaeger card to demonstrate how to test for near vision.

INSPECT EXTERNAL OCULAR STRUCTURE

Demonstrate the confrontation test and explain peripheral field loss.

INSPECT ANTERIOR EYEBALL STRUCTURE

Demonstrate the Hirschberg test and discuss symmetry in infants.

ADVANCED PRACTICE TECHNIQUES

Discuss the six positions of gaze and explain how an abnormal response can indicate extraocular muscle (EOM).

 ●

DEVELOPMENTAL COMPETENCE

● ●

●

Learning Activities

Resources

Discussion Topic: Discuss ways of grossly checking visual acuity in a bedridden patient or in a patient who cannot read. Activity: Have students practice using the Snellen eye chart on each other—if possible, have those who wear glasses or contacts read the charts with and without their corrective lenses and compare the results. Activity: Have students compare and contrast myopia and hyperopia and the use of corrective lenses. Discussion Topic: How do you make children more comfortable with the eye examination?

Figures 15.9 through 15.24

∙Discussion Topic: Have students discuss the environmental effects on eye health. Online Activity: Have students go online and take a color blindness test. Activity: Assign students to compare the differences in education and practices of optometrists and ophthalmologists.

During your demonstration, emphasize observing a person’s movements and facial expressions, as well as the symmetry that should be present in the patient’s eyes, eyelid lag, and palpebral fissures. Use Figure 15.24 and demonstrate eversion of the upper eyelid on one of the class members. Have an optometrist or ophthalmologist come to the class to discuss various aspects of health promotion and the eyes. Darken the room and demonstrate the papillary light reflex on a volunteer.

Figures 15.25 through 15.34

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Demonstrate how to measure pupil size, the test for accommodation, and how to record the response of the pupils. Bring in several ophthalmoscopes so that the students can practice with them and become comfortable with their use. Demonstrate the use of the ophthalmoscope and then have students examine each other. Discuss how a normal ocular fundus should look. Discuss the seven points important to note when examining the retinal vessels. Show several pictures of both normal and abnormal vessels. Show pictures of a normal macula and of several types of macular degeneration. Go over the visual acuity of the child and when it is appropriate to use certain tests.

IN-CLASS/ONLINE CASE STUDY C.K. Is a 76-year-old woman who presents to the family practice with complaints of difficulty seeing at night, especially when driving. The patient was last seen by the ophthalmologist 6 months ago and needs a referral to be seen by the specialist. The patient has hypertension and diabetes, both managed with medications. She has no complaints of pain at this time. Vital signs are T 97.5, P 68, R 16, and BP 120/60. 1. What subjective information should the nurse obtain?

Answer: The nurse should ask the patient about difficulty seeing or blurring. Other questions include the following: Any blind spots? Did the condition come on suddenly or progress slowly? Is it in one eye or both? Is it constant or does it come and go? Do objects appear out of focus, or does it seem like a clouding over objects? Does it seem like grayness of vision? Do you see any halos or rainbows around objects? Rings around lights? Any loss of peripheral vision? Rationale: Floaters are common with myopia or after middle age. Halos around lights occur with acute narrow-angle glaucoma. Scotoma, a blind spot surrounded by an area of normal or decreased vision, occurs with glaucoma or other optic nerve disorder. 2. The nurse is assessing the internal anatomy of the eye. What are the physical features? Answer: The eye has three concentric coats, or layers. The sclera is a tough, protective, white covering, continuous anteriorly with the smooth, transparent cornea. The cornea, part of the refracting media of the eye, covers the iris and pupil. Touching the cornea with a wisp of cotton stimulates a blink, referred to as the corneal reflex. Cranial nerves V and VII innervate this reflex. The middle layer contains the choroid, which has dark pigmentation to prevent light from reflecting internally and is highly vascular, to deliver blood to the retina. The choroid is continuous with the ciliary body and the iris. The lens, which divides the eye into the anterior and posterior segments, is a transparent structure located behind the pupil. The lens keeps viewed objects in continual focus on the retina. The inner layer contains the retina, which is the visual receptive layer of the eye. In the retina, light waves are changed into nerve impulses. Rationale: The anatomic features are important components of the assessment. The physical examination can assist in determining abnormalities. 3. The nurse is assessing the patient’s eyes through the ophthalmoscope. What structures can be viewed through the scope? Answer: The media and the ocular fundus can be inspected using an ophthalmoscope. In the media the anterior chamber, the lens and the vitreous are visible. The retinal structures viewed with an ophthalmoscope are the optic disc, the retinal vessels, the general background, and the macula. Fibers from the retina converge at the optic disc to form the optic nerve. The color of the disc (optic papilla) varies from creamy yellow-orange to pink. It is round or oval; has margins that are distinct and sharply demarcated, especially on the temporal side; and has a physiologic cup where blood vessels exit and enter. Rationale: The ophthalmologic examination can assist in determining abnormalities. 4. What are some possible causes of decreased visual functioning in older adults?

Answer: Cataract formation, or lens opacity, can be expected by age 70 years. Glaucoma or increased ocular pressure increases with age. Chronic, open-angle glaucoma is the most common type and involves a gradual loss of peripheral vision. Macular degeneration is a breakdown of the cells in the macula, resulting in loss of central vision in the affected eye; peripheral vision is not affected. Rationale: As a person ages, the eyes age as well. The lens becomes opaque, and an increase in ocular pressure can occur. The macula may also break down and degenerate. 5. What is the most likely cause of this patient’s night blindness? Answer: Based on the history presented, this patient needs to be evaluated for glaucoma or vitamin A deficiency. Rationale: Night blindness occurs with glaucoma or vitamin A deficiency.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES ●

Patient-Centered Care/Human Flourishing o Objective Data o Health Promotion and Patient Teaching ● Informatics/Nursing Judgment o Subjective Data o Objective Data o Documentation and Critical Thinking

HEALTH AND ILLNESS CONCEPTS THEME: Protection and Movement ● Concept: Sensory Perception o Exemplar: External Anatomy o Exemplar: Internal Anatomy o Exemplar: Visual Pathways and Visual Fields o Exemplar: Visual Reflexes PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles ● Concept: Health Promotion o Exemplar: Health Promotion and Patient Teaching ● Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS Essential IV: Information Management and Application of Patient Care Technology o Subjective Data Objective Data Documentation and Critical Thinking o Objective Data o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS ● ● ●

Domain 2: Person-Centered Care Health Promotion and Patient Teaching Domain 3: Population Health o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies

o Subjective Data Objective Data Documentation and Critical Thinking

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES Domain 2: Roles/Responsibilities Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 16: Ears CHAPTER OBJECTIVES 45. 46. 47. 48. 49. 50. 51.

List the anatomic landmarks of the external ear. Describe the tympanic membrane and its anatomic landmarks. List the functions of the middle ear. State the functions of the inner ear that can be assessed. Differentiate among the types of hearing loss. Relate the anatomic developmental differences that alter hearing. Incorporate health promotion concepts when performing an assessment of the ears.

STUDENT RESOURCES

understand

      

Textbook Chapter 16 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus EXTERNAL EAR MIDDLE EAR INNER EAR

Content Highlights Bring in an ear anatomy model to explain the external ear, ear canal, tympanic membrane (TM), inner ear, and eustachian tube.

Infants and Children

 

Explain the three functions of the middle ear and review its various openings and their functions. 

HEARING DEVELOPMENTAL COMPETENCE

Learning Activities

Demonstrate and discuss how to assess the functions of the inner ear.  Review the function of hearing of the auditory system at its three levels. Discuss why it is important to understand that each ear is but half of the total



Activity: Obtain a diagram of the ear and have the students label the structures. Small Group activity: Assign student groups to investigate the auditory system and have them relate to the class the functions of the three levels with a model. Online Activity: Research cochlear implants and list the criteria a patient must meet to qualify for this implantable hearing solution. Discussion Topic: What can do damage to your hearing in everyday life? Are there products to protect and to improve hearing? Activity: Assign students to prepare teaching materials

Resources Figure 16.1 Figure 16.2 Figure 16.3 Figure 16.4

TEACHING STRATEGIES Content Focus The Adult The Aging Adult GENETICS AND ENVIRONMENT

Content Highlights

Learning Activities

sensory organ. Examine the two different types of hearing loss and what types of sounds are affected by each type.

that identify environmental factors that may cause hearing loss and devices used to decrease the risk, if available.

Resources

Review the inner ear development during gestation. Compare the inner ear layout of infants to that of adults. Discuss how the work and lifestyle of an adult can affect ear health. Explain that impacted cerumen and the occurrence of sensorineural loss are primary causes of hearing loss in the aging adult.

SUBJECTIVE DATA Additional History for Infants and Children

Mention the predisposing genetic and environmental factors in otitis media. Ask students how many of the factors apply to them or to their children. Discuss being aware of hearing loss clues during the normal conversation of the exam. Explain the importance of periodic, professional ear cleaning and the dangers of using a cotton ear swab.



Small Group Activity: Assign a group of students to make a decibel chart with examples of loud noises that can affect hearing. Discussion Topic: Discuss relevant infection control practices.

Talk about the risk of hearing deficit in children exposed to certain diseases. OBJECTIVE DATA INSPECT AND PALPATE THE EXTERNAL EAR

Discuss the many different sizes and shapes of ears. Consider how abnormal findings for the external ear do not necessarily reflect problems with the middle or inner ear or hearing.

INSPECT WITH THE OTOSCOPE

See whether anyone in the class has a Darwin’s tubercle.



Small Group Activity: Assign students to perform an ear examination. Have them work in groups of three: one to follow the checklist and textbook, one to perform the examination, and one to act as patient. Allow sufficient time for students to rotate roles so that each has an opportunity to be the examiner. Discussion Topic: Discuss examination modifications needed for patients at various developmental stages.

Figure 16.6 through Figure 16.13 Table 16.1 through Table 16.7

TEACHING STRATEGIES Content Focus TEST HEARING ACUITY THE VESTIBULAR APPARATUS DEVELOPMENTAL COMPETENCE Infants and Young Children The Aging Adult

Content Highlights With the help of a volunteer, use the techniques and equipment needed for an otoscopic exam. Demonstrate how to accurately choose the speculum size and how to safely insert the speculum into the ear canal. Review Table 16.6 for information on abnormal tympanic membranes.

Learning Activities  

 Bring in an audiometer to demonstrate on a volunteer. Perform several whispered voice tests on the students, allowing them to be both nurse and patient. Ask an audiologist to come to class to demonstrate the machines that may be used to assist in screening for hearing loss.

Documentation Activity: Instruct students to document the results of the previous examinations. Small Group Activity: If students from various ethnic groups are in the class, encourage students to examine one another’s ears to learn the variations in cerumen that may occur among individuals. Discussion Topic: Discuss intrauterine exposures that may affect hearing.

Discuss the inaccuracies of the Weber and Rinne tuning fork tests. Provide research material confirming this information. Discuss the Romberg test in more detail, referring the students to Chapter 24. Use Figure 16.12 to illustrate ear position for children for an exam. Review the behavioral manifestations of hearing loss in children. Show pictures of the pendulous earlobes and coarse, wiry hair that are common in the aging adult. Have a representative from a hearing aid company come in and demonstrate the handling and use of various hearing aids and how to change the batteries.

Resources

IN-CLASS/ONLINE CASE STUDY P.P. is a 4-year-old boy who presents to the pediatrician’s office with pain in his right ear. Subjective Data Mom states that her son woke up in the middle of the night, crying, 2 nights ago. She gave the child ibuprofen, and he went back to sleep. Last night he woke up in pain, and he was inconsolable. She felt the physician should see him. Attends preschool program Lives with mother Father estranged Objective Data TM appears inflamed—it is red and may be bulging and immobile T = 100.3 Last ibuprofen 3 hours ago Questions 1. What other assessments should be included for this patient? 2. What questions are appropriate for a patient presenting with earache? 3. What risk factors are associated with earaches for this age group? 4. From the readings, what is the difference between otitis media and otitis externa? 5. From the readings, what is the most probable cause of the earache in this patient? 6. What are three nursing diagnoses? 7. What interventions should be included in the nursing care plan? Answers 1. A full assessment of the HEENT is necessary to determine the cause of the earache. A focused assessment of the ear and underlying structures includes inspecting the internal ear structures. Use an otoscope to inspect the outer and middle ear. Inspect the external ear canal for cerumen, edema, erythema, discharge, and foreign bodies. Inspect the tympanic membrane for landmarks, color, contour, translucence, and fluctuation. Test the acoustic cranial nerve (VIII) to evaluate auditory function. Perform the whispered voice test. 2. The following questions help determine the cause of an earache in a child and the interventions necessary:  Does the pain interfere with sleep or the child’s function?  How often does it occur?  How long does the pain last?

5. 6. 7.

 Does the pain appear worse when the child is lying down or sitting up?  Is the pain relieved with medications?  Which medications relieve the pain? Patients with earache are at risk for otitis media with effusion (OME), an inflammation of the middle ear space resulting in accumulation of serous fluid in the middle ear. Patients are also at risk for hearing loss, vomiting, fever, and pain. Children are especially at risk because of shorter and wider eustachian tubes, which provide an easier passage for pathogens. Otitis media: The major symptom associated with AOM is ear pain (otalgia). Infants unable to verbally communicate pain may demonstrate irritability, fussiness, crying, lethargy, and pulling at the affected ear. Associated manifestations include fever, vomiting (infants), and decreased hearing (older children and adults). On inspection in the early stages, the TM appears inflamed; it is red and may be bulging and immobile. Otitis externa: Erythema and edema of the auditory canal may be an indication of otitis externa. The infection may cause the canal to become edematous and occluded. Purulent discharge may occur secondary to otitis externa or with rupture of the TM associated with acute otitis media. This child’s earache is most likely caused by otitis media. See answer choice 2. Pain related to infection, deficient knowledge related to antibiotic use, and risk for deficient sensory perception related to infection Interventions include teaching the importance of finishing the antibiotic to prevent resistance, giving pain medications as prescribed for comfort, seeking medical attention if pain persists or remains unresolved in 1 week, and seeking medical attention if hearing appears to be affected after the infection is resolved.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Informatics/Nursing Judgment o Subjective Data o Objective Data

HEALTH AND ILLNESS CONCEPTS THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: External Ear o Exemplar: Middle Ear o Exemplar: Inner Ear o Exemplar: Hearing THEME: Mood and Cognition  Concept: Cognition o Exemplar: Genetics and Environment PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data

BSN ESSENTIALS 

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data o Text heads or features as appropriate

2021 AACN ESSENTIALS DOMAINS 

Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities

o o

Subjective Data Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 17: Nose, Mouth, and Throat CHAPTER OBJECTIVES 52. 53. 54. 55. 56. 57. 58. 59.

Name the functions of the nose. List the anatomic landmarks of the external nose. Describe the nasal cavity. Name the paranasal sinuses and their functions. Identify the structures of the oral cavity. List the functions of the mouth. Identify the effects of some of the age-related changes that take place in the mouth. Incorporate health promotion concepts when performing an assessment of the nose, mouth, and throat.

STUDENT RESOURCES

understand

      

Textbook Chapter 17 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus NOSE

Content Highlights

THROAT

Use anatomy models or diagrams to detail the structures, nasal cavity, and paranasal sinuses. Using Figures 17.2 and 17.3, make work sheets with the arrows pointing to the necessary material for class review.

DEVELOPMENTAL COMPETENCE

Figure 17.6 presents an example of the development of deciduous teeth.

Infants and Children

Cover hyperemic gums. Discuss how to remember to mention this to pregnant patients and to emphasize the importance of dental visits during pregnancy. Many times dental information is not discussed.

MOUTH

Learning Activities 

 

The Pregnant Woman The Aging Adult GENETICS AND ENVIRONMENT

Discuss malocclusion and the many associated problems. Discuss how the sense of smell enhances the taste of food and how patients with a reduced sense of smell may be uninterested in food, which can contribute to nutrition issues. Review a list of medications associated with the aging adult that can



Resources

Figure 17.1 Discussion topic: What are cultural differences and attitudes about dental health? Can where you are born though Figure 17.5 predict your dental health? Discussion topic: What foods can promote good dental Figure 17.6 health? Activity: Have the class label a diagram of the oral cavity and sinuses. Small Group Activity: Assign students to prepare teaching materials that address care of the teeth and mouth. Activity: Bring in examples of smokeless tobacco (chewing tobacco and snuff) for the students to compare (but not to sample!). Assign students to prepare teaching materials that address the health risks of smokeless tobacco.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

cause dry mouth.

Mouth and Throat

Review the conditions discussed and the culture in which the occurrence rate is the highest. Divide the class into two groups. Provide one group with answers to examination questions that should lead the other group to specific conclusions. Try to adequately cover several nasal, mouth, and throat infections or diseases.

Additional History for Infants and Children

Discuss how mouth lesions can be symptoms of many different medical problems.

Additional History for the Aging Adult

Examine reasons for bruxism, emphasizing that this problem is common in both children and adults (http://www.mayoclinic.com/health/bruxism/DS0033 7). With the help of a volunteer, describe and demonstrate preparation for an examination and the positioning of the patient. Verbally cover the proper steps for inspection, the use of the otoscope, and how to palpate the sinus area and check for polyps. Discuss how allergies might affect the patient.

SUBJECTIVE DATA Nose



 

OBJECTIVE DATA INSPECT AND PALPATE THE NOSE PALPATE THE SINUS AREAS INSPECT THE MOUTH INSPECT THE THROAT DEVELOPMENTAL COMPETENCE Infants and Children



Activity: Assist (and observe) the class in practicing positioning a patient for examination and using an otoscope. Activity: Assist and observe students with the use of a tongue blade. Discussion Topic: Discuss how to approach an infant or a child for an oral exam. Discuss new ideas for making children more comfortable and the exam less traumatic.

Discussion Topic: Discuss with students the potential barriers to completing a thorough examination of the nose, mouth, and throat and ways of overcoming those barriers. Online Activity: Research the different types of dental practices. Make a list of mouth and teeth problems and categorize them according to referral possibilities.

Allow students to palpate each other’s sinus areas and document their findings. Follow up with an examination of your own for confirmation or constructive criticism. With the help of a volunteer, demonstrate the gentle use of the tongue blade for examination. Figures 17.19 and 17.20 demonstrate how to inspect all areas. Emphasize special care with patients who gag easily.

Figure 17.7 through Figure 17.24 Table 17.1 through Table 17.6

TEACHING STRATEGIES Content Focus The Pregnant Woman

Content Highlights

Learning Activities

Resources

While the students practice the proper techniques, point out such things as Stensen duct, leukoedema, Fordyce granules, torus palatinus, and the tonsils.

The Aging Adult Discuss the breath odors mentioned in the text and the possible referrals necessary to investigate the suggested problems. Discuss some of the many ways to distract and entertain infants and children, with the parent’s help, to obtain proper positioning. Cover what to look for, such as a sucking tubercle, Epstein’s pearls, and Bednar aphthae, as well as any bruising or lacerations on the infant.

IN-CLASS/ONLINE CASE STUDY B.W. is a 44-year-old man who presents to the family practice with complaints of sore throat, hoarseness, and a dry cough that worsens at night. He states that the cough started 6 days ago, and the sore throat and hoarseness began 3 days ago and appear to be getting worse The patient has a history of prediabetes, which is controlled through diet and exercise. Vital signs are T 99.5, P 58, R 16, and BP 110/55. 1. What subjective information should the nurse obtain? Answer: How frequently do you get sore throats? When is the pain the worst? What relieves the pain (e.g., cool liquids, warm liquids, cough drops)? Are you having postnasal drip? Is it worse when arising? What is the humidity level in the room where you sleep? Do you smoke? In regard to the hoarseness, did your voice change? Do you feel like you have to clear your throat or like a lump is in your throat? Is the cough productive? Do you use your voice a lot at work or recreation? Rationale: The history helps determine whether an infection is present. Hoarseness of the larynx has many possible causes, including overuse of the voice, upper respiratory infection, chronic inflammation, lesions, or a neoplasm.

