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Fig. 1 Los Angeles freeway system, 1998. Map dates indicate
opening
of first segment (from David Brodsly, L.A. Freeways: An
Appreciative
Essay [Berkeley: University of California Press, 198 I ] )

The Folklore of the Freeway:
Space, Culture, and Identity in Postwar
Los Angeles
Eric R. Avila
Modern environments and experiences cut across all
boundaries of geography and ethnicity, of class and
nationality, of religion and ideology: in this sense,
modernity can be said to unite all mankind. But it
is a paradoxical unity, a unity of disunity: it pours
us all into a maelstrom of perpetual disintegration
and renewal, of struggle and contradiction, of am-
biguity and anguish. To be modern is to be part of
a universe in which, as Marx said “all that is solid
melts into air.”
-Marshall Berman, A21 That Is Solid Melts into Air
Man loves to create roads, that is beyond dispute.
But may it not be . . . that he is instinctively afraid
of attaining his goal and completing the edifice he
is constructing? How do you know, perhaps he only
likes that edifice from a distance and not a t all a t
close range, perhaps he only likes to build it, and
does not want to live in it.
-Fyodor Dostoyevsky, Notes from the Underground
Los Angeles in the age of the freeway saw a profound trans-
formation in the shape of the city and the color of its inhabit-
an ts . I t fulfilled i ts destiny by becoming the ult imate

“fragmented metropolis.”’ The acceleration of suburbanization,
coupled with the dramatic expansion of the city’s nonwhite
population (African Americans and Chicanos in particular) ,
created a regional geography splintered into isolated pockets
Aztlan 23:l Spring 1998 15
Avila
of race and class. As the historic ethnic diversity of commu-
nities like Boyle Heights and Watts gave way to expanding
brown barrios and black ghettos, new communities sprouted
on the urban fringe, insulated from the racialized masses of
the inner city. This was not an accident of poor planning. It
was, in fact, the intended consequence of homeowners,
realtors, developers, and government officials who sought to
preserve southern California’s legacy of building separate and
unequal communities.2
Various civic institutions of postwar Los Angeles under-
pinned the construction of suburban whiteness. Central to that
process was the freeway, which furthered the production of
white space within the larger urban region. The freeway did
not cause white flight, but it did sharpen the contrast between
white space and nonwhite space in the postwar urban region
by creating a conduit for capital flight away from downtown
and by wreaking havoc upon the inner-city communities of
East and South Central Los Angeles. Although many urban
historians have traced the evolution of the freeway system and
its impact upon the spatial and economic development of the
metropolis, very few have considered how diverse peoples of
Los Angeles have understood and assigned meaning to that
complex p r o c e ~ s . ~

As the freeway took shape, a folklore developed in the re-
gional culture that reflected the very different ways in which
people experienced the freeway and its cons t r~c t ion .~ The
folk-
lore of the freeway surfaced in such diverse cultural produc-
tions as public ceremonies, theme parks, novels, murals, and
poems, and reflected a cultural response to modernization in
the postwar, postindustrial American city. Such cultural pro-
ductions revealed a deep ambivalence about the introduction
of the freeway. On the one hand, the freeway emerged in off-
cia1 civic culture as a symbol of progress and modernity, a
harbinger of a better tomorrow. On the other hand, Chicanos
and Chicanas, who suffered the imposition of the freeway upon
their neighborhoods, questioned the good it brought to their
city and drew upon cultural forms to record that experience.
Chicanos and Chicanas are but one social group who came to
terms with the Los Angeles freeway, but their interpretation
of the freeway illuminates the larger cultural response to the
structural transformation of urban life in postwar, post-
industrial America.
16
Folklore of the Freeway
Sixteen Freeways in Search of a Suburb
Central to that process was the freeway. I t did not initiate resi-
dential and industrial development in suburban southern
California, but it facilitated such development by paving ac-
cess to undeveloped land. Under the landmark Collier Burns
Act of 1947, Los Angeles County received millions of state dol-
lars for freeway construction. Although the bill was aimed a t
developing the state highway system as a whole, it clearly fa-
vored the construction of freeways in the state’s metropolitan

areas. Thus Los Angeles County received a larger piece of the
pie.5 The construction of metropolitan freeways directed the
movement of people and their money toward the suburbs and
away from the inner city, promoting what some scholars call
the “Lakewoodization” of suburban southern California-the
process by which