2. The nurse is assessing the structures of the oral cavity. What are the physical features? Answer: The lips, the insides of both cheeks, the roof of the mouth or palate, the mandible, and the maxilla form the oral cavity. An adult mouth has 32 teeth, the tongue, gums, and openings for three pairs of salivary glands (parotid, submandibular, and sublingual), and the uvula. The oropharynx is separated from the mouth by a fold of tissue on each side, the anterior tonsillar pillar. Behind the folds are the tonsils, each a mass of lymphoid tissue. Tonsillar tissue enlarges during childhood and puberty and then involutes. The nasopharynx is continuous with the oropharynx, although it is above the oropharynx and behind the nasal cavity. The pharyngeal tonsils (adenoids) and the eustachian tube openings are located here. Rationale: The anatomic features are important components of the assessment. The physical examination can assist in determining abnormalities. Examination of the teeth indicates the patient’s oral health. 3. The nurse notes that the patient’s teeth are stained yellow and asks the patient about tobacco use. The patient states that he chews one bag of tobacco every other day. What health promotion concepts should the nurse include in the teaching plan? Answer: Smokeless tobacco (SLT) contains cancer-producing chemicals, such as nitrosamines, that increase the risk of oral cancers (pharynx, larynx, and esophagus). Early signs of oral cancer should be discussed, as well as other effects of SLT use, such as gum recession, tooth discoloration, bad breath, nicotine dependence, and unhealthy eating habits. SLT is not a healthy alternative to smoking. Rationale: Using smokeless tobacco can be detrimental to a person’s health. The two types of SLT most commonly used in the United States are chewing tobacco and snuff. The largest group of SLT users is American Indian and Alaskan Native children, but SLT use is also high among young white men. 4. What is the most likely cause of this patient’s cough, sore throat, and hoarseness? Answer: Based on the history presented, this patient should be evaluated either for strep throat or for an upper respiratory infection. Rationale: Strep throat presents with sore throat and cough. Hoarseness of the larynx has many causes, including overuse of the voice, upper respiratory infection, chronic inflammation, lesions, or a neoplasm.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Objective Data o Health Promotion and Patient Teaching

 

o Figure 17.25 Safety/Nursing Judgment o Objective Data Informatics/Nursing Judgment o Subjective Data o Objective Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: Nose o Exemplar: Mouth THEME: Homeostasis and Regulation  Concept: Gas Exchange o Exemplar: Genetics and Environment PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Safety o Exemplar: Objective Data  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Patient Education

o o

Exemplar: Health Promotion and Patient Teaching Exemplar: Figure 17.25

BSN ESSENTIALS   

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Objective Data Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential IX: Baccalaureate Generalist Nursing Practice o Objective Data o Health Promotion and Patient Teaching o Figure 17.25

2021 AACN ESSENTIALS DOMAINS 



Domain 2: Person-Centered Care o Objective Data o Health Promotion and Patient Teaching o Figure 17.25 Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Subjective Data o Objective Data o Health Promotion and Patient Teaching o Figure 17.25

ANSWERS TO QUESTIONS IN THE STUDY GUIDE

Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 18: Breasts, Axillae, and Regional Lymphatics CHAPTER OBJECTIVES 1. 2. 3. 4. 5. 6. 7. 8.

Identify significant breast anatomy. Describe the composition of breast glandular tissue. Relate the changes that occur in Cooper’s ligaments with cancer. Describe the ways of documenting clinical findings from a breast examination. Relate the anatomy of the breast lymphatic system. Review breast development in the adolescent female. Review breast changes that occur during pregnancy. Describe the procedure for teaching breast self-examination and incorporating health promotion concepts when performing an assessment of the breasts.

STUDENT RESOURCES

understand

      

Textbook Chapter 18 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus INTERNAL ANATOMY LYMPHATICS DEVELOPMENTAL COMPETENCE

Content Highlights Bring in a model and a diagram of a breast and review the external and internal characteristics. Discuss the three different tissues of the breast and how the glandular tissue produces milk.

Learning Activities 

 Examine why the upper outer quadrant is the site of most breast tumors.

The Adolescent The Pregnant Woman The Aging Woman

Explain the function of lymphatic drainage using a diagram and review the four groups of axillary nodes. Discuss whether the lymphatic drainage has anything to do with breast cancer.



Activity: Obtain a diagram of the breast and have students label the different tissues, ligaments, and breast characteristics or have them draw a sketch of the breast and surrounding tissues. Small Group Activity: Supply a breast mannequin for each one or two students. While students perform an examination on the mannequins, observe for technique. Online Activity: Have students investigate breast cancer awareness groups in their community. What type of services do they offer?

Review the development of the breast, starting with puberty, and discuss how hormone development stimulates breast changes. Use Table 18.1 to explain Tanner staging. Discuss the common changes in breasts during menarche. Discuss the expansion of the duct system and physical

Resources Figure 18.1 Figure 18.2 Figure 18.3 Figure 18.4 Table 18.1

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

changes in the breast during pregnancy.

THE MALE BREAST GENETICS AND ENVIRONMENT Breast Cancer

SUBJECTIVE DATA Breast Axilla Additional History for the Preadolescent Additional History for the Pregnant Woman Additional History for the Menopausal Woman Risk Factor Profile for Breast Cancer OBJECTIVE DATA

Explain how a decrease in estrogen and progesterone changes breast characteristics as a woman ages. Using Figure 18.20, discuss gynecomastia during adolescence and testosterone deficiency in the aging male.



 Give some examples of genetic and environmental factors that may affect breast development. Discuss how diet, breastfeeding, and early screening may reduce the risk of breast cancer. Emphasize the importance of being sensitive to a patient’s anxiety and attitude about having the breasts examined. Review each of the examination questions and its rationale. Explain how to do a breast self-exam.

Discussion Topic: Discuss the effects of growth hormones in food products on children and the general population. Discussion Topic: Discuss the effects of BPA on male gynecomastia.



Discussion Topic: Discuss how patients can lower their risk of breast cancer.

Table 18.2



Activity: Have students interview a Reach to Recovery volunteer (by contacting the local chapter of the

Figure 18.6 through Figure

Discuss ways to make the adolescent patient comfortable about discussing breast changes at puberty. Explain the benefits of breastfeeding for both the mother and the infant. Discuss decreased firmness and shrinkage, emphasizing reassurance for the patient that these changes are normal. Review breast cancer risk factors in Table 18.2. Show a video demonstrating how to prepare a patient for a breast exam. Explain the equipment needed for

TEACHING STRATEGIES Content Focus INSPECT THE BREASTS General Appearance Skin Lymphatic Drainage Areas Nipple Maneuvers to Screen for Retraction INSPECT AND PALPATE THE AXILLAE

Content Highlights the exam. With the help of a volunteer, demonstrate the positions used for the different parts of the examination. Discuss symmetry of size and shape in the breasts and normal ranges. Emphasize that a sudden increase in size should be investigated.

  

Review how to observe the axillary and supraclavicular regions.

American Cancer Society). Have them share their interview with the class. Activity: Assign students to perform a breast exam on a patient in a clinical setting. Activity: Designate a day each month to remind female students to do a breast self-examination. Discussion Topic: Discuss the importance of examining the male breast and ways of creating an environment that will provide psychological comfort for both patient and practitioner.

Define supernumerary nipple. Demonstrate retraction maneuvers.

PALPATE THE BREASTS

Review the position of the patient and palpations of the axillae in four directions.

EXAMINING THE WOMAN WITH A HEALED MASTECTOMY

Detail the characteristics of a lump using Figure 18.16 and use Tables 18.3 and 18.4 to explain how to differentiate breast lumps.

THE MALE BREAST

Discuss how to teach breast self-examination and the best time to perform the exam. Remember: Keep it simple!

DEVELOPMENTAL COMPETENCE

Learning Activities

Ask a male volunteer to act as a patient and demonstrate the examination in this section. Review areas of palpation. Review care for adolescent males. Discuss both normal and possible abnormal findings. Use a doll or an infant mannequin to demonstrate the correct way to examine an infant.



Activity: Assign students to patients of different ethnic groups. Have students interview the patients for barriers to breast self-examination.

Resources 18.19 Table 18.3 through Table 18.7

TEACHING STRATEGIES Content Focus Infants and Children The Adolescent

Content Highlights

Learning Activities

Resources

Review age development and body mass index when examining an adolescent. Explain that a chart can be helpful in showing the adolescent the normal stages of breast maturity.

The Pregnant Woman Review nursing and changes in the breasts. The Lactating Woman The Aging Woman

Discuss the changes in the breast that are due to aging.

IN-CLASS/ONLINE CASE STUDY D.F. is a 27-year-old woman who presents to the gynecologist’s office for her yearly examination complaining of bilateral breast pain and tenderness. Subjective Data Last menstrual cycle: 18 days ago Pain is dull pain Breasts feel heavy and tender Performs monthly breast self-examinations Objective Data Breasts moderate size, evenly pigmented, bilaterally symmetric, and hang equally with smooth contour. Venous patterns bilaterally similar. Breasts firm, smooth, elastic without tenderness, lumps, or nodules. Areolae round, nipples protruding, symmetric, soft, pliable, smooth, and intact without discharge. Axillary lymph nodes are not palpated. Questions 1. What other questions should the nurse ask about the breast pain? 2. What are some of the causes of breast pain? 3. Develop a problems list from the objective and subjective data. 4. What should be included in the plan of care?

5. Based on the readings and the subjective and objective data, what is the most likely cause of breast pain for this patient? Answers 60. Questions or assessments associated with breast pain include the following:  Where does it hurt?  Is it in one breast or both?  Is there a specific location or is the pain generalized?  When did the pain in your breasts first begin?  Describe the pain. Rate the severity of the pain on a scale from 0 to 10.  Does the pain or tenderness prevent you from carrying out routine activities?  Have you noticed any specific activities that bring on the pain? For example, do you experience pain during sexual activity? When you exercise? When wearing a certain bra or when not wearing a bra? Does it worsen with drinking coffee or other caffeinated beverages?  Have you noted any recent changes in your breasts, such as changes in size, shape, tenderness, lumps, or discharge?  Is the breast tenderness associated with a swollen feeling in the breasts? If yes, when do you notice the swelling? Is the swelling related to your menstrual cycle? 61. Benign breast disease is a term that represents a number of breast-related symptoms and problems, including breast pain or tenderness, swelling, lumps, discharge, and inflammation. Fibrocystic changes to the breast refers to a variety of conditions associated with multiple benign masses in the breast caused by ductal enlargement and the formation of fluid-filled cysts, commonly seen in middle-aged women. Fibroadenoma is a common, benign breast tumor in young women that consists of glandular and fibrous tissue. Ductal ectasia is a benign breast disease characterized by inflammation and dilation involving one or multiple subareolar ducts. An intraductal papilloma is a small, benign tumor growth in the major ducts, usually within 1 to 2 cm of the areolar edge. Breast cancer is a major health problem for women. It is the most common non-skin-related malignancy in American women. 62. The problems list includes the following:  Breast pain  Heaviness and tenderness 4. The plan of care should include having the patient continue monthly breast self-examinations and monitoring for changes. Teaching should also include checking the nipples for discharge. Management for the breast pain would include antiinflammatories, such as ibuprofen. 5. The most likely cause of this patient’s breast pain is cyclic bilateral breast edema or fullness. This is a normal occurrence caused by hormonal fluctuations associated with the menstrual cycle. Significant edema should be further evaluated, especially if it is unilateral, has other associated findings, or influences the woman’s ability to participate in normal activities.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Subjective Data o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS  

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential IX: Baccalaureate Generalist Nursing Practice o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS  

Domain 2: Person-Centered Care o Subjective Data o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Subjective Data o Objective Data o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN

Chapter 19: Thorax and Lungs CHAPTER OBJECTIVES 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Name the components of the thoracic cage. Describe the surface landmarks on the thorax. List the contents of the mediastinum. Describe the borders of the lung. Describe the anatomic demarcation of the five lobes of the lungs. Describe the pleurae and their function. List the structures that compose the respiratory dead space. Discuss the location and functions of the trachea and bronchial tree. Summarize the mechanics of respiration. Discuss developmental care associated with the thoracic cavity. Incorporate health promotion concepts when performing an assessment of the thorax and lungs.

STUDENT RESOURCES

understand

      

Textbook Chapter 19 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

POSITION AND SURFACE LANDMARKS

Bring in a skeletal model and let students perform hands-on exploration of the thoracic cage.

Anterior Thoracic Landmarks

Define the surface landmarks and each part of the thoracic cage from both the anterior and posterior perspectives. Discuss the difficulties of finding the posterior landmarks in general and especially in obese patients.

Learning Activities  

Posterior Thoracic Landmarks Reference Lines THE THORACIC CAVITY

Demonstrate accurate reference lines on both the anterior and posterior chest of a volunteer. Explain and define the thoracic cavity and the lung borders.

Lobes of the Lungs Pleurae Trachea and Bronchial Tree

Bring in a model of the lungs and let the students examine it closely. Ask a representative of the American Cancer Society to visit the class and present health promotion materials for smoking cessation (including photos of the lungs of smokers).



Resources

Activity: Hand out diagrams, and have the class draw the reference lines for the thoracic cage. Activity: Have students play “Password” with the names of the thoracic landmarks. These terms need to be committed to memory to communicate findings clearly either verbally or in writing. Discussion Topic: Discuss the clinical significance of the fact that the posterior chest consists of almost all lower lobe.

Figure 19.1 Figure 19.2 Figure 19.3 Figure 19.4

Activity: Have students make a lung model of Play-Doh or clay. Use different colors for the different lobes to cement their understanding of the lung structures. (As an interesting twist, bring in some dirt particles in which to roll their completed lung to portray smokers’ lungs or coal miners’ lungs.)

Figure 19.5 through Figure 19.11

Explain the function and structure of the pleural cavity. Demonstrate how the pleurae work, showing

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

what happens when the cavity fills with air or fluid. Explain the structure and function of trachea and bronchi.

MECHANICS OF RESPIRATION Control of Respirations Changing Chest Size DEVELOPMENTAL COMPETENCE

Explain dead space in more detail. Define the four major functions of the respiratory system. Have students practice both hypoventilation and hyperventilation and discuss how they feel after each bout of respiration. Explain involuntary control of respiration. Have students do jumping jacks or run in place to demonstrate changes in breathing patterns. Review hypercapnia and hypoxemia, discussing symptoms of extremes in these areas.

 



Discussion Topic: Discuss the effects of environment and smoking on the unborn fetus and on children. Online Activity: Have students research fetal respiratory development or phases of lung development. Online Activity: Have students research the effects of aging on lung elasticity, focusing on whether any preventive measures can be taken to reduce the decline of respiratory muscle strength.

Infants and Children The Pregnant Woman

Show a video of respiration. Demonstrate the use of the accessory neck muscles because of forced inspiration.

The Aging Adult GENETICS AND ENVIRONMENT

Review respiratory development in infants. Explain the effects of postnatal exposure to secondhand smoke on the respiratory system of an infant. Explain the effects of increased demand on a pregnant woman’s system to provide oxygen for her fetus. Explain the effects of age on vital capacity and residual volume. Give examples of ethnic groups with an increased risk of respiratory disease and how chest volume is

Figure 19.12 Figure 19.13

TEACHING STRATEGIES Content Focus

SUBJECTIVE DATA Additional History for Infants and Children Additional History for the Aging Adult

OBJECTIVE DATA INSPECT THE POSTERIOR CHEST Thoracic Cage PALPATE THE POSTERIOR CHEST Symmetric Expansion Tactile Fremitus PERCUSS THE POSTERIOR CHEST Lung Fields

Content Highlights influenced by ethnicity. Examine comparisons of tuberculosis and asthma rates for the United States and several other countries. Review each question the examiner asks and explain the rationale. Discuss other problems that can arise from having a long-standing cough.

Learning Activities



Small Group Activity: Have students work in pairs. One student is the “patient,” and the other student is the “nurse.” Provide the “patient” with a list of symptoms to present to the “nurse” for diagnosis. Observe and assist students as they practice asking questions to collect data for the examination.



Activity: Observe and assist class members as they practice palpation and percussion. Activity: Obtain foam cups with lids. Fill one with water or dirt and leave the other empty. Have students practice listening for the difference in percussion notes between the two cups. The sounds will be exaggerated, but this is a useful beginning. Clinical Activity: Assign students to complete a respiratory assessment of a patient in the clinical area. Activity: Have students document the results of the respiratory assessment completed on a patient. Have students critique each other’s documentation techniques.

Review the questions in this section, discussing what substances could be found in the home that are harmful to the respiratory system. Discuss the benefits of physical activity on lung function. Review how to prepare the patient and complete an examination.

 Show a diagram of the posterior chest and the proper positioning of the hands. Discuss the importance of noting the position in which the patient is most comfortable breathing. Demonstrate several positions and discuss their significance. Demonstrate how to confirm symmetric chest expansion. Review the factors that affect the normal intensity of tactile fremitus.

 

Demonstrate percussion of the posterior chest. Explain how to determine the predominant note over lung fields.

AUSCULTATE THE

Resources

Figure 19.14 through Figure 19.20 Table 19.1

TEACHING STRATEGIES Content Focus POSTERIOR CHEST

Content Highlights

Learning Activities

Resources

Discuss reasons for a larger diaphragmatic excursion in well-conditioned people.

Breath Sounds Adventitious Sounds

Discuss the three types of normal breath sounds. Review how to evaluate normal breath sounds and how to ignore background noise.

Voice Sounds INSPECT THE ANTERIOR CHEST

Review abnormal sounds in the lungs. See Table 19.6. Discuss conditions for which noisy breathing is a symptom.

PALPATE THE ANTERIOR CHEST

Demonstrate palpating symmetric chest expansion. Discuss normal ranges.

PERCUSS THE ANTERIOR CHEST

Discuss the reason for using the sequence illustrated in Figure 19.23.

AUSCULTATE THE ANTERIOR CHEST

Demonstrate and explain hand positioning on the chest.

Breath Sounds

Define how to evaluate normal, abnormal, and adventitious sounds.

Measurement of Pulmonary Function Status DEVELOPMENTAL COMPETENCE Infants and Children The Pregnant Woman



Online Activity: Have students find audio clips of adventitious lungs sounds. Discuss what makes these sounds.

Explain forced expiratory time and bring in both a pulse oximeter and a spirometer for students to use; evaluate the data obtained. Review inspection and measurement of an infant or a child. Explain the Apgar scoring system. Review Table 19.2. Emphasize the importance of patient care for the aging adult during the examination.

Figure 19.21 through 19.27 Table 19.2 through Table 19.9

TEACHING STRATEGIES Content Focus

Content Highlights

The Aging Adult The Acutely Ill Person

Discuss the use of a second examiner to help position the patient. Use two volunteers, one as the patient and one as the second examiner, and demonstrate techniques that can make the examination easy on the patient and still productive.

IN-CLASS/ONLINE CASE STUDY M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough. Subjective Data PMH: HTN, DM Cough is productive, bringing up green phlegm Runny nose, sore throat Denies fever Sore throat pain when swallowing No history of smoking or seasonal allergies Complains of fatigue Objective Data Vital signs: T 37 P 72 R 14 BP 134/64 Lungs: + Rhonchi bilateral upper lobes, wheeze O2 Sat = 98% Ears = TM bulging Nose = + erythema, yellow discharge Throat = + erythema, – pustules Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day

Learning Activities

Resources

Questions 1. What other questions should the nurse ask about the cough? 2. Develop a problems list from the objective and subjective data. 3. What nursing diagnoses can be derived from the problems list? 4. What should be included in the plan of care? 5. What risk factors are associated with this age group? 6. Based on the readings, what is the most likely cause of this patient’s cough? Answers 1. Questions or assessments associated with cough include the following:  When did you first notice the cough?  Is the cough constant or does it come and go?  Has the cough changed since you first noticed it?  Describe your cough. Is it dry? Productive? Hacking? Hoarse?  How often are you coughing up sputum (all of the time or periodically)? How much sputum do you cough up?  What is the color of the sputum?  What is the consistency of the sputum (thick, thin, frothy)?  Have you noticed whether the sputum has an odor?  Have you noticed any other symptoms along with the cough, such as shortness of breath, chest pain or tightness with breathing, fever, stuffy nose, noisy respiration, hoarseness, or gagging?  Does the cough tire you out?  Does it keep you awake at night?  Have you done anything to treat the cough yourself, such as medications, fluids, or a vaporizer? Have these measures been effective? 2. The problems list includes the following:  Cough  Sore throat  Yellow discharge  Inflammation of the ears  Pain  Runny nose 3. The two main diagnoses at this time are (1) ineffective airway clearance related to cough and sore throat (2) and acute pain related to sore throat and inflammation in ears.

4. The plan of care should include determining the cause of the cough and treating symptoms. Antiinflammatories may be prescribed for pain management in addition to antihistamines; increasing fluid intake; and monitoring for signs and symptoms of subsequent infections, such as pneumonia or bronchitis. 5. Risk factors include pneumonia, bronchitis, and dehydration. 6. Rhonchi in the upper lobes are indicative of bronchitis. Rhonchi are heard in disorders causing obstruction of the trachea or bronchus, such as chronic bronchitis.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Informatics/Nursing Judgment o Subjective Data o Objective Data



Concept: Acid-Base Balance o Exemplar: Mechanics of Respiration  Concept: Perfusion o Exemplar: Mechanics of Respiration THEME: Protection and Movement  Concept: Infection o Exemplar: Genetics and Environment PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data

BSN ESSENTIALS  

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential VII: Clinical Prevention and Population Health o Genetics and Environment

2021 AACN ESSENTIALS DOMAINS  

Domain 3: Population Health o Genetics and Environment Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Genetics and Environment o Subjective Data

Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 20: Heart and Neck Vessels CHAPTER OBJECTIVES 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.

Relate anatomic structures to the correct landmark or anatomic location. List the significant anatomic features of the heart. State why two distinct components to each heart sound exist. List three conditions that result in cardiac murmurs. Describe the characteristics of heart sounds. Summarize the spread of the cardiac impulse through the heart. Describe the carotid artery pulse. Discuss the significance of jugular vein assessment. Describe the function of the foramen ovale and the ductus arteriosus. Cite the risk factors associated with heart disease and stroke. List the hemodynamic changes that occur with aging. Incorporate health promotion concepts when performing an assessment of the heart and neck vessels.

STUDENT RESOURCES

understand

      

Textbook Chapter 20 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS in text



Subjective Data

lesson focus



Recognize Cues

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

POSITION AND SURFACE LANDMARKS

Bring in a heart anatomy model to explain the great vessels, the heart structure, and the flow of blood.

Learning Activities 

Activity: Obtain a diagram of the heart and have students label the structures or have them draw a sketch of the heart and great vessels with labels. Have

Resources Figure 20.1 Figure 20.2

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities 

HEART WALL, CHAMBERS, AND VALVES DIRECTION OF BLOOD FLOW

CARDIAC CYCLE

HEART SOUNDS

Discuss the layers of the heart wall and their purposes. Using the heart anatomy model, examine the atriums and ventricles, along with the valves. Explain how the valves work and discuss signs and symptoms of improperly functioning valves. Demonstrate the blood flow to and from the heart. Discuss the oxygenation and distribution of blood. Review Figure 20.5. Show a video of the cardiac cycle. Explain the two phases of the cardiac cycle: diastole and systole. Discuss the fact that the valves are the origin of the first and second heart sounds. Explain why pressure in the right side of the heart is much lower than in the left side. Observe students (and assist them, if necessary) in the proper use of the stethoscope.



Extra Heart Sounds Murmurs Characteristics of Sound

Figure 20.3 Figure 20.4 Figure 20.5 Figure 20.6



Clinical Activity: Assign students to complete a cardiac assessment of a patient in the clinical setting.



Figure 20.7 Online Activity: Have students access the website www.easyauscultation.com and listen to heart sounds. The site offers many audio tracks of usual and unusual heart sounds and rhythms. Activity: Focus on the S1 and S2 heart sounds. Have students, in pairs, listen to each other’s S1 and S2 heart sounds. During this assessment, have them also note how the S1 coincides with the carotid pulse. (Reminder: Palpate the carotid pulse gently.)

Normal Heart Sounds Discuss the various heart sounds and their physiologic causes. Explain how the first heart sound (S1), heard loudest at the apex, is a combination of the mitral valve and the tricuspid valve closing almost, but not quite, simultaneously; the same is true for the second heart sound (S2) with the aortic and pulmonic valves. Discuss the effects of respiration on the heart sounds.

them also trace the flow of blood through the heart. Activity: The game of “Challenge and Response” can be played. The names of the anatomic structures are used as challenges, and the responder must provide a brief description within 30 seconds. Small Group Activity: Assign student groups to investigate a particular valve and have them explain to the class what could cause the valve to function improperly.

Resources



Discuss the causes of the third and fourth heart sounds and whether their presence indicates

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

abnormalities. Discuss conditions that cause murmurs.

CONDUCTION PUMPING ABILITY

THE NECK VESSELS The Carotid Artery Pulse Jugular Venous Pulse and Pressure DEVELOPMENTAL COMPETENCE Pregnancy

Define and discuss the four characteristics of heart sounds: frequency, intensity, duration, and timing. Explain the automaticity of the heart. Show a video that describes and traces the electrical impulses that prompt the heart to contract. Bring in examples of electrocardiograms of both a normal heart rhythm and an abnormal one.



Activity: Provide students with several examples and have them practice using the cardiac output equation mentioned in the chapter.

Explain how the heart’s pumping ability, or cardiac output, changes during exercise; describe the changes that happen to the heart to accommodate the increased volume of blood. Discuss the terms preload and afterload. Examine Figure 20.10 in class. Explain the differences between the carotid artery pulse and the jugular venous pulse; address specifically what is happening in the heart during each recorded wave. Discuss the usefulness of each pulse in diagnostic activities. Explain the functionality of the fetal heart and its differences from a newborn heart. Describe the circulatory adaptations that happen after the lungs inflate after birth.

Infants and Children The Aging Adult

Discuss the increase in cardiac output in a pregnant woman and the reasons for increases and decreases in blood pressure during pregnancy.

Figure 20.8 Figure 20.9

Figure 20.10 Figure 20.11 Figure 20.12 Figure 20.13 Figure 20.14

TEACHING STRATEGIES Content Focus GENETICS AND ENVIRONMENT

SUBJECTIVE DATA Additional History for Infants

Content Highlights Discuss how the lifestyle of an adult affects cardiac changes. Clearly define what cardiac changes can be attributed to the aging process and separately to culture and genetics. Review the list of questions asked in a cardiac exam. Emphasize the importance of collecting cultural and genetic information. Discuss what extra information is necessary in an exam for a child, a pregnant woman, and an aging adult.

Learning Activities





Additional History for Children

Resources

Activity: Have students take a classmate’s carotid artery pulse and try to observe the jugular venous pulse. Activity: Have students consider five adult family members and list the lifestyle habits for each that might affect cardiac changes. Are there concerns that arise as they evaluate this information? Are there also cultural and genetic factors to consider?

Additional History for Pregnancy Additional History for the Aging Adult OBJECTIVE DATA THE NECK VESSELS

Demonstrate how to palpate and auscultate the carotid artery. Emphasize the importance of light pressure to the carotid artery during these proceedings.



Clinical Activity: Assign students to assess the neck vessels of a patient in the clinical setting.



Clinical Activity: Assign advanced practice students to perform a cardiac examination on a premature infant in a clinical setting. Clinical Activity: Have students visit a pediatric cardiac

Palpate the Carotid Artery Auscultate the Carotid Artery Inspect the Jugular Venous Pulse THE PRECORDIUM Inspect the Anterior Chest

Demonstrate proper positioning for the inspection of the jugular venous pulse. Explain how to distinguish the internal jugular vein pulsation from that of the carotid artery, using Table 20.1 to reinforce the discussion. Emphasize the importance of proper lighting and positioning during exams. Ask for a male volunteer to act as patient and demonstrate the examinations described in this section. Discuss both normal and



Figure 20.15 through Figure 20.30 Table 20.1 through Table 20.11

TEACHING STRATEGIES Content Focus

Content Highlights

Palpate the Apical Impulse

possible abnormal findings.

Palpate Across the Precordium

Bring in a doll or an infant mannequin to demonstrate the correct way to examine an infant.

Percussion

Explain that many murmurs found in children are benign; discuss how to make this clear to a worried parent.

Auscultation PROCEDURES FOR ADVANCED PRACTICE Estimate the Jugular Venous Pressure

Learning Activities unit. Have them interview a pediatric cardiac specialist.

Demonstrate how the fetal shunt closes and discuss Table 20.10 and the defects that occur when the shunt does not close properly. Discuss why aging adults experience orthostatic hypotension.

DEVELOPMENTAL COMPETENCE Infants Children Pregnancy The Aging Adult

IN-CLASS/ONLINE CASE STUDY S.P. is a 75-year-old woman who presents to the provider’s office with fatigue. Subjective Data

Resources

PMH: HTN, hyperlipidemia, MI 3 years ago Fatigue started about a month ago, getting worse Relieved with rest, exacerbated with activity Denies chest pain Ankles swollen Objective Data Vital signs: T 37 P 112 R 18 BP 110/54 Lungs: bilateral lower lobe crackles O2 Sat = 94% Skin = cool to touch CV = heart rate regular, positive peripheral pulses, ECG = no changes +2 edema bilateral ankles Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day Questions 1. What other questions should the nurse ask about the fatigue? 2. What other assessments are necessary for this patient? 3. What are some causes of fatigue? 4. Develop a problems list from the objective and subjective data. 5. What should be included in the plan of care? 6. Based on the readings, what is the most likely cause of fatigue for this patient? Answers 1. Questions or assessments associated with fatigue include the following:  When do you notice fatigue?  Was the onset sudden or gradual?  Is the fatigue worse in the morning or evening?  Are you too tired to take part in normal activities?  Do you take iron pills?  Do you eat foods with iron, such as green, leafy vegetables and liver?  For women who are not postmenopausal: Do you have a heavy menstrual flow?  Have you had any other symptoms associated with the fatigue, such as rapid heart rate, headache, pale skin, sore tongue or lips, or changes in your nails?

  2. 3. 4.

Have you noticed any unusual feelings in your feet and hands, muscle weakness, or trouble thinking? Have you experienced tenderness of the back, shoulder, arm, or jaw in the last few weeks? A full cardiac assessment, including electrocardiogram, pulses, circulation checks, and lab studies may be needed to determine the cause of fatigue and rule out heart failure. Anemia is also a known cause of fatigue and would require further studies and monitoring. Fatigue may be experienced during daily activities such as shopping, climbing stairs, carrying groceries, or walking because the heart cannot pump enough blood to meet the body tissue needs. Fatigue can also be caused by depression, anxiety, anemia, and heart disease. The problems list includes the following:  Fatigue  Edema  History of myocardial infarction (MI)  Low O2 saturation  Tachycardia  Crackles in bases The plan of care should include treatment for congestive heart failure. Oxygen, aspirin, and diuretics are common treatments. This patient should be placed on a telemetry monitor and should have frequent laboratory studies to determine whether the heart muscle was affected by fatigue. This patient likely has heart failure. Fatigue and exertional dyspnea are manifestations of mild anemia and heart failure, more specifically, left ventricular failure. The patient complains of fatigue and shortness of breath, including orthopnea, dyspnea on exertion (DOE), and paroxysmal nocturnal dyspnea (PND). Findings may reveal precordial movement, displaced apical pulse and palpable thrill, S3, and systolic murmur at the apex. In the acute phase, the patient usually has crackles bilaterally from pulmonary edema.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Genetics and Environment o Subjective Data o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Homeostasis and Regulation  Concept: Perfusion o Exemplar: Heart Wall, Chambers, and Valves o Exemplar: Direction of Blood Flow o Exemplar: Cardiac Cycle  Concept: Nutrition o Exemplar: Genetics and Environment PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Health Care Delivery  Concept: Population Health o Exemplar: Genetics and Environment THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Clinical Judgment o Exemplar: Subjective Data  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS

  

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential VII: Clinical Prevention and Population Health o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Genetics and Environment o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o Genetics and Environment o Health Promotion and Patient Teaching Domain 3: Population Health o Genetics and Environment Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Genetics and Environment o Subjective Data o Objective Data o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

CHAPTER OBJECTIVES 29. 30. 31. 32. 33. 34. 35. 36. 37. 38.

Relate the structure and functions of arteries and veins. List the pulses accessible to examination. Describe the mechanisms that keep blood moving toward the heart in the venous system. Explain the term capacitance vessels. List the risk factors for venous stasis. Relate the structure and functions of the lymph vessels. Describe the function of the lymph nodes. Cite the location of superficial groups of lymph nodes that are accessible to examination. Name the related organs and functions of the lymphatic system. Incorporate health promotion concepts when performing an assessment of the peripheral vascular system.

STUDENT RESOURCES

understand

      

Textbook Chapter 21 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ARTERIES VEINS

Content Highlights Discuss the location of the arteries that are palpable. Demonstrate taking a pulse in each location. Explain ischemia and give examples of symptoms with partial blockage.

Learning Activities 



VENOUS FLOW LYMPHATICS Related Organs DEVELOPMENTAL COMPETENCE Infants and Children Pregnancy The Aging Adult GENETICS AND ENVIRONMENT

Examine the three types of veins in the legs, providing a model showing the major veins and arteries. Discuss the three elements that are necessary for efficient venous return. Show a video of the venous flow.



Resources

Activity: Assign students to prepare or obtain teaching Figure 21.1 materials for persons at risk for development of venous through Figure 21.6 stasis. Discussion Topic: Speculate why the right lymphatic duct drains only the upper right side, but the thoracic duct drains the rest of the body. Online Activity: Have students find current medical research about the vascular system or the lymphatic system. Have them present in class the current scholarly conversation in these areas.

Review the three functions of the lymphatic system. Discuss the locations of the lymph nodes and the contribution the lymphatic system makes to the immune system. Examine the functions of the spleen and what happens to the body when the spleen is injured or removed. Compare the size of lymph nodes in children, adults,

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

and the aging adult. Invite a pubertal child, an adult, and an aging adult model to class for the students to palpate the lymph nodes and compare size and ease of palpation.

SUBJECTIVE DATA OBJECTIVE DATA INSPECT AND PALPATE THE ARMS INSPECT AND PALPATE THE LEGS Color Changes The Doppler Ultrasonic Probe The Ankle-Brachial Index The Wells Score for Leg Deep Vein Thrombosis DEVELOPMENTAL COMPETENCE

Review the impact of pregnancy on the vascular system. Explain that it is important to list any medications the patient may be taking, noting that side effects may include water retention, which could account for swelling.



 Discuss the fact that asymmetrical limbs should be an immediate indication of an abnormality. Demonstrate the modified Allen test. Bring in a laser Doppler and demonstrate its proper use on a student volunteer. Demonstrate measuring the legs at the widest point. Examine a volunteer’s legs, demonstrating the various pulse locations.  Bring in a Doppler ultrasonic stethoscope and allow students to practice using this piece of equipment on each other.  Provide students with several examples that enable them to use the formula in this section.

Figures 21.8 Small Group Activity: Pair up the students and have through 21.23 them practice the modified Allen test on each other. Tables 21.1 Assist them as necessary to ensure correct occlusion through 21.6 pressure. Activity: Have students come to lab in T-shirts and running shorts or a bathing suit so that all areas may be examined. Assign students to work in groups of three: one to follow the checklist and textbook, one to perform the examination, and one to act as patient. Allow sufficient time for students to rotate roles so that each has an opportunity to be the examiner. Students frequently have difficulty palpating the pedal pulses, so be sure to verify the findings reported. Activity: Instruct students to document the results of the previously mentioned examination using appropriate descriptions for the location of any unusual findings. Activity: Divide students and have them measure and calculate the ankle-brachial index on each other. Provide assistance as needed.

Discuss which vaccinations can produce local lymphadenopathy.

Infants and Children Pregnancy

Show the class several pictures of mild to serious bilateral pitting edema.

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

The Aging Adult

IN-CLASS/ONLINE CASE STUDY S.R. is a 65-year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. 1. What subjective information should the nurse obtain? Answer: Ask the patient when the swelling started. Other questions include the following: What time of the day is the swelling worst? Does the swelling come and go, or is it constant? What seems to bring it on (e.g., trauma, standing all day, sitting)? What relieves the swelling (e.g., elevation, support hose)? Is the swelling associated with pain, heat, redness, ulceration, and hardened skin? Rationale: The history helps determine whether CHF is present. The patient’s edema is bilateral; if the cause is local obstruction or inflammation, the edema is generalized or unilateral. 2. The nurse is assessing the patient’s pulses. Which locations should the nurse check? Answer: The nurse should check the pulses in the lower extremities: the popliteal, dorsalis pedis, and posterior tibial. The following arteries are also accessible to examination: temporal, carotid, aortic, brachial, ulnar, radial, and femoral. Rationale: The nurse should check the pulse to ensure that the patient has adequate circulation and perfusion, especially in the lower extremities. 3. The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas sample. How should the nurse proceed? Answer: Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. A palmar blush, a return to the hand’s normal color, suggests adequate circulation in approximately 2 to 5 seconds. Rationale: The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery.

4. What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs? Answer: Based on the history presented, this patient should be evaluated for hypertension and CHF. Rationale: CHF presents with bilateral, dependent pitting edema. The patient also presents with elevated blood pressure. The cough is related to pulmonary edema.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

o Exemplar: Veins THEME: Protection and Movement  Concept: Immunity o Exemplar: Lymphatics PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Health Care Delivery  Concept: Health Disparities o Exemplar: Genetics and Environment THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Patient Information o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS  

2021 AACN ESSENTIALS DOMAINS  

Domain 2: Person-Centered Care o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data



Domain 2: Roles/Responsibilities o Subjective Data o Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 22: Abdomen CHAPTER OBJECTIVES 39. Identify the organs located within each of the four abdominal quadrants. 40. Identify pertinent topics that must be reviewed during the abdominal portion of the interview. 41. Use measures that will enhance abdominal wall relaxation. 42. Use the correct sequence of examining techniques. 43. Interpret findings obtained during inspection of the abdomen. 44. Interpret findings obtained during auscultation of the abdomen. 45. Interpret findings obtained during percussion of the abdomen. 46. Interpret findings obtained during palpation of the abdomen. 47. Incorporate health promotion concepts when performing an assessment of the abdomen.

STUDENT RESOURCES

understand

      

Textbook Chapter 22 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus SURFACE LANDMARKS INTERNAL ANATOMY

Content Highlights

Learning Activities 

Review Figures 22.1 and 22.2, explaining that the internal organ locations are approximations because each patient is different and organ placement may be slightly, but not drastically, different. Use a mannequin with removable organs to help the students become familiar with organ locations. Have a student volunteer to come to class prepared to have the organs outlined on his or her abdomen with a marker.



DEVELOPMENTAL COMPETENCE

Infants and Children

Discuss the problems with constipation faced by pregnant women. Have students offer suggestions for relief of constipation.

 

Small Group Activity: Using the photographs in the text as a guide, have students name the abdominal organs on a peer. This exercise can be done in groups of three, with students taking turns with each role. Student 1 is the patient, student 2 follows the text, and student 3 acts as the examiner. Small Group Activity: When students have learned the anatomy and physiology of the abdomen, have them complete an abdominal assessment using each other as patients. Activity: Have students document the results of the examination completed on a peer.  Activity: Have students try to list the organs in each quadrant from memory. Discussion Topic: There should be at least one inclass/online discussion topic per chapter. From IM, bulleted if more than one included.

Review the changes of aging in the gastrointestinal system and suggest ways to ease these discomforts.

The Pregnant Woman

Resources Figure 22.1 Figure 22.2 Figure 22.3 Figure 22.4 Figure 22.5

TEACHING STRATEGIES Content Focus The Aging Adult GENETICS AND ENVIRONMENT

SUBJECTIVE DATA Additional History for Infants and Children Additional History for Adolescents

Content Highlights 

Online Activity: Have students research online several fast food companies and their responses to the prevalence of obesity in the United States.

Review the examination questions, focusing on changes in appetite and noting that many stressors can cause either overeating or disinterest in food.

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Activity: Have students assess their neighborhood for food choices and report on what options are available for families, students, and aging adults in terms of cost and accessibility.

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Figure 22.7 Online Activity: Have students find Internet sources through Figure that offer audio clips of vascular sounds. 22.31 Online Activity: Have students listen to percussion Tables 22.1 sounds on a medical or educational website. through 22.7 Activity: Give students a blank abdomen drawn on paper and have them draw in the organs from memory. Discussion Topic: Discuss normal and abnormal findings for an infant, a child, and an older adult. Activity: In the clinical setting, have students analyze the dietary history and abdominal assessment findings for an assigned patient. Activity: Encourage students to practice on family

Discuss abdominal pain in the child, reviewing the possible causes. Explain how to assess anorexia nervosa in an adolescent, being careful not to confuse it with a high metabolism.

OBJECTIVE DATA

Discuss how many elderly live and eat alone and how this contributes to their poor nutrition and food choices. Demonstrate the examination with a volunteer.

AUSCULTATE BOWEL SOUNDS AND VASCULAR SOUNDS

Resources

Examine the “obesogenic” environment prevalent in the United States. Discuss some societal changes that have occurred in response to this problem (e.g., apple slices in the McDonald’s Happy Meals).

Additional History for the Aging Adult

INSPECT THE ABDOMEN

Learning Activities

Discuss the bowel sounds, including the two distinct patterns of abnormal bowel sounds: hyperactive and hypoactive. Play an audio clip of normal and abnormal bowel sounds for the class.

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PERCUSSION

Demonstrate how to percuss to determine tympany and dullness.

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PALPATE SURFACE AND DEEP AREAS

On the same student who volunteered to have the organs marked on his or her abdomen, percuss the

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TEACHING STRATEGIES Content Focus PROCEDURES FOR ADVANCED PRACTICE DEVELOPMETNAL COMPETENCE The Infant

Content Highlights organ boundaries; see whether the markings are accurate. Discuss how the height of the liver corresponds with the height of the patient; demonstrate this with several student volunteers.

Learning Activities members of various ages.

Discuss and demonstrate the two percussion tests that differentiate ascites from gas distention. Emphasize that ultrasound is the most definitive assessment tool.

The Child The Aging Adult

Review ways to enhance complete muscle relaxation as an aid to a thorough, comfortable examination. Remind students always to palpate tender areas last to avoid muscle rigidity that would interfere with the rest of the examination. Reiterate that many of the internal organs are not palpable, so the examiner should not get frustrated but should ask for help from an experienced examiner to verify findings (or lack thereof). Discuss both the locations of the gallbladder and appendix and ways to assess pain arising from these organs, because these types of pain are common conditions. Examine abnormalities in the infant, such as umbilical hernia and diastasis recti, and their treatments. Emphasize the need for privacy when examining the child or adolescent.

Resources

TEACHING STRATEGIES Content Focus

Content Highlights Bring in an older, thin adult volunteer so that the students can practice palpation; in this type of individual, the abdominal wall is thinner, and organs are easier to palpate.

IN-CLASS/ONLINE CASE STUDY J.P. is a 50-year-old man who presents to the gastroenterologist with cramping and diarrhea. Subjective Data Pain level is a 6/10 location = right and left lower abdomen Works as a union construction worker, has missed 1 day of work States he has been going to the bathroom about 8 to 10 times a day for past 2 days Appetite is decreased PMH: Crohn disease, depression, anxiety Objective Data Vital signs: T 37 P 80 R 14 BP 120/68 Bowel sounds hyperactive in all four quadrants Medications: Infliximab (Remicade) infusions every 6 weeks, fluoxetine (Prozac) 25 mg per day Weight = 145, last visit weight = 152 Questions 1. What other assessments should be included for this patient?

Learning Activities

Resources

2. 3. 4. 5. 6.

What questions should the nurse ask with regard to the abdominal pain? From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain? Develop a problems list from the subjective and objective findings. What should be included in the plan of care? What interventions should be included in the plan of care for this patient?

Answers 1. The assessment should include the onset, location, duration, characteristics, aggravating factors, related symptoms, treatment by the patient, and severity. 2. Questions should include the following:  How long have you had abdominal pain?  Where is it located?  When did you first feel the pain?  What activity were you doing when the pain occurred?  Describe the pain: Is it constant or does it come and go?  Have you had episodes of this pain before? Did the pain start suddenly? Is the pain associated with other symptoms, such as stress, fatigue, nausea and vomiting, gas, fever, chills, constipation, diarrhea, rectal bleeding, frequent urination, or penile discharge? 3. Based on the readings and history, this patient is likely having an exacerbation of his Crohn disease. Inflammation may occur from mouth to anus, but it commonly affects the terminal ileum and colon. Affected mucosa is ulcerated and has fistulas, fissures, and abscesses that may form adjacent to healthy bowel segments. Clinical findings: Patient complains of severe abdominal pain, cramping, diarrhea, nausea, fever, chills, weakness, anorexia, and weight loss. 4. The problems list should include the following: a. Weight loss b. High risk for dehydration c. Depression, treated d. Exacerbation of Crohn disease e. Lost time from work f. High risk for nutritional imbalances 5. The plan of care should include treatments to attain remission of the disease, monitoring for signs of dehydration, stress management teaching, and nutritional counseling.

Interventions include hydrating the patient, nutritional supplements, antidiarrheal medications, antispasmodics for abdominal pain, and followup with a gastroenterologist. Notify the health care provider if symptoms worsen or do not subside. Determine the cause of the inflammation. Monitor the patient for pain.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Objective Data o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data



Concept: Nutrition o Exemplar: Subjective Data THEME: Protection and Movement  Concept: Pain o Exemplar: Subjective Data  Concept: Infection o Exemplar: Hepatitis B and Hepatitis C PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS   

Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o Surface Landmarks Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential IX: Baccalaureate Generalist Nursing Practice o Objective Data o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS  

Domain 1: Knowledge for Nursing Practice o Surface Landmarks Domain 2: Person-Centered Care o Objective Data

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o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data Domain 10: Personal, Professional, and Leadership Development o Surface Landmarks

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES  

Domain 1: Values/Ethics o Health Promotion and Patient Teaching Domain 2: Roles/Responsibilities o Surface Landmarks o Subjective Data o Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 23: Musculoskeletal System CHAPTER OBJECTIVES 48. List the functions of the musculoskeletal system. 49. List the three types of muscles and their movements. 50. Differentiate between synovial and nonsynovial joints. 51. Describe the shape and surface landmarks of the spine. 52. Describe the location and function of the various joints in the body. 53. Discuss the developmental care regarding the musculoskeletal system. 54. Incorporate health promotion concepts when performing an assessment of the musculoskeletal system.

STUDENT RESOURCES

understand

      

Textbook Chapter 23 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

Content Focus

Content Highlights

MUSCULOSKELETAL COMPONENTS

Review how the cells of the bone are continually turning over and remodeling.

Fibrous, Cartilaginous, and Synovial Joints

Have students participate in making a list of synovial joints in the body.

Muscles

Review and demonstrate the muscle movements listed in the chapter and pictured in Figure 23.2. Have students act out the movements as you discuss them.

Temporomandibular Joint Spine Shoulder

Demonstrate the four motions of the vertebral column. Provide a model of the spinal column so that the students can feel the vertebrae and the intervertebral disks.

Wrist and Carpals Elbow Hip

Point out the group of four muscles and tendons that encloses the shoulder joint. Use Figures 23.7 and 23.8. Have the students find their own acromion process, greater tubercle, and coracoid process. Assist those who need help distinguishing the landmarks.

Knee Ankle and Foot DEVELOPMENTAL COMPETENCE

Have students palpate the bony landmarks of the hips and knees. Provide a model of the hip and knee with the muscles and ligaments for the students to examine. Discuss how the knee is the largest joint in the body and compare it with the hip in terms of size and complexity.

Learning Activities 

Activity: Have students create flash cards with the movements of the body on one side and the definition of the term on the other. Each word needs to become part of the working vocabulary of the health care provider.  Activity: Obtain a picture of a skeleton. Assign students to label the anatomic landmarks of each joint.  Activity: If possible, arrange for a company representative to bring a machine that screens for bone density for the students to use.  Online Activity: Have students investigate osteoporosis and the patent medications that are prescribed for it. Discuss the evidence for and against osteoporosis medications.  Activity: Assign students to develop or locate exercises that would be appropriate for various age groups.  Activity: Assign students to develop a health promotion program for the prevention of osteoporosis that is directed toward both teenagers and older adults. If possible, make arrangements for students to present the programs in the community.

Infants and Children Pregnancy The Aging Adult GENETICS AND ENVIRONMENT

Discuss the weight-bearing capabilities of the heads of the metatarsals and the calcaneus (heel). Explain what happens to the foot’s bones, muscles, and joints when a patient is obese. Review how long bones grow in length and width. Show pictures of the growth plate and explain how it works.

Resources Figure 23.1 Figure 23.2 Figures 23.3 through 23.14

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

SUBJECTIVE DATA Additional History for Infants and Children Additional History for Adolescents Additional History for the Aging Adult

Examine the upper back changes that put pressure on the ulnar and median nerves during the third trimester. Invite a pregnant woman in her third trimester to class to discuss the nerve pressures she is experiencing. Review the positive physical effects of exercise on osteoporosis and on quality of life. Review examination questions, allowing students to choose several on which to elaborate. Discuss broken bones in the infant and child, which may be signs of abuse or neglect but which can also just be the results of boisterous childhood activities. Emphasize sports assessments for adolescents and note that many adolescents will try to “tough it out.”

OBJECTIVE DATA ORDER OF THE EXAMINATION

Bring in several types of mobility aids and let students try them out, noting any drawbacks to using them. Emphasize the importance of the patient’s comfort by ensuring privacy and using gentle movements. Review Tables 23.2 through 23.6 for views of swollen joints.

Inspection Palpation

Explain that excessive heat in a joint is an indication of injury or infection. Encourage students to feel, using the top of the hand, where the skin is thin.

Range of Motion Review the range of motion (ROM) of all the joints.



Group Activity: Assign students to work in groups of three: one to follow the checklist and textbook, one to perform the examination, and one to act as patient. Allow sufficient time for students to rotate roles so that each has an opportunity to be the examiner. Instruct students to document the results of the previous examination, using appropriate descriptions for the location of any unusual findings.  Online Activity: Have students search the Internet for community resources available to patients with

Figures 23.15 through 23.55 Tables 23.1 through 23.9

TEACHING STRATEGIES Content Focus Muscle Testing TEMPOROMANDIBULAR JOINT

Content Highlights Ask students to demonstrate ROM. Observe aloud that even the students have differences in ROM. Review the grading system for muscle testing, discussing how to grade accurately.

CERVICAL SPINE UPPER EXTREMITY Shoulder Elbow

Explain that shoulder pain could be stress related and referred from the neck muscles. Have students pair up and examine the wrist and the hand. Observe them as they work through each part of the examination, offering suggestions and instructions.

Learning Activities musculoskeletal disorders and design a resource book.  Clinical Activity: Assign students to complete a musculoskeletal assessment of a patient in the clinical area. Have students document the results of the musculoskeletal assessment.  Discussion Topic: Have students discuss some of the abnormalities listed in the text that they see while out in the community.  Discussion Topic: Discuss how much weight the hips and knees support and how each extra pound adds 6 psi to the hip joint and 4 psi to the knee joint.

Wrist and Hand LOWER EXTREMITY

Explain that assessment of the knee can be difficult in muscular or obese patients with heavy limbs or decreased mobility.

Hip Knee

Have students wear shoes to class that are well used. Have them exchange the shoes and note any areas of wear and accommodation.

Ankle and Foot SPINE SPECIAL PROCEDURES FOR ADVANCED PRACTICE Straight Leg Raising or Lasègue Test Measure Leg Length Discrepancy

Have student volunteers remove their shirts and allow fellow students to assess their spine for spinal curvature, marking the spine as instructed in the text. Note that infants cannot and children do not always complain of pain but may reveal problems by refusing to manipulate or use the affected area. Examine why the US Preventive Services Task Force does not support routine screening for idiopathic scoliosis.

Resources

TEACHING STRATEGIES Content Focus DEVELOPMENTAL COMPETENCE

Content Highlights

Learning Activities

Consider why kyphosis is common in both adolescents and in aging adults.

Infants Preschool-Age and SchoolAge Children Adolescents Pregnancy The Aging Adult

IN-CLASS/ONLINE CASE STUDY S.P. is a 3-year-old female toddler who presents to the pediatrician’s office for a yearly well visit. The child complains that her leg hurts. Subjective Data PMH of otitis media Immunizations: Up to date No medications No allergies Pain: 3/5 on pain scale Attends preschool Unable to recall injuring leg Objective Data Vital signs: T 37 P 92 R 18 BP 100/70

Resources

Lungs: clear in all fields Heart rate and rhythm regular Moving all extremities + Range of motion (ROM) legs and arms Strength 5/5 in all extremities Questions 1. What other questions should the nurse ask? 2. What techniques are helpful to incorporate in assessing a patient in this age group? 3. What other assessments should the nurse make for this clinical presentation? 4. What are a few of the major differences in the musculoskeletal assessment of a child? 5. What should be included in the plan of care? 6. Based on the readings, what is the most likely cause of leg pain for this patient? Answers 55. Ask the patient or parent the following questions:  Where do you feel the pain?  When did you first notice the pain? Is the pain related to movement?  Describe how the pain feels.  How severe is the pain? (For this patient, use a pain scale for children.)  Did the pain occur suddenly?  When during the day do you feel the pain?  Does the pain move from one joint to another?  Has there been any injury, overuse, or strain of muscles or joints?  Were you ill before the onset of pain?  What have you done to relieve the pain?  How effective has it been?  Ask the if the parent has noticed the daughter favoring one leg over another. 56. A 3-year-old child will most likely be active. Observe the child at play to assess ROM. Make a game out of assessing muscle strength, such as by asking the child to squeeze your finger. Ask her to bend down and touch her toes to assess the spinal column. Obtain the help of the parent whenever possible. Ask the child to push against the parent’s hands with both feet to assess leg strength. 57.

58. Check to be sure there is no gross deformity in the affected leg. Assess ROM, muscle strength, and whether the pain occurs during assessment. Assess for bruising and obtain a history for possible injuries. 59. 60. There are several differences in the assessment of the system for infants and young children. Infants’ movement is assessed during voluntary movement and hip joints and feet are assessed for abnormalities. Assessing the musculoskeletal system of an older adult usually follows the same procedures as for an adult. Older adults may be slower at performing ROM and their muscle strength may be less than that of a younger adult. 61. 62. Instruct the parent to follow up with the pediatrician if the pain gets worse or if signs of deformity present. Treat pain with antiinflammatories. 63. 64. This patient is likely suffering from leg cramps. Muscle pain is described as “crampy.”

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Genetics and Environment o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

HEALTH AND ILLNESS CONCEPTS THEME: Protection and Movement  Concept: Mobility o Exemplar: Musculoskeletal Components o Exemplar: Genetics and Environment THEME: Homeostasis and Regulation  Concept: Nutrition o Exemplar: Genetics and Environment o Exemplar: Subjective Data PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

BSN ESSENTIALS   

Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential VII: Clinical Prevention and Population Health o Health Promotion and Patient Teaching o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Genetics and Environment o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS

  

Domain 2: Person-Centered Care o Genetics and Environment o Health Promotion and Patient Teaching Domain 3: Population Health o Genetics and Environment o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Genetics and Environment o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 24: Neurologic System CHAPTER OBJECTIVES 65. Name the two parts of the nervous system. 66. Describe the various functions of the central nervous system. 67. Describe the function of the peripheral nervous system. 68. Relate the name and function of each of the 12 cranial nerves. 69. Relate the term dermatome to the spinal nerves. 70. Describe the term reflex arc. 71. Describe the autonomic nervous system.

72. List developmental considerations for infants and older adults. 73. Differentiate among the three types of neurologic examinations. 74. Incorporate health promotion concepts when performing an assessment of the neurologic system. STUDENT RESOURCES

understand

      

Textbook Chapter 24 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS in text



Test the Reflexes

lesson focus

 

Recognize Cues Analyze Cues

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus

Content Highlights

THE CENTRAL NERVOUS SYSTEM

Provide students with a drawing of the cerebral cortex and have them label the areas, defining the function of each. Discuss the lobes and their functions, examining what types of functions would be impaired if the brain sustains injury to certain locations. Review the three areas of the brainstem and their contents.

Pathways of the CNS Upper and Lower Motor Neurons

Learning Activities  



Bring in a brain model with removable pieces to better explain brain function. Invite a bald model to class and draw the parts of the brain with washable marker.

THE PERIPHERAL NERVOUS SYSTEM

Bring in a real sheep’s brain for dissection and explain the areas of the brain as the dissection progresses. Discuss the four types of reflexes. Examine the five components of the deep tendon reflex.

 

Reflex Arc

Create a matching quiz of the cranial nerves and their number, type, and function. 

Cranial Nerves Invite a chiropractor to speak about the vertebrae and

Resources

Online Activity: Have students research online and watch a clip of the sensory pathways in the brain. Discussion Topic: Have students discuss whether they know someone who had a serious brain injury, stroke, or disease and what bodily functions were affected. Activity: Have students develop flash cards with areas of the brain on one side and related behavior, sensation, and function on the back.

Figure 24.1 through 24.5

Activity: Have students research ways to slow the effects of aging on the brain. Activity: Assign students to develop visual materials that depict primitive reflexes routinely assessed in infants. Small Group Activity: Assign specific neurologic disorders to small groups. Have each group describe

Figure 24.6 through 24.8

TEACHING STRATEGIES Content Focus Spinal Nerves Autonomic Nervous System DEVELOPMENTAL COMPETENCE Infants

Content Highlights

Learning Activities

spinal nerves and their connections to certain body segments.

Resources

the relevant neurologic examinations and expected findings.

Discuss the milestones that occur as myelinization progresses. Show on the brain model the route of myelinization. Discuss the many ways the aging process affects the brain. Examine how good health practices can mitigate these losses.

The Aging Adult GENETICS AND ENVIRONMENT SUBJECTIVE DATA Additional History for Infants and Children

Review the major modifiable risk factors for stroke. Display a map showing the “stroke belt.” Review the examination questions, distinguishing among syncope, dizziness, and vertigo. Give examples of several types of auras.

Additional History for the Aging Adult

Review the illnesses in the pregnant woman that could cause neurologic damage to her fetus. Demonstrate how to assess deep tendon reflexes, and assess for clonus.

OBJECTIVE DATA TEST CRANIAL NERVES

Review the warning signs of Alzheimer disease listed in Table 24.1. Review the sequence for the complete neurologic examination; discuss reasons for this particular sequence.

Cranial Nerve I-Olfactory Nerve

Discuss what the asymmetry in the sense of smell could portend.

Cranial Nerve II-Optic

Show several video clips of nystagmus. Discuss the

 



Discussion Topic: Have students discuss whether they have experienced headaches, vertigo, or seizures. Online Activity: Have students research auras in relation to both seizures and headaches. (The Mayo Clinic website has a video clip at http://www.mayoclinic.com/health/migraineaura/MM00659.)

Online Activity: Have students compile a list of resources available to patients with neurologic disorders. This list should include resources from the Internet.

Figures 24.9 through 24.14

TEACHING STRATEGIES Content Focus

Content Highlights

Nerve

vision problems of those with nystagmus.

Cranial Nerve III, IV, and VI-Oculomotor, Trochlear, and Abducens Nerves

Emphasize that if the patient has pain with clenching of the teeth, a dental examination should be considered.

Cranial Nerve V— Trigeminal Nerve

See Table 24.2 for several disorders that affect the facial nerves.

Learning Activities

Resources

Cranial Nerve VII—Facial Nerve Cranial Nerve VIII— Acoustic (Vestibulocochlear) Nerve Cranial Nerves IX and X— Glossopharyngeal and Vagus Nerves Cranial Nerve XI—Spinal Accessory Nerve Cranial Nerve XII— Hypoglossal Nerve INSPECT AND PALPATE THE MOTOR SYSTEM

Discuss how to assess muscle size, strength, tone, and involuntary movements, focusing on any difficulties or barriers to the examination.

Muscles Cerebellar Function ASSESS THE SENSORY

Have a student volunteer demonstrate the cerebellar function tests while you provide additional information about alternate tests for obese or older adult patients.



Small Group Activity: Have students, working in pairs, perform a complete neurologic assessment on one another. Using chart forms from clinical facilities used by the school, have students document the examination completed on a peer.

Figures 24.15 through 24.59 Tables 24.1 through 24.12

TEACHING STRATEGIES Content Focus

Content Highlights

SYSTEM Anterolateral (Spinothalamic) Tract Posterior (Dorsal) Column Tract TEST THE REFLEXES Stretch Reflexes or Deep Tendon Reflexes (DTRs) Superficial (Cutaneous) Reflexes NEUROLOGIC RECHECK DIABETIC NEUROPATHY SCREENING DEVELOPMENTAL COMPETENCE Infants (Birth to 12 Months) Preschool-and School-Age Children

Bring in documentation for a patient with sensory problems and show the class the diagram of the problem area. Invite a person with diabetes to speak to the class about the loss of sensation in the extremities, the problems it causes, and the ways the person compensates to function properly. Allow students to test the reflexes of a partner in class. Evaluate their methods and assist them in proper positioning. Discuss how the sensory receptors for superficial (cutaneous) reflexes are in the skin rather than in the muscle. Bring in a baby model and demonstrate as many parts of the neurologic assessment as possible for the baby’s age. If acceptable to the mother, allow students to perform some of the examination. Review the Denver II screening tool. Provide a copy of it for the students to keep for future reference. Have a student with a young child volunteer to administer the test to his or her child and report back with results. Emphasize giving the aging adult additional time to respond to your examination requests.

The Aging Adult Emphasize the importance of assessing for improvement or deterioration in neurologic status

Learning Activities

Resources

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

and the necessity of precise, thorough documentation to substantiate the assessment findings.

IN-CLASS/ONLINE CASE STUDY D.F. is a 37-year-old woman who presents to the emergency department after having a seizure. Subjective Data PMH: Seizures, unknown type Headache Housewife Feels weak No loss of consciousness Objective Data Vital signs: T 37 P 72 R 18 BP 114/64 Lungs: clear all bases O2 sat = 100% CV = heart rate regular, positive peripheral pulses PERRLA Questions 1. What other questions should the nurse ask about the seizures? 2. What other assessments are necessary for this patient? 3. What are some of the causes of seizures? 4. Develop a problem list from objective and subjective data. 5. What should be included in the plan of care? 6. What other risk factors are associated with this presentation? 7. Based on the readings and the subjective and objective data, this patient most likely had what type of seizure?

Resources

Answers 1. Questions or assessments associated with seizures include the following:  Have you had a seizure before?  How often are you having seizures or convulsions?  When was your last seizure?  What are they like?  Do you become unconscious?  Do you have any warning signs before the seizure starts?  Describe what happens.  How do you feel after the seizure?  Are you confused? Do you have a headache or aching muscles?  Do you spend an unusual amount of time sleeping?  Are there any factors that seem to start these seizures, such as stress, fatigue, activity, or discontinuing medication?  Do you take any actions to prevent hurting yourself during seizures?  How have the seizures affected your life? Your occupation?  Do you wear any identification that indicates you have seizures? 2. A complete neurologic assessment, including the cranial nerves, is necessary. 3. Common causes of seizures may be idiopathic epilepsy, a pathologic process, endogenous or exogenous poison, metabolic disturbances, or fever. 4. The problems list includes the following:  Weakness  Headache  Postseizure 5. The plan of care should include patient safety measures in the event the patient has another seizure. Although the seizure will probably not be evident during the examination, you need to determine how the patient is caring for this disorder to maintain safety and prevent recurrence of seizures. Pain management for the headache and increasing activity, as tolerated, would also be indicated.

6. Because seizures may be a chronic disease that affects patients’ driving, personal relationships, and employment, the nurse needs to learn how seizures have affected the patient’s life and if or how the patient has adapted to the seizure condition. Carrying identification about seizures helps those who may assist a patient who is experiencing a seizure. 7. The patient most likely had a simple seizure because she did not lose consciousness.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data



Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching

HEALTH AND ILLNESS CONCEPTS THEME: Protection and Movement  Concept: Sensory Perception o Exemplar: The Central Nervous System o Exemplar: The Peripheral Nervous System  Concept: Mobility o Exemplar: The Central Nervous System o Exemplar: The Peripheral Nervous System o Exemplar: Developmental Competence  Concept: Pain o Exemplar: The Central Nervous System  Concept: Inflammation o Exemplar: Genetics and Environment  Concept: Infection o Exemplar: Genetics and Environment THEME: Mood and Cognition  Concept: Cognition o Exemplar: The Central Nervous System o Exemplar: Genetics and Environment o Exemplar: Health Promotion and Patient Teaching THEME: Homeostasis and Regulation  Concept: Thermoregulation o Exemplar: The Central Nervous System

BSN ESSENTIALS  

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o Health Promotion and Patient Teaching Domain 3: Population Health o Health Promotion and Patient Teaching Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Subjective Data o Objective Data o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 25: Male Genitourinary System CHAPTER OBJECTIVES 75. List the structures of the male genitals. 76. Name the major structures of the penis. 77. Describe the function of the cremaster muscle. 78. Identify the structures that provide transport for sperm. 79. Relate the significance of the inguinal canal and the femoral canal.

80. Discuss the importance of teaching testicular self-examination as health promotion during assessment. STUDENT RESOURCES

understand

      

Textbook Chapter 25 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES

Content Focus THE MALE GENITALIA Penis Scrotum

Content Highlights Pass out a diagram of the male genitalia, encompassing Figures 25.1 through 25.3, and have students fill in the information.

Learning Activities 

Activity: Have students use mannequins provided by the university to practice palpating both normal testes and those with nodules.

Resources Figures 25.1 through 25.3 Table 25.1

Point out the reasons for the contraction or relaxation of the scrotum.

Inguinal Area DEVELOPMENTAL COMPETENCE Infants Adolescents Adults and Aging Adults GENETICS AND ENVIRONMENT

SUBJECTIVE DATA Additional History for Infants and Children Additional History for Preadolescents and Adolescents Additional History for the Aging Adult

Examine what makes the inguinal area a potential site for a hernia. Review Table 25.1. Discuss other changes that take place during this same period. Discuss medications that can affect the sexual performance of an aging adult male, possibly resulting in withdrawal from sexual activity. Discuss circumcision and the arguments for and against it. Discuss its associated religious connections. Display a circumcised penis and an uncircumcised penis and discuss the care of both. Review examination questions, discussing the problems associated with the range of urine colors on the color wheel. Review Table 25.2.



 Discuss the fact that gay men and uncircumcised men are at increased risk for sexually transmitted infections (STIs); emphasize the importance of STI testing. Discuss the signs of sexual abuse in children.



Online Activity: Have students find the appropriate Figure 25.4 hotline number and website for both child and elder abuse. Online Activity: Have students obtain information on sexually transmitted infections and their prevention. Online Activity: Assign the students to search the Internet for resources available to men with sexual dysfunctions, such as erectile dysfunction, and prepare resource packets for patients.

Explain the best way to teach a young boy to do a testicular self-examination.

TEACHING STRATEGIES Content Focus

OBJECTIVE DATA INSPECT AND PALPATE THE PENIS INSPECT AND PALPATE THE SCROTUM

Content Highlights Explain that many men think that changes in sexual function mean that their sex life is over; discuss how to disabuse them of this notion. Relate your own experiences with male genitourinary exams and how you developed a confident, professional, businesslike demeanor.

Learning Activities



 Discuss the appropriate steps to take when pubic lice are found during the examination.

INSPECT AND PALPATE FOR HERNIA

Show pictures of transillumination of the scrotum. Discuss abnormalities that could be discerned by transillumination.

PALPATE INGUINAL LYMPH NODES

Discuss why men are at greater risk for inguinal hernias than women are.

SELF-CARE—TESTICULAR SELF-EXAMINATION (TSE)

Demonstrate a TSE on a mannequin. Ask the men in the class if they regularly perform this examination.

ASSESS URINARY FUNCTION

Explain that inguinal hernias are also found in children.

DEVELOPMENTAL COMPETENCE

Emphasize the importance of talking to the adolescent about normal development and what to expect as puberty progresses.

 



Resources

Figures 24.5 Discussion Topic: Discuss ways of creating an through 24.15 environment that provides psychological comfort Tables 25.2 for both patient and practitioner. Small Group Activity: Assign students to prepare or through 25.7 obtain teaching materials for the teaching of TSE. Activity: Assign students to instruct a patient or group of patients how to perform TSE. Activity: Assign students to a health care provider, who will serve as preceptor for each student as he or she learns to perform this examination. Activity: Assign students to keep a log during their experience with the preceptor. Encourage them to record both successes and questions. Activity: Review documentation of examinations performed by students.

Infants and Children The Adolescent The Aging Adult

IN-CLASS/ONLINE CASE STUDY J.D. is a 64-year-old man who presents to the family practice complaining of increased urination at night. The patient has a past medical history of hypertension, hyperlipidemia, and coronary artery disease (CAD). Vital signs are T 97.5, P 85, R 16, and BP 120/60. 1. What subjective information should the nurse obtain? Answer: Further information is needed about the urine’s quality and consistency. Ask the patient whether he has any trouble starting the urine stream. Questions may include the following: Need to strain to start or maintain the stream? Any change in the force of the stream (e.g., narrowing, becoming weaker)? Do you experience any dribbling (e.g., do you need to stand closer to the toilet)? Afterward, do you still feel as if you need to urinate? Ever had any urinary tract infections (UTIs)? Are you urinating more often than usual? Any pain or burning when urinating? Is the usual urine clear, discolored, or cloudy? Rationale: The average man voids five to six times per day. Nocturia, along with frequency and urgency, occurs in urinary tract disorders. Burning is common with acute cystitis, prostatitis, and urethritis. Straining, loss of force, dribbling, and residual urine sensation occur with progressive prostatic obstruction. 2. The nurse is performing the physical examination of the patient’s genitals. What are the major structures of the male genitalia? Answer: The penis consists of three cylindric columns of erectile tissue—the two corpora cavernosa and the corpus spongiosum. The glans, corona, urethra, foreskin (or prepuce), and frenulum are the other major structures. A description is found in the text. The cremaster muscle elevates the testis toward the body when the ambient temperature is cool, bringing the testes closer to the body to absorb the heat necessary for sperm viability. The muscle relaxes and the scrotum lowers when the temperature is warmer. This keeps the testes at 3°C below the abdominal temperature. Rationale: The nurse should check the pulse to ensure that the patient has adequate circulation and perfusion. 3. The nurse needs to assess the patient for a hernia. What is the proper procedure for this assessment? Answer: Palpate the inguinal canal. For the right side, ask the patient to shift weight onto the left leg. Then place your right index finger low on the right scrotal half. Palpate up the length of the spermatic cord, invaginating the scrotal skin and external inguinal ring. Gently insert your finger into the triangular, slitlike opening, and ask the patient to bear down. Rationale: Hernias can be common in men, especially with advancing age. A palpable herniating mass bumps against the fingertip or pushes against the side of the examiner’s finger. 4. What is the most likely cause of this patient’s urinary frequency at night? Answer: Based on the history presented, this patient should be evaluated for benign prostatic hypertrophy, UTI, or sexually transmitted infection. Rationale: All three diagnoses may be related to this patient’s presentation and need to be explored further.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Developmental Competence o Objective Data o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data THEME: Nursing Attributes and Roles  Concept: Health Promotion o Exemplar: Genetics and Environment  Concept: Patient Education o Exemplar: Objective Data o Exemplar: Health Promotion and Patient Teaching

HEALTH AND ILLNESS CONCEPTS THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: The Male Genitalia  Concept: Sexuality o Exemplar: Developmental Competence

BSN ESSENTIALS     

Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o The Male Genitalia Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Genetics and Environment Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential VII: Clinical Prevention and Population Health o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Developmental Competence o Objective Data o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS  

 

Domain 1: Knowledge for Nursing Practice o The Male Genitalia Domain 2: Person-Centered Care o Developmental Competence o Objective Data o Health Promotion and Patient Teaching Domain 3: Population Health o Genetics and Environment Domain 8: Information and Healthcare Technologies

o o

Subjective Data Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 



Domain 1: Values/Ethics o Developmental Competence o Genetics and Environment o Objective Data Domain 2: Roles/Responsibilities o Subjective Data o Objective Data

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 26: Anus, Rectum, and Prostate CHAPTER OBJECTIVES 81. Summarize the anatomy of the anus and rectum. 82. Describe the prostate gland. 83. Outline structures that can be examined through the rectum. 84. Describe developmental care for examination of anal, rectal, and prostate structures. 85. Incorporate health promotion concepts when performing an assessment of the anus, rectum, and prostate.

STUDENT RESOURCES

understand

      

Textbook Chapter 26 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus ANUS AND RECTUM PROSATE

Content Highlights Discuss the anal canal, explaining the presence of somatic sensory nerves and the importance of the sphincters. Explain what the valves of Houston feel like during a rectal exam and discuss their purpose.

Learning Activities  

Activity: Have students conduct classes on colorectal and prostate cancer screening. Online Activity: Have students find a video of a colonoscopy online. (Try the Mayo Clinic website.)

Regional Structures DEVELOPMENTAL COMPETENCE GENETICS AND ENVIRONMENT

Explain the purpose of the prostate during sexual intercourse. Discuss prostate problems that arise as men age. Using a model of the anus and rectum, demonstrate how a manual rectal exam usually reaches up to 10 cm. Bring in a colonoscope to show how much farther into the anus the colonoscope can examine. Explain the gastrocolic reflex. Discuss what makes the prostate gland double in size at puberty.

SUBJECTIVE DATA Additional History for

Discuss why diets high in meat and dairy products increase the risk of prostate cancer. Discuss what types of diseases or illnesses involve changes in bowel habits as symptoms. Explain that age is a factor in changing bowel habits.

 

Discussion Topic: Discuss students’ experiences with rectal examinations. Discussion Topic: Discuss hemorrhoid treatment.

Resources Figure 26.1

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Infants and Children

OBJECTIVE DATA INSPECT THE PERIANAL AREA

Review additional questions necessary for the evaluation of children, explaining that sometimes changes in bowel habits (e.g., sudden encopresis) can be a sign of sexual trauma. Discuss reasons for different exam positions for men and women.

 

Palpate the Anus and Rectum

Review proper angling of the index finger for ease of insertion into the anus. Discuss how the prostate should feel and what types of laboratory tests are necessary.

DEVELOPMENTAL COMPETENCE

Discuss reasons internal palpation would be necessary in an infant or child.

Infants and Children

Explain reasons for decreased sphincter control and whether there are ways to prevent it.



Activity: Have students practice the rectal examination on an anatomic model. Activity: Assign students to work with a preceptor who performs frequent rectal examinations in his or her practice so that they can gain experience with a variety of patients. Small Group Activity: Have students prepare teaching materials related to the rectal examination and the prostate examination.

Figures 26.3 through 26.6 Tables 26.1 through 26.3

The Aging Adult

IN-CLASS/ONLINE CASE STUDY M.L. is a 50-year-old man who presents to the family practice for a yearly physical examination. The patient has noticed a change in bowel movements. He states that his stools are dark colored and that he has been passing gas more frequently. His last bowel movement was this morning before the office visit. He has no other complaints at this time. The patient has a past medical history of depression and hemorrhoids. Vital signs are T 97.5, P 85, R 16, and BP 110/55. 1. What subjective information should the nurse obtain? Answer: Further information is needed regarding the bowel movements. Ask the patient whether he has any trouble straining at stool, incomplete evacuation, or an urge to have a bowel movement but nothing comes. Assess eating patterns. Ask the patient whether stools have a

hard consistency. Other questions include the following: Any problems in the rectal area, such as itching, pain, burning, or hemorrhoids? Are you using any hemorrhoid preparations? Any trouble controlling your bowels? Any history of colon cancer, polyps, or prostate cancer in the family? Rationale: Assess usual bowel routing. Constipation is fewer than three stools per week. Black stools may be tarry as a result of occult blood from gastrointestinal (GI) bleeding or from ingestion of iron medications. Fecal incontinence may be a sign of underlying disease. Pain during stooling may indicate formation of hemorrhoids. 2. The nurse is preparing to perform the physical examination. What are the major structures of the anus and rectum? Answer: The anal canal is a 3.8 cm outlet of the GI tract. It is lined with modified skin that merges with the rectal mucosa. In addition to autonomic nerves, numerous somatic sensory nerves are present and make the area sensitive to pain. Internal and external sphincters surround the canal. The external sphincter provides voluntary control for the expulsion of feces and gas. Anal columns in the rectum end at the anorectal junction and contain an artery and a vein. Enlargement of these veins forms hemorrhoids. The anal valve is at the lower end of each column, and the anal crypt is a small recess above the anal valve and between the columns. The rectum, a 12-cm-long portion of the distal large intestine, extends from the sigmoid colon to the anal canal. The valves of Houston are semilunar transverse folds in the rectal interior. The peritoneum covers only the upper two thirds of the rectum. Rationale: Assessing the structures helps detect any abnormalities. 3. The nurse needs to assess the patient’s anal area. What is the proper procedure for this assessment? Answer: Perform a rectal examination by having the patient positioned in the left lateral decubitus or standing position. Instruct the standing male patient to point his toes together. The equipment needed includes a penlight, lubricating jelly, glove, and guaiac test container. Rationale: The proper position assists in the assessment of the structure and function of the anus and sphincter. The guaiac test helps determine whether there is occult blood in the stool. 4. What health promotion concepts should the nurse teach this patient regarding the anus, rectum, and prostate? Answer: Early detection of colorectal cancer helps to identify precancerous polyps so that they can be removed before they become cancerous; also, screening helps to detect colorectal cancer early, when treatment is most effective. Rationale: Colorectal cancer is the second leading cancer killer in the United States. Health promotion should include informing adults aged 50 years or older to have regular colorectal screening tests.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing

 

o Genetics and Environment o Health Promotion and Patient Teaching Safety/Nursing Judgment o Objective Data Informatics/Nursing Judgment o Subjective Data o Objective Data

NURSING CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH AND ILLNESS CONCEPTS THEME: Homeostasis and Regulation  Concept: Elimination o Exemplar: Anus and Rectum  Concept: Nutrition o Exemplar: Genetics and Environment THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: Prostate PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Genetics and Environment o Exemplar: Health Promotion and Patient Teaching  Concept: Health Promotion o Exemplar: Genetics and Environment

THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data  Concept: Safety o Exemplar: Objective Data

BSN ESSENTIALS    

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Objective Data Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data Essential VII: Clinical Prevention and Population Health o Genetics and Environment Essential IX: Baccalaureate Generalist Nursing Practice o Genetics and Environment o Health Promotion and Patient Teaching

2021 AACN ESSENTIALS DOMAINS 

  

Domain 2: Person-Centered Care o Genetics and Environment o Objective Data o Health Promotion and Patient Teaching Domain 3: Population Health o Genetics and Environment Domain 5: Quality and Safety o Objective Data Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data



Domain 2: Roles/Responsibilities o Genetics and Environment o Subjective Data o Objective Data o Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 27: Female Genitourinary System CHAPTER OBJECTIVES 86. List the external structures of the female genitalia. 87. Describe the structures of the internal female genitalia. 88. Outline the changes observed during puberty. 89. Cite changes found during pregnancy. 90. Outline the changes observed during the perimenopausal period. 91. Incorporate health promotion concepts when performing an assessment of the female genitourinary system.

STUDENT RESOURCES

understand

      

Textbook Chapter 27 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus EXTERNAL GENITALIA INTERNAL GENITALIA DEVELOPMENTAL COMPETENCE

Content Highlights Review the many parts of the external and internal genitalia, explaining their purposes. Bring in an anatomic model for better observation.

Learning Activities  

Discuss the link between early menarche and obesity; also, examine how the nurse would evaluate the body mass index when considering pubertal development.

Infant and Adolescents Pregnancy

Resources

Discussion Topic: Discuss infection control precautions. Figures 27.1 through Activity: Have students practice the examination on a Table 27.1 mannequin to provide them the opportunity to learn the anatomy of the female genitalia.

Explain why pregnant women have an increased risk for yeast infections. Discuss the changes of the female genitourinary organs during pregnancy.

Sexual Identity Examine the changes that occur in the aging woman

TEACHING STRATEGIES Content Focus The Aging Woman GENETICS AND ENVIRONMENT

Content Highlights

Additional History for Infants and Children Additional History for Preadolescents and Adolescents

Discuss how to address poor perineal hygiene with the parent without seeming to imply that he or she is neglecting the child.

Additional History for the Aging Adult

Address the procedure to follow when adolescents reveal sexual abuse.

OBJECTIVE DATA POSITION EXTERNAL GENITALIA Inspection Palpation

Resources

with regard to sexual function. Investigate the myths concerning decreased sexual desire and sexual pleasure. Discuss female genital mutilation. Have the class read an article by 2013 Woman of the Year, Waris Dirie, about her experience with this practice. Emphasize the many frustrating symptoms associated with menopause. Discuss alternative therapies and treatments for reducing those symptoms; mention emotional stressors associated with menopause.

SUBJECTIVE DATA

Learning Activities

Reflect on the privacy needed for a sexual relationship. Discuss how an aging couple in a nursing home might have trouble with interruptions and other problems. Discuss the equipment needed for a vaginal exam. Bring in several different types of speculums, both plastic and metal. Compare the comfort of the plastic and metal speculums. Ask students their opinions on which they would rather use and have used on them. Allow them to practice with the speculum on a mannequin if possible.



Discussion Topic: Discuss ways of creating an environment that will provide psychological comfort for both patient and practitioner. Activity: Assign students to obtain a sexual history from a patient.

Online Activity: Have students obtain information on sexually transmitted infections and their prevention.

Note that the examination position puts the woman in a vulnerable state. Make additional suggestions on

Figures 27.3 through 27.8

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

how to make the woman comfortable and how to engage her as a participant in the examination.

INTERNAL GENITALIA Speculum Examination Inspect the Cervix and Its Os Obtain Cervical Tests and Cultures Inspect the Vaginal Wall Bimanual Examination Rectovaginal Examination (If Indicated) DEVELOPMENTAL COMPETENCE

Discuss the differences in the pelvic musculature between a nulliparous woman and a multiparous woman. Examine whether there are ways to increase muscle tone in the vaginal opening. Stress the importance of inserting the speculum in the correct direction to avoid causing the patient pain or discomfort. Discuss the importance of keeping the patient informed of the exam procedures.



Online Activity: Have students watch a video of a proper pelvic examination. Have them discuss in class what they learned.

Review Table 27.4, which displays abnormalities of the cervix. Explain that cervical secretions should be odorless and nonirritating. Discuss the reasons for the three cellular specimens: the vaginal pool, the cervical scrape, and the endocervical canal. Bring in the equipment needed to obtain these specimens so the students can see how these devices work. Emphasize that practice is the best way to learn how to distinguish between a pelvic exam with normal findings and one that reveals abnormalities. Discuss how to locate the pelvic organs during the bimanual examination.

Infants and Children The Adolescent The Pregnant Woman

Encourage honesty and openness when examining an adolescent; reiterate the importance of privacy. Review the special needs of an aging adult during a pelvic examination. Bring in both a Pedersen and a

Figures 27.9 through 27.22 Table 27.2 through 27.8

TEACHING STRATEGIES Content Focus The Aging Adult

Content Highlights

Learning Activities

Graves speculum; discuss the differences between these instruments.

IN-CLASS/ONLINE CASE STUDY M.L. is a 20-year-old female nursing student who is being seen in the OB-GYN clinic for a yearly physical. Subjective Data Patient asks about birth control options States she feels fine physically, no complaints at this time Enrolled in college for nursing Has steady boyfriend, 1-year relationship Sexually active Lives on campus Nonsmoker Exercises 3 times a week Objective Data Vital signs: T 37 P64 R 12 BP 104/64 Weight: 135 Height: 5 feet, 3 inches Last menstrual cycle = 10 days ago Current birth control method = condoms Questions 1. What patient care equipment does the nurse need for this visit? 2. What personal protective equipment does the nurse or provider need to prepare for this visit? 3. Describe proper hand hygiene. 4. What other information needs to be gathered for this patient?

Resources

5. What techniques of physical assessment might be used in this visit? 6. What teaching should the nurse consider from the information gathered? Answers 1. The patient care equipment necessary for the exam includes the following:  Thermometer  Blood pressure cuff  Stethoscope  Vaginal speculums  Personal protective equipment  Reflex hammer  Culture kit for Pap test  Sexually transmitted infections (STI) testing kit, if warranted 2. Standard Precautions for infection control include personal protective equipment worn by the nurse. This equipment includes the use of gloves, masks, eye protection, face shields, and gowns. 3. When washing the hands with soap and water, wet the hands and then apply enough soap to cover hand surfaces completely. Rub the hands palm to palm, palms to back of hands with the fingers interlocked, dorsum, palm to palm with fingers interlocked, backs of fingers to opposing palms with fingers interlocked, and rotating thumbs clasped in palms. 4. Because the patient is sexually active, consider asking about risk factors associated with STIs; ask about partners’ past sexual history if the relationship is monogamous. Also, ask about past pregnancies, former methods of birth control, and whether patient performs breast selfexaminations. 5. This patient needs a full physical, including a gynecologic exam; therefore, inspection, palpation, auscultation, and percussion will all be used. A breast examination should also be performed. 6. Teaching should include prevention of STIs, including safe sex practices, breast self-examination, pregnancy prevention, birth control methods, and instructions for use of the birth control method chosen.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Developmental Competence o Genetics and Environment o Subjective Data o Health Promotion and Patient Teaching  Informatics/Nursing Judgment o Subjective Data o Objective Data

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Health Promotion o Exemplar: Genetics and Environment  Concept: Patient Education o Exemplar: Health Promotion and Patient Teaching THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data

BSN ESSENTIALS  

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o Developmental Competence o Health Promotion and Patient Teaching Domain 3: Population Health o Genetics and Environment Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Developmental Competence

o o o

Subjective Data Objective Data Health Promotion and Patient Teaching

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 28: The Complete Health Assessment: Adult CHAPTER OBJECTIVES 92. Use recommended techniques to perform a complete history and physical examination for an adult. 93. Thoroughly, accurately, and clearly record all data, including documenting relevant normal or negative findings in addition to any concerns. STUDENT RESOURCES

understand

      

Textbook Chapter 28 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS in text



Documentation and Critical Thinking

lesson focus

 

Recognize Cues Analyze Cues

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THE HEALTH HISTORY GENERAL APPEARANCE

Content Highlights Discuss how to multitask by making observations while interviewing the patient.



Learning Activities

Resources

Activity: Have students make their own checklist for the health history. Have them exchange checklists with another student for constructive criticism.

Review Selected Photos in each section.

TEACHING STRATEGIES Content Focus MEASUREMENT

Content Highlights Explain how general appearance can reveal many things about a patient, from medical conditions to self-esteem issues to depression.

HEAD AND FACE EYES



VITAL SIGNS SKIN

Learning Activities

Emphasize that a good, thorough, complete health assessment takes time; the nurse should set aside plenty of time and not short-change the patient. Discuss how to inquire about environmental factors (e.g., workplace, recreational activities) when examining the head and face, eyes, ears, nose, mouth, and throat.



EARS NOSE MOUTH AND THROAT

Instruct students to make a thorough examination of the breasts, reminding them that most breast cancers are found in the upper outer quadrant. Discuss how to help the woman remember to perform monthly breast self-examination (BSE).



Activity: Have students work with a preceptor to perform a number of both complete and focused or follow-up examinations. Activity: Have students work with a preceptor in different health care settings, such as long-term care facilities, to experience and compare the differences in developmental care for the young adult to the aging adult. Small Group Activity: Have students review a history and physical completed by another practitioner and critique the examination for its completeness and clarity. Discussion Topic: Have students discuss the part of the examination that is most problematic for them. Have other students posit suggestions for improvement.

NECK CHEST, POSTERIOR AND LATERAL CHEST, ANTERIOR

Remind students that the patient should be covered as much as possible to prevent embarrassment and chill. Discuss the best way to remember all the neurologic function testing areas.

HEART UPPER EXTREMETIES

Explain that the male genitalia examination causes an erection. Discuss ways to be matter of fact about this phenomenon.

FEMALE BREASTS MALE BREASTS

Examine reasons for obtaining vaginal and rectal specimens.

NECK VESSELS

Resources

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

HEART ABDOMEN INGUINAL AREA LOWER EXTRIMETIES MUSCULOSKELETAL NEUROLOGIC LOWER EXTREMITIES MUSCULOSKELETAL MALE GENITALIA MALE RECTUM FEMALE GENITALIA

DOCUMENTATION AND CRITICAL THINKING Recording the Data

Emphasize that documentation must be thorough and should be able to withstand legal scrutiny. Provide some examples of both adequate and inadequate documentation.

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Clinical Activity: Have students bring in the documentation from the health assessment they completed for a prior activity. Have student pairs exchange and critique the documentation. Ask the students to reword or expand on any item that is insufficient or be more concise on sections that are wordy.

Resources

IN-CLASS/ONLINE CASE STUDY M.P. is a 45-year-old woman who presents to the family practice for a yearly check-up. Subjective Data Married Exercises daily Nonsmoker, never smoked Registered nurse in hospital setting Has two children who live at home No complaints at this time Objective Data Vital signs: T 36.7 BP 108/62 HR 62 Resp 14 Height: 5 feet, 7 inches Weight: 160 lb Immunizations: Up-to-date Medications: No medications, multivitamin daily Allergy to PCN = Hives Questions 1. How should the nurse proceed with the physical exam? 2. What interventions can help make the patient more comfortable during the physical examination? 3. What pointers or tips can the experienced nurse give to a new nurse who wants to improve his or her technique? 4. What are the components of the general survey? 5. How should the nurse perform the abdominal assessment? Answers 1. Each nurse has a unique way of performing the head-to-toe assessment. Starting with less invasive examination procedures will allow time to establish trust with the patient. However, establishing a routine helps the nurse become organized and develop a system for the physical examination. Therefore, beginning with the head, examine the facial characteristics—skin, hair, eyes, ears, mouth, throat, and range of motion of the neck—in a systematic, organized manner, incorporating the neurologic, integumentary, musculoskeletal, visual, and auditory systems in the head, neck, nose, and mouth regions. Then move on to the next region of the body and repeat the process. After all body regions have been examined, document the findings by body system.

2. After the initial observations, obtain the history, assess vital signs, assess vision, and prepare the patient for the examination. Instruct the patient to first empty the bladder (collect a specimen if necessary based on patient history) and then to remove clothing, put on a gown if needed, and sit on the examination table. Make sure the examination room is warm and that equipment is prewarmed. Provide explanations before doing assessment procedures. 3. Tips for success include the following:  Be organized; have all equipment needed at hand.  Develop a routine; this helps with consistency.  Before you begin the actual assessment, have a clear picture in your mind of what you plan to do and in what order.  Practice, practice, practice so that you learn to become systematic and inclusive.  Imagine yourself as the patient and consider how you would want a nurse to be prepared if he or she were to assess you. 4. Components of the general survey (collected during the history) are the following: Level of consciousness and mental status  Mood or affect  Personal hygiene  Skin color  Posture and position  Mobility  Ability to hear and speak 5. To perform the abdominal assessment, the nurse should alter the sequence of the assessment to avoid introducing tension to the abdominal region. The abdominal exam proceeds in the following order:  Observe skin characteristics from pubis to midchest region for scars, lesions, vascularity, bulges, and navel.  Inspect abdominal contour.  Observe for movement of abdomen, peristalsis, and pulsations.  Auscultate abdomen (all quadrants) for bowel sounds, bruits, and venous hums.  Lightly palpate all quadrants for tenderness, guarding, and masses.  Deeply palpate all quadrants for tenderness, guarding, and masses.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o The Health History o Female Breasts  Informatics/Nursing Judgment o Documentation and Critical Thinking

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Female Breasts o Exemplar: Male Genitalia  Concept: Critical Thinking o Exemplar: Documentation and Critical Thinking THEME: Nursing Attributes and Roles  Concept: Technology and Informatics o Exemplar: Documentation and Critical Thinking

BSN ESSENTIALS 

Essential IV: Information Management and Application of Patient Care Technology o Documentation and Critical Thinking

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Essential VII: Clinical Prevention and Population Health o Female Breasts Essential IX: Baccalaureate Generalist Nursing Practice o The Health History

2021 AACN ESSENTIALS DOMAINS   

Domain 2: Person-Centered Care o The Health History o Female Breasts Domain 8: Information and Healthcare Technologies o Documentation and Critical Thinking Domain 10: Personal, Professional, and Leadership Development o The Health History

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o The Health History o Documentation and Critical Thinking

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 29: The Complete Physical Assessment: Infant, Young Child, and Adolescent CHAPTER OBJECTIVES 1.

Use recommended techniques to perform a complete history and physical examination.

STUDENT RESOURCES

understand

      

Textbook Chapter 29 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THE NEONATE AND INFANT Vital Signs Measurement General Appearance Chest and Heart Abdomen

Content Highlights Discuss how the order of a neonate or infant examination may be rearranged according to baby’s behavior. Examine how to take advantage of a quiet baby and what tests to perform for a crying child. Emphasize how to make the parent comfortable by explaining aloud the procedures and the reasons for them as they are performed.

Learning Activities 

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Resources

Selected photos Discussion Topic: Discuss the importance of keeping in Sequence area. the neonate or infant at a stable body temperature during the examination. Activity: Have students work with a preceptor in different health care settings, such as pediatric settings, to experience and compare the differences in developmental care for the various young age groups.

Discuss how to assess for abuse or neglect. Review the connections between certain parts of the examination (e.g., nutrition and sucking reflex).

TEACHING STRATEGIES Content Focus Head and Face Eyes

Content Highlights

Learning Activities

Discuss how to know whether the absence of a particular reflex is grounds for a referral to a specialist or only requires closer examination at a follow-up visit.

Ears Nose

Examine why the nurse should save the otoscopic examination until the end of the assessment.

Mouth and Throat Neck Upper Extremities Lower Extremities Genitalia Spine and Rectum Final Procedures THE YOUNG CHILD

Discuss how to make the young child comfortable with the nurse and with the examination.

The Health History General Appearance Measurement

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Online Activity: Have students research activities for the young child to perform that will provide assessment information to the nurse through observation only.

Explain that it is best to let it seem as if the young child has choices during the examination, even if they are limited ones, such as whether the child would like the ears or eyes examined first. Emphasize that the nurse must be firm but not overbearing.

Upper Extremities Head, Face, and Neck

Discuss the importance of the parent’s cooperation and support during the examination.

Resources

TEACHING STRATEGIES Content Focus Eyes Nose Mouth and Throat Ears

Content Highlights

Learning Activities

Explain the importance of knowing developmental milestones, and emphasize the fact that all children develop at different rates. Emphasize that if the nurse can make the examination fun for the young child, he or she will be a much more cooperative patient in the future.

Posterior Thorax Anterior Thorax, Heart, and Lungs Abdomen Genitalia Lower Extremities Examining Young Children THE ADOLESCENT Position Sitting Up Position Supine

Ask the students if they remember the first complete examination they had as an adolescent. Ask them to share their experiences, discussing whether they were nervous, embarrassed, or uncomfortable and whether the nurse eased their feelings.

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Discussion Topic: Discuss ways to make the adolescent at ease during the examination.

IN-CLASS/ONLINE CASE STUDY J.P. is a 12-year-old boy who presents to the pediatric office for his annual visit. Subjective Data Lives with mother and father, both present for visit

Resources

Attends upper elementary school Only child No smokers in home No weapons in home Objective Data Vital signs within normal limits Height and weight within normal limits Immunizations up to date No medications No allergies Physical exam within normal limits Questions 1. What special considerations should the nurse keep in mind regarding the physical exam with this age group? 2. What similarities does the assessment of this age group have compared with an adult exam? 3. What are the expected findings for the following systems: skin, hair, and nails and musculoskeletal system? 4. What are some abnormal findings for the following systems: skin, hair, and nails and musculoskeletal system? 5. How should the nurse assess the reproductive system for boys in this age group? 6. In which stage of development is this patient using the Tanner stages for boys? Answers 1. Although the sequence of examination for the adolescent is the same as for an adult, the nurse needs to be aware that as children enter their teen years they should be given a choice about whether a parent is present during the physical exam. This ensures privacy and encourages teens to begin assuming responsibility for their health care. 2.

The following systems are similar to the adult exam in the adolescent patient: a. Head, eyes, ears, nose, and mouth and throat b. Lung and respiratory system c. Heart and peripheral vascular system d. Abdomen and gastrointestinal system e. Neurologic system

3. Skin: As the child becomes an adolescent, the skin undergoes significant maturational development. The skin texture takes on more adult characteristics. In addition, the skin has increased perspiration, oiliness, and acne secondary to an increase in sebaceous gland activity. 4. Hair and nails: The presence and characteristics of facial hair in boys and body hair in both boys and girls change significantly, and by the end of adolescence there is an adult hair distribution pattern. The examination findings are the same as those for an adult. 5. Musculoskeletal system: The normal findings for an adolescent are the same as those for an adult. A young person with low self-esteem or feelings of rejection may assume a slumped, careless, and apathetic posture. 6. Skin: The most common abnormal finding and concern for the adolescent is acne. Acne may appear in children 7 to 8 years of age but peaks in adolescence at approximately 16 years of age. Although most acne appears on the face, it may also be prevalent on the chest, back, and shoulders. Acne may appear as blackheads (open comedones) or whiteheads (closed comedones). Inflamed lesions of acne can be mild or severe. These lesions are painful and are concerning to the patient because of their appearance. 7. Hair and nails: Persistent nail biting may be a habit, indicating an abnormal behavior or coping mechanism for dealing with stress. The nurse should take the time to evaluate why nail biting persists. 8. Musculoskeletal system: Poor posture, regardless of the cause (e.g., low self-esteem or heavy backpack), contributes to kyphosis. A curvature less than 10 degrees is considered a normal variation, and a curvature between 10 and 20 degrees is considered mild kyphosis. Curvature of the spine greater than 10 degrees needs further evaluation for early treatment. Postural kyphosis is almost always accompanied by a compensatory lordosis, an abnormally concave lumbar curvature. 9. The male exam: Procedures and techniques include the genitalia assessment. This assessment is important to ensure that maturational development is progressing according to sexual maturity ratings (Tanner stages [see Table 26.1]) and because testicular cancer occurs in this age group. This is also the time when teen modesty is at its peak. The nurse must take time to develop a relationship with the patient and reassure him in a matter-of-fact manner that the examination of the genitalia is an essential part of a complete examination. Ensuring privacy and adequate draping when the genitalia are not being examined are important. Deferring the genitalia assessment to the last procedure of the examination is usually best. The process of examination is essentially the same as for an adult. 10. Findings: Expected findings for a young adolescent boy depend on the maturational stage of the patient. Findings for an older adolescent are essentially the same as previously discussed for an adult. 11. Adolescent development varies in the pubic region; however, a 12-year-old boy will usually fall between Tanner stage 2 and 3 of development. Stage 2 characteristics include pubic hair is starting to appear, the penis is slightly enlarged, and both testicles and scrotum begin to enlarge and develop a darker skin tone and texture. In stage 3, the adolescent will have increasing hair growth over the entire region, and the hair becomes thicker and fuller. The male penis becomes larger in length, and the testes and scrotum continue to grow.

NURSING CURRICULUM STANDARDS



Patient-Centered Care/Human Flourishing o The Adolescent

BSN ESSENTIALS 

Essential IX: Baccalaureate Generalist Nursing Practice o The Adolescent

2021 AACN ESSENTIALS DOMAINS 

Domain 2: Person-Centered Care o The Adolescent

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o The Adolescent

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 30: Bedside Assessment and Electronic Documentation CHAPTER OBJECTIVES 1.

Use recommended techniques to perform an appropriate reassessment of the hospitalized patient.

STUDENT RESOURCES

understand

      

Textbook Chapter 30 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THE HEALTH HISTORY GENERAL APPEARANCE

Content Highlights Emphasize that the nurse should have adequate knowledge of the patient and his or her condition before entering the patient’s room and beginning to question the patient.

Learning Activities 

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MEASUREMENT NEUROLOGIC SYSTEM RESPIRATORY SYSTEM CARDIOVASCULAR SYSTEM

Review how the general appearance assessment can give important clues to the patient’s needs. Examine the standard measurements that must be taken and recorded correctly. Discuss the fact that any new neurologic issue may be a sign of serious complications.

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Resources

See Selected Activity: Have students submit appropriate Photos in documentation for an examination they have Sequence performed. section. Clinical Activity: Assign students to work with a preceptor in the hospital setting to perform a number of assessments on hospitalized patients. Activity: Have students review assessments of hospitalized patients completed by another practitioner and critique the examination for completeness and clarity. Online Activity: Have students research the creation of SBAR and how it improved military performance and reduced errors in communication.

TEACHING STRATEGIES Content Focus SKIN ABDOMEN GENITOURINARY ACTIVITY ELECTRONIC HEALTH RECORDING

Content Highlights Explain the importance of locating both the posterior tibial pulse and the dorsalis pedis pulse in patients who are bedridden or on bed rest.

Learning Activities 

Resources

Discussion Topic: Have students offer their experiences with electronic charting. Discuss the pros and cons of different types of systems.

Note that an intravenous (IV) site can easily become infected or broken down; emphasize the importance of good IV site care.

Patient Safety

Review the normal activities that are encouraged after surgical procedures. Give the class some examples of illnesses or procedures and have them discuss activities for successful recovery.

USING SBAR FOR STAFF COMMUNICATION

Show the class several examples of electronic charting. Discuss the implementation of SBAR for communication. Provide the students with several scenarios and have them give examples of correct SBAR communication.

IN-CLASS/ONLINE CASE STUDY M.R., a 51-year-old man, was rushed to the emergency department after a motor vehicle accident 3 days ago. M.R. is now in the intensive care unit (ICU). Subjective Data Lost consciousness at the scene Pain 6/10 in left leg and right arm Family at bedside

Objective Data Fractured left femur, repaired with casting, same day as accident; casting clean, dry, and intact; positive distal pulses; positive cap refill toes Fractured left wrist, repaired with external fixator, same day as accident; four pins, clean, dry, and intact with two fixator rods lateral surfaces; no drainage; cleaned ever shift; positive pulses; positive cap refill in nail beds Intravenous (IV) 20 gauge, site right forearm, placed 1 day ago, patent, no edema Vital signs: T 36.7 BP 108/62 HR 72 Resp 18 Height: 5 feet, 9 inches Weight: 190 lb Medications: 1 mg morphine IV per 2 to 4 hours as needed for severe pain, Percocet 5/325 mg PO two every 4 to 6 hours as needed for moderate or breakthrough pain, ibuprofen 300 mg PO every 6 hours as needed for edema, Ancef 1 g IV every 12 hours prophylactically after surgery for external fixation of fracture Questions 1. What physical assessment data are collected during shift assessment? 2. Assess and document the patient’s pain assessment. 3. Identify the differences between comprehensive assessment and shift assessment. 4. How will the nurse adapt the assessment of the skin to the hospitalized patient? 5. How will the nurse adapt the assessment of the musculoskeletal system for this patient? Answers 1. Common physical assessment data collected during shift assessment include the following:  Vital signs: temperature, pulse, respirations, blood pressure and oxygen saturation  Neurologic: orientation to person, place, time, and situation  Communication: able to understand and speak, speech clear, appropriate  Cardiac and peripheral vascular system: S1 and S2, rate, rhythm, radial and pedal pulses rhythm and amplitude, warmth of extremities, capillary refill  Lungs and respiratory system: ease of breathing, skin color, symmetry of thorax, lung sounds  Abdomen and gastrointestinal system: appearance of abdomen, bowel sounds, light palpation of the abdomen  Musculoskeletal system: symmetric movement of upper and lower extremities  Skin: turgor and intactness  Drains, catheters, or tubes: location, patency, and description of drainage, if any

2. Procedure: Perform a symptom analysis of the patient’s pain.  Onset: When did the pain start this morning?  Location: Where do you feel the pain?  Duration: Is the pain in your leg constant, or does it come and go?  Characteristics: What does the pain feel like?  Aggravating factors: What makes the pain worse?  Related symptoms: Do you have any other symptoms along with the pain, such as nausea or sweating?  Treatment: How well did the pain medication relieve the pain last night? Did you use any other pain relief methods, such as relaxation or distraction, to relieve pain?  Severity: On a scale of 0 to 10, how would you rate the pain, using 10 as the worst pain you have ever had?  Data: Patient reports an aching pain in his left leg of 5/10, present since surgery, relieved by distraction and pain medications and aggravated by moving his leg, knee, or ankle. 3. Nurses perform shift assessments by collecting data on patients, regardless of their diagnosis. There are a few differences when conducting an assessment of the hospitalized patient. First, the sequence of examination may vary to accommodate the patient’s limitations. For example, when assessing the lung sounds of a patient who is supine, the nurse may delay auscultating lateral and posterior lung sounds until the patient turns to the side or transfers to a chair. Second, the shift assessment focuses on the immediate needs and potential complications of each patient. For example, when assessing a patient admitted with an exacerbation of heart failure, the nurse’s primary focus is the cardiovascular and pulmonary assessment rather than the range-of-motion assessment. Finally, the nurse assesses not only the hospitalized patient but also the equipment used in his or her treatment. For example, for patients receiving IV fluid therapy, the nurse inspects the IV insertion site for redness and pain and then follows the tubing up to the intravenous fluid hanging to make sure it is the correct fluid infusing at the ordered rate and that the tubing is labeled with the date it was hung. 4. Assessment of the skin is adapted to the hospitalized patient as follows:  Skin inspection and palpation are essential for all patients on admission and as indicated throughout their hospitalization.  Perform a risk assessment for pressure ulcers using a validated tool, such as the Braden scale (available at www.bradenscale.com under the heading “Products”). This scale includes risk factors such as the patient’s sensory perception, the moisture of the skin, activity level, mobility, nutrition, and amount of friction and shear to the skin. 5. Assessment of the musculoskeletal system is adapted to the hospitalized patient as follows:  Assessing circulation, movement, and sensation of the toes distal to the cast are critical. Because of the cast’s location, the dorsalis pedis pulse is not accessible to palpation. Instead, circulation is determined by assessing capillary refill in the toes and noting the temperature and color of the skin.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Patient Safety  Teamwork and Collaboration/Professional Identity o Using SBAR for Staff Communication  Quality Improvement/Spirit of Inquiry o Patient Safety  Informatics/Nursing Judgment o The Health History o Electronic Health Recording

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Technology and Informatics o Exemplar: The Health History o Exemplar: Electronic Health Recording  Concept: Safety o Exemplar: Patient Safety  Concept: Communication o Exemplar: Using SBAR for Staff Communication

BSN ESSENTIALS   

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Patient Safety Essential IV: Information Management and Application of Patient Care Technology o The Health History o Electronic Health Recording Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o Using SBAR for Staff Communication

2021 AACN ESSENTIALS DOMAINS   

Domain 5: Quality and Safety o Patient Safety Domain 6: Interprofessional Partnerships o Using SBAR for Staff Communication Domain 8: Information and Healthcare Technologies o The Health History o Electronic Health Recording

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o The Health History o Electronic Health Recording

Patient Safety

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 31: Pregnancy CHAPTER OBJECTIVES 94. Discuss pregnancy and the endocrine placenta. 95. Differentiate the three types of signs and symptoms of pregnancy. 96. Discuss the changes associated with each trimester of pregnancy. 97. State methods of determining weeks of gestation. 98. Discuss developmental care associated with pregnancy. 99. List genetic testing that may be done during a pregnancy.

STUDENT RESOURCES

understand

      

Textbook Chapter 31 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

    

Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

CLINICAL JUDGMENT CLASSROOM TOOLS

in text



Documentation and Critical Thinking

lesson focus

 

Recognize Cues Analyze Cues

INSTRUCTOR RESOURCES before class

 

Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

     

after class



Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus THE ENDOCRINE PLACENTA CHANGES DURING NORMAL PREGNANCY First Trimester Second Trimester Third Trimester Determining Weeks of Gestation DEVELOPMENTAL COMPETENCE GENETICS AND ENVIRONMENT

Content Highlights

Learning Activities

Discuss the progression from fertilization to the time when the placenta begins to support the pregnancy. Explain the common terminology used to describe a woman and her pregnancies.

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Discuss the three types of signs and symptoms of pregnancy. Ask for student input about signs or symptoms they experienced. Discuss the changes in human chorionic gonadotropin levels from implantation to the time of viable pregnancy at 5 weeks.

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Compare the differences in physiology in the first and second trimesters. Explain why women with periodontal disease are at risk for preterm delivery.

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Examine the progressive lordosis and carpal tunnel syndrome that occur as the body compensates for the weight of the fetus and breasts, respectively.

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Activity: Have students attend a prenatal class. Activity: Assign students to rotate through a perinatal clinic with a practitioner. This assignment should include a prenatal and a postnatal home visit. Have students design a teaching plan for each patient. Activity: Have students observe a fetal ultrasound evaluation, either in person or by watching a recording with an explanation of the features noted by ultrasonography. Activity: Have a student interview a patient from a different culture to understand the patient’s cultural beliefs and practices associated with pregnancy. Activity: Make cards that list the presumptive, probable, and positive signs of pregnancy, one on each card, but do not label the cards. Have students sort the cards into the three categories.

Have the students practice the calculation provided by Nägele‘s rule.

Resources Figure 31.1 Figure 31.2 Figure 31.3 Figure 31.4

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Discuss the risks adolescents face with pregnancy. Invite an adolescent or a woman who had a teen pregnancy to speak in class about her experience.

SUBJECTIVE DATA OBJECTIVE DATA

Explain that a knowledge of pregnancy cultural customs is important in providing good patient care. Review the examination questions, focusing on the medical history and current medications that may affect fetuses.

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 GENERAL SURVEY SKIN

Emphasize that the pelvic examination is uncomfortable for many women and discuss ways to put them at ease.

MOUTH

Demonstrate how to document an obstetric history.

NECK

Discuss the importance of determining the patient’s attitude to assess for acceptance of the pregnancy, among other things.

BREASTS HEART LUNGS PERIPHERAL VASCULAR NEUROLOGIC INSPECT AND PALPATE THE ABDOMEN

Online Activity: Have students search online for suggestions for patients concerning dental care during pregnancy. Discussion Topic: Have students discuss their experience with family and friends and their attitudes upon learning about a new pregnancy. Discuss whether the attitude changed as the pregnancy progressed.

Explain that patients need to understand the changes that are occurring in their breasts and that breast selfexaminations are still necessary during pregnancy. Bring in a pregnant volunteer model and demonstrate the abdominal inspection, measuring the fundus and palpating the fetus’s head. On the aforementioned volunteer, demonstrate Leopold maneuvers after discussing the terminology in the section.

Leopold Maneuvers

Figures 31.5 through 31.15 Tables 31.1 through 31.4

TEACHING STRATEGIES Content Focus

Content Highlights

AUSCULTATE THE FETAL HEART TONES

Bring in a Doppler ultrasound machine to auscultate the fetal heart tones. Discuss the normal rate and compare the sounds of the heart rate with the sounds of the funic souffle.

Learning Activities

PELVIC EXAMINATION Genitalia Speculum Examination Bimanual Examination Blood Pressure ROUTINE LABORATORY AND RADIOLOGIC IMAGING STUDIES

Discuss what to do when the genital exam reveals adverse findings. Provide the class with pictures of views of the cervix; explain the reason for the appearance of the cervix in each picture. Bring in an avocado and a grapefruit to help the students understand what they are feeling during a bimanual examination. Discuss how laboratory tests can identify issues that physical examinations cannot reveal. Review typical laboratory tests performed during pregnancy and prenatal testing.

IN-CLASS/ONLINE CASE STUDY Anna is a 29-year-old G2P1 who has just had a 20-week routine anatomy ultrasound. The doctor informed her that there were some “soft markers” for Down syndrome and that genetic amniocentesis is available if she wants to have it. 1. Anna asks whether the ultrasound shows that the fetus has Down syndrome. How can the nurse explain the soft markers for Down syndrome?

Resources

Answer: The nurse should explain that the ultrasound cannot diagnose Down syndrome but can reveal findings that are sometimes associated with Down syndrome. Some markers for Down syndrome that can be seen on ultrasound include echogenic bowel, echogenic intracardiac focus, and choroid plexus cysts. Although these markers are associated with an increased risk of Down syndrome, they are not diagnostic. Rationale: It is very important that patients understand the difference between screening and diagnosis. Genetic amniocentesis and choriovillus sampling are the only ways to diagnose Down syndrome in the prenatal period. There is controversy surrounding the identification of soft markers for Down syndrome on a routine ultrasound. Because these findings may lead a family to seek genetic amniocentesis, which is associated with a 0.5% risk of fetal loss, it is possible to lose a fetus who is unaffected by Down syndrome through amniocentesis that is done in response to ultrasound findings. Some of the ultrasound findings in isolation may not be highly correlated with Down syndrome, but the findings of several markers are more highly correlated. Very thorough genetic counseling is indicated to provide the parents with accurate information to enable them to decide whether they wish to have invasive testing. 2. What counseling should Anna receive about amniocentesis? Answer: Anna should receive nondirective counseling about the availability of amniocentesis. She should be made aware of the risks of amniocentesis, which include bleeding, infection, rupture of membranes, and fetal loss. All these complications occur at a rate of less than 1%. She should also be aware of what information the amniocentesis can provide, what its limitations are, and the length of time for results. She should be given information on Down syndrome and the options of care if it is identified. Rationale: It must be made clear to Anna that amniocentesis can only reveal the presence of a chromosomal disorder. The spectrum of persons with Down syndrome ranges from mild to severe intellectual impairment. The amniocentesis cannot discern where on the spectrum of impairment the child would be. Down syndrome is also associated with many medical problems, including cardiovascular defects, leukemia, and immunologic and gastrointestinal diseases. Some defects can be noted by ultrasound, but not all can be identified. A woman contemplating amniocentesis must also think ahead to what the family will do with the results of the test. There are two options: to continue the pregnancy or to terminate the pregnancy. 3. Anna decided to go home and discuss the findings with her family. She ultimately decided to have genetic amniocentesis and is back today for that appointment. What are the nursing implications of genetic amniocentesis? Answer  Review the counseling information and procedure with Anna.  Provide an opportunity for her to ask questions before the procedure.  Make sure informed consent has been obtained by a nurse or physician.  Check the maternal blood type and give RhoGAM if the mother is Rh negative.  Point out the fetal heartbeat on the ultrasound image and show Anna the heartbeat again after the procedure.  Provide emotional support during the procedure..  Ensure that Standard Precautions are used during the procedure  Double check all labels on specimens.

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Teach Anna the danger signs that may occur after the procedure: o Vaginal bleeding o Leakage of fluid vaginally o Cramping o Fever  Tell Anna when the results will be available and how they will be communicated to her. Rationale: The benefits and risks of amniocentesis should be reviewed again before the procedure. Informed consent must be given before the procedure. Some institutions have a timeout protocol, whereby before the procedure, a health care provider announces the patient’s name and birth date and the procedure. The team and the patient must all concur before the procedure is started. If the maternal blood type is Rh negative, RhoGAM is indicated after the procedure. Because of the invasive nature of amniocentesis, small amounts of fetal blood may leak into the maternal system, which can then form antibodies if the fetus is Rh positive. These antibodies can cross the placenta and harm the fetal blood cells. The purpose of RhoGAM is to prevent the antibody formation. The patient should see the fetal heartbeat before and after the procedure so that she is reassured that the fetus tolerated the procedure well. Standard Precautions are indicated because of the invasive nature of the procedure. Accurate labeling and double checking of all specimen identification are essential. The period after an amniocentesis is a time of anxiety for the family. They worry about complications from the procedure, and they worry about the results. Anna should be given a 24-hour phone number to call in case she experiences any complications. Clear explanations about how and when results will be received can help reduce some of the worry. Some women choose not to share the information about the amniocentesis with others and thus may have limited support while awaiting results. 4. The results of the amniocentesis show trisomy 21. After genetic counseling, Anna chooses to continue the pregnancy. How can the nurse help Anna at this time in her pregnancy? Answer  Support her decision.  Explore the support she has from her family and friends for her decision.  Let her know of any further testing that would be indicated during the pregnancy. In the case of trisomy 21, a fetal echocardiogram may be ordered.  Refer her to the National Association for Down syndrome (http://nads.org), which can provide much information and support for her and her family.  Later in the pregnancy, refer her to a lactation consultant who is experienced in working with newborns with Down syndrome. Rationale: The decision to keep a pregnancy with a fetus with Down syndrome may be supported wholeheartedly by some families and questioned by others. It is helpful for the woman to discuss this with the nurse to help her anticipate the reactions of those close to her. The nurse needs to show support for the woman’s decision and assist her in finding resources that will aid her in helping this child become an integral member of the family. The age of Anna’s other child must be considered and age-appropriate information given to this child.

Breastfeeding is beneficial to all newborns. The newborn with Down syndrome is more prone to infection and gastrointestinal problems for which breast milk is especially beneficial. However, breastfeeding can be challenging with an infant with Down syndrome. Problems such as poor muscle tone, poor suck, gagging, and tiring easily are frequently found in these infants. An experienced lactation consultant can address these problems to help the infant receive the benefits of breast milk.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Alcohol, Drugs, and Pregnancy o Subjective Data o Objective Data o Documentation and Critical Thinking  Teamwork and Collaboration/Professional Identity o Alcohol, Drugs, and Pregnancy  Safety/Nursing Judgment o Subjective Data  Informatics/Nursing Judgment o Subjective Data o Objective Data o Documentation and Critical Thinking

THEME: Sexuality and Reproduction  Concept: Reproduction o Exemplar: The Endocrine Placenta o Exemplar: Changes During Normal Pregnancy  Concept: Sexuality o Exemplar: Subjective Data THEME: Protection and Movement  Concept: Fatigue o Exemplar: Changes During Normal Pregnancy  Concept: Pain o Exemplar: Alcohol, Drugs, and Pregnancy THEME: Homeostasis and Regulation  Concept: Elimination o Exemplar: Changes During Normal Pregnancy  Concept: Hormonal Regulation o Exemplar: Changes During Normal Pregnancy  Concept: Gas Exchange o Exemplar: Changes During Normal Pregnancy  Concept: Hormonal Regulation o Exemplar: Changes During Normal Pregnancy  Concept: Nutrition o Exemplar: Subjective Data THEME: Maladaptive Behavior  Concept: Addiction o Exemplar: Alcohol, Drugs, and Pregnancy o Exemplar: Subjective Data THEME: Mood and Cognition  Concept: Anxiety o Exemplar: Objective Data PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Collaboration

o Exemplar: Alcohol, Drugs, and Pregnancy  Concept: Technology and Informatics o Exemplar: Subjective Data o Exemplar: Objective Data o Exemplar: Documentation and Critical Thinking  Concept: Safety o Exemplar: Subjective Data THEME: Nursing Attributes and Roles  Concept: Patient Education o Exemplar: Subjective Data o Exemplar: Objective Data  Concept: Critical Thinking o Exemplar: Documentation and Critical Thinking

BSN ESSENTIALS  

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Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Subjective Data Essential IV: Information Management and Application of Patient Care Technology o Subjective Data o Objective Data o Documentation and Critical Thinking Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o Alcohol, Drugs, and Pregnancy Essential IX: Baccalaureate Generalist Nursing Practice o Alcohol, Drugs, and Pregnancy o Subjective Data o Objective Data o Documentation and Critical Thinking

2021 AACN ESSENTIALS DOMAINS 

Domain 2: Person-Centered Care o Alcohol, Drugs, and Pregnancy

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o Subjective Data o Objective Data o Documentation and Critical Thinking Domain 5: Quality and Safety o Subjective Data Domain 8: Information and Healthcare Technologies o Subjective Data o Objective Data o Documentation and Critical Thinking

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

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Domain 2: Roles/Responsibilities o Alcohol, Drugs, and Pregnancy o Subjective Data o Objective Data o Documentation and Critical Thinking Domain 3: Interprofessional Communication o Alcohol, Drugs, and Pregnancy

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.

TEACH FOR NURSES LESSON PLAN Chapter 32: Functional Assessment of the Older Adult CHAPTER OBJECTIVES 100. Differentiate activities of daily living and independent activities of daily living. 101.Describe the various functional assessments that may be performed with the older adult. 102. List the other domains of assessment that may be performed with the older adult.

103.

Discuss the aspects of assessment for elder mistreatment.

STUDENT RESOURCES

understand

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Textbook Chapter 32 Sherpath* Animations Audio Audio Glossary Key Points Clinical References

apply

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Next Generation NCLEX™ (NGN)-Style Case Studies Elsevier Adaptive Quizzing* Video Assessment Answer Keys, Study Guide, Lab Manual Review Questions

INSTRUCTOR RESOURCES

before class

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Nursing Curriculum Standards (below) Clinical Judgment Classroom Tools (above)

in class

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after class

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Test Bank (Evolve)

* Sold separately from textbook.

TEACHING STRATEGIES Content Focus FUNCTION

Content Highlights

Instrumental Activities of Daily Living

Discuss the three domains of a functional assessment and the two approaches. Examine how observing a patient’s ability to perform tasks may be necessary when patient-reported capabilities are incongruent with caregiver information or the nurse’s clinical observation.

Advanced Activities of Daily Living

Review the Katz assessment, requesting input from students about improvement.

Measuring Physical Performance

Discuss the instrumental activities of daily living (IADLs) instruments and their cultural and gender biases. Examine the concerns with overreporting performance to obtain additional services or underreporting because of fear of losing independence.

Activities of Daily Living

Assessment of Risk for Functional Decline During Hospitalization

Learning Activities 

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 Assessment of Cognition Depression and Function Social Domain

Provide students with a copy of the Tinetti Gait and Balance Evaluation. Using a student volunteer, administer the test. Discuss the significance of the scores. 

Resources

Figures 32.1 Activity: Assign students to visit an assisted living facility or a continuing care retirement community through 32.9 in their area. Have them write a report on their opinion of the services offered and improvements that could be made.  Online Activity: Have students access several other ADL assessments, some of which are listed in the text. Compare the assessments for thoroughness. Discuss what additional information might be important to note. Activity: Have students use one of the evaluative scales on themselves, such as the Katz Index of ADL or the Lawton IADL Scale. Then have them administer the same tools to an older adult and compare the responses. If possible, have them choose adults from different cultural groups. Activity: On the basis of availability of friends or family members in the older age group, assign students to complete a functional assessment of an older person. Have each student present a brief description of the person and the results of this assessment. Online Activity: Have students research and report the

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

CAREGIVER ASSESSMENT

Discuss the three predictive variables that the HARP assesses, focusing on how reduced IADL ability within 2 weeks before admission affects the HARP score.

means for recording and reporting elder abuse in their communities. Online Activity: Have students research and report on community agencies that assist older individuals with ADLs.

Assessment of Caregiver Burden CONTEXTS OF CARE

Examine the three disorders that alter cognition. Discuss the importance of understanding the underlying reasons for altered cognition to determine the appropriate treatment.

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Acute Care Setting Hospital at Home

Emphasize that depression is not a normal part of aging and discuss what preventive measures can be taken with older adults.

Community Home Care Assisted Living Continuing-Care Retirement Communities

Provide the students copies of the Norbeck Social Support Questionnaire. Have them think about an older person in their family as they review the questions. Ask a social worker who works with abused older adults to address the class on issues concerning the mistreatment and abuse of older adults in their community. Emphasize the importance of support for the caregiver and the necessity of assessing how the caregiver handles stress. Remind the class that every person reacts differently to stress. Discuss the different assessments needed, depending on the location of the care setting. Explain the benefits of an acute care for older adults unit.

Resources

TEACHING STRATEGIES Content Focus

Content Highlights

Learning Activities

Resources

Present statistics on the number of home care providers available in the United States today compared with 10 years ago.

MAINTAINING INDEPENDENCE

Discuss the assisted living facilities and continuing care retirement communities available in your area. Ask students about their personal knowledge of these facilities. Provide an example of a graduated exercise plan for an older adult. Have the students provide suggestions to enhance your plan.

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Exercise Health Care Maintenance ENVIRONMENTAL ASSESSMENT

Discuss the importance of prevention services in the health of the older adult. Assess environmental hazards that can cause severe damage to the older adult. Focus primarily on the home.

Falls Older-Adult Drivers Sleep SPIRITUAL ASSESSMENT

Invite an exercise instructor who specializes in classes for older adults who need help with balance and strength training to come to class and demonstrate exercises that can help reduce fall risks. Discuss how to tactfully suggest to an older adult that he or she should consider giving up driving privileges.

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Small Group Activity: Divide the class into groups Table 32.1 Table 32.2 and have the students create an exercise plan for Table 32.3 an older adult. Provide each group with a case study of a patient and instruct the group to tailor its exercise plan to meet that person’s needs, taking into consideration the patient’s current limitations.  Activity: Have students assess their own homes for hazards. Discuss the fact that sometimes it is difficult to see the hazards in a familiar space. Report any significant findings. Online Activity: Have students access the driver’s selfassessment test on the AAA website or the AARP website. Clinical Activity: In the clinical setting, have students practice assessment of the cognitive domain using the MMSE or other tools on hospitalized older adults.

SPECIAL CONSIDERATIONS Assessing Those in Pain

Review the Pittsburgh Sleep Quality Index and Table 32.3. Discuss the possibility of sleep apnea.

Assessing Older Adults with Altered Cognition

Discuss how spirituality can affect patients’ views of themselves and their lives, either contributing to their

TEACHING STRATEGIES Content Focus

Content Highlights discouragement or supporting health promotion. Discuss how to make the patient comfortable during the assessment. Examine attitudes and beliefs about older adults and how this can affect the care they receive. Explain that pain is a very subjective feeling and that the nurse should never dismiss the patient’s report of pain. Review ways to communicate with a cognitively impaired older adult.

IN-CLASS/ONLINE CASE STUDY P.J. is an 82-year-old man who presents to the outpatient office for a 6-month check-up. Subjective Data Lives in assisted living apartments Widower One meal a day in dining room; has light meals for breakfast and lunch Nonsmoker, never smoked Retired police officer Has three grown children who live nearby Walks with cane Complains of urinary incontinence Objective Data Vital signs: T 37.7 BP 108/62 HR 62 Resp 14

Learning Activities

Resources

Height and weight = Within normal limits Immunizations = Up to date Medications: Digoxin (Lanoxin) 0.5 mcg per day, hydrochlorothiazide (HCTZ) 5 mg per day, aspirin 81 mg per day Allergy to sulfa medications = Hives Questions 1. What special considerations should the nurse keep in mind regarding the physical exam for individuals in this patient’s age group? 2. What similarities does assessment of older adults have to the assessment of younger adults? 3. What are the expected findings in the older adult for the following systems: skin, hair and nails, eyes and vision, ears and hearing, mouth, and musculoskeletal system? 104. What are some abnormal findings in the older adult for the following systems: skin, eyes and vision, ears and hearing, mouth, and musculoskeletal system? 105. Based on the readings and the objective and subjective findings, what is the most likely cause of this patient’s urinary incontinence? 106. What interventions should be implemented for this patient’s urinary incontinence? Answers 1. When obtaining a health history from an older adult, seek information directly from the patient first, if possible, rather than from relatives who may accompany the patient. During the interview, maintain eye contact so that the patient can see the movements of the mouth, which helps if the individual has a hearing problem. Observe for hearing or vision deficits that affect data collection. 2. Assessment of the following systems in older adults is similar to that performed for the adult:  Nose, mouth, and throat  Lung and respiratory system  Heart and peripheral vascular system  Abdomen and gastrointestinal system  Neurologic system 3. 

Expected findings in the older adult are as follows: Skin: As the skin thins, it takes on a parchmentlike appearance, especially over bony prominences, the dorsal surfaces of the hands and feet, the forearms, and the lower legs. The skin hangs loosely on the frame, secondary to a loss of adipose tissue and loss of elasticity. The skin may be cool because of impaired circulation. Skin tears may occur because of thin, fragile texture. Normal variations in the skin of the older adult include findings such as the following: o Solar lentigo (liver spots): irregularly shaped, flat, deeply pigmented macules that may appear on body surface areas repeatedly exposed to the sun.

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Seborrheic keratoses: pigmented, raised, warty-appearing lesions that may appear on the face or trunk. Differentiate these benign lesions from similar-appearing actinic keratoses, which are premalignant lesions. o Acrochordon (skin tag): small, soft tag of skin that generally appears on the neck and upper chest. These tags may or may not be pigmented. Hair and nails: The hair becomes thin, gray, and coarse in texture. Symmetric balding may occur in men; a decrease in the amount of body, pubic, and axillary hair occurs in both men and women. Men have an increase in the amount and coarseness of nasal and eyebrow hair, and women may develop coarse facial hair. Eyes and vision: Eyebrows may be thin along the outer edge, and the remaining brow hair may appear coarse. Pseudoptosis, or relaxed upper eyelid, may be seen, with the eyelid resting on the eyelashes. Orbital fat may have decreased, so that the eyes appear sunken, or may herniate, causing bulging on the lower eyelid or inner third of the upper eyelid. The lacrimal apparatus may function poorly, giving the eye a lack of luster. Brown spots may appear near the limbus as a normal variation. Bulbar conjunctiva may appear dry, clear, and light pink without discharge or lesions. The cornea is transparent, clear, and often yellow; arcus senilis (a gray-white circle around the limbus) is common but not associated with any pathologic condition. Ears and hearing: If the patient wears a hearing device, the ear should be carefully assessed for any skin irritation or sores that may be secondary to the molded device. The presence of (or an increase in) wiry hair in the opening of the auditory canal may be seen, and the tympanic membrane may appear whiter, opaque, and thickened. If the patient wears a hearing device, there is an increased likelihood of cerumen impaction. Mouth: The surface of the lips may be marked with deep wrinkling. Aging causes the gum line to recede secondary to bone degeneration, causing the teeth to appear longer. The teeth may become darkened or stained. Musculoskeletal system: Muscle mass is decreased compared with findings in younger adults. Muscles that are not equal bilaterally may indicate muscle atrophy. Common findings include osteoarthritic changes in joints, which may result in decreased range of motion in the affected joints. Many joints may not have the expected degree of movement or range of motion seen in younger adults. Some abnormal findings in the older adult are as follows: Skin: Abnormal findings of the skin in older adults are the same as those discussed for younger adults. Dry skin may indicate dehydration or malnutrition. Tenting of the skin may indicate moderate to severe dehydration. Edema may indicate fluid retention from cardiovascular or renal disease. Bruising, lacerations, and pressure ulcers required addition follow-up. Eyes and vision: Abnormal findings include ectropion, in which the lower eyelid drops away from the globe, or entropion, in which the lower eyelid turns inward. Ears and hearing: Presbycusis is hearing loss associated with aging. The ability to hear high-frequency sounds diminishes first, making high-pitched sounds such as “s” and “th” difficult to hear and tell apart. The speech of others seems mumbled or slurred. Mouth: Abnormal findings include fissures at the corners of the mouth (perlèche); these may be associated with overclosure of the mouth or vitamin deficiency. The older patient is at higher risk for squamous cell carcinoma of the lip, especially if the patient has been a longtime pipe smoker. The gums may become more friable and bleed with slight pressure. Many older adults may become edentulous or

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have caps or bridges. Dental occlusion surfaces may be markedly worn down. Malocclusion of the teeth may be common secondary to the migration of teeth after tooth extraction. A red, edematous tongue with erosions in the corners of the mouth may indicate iron deficiency anemia. Musculoskeletal system: Assess range of motion of the neck with one movement at a time, rather than a full rotation of the neck, to avoid causing dizziness on movement. A stiff neck in an older adult may indicate cervical arthritis. Note any pain, crepitus, dizziness, or limited movement.

5. This patient most likely has a urinary tract infection. A temperature of 37.7°C indicates a low-grade fever. This common urinary disorder occurs when the person is unable to control urination associated with relaxation of the bladder or urinary sphincter. The prostate should be assessed to rule out enlargement causing stasis in the ureters. 6. Interventions should include an antibiotic for the urinary tract infection. Care must be taken in prescribing the antibiotic because the patient is allergic to sulfa medications. Also, increasing fluid intake is an important intervention for healing and preventing urinary tract infections. The patient should follow up with his provider if the symptoms worsen or persist.

NURSING CURRICULUM STANDARDS

QSEN / NLN COMPETENCIES 

Patient-Centered Care/Human Flourishing o Function o Contexts of Care o Environmental Assessment  Teamwork and Collaboration/Professional Identity o Function o Contexts of Care  Safety/Nursing Judgment o Environmental Assessment

NURSING CONCEPTS

The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2021). Concepts for nursing practice (3rd ed.). St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis 9e textbook. A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve. HEALTH CARE RECIPIENT CONCEPTS THEME: Attributes and Resources  Concept: Family Dynamics o Exemplar: Caregiver Assessment  Concept: Functional Ability o Exemplar: Function o Exemplar: Maintaining Independence HEALTH AND ILLNESS CONCEPTS THEME: Mood and Cognition  Concept: Cognition o Exemplar: Function o Exemplar: Special Considerations  Concept: Mood and Affect o Exemplar: Function THEME: Protection and Movement  Concept: Mobility o Exemplar: Function o Exemplar: Maintaining Independence  Concept: Pain o Exemplar: Special Considerations THEME: Homeostasis and Regulation  Concept: Sleep o Exemplar: Environmental Assessment o Exemplar: Table 32.3

PROFESSIONAL NURSING AND HEALTH CARE CONCEPTS THEME: Care Competencies  Concept: Collaboration o Exemplar: Function o Exemplar: Contexts of Care  Concept: Safety o Exemplar: Environmental Assessment

BSN ESSENTIALS   

Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes o Function o Contexts of Care Essential VII: Clinical Prevention and Population Health o Contexts of Care Essential IX: Baccalaureate Generalist Nursing Practice o Function o Environmental Assessment

2021 AACN ESSENTIALS DOMAINS 

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Domain 2: Person-Centered Care o Function o Contexts of Care o Environmental Assessment Domain 5: Quality and Safety o Environmental Assessment Domain 6: Interprofessional Partnerships o Function

INTERPROFESSIONAL COLLABORATIVE PRACTICE CORE COMPETENCIES 

Domain 2: Roles/Responsibilities o Function o Contexts of Care

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Domain 3: Interprofessional Communication o Function o Contexts of Care

ANSWERS TO QUESTIONS IN THE STUDY GUIDE Note: Answers to these questions can be found on Evolve site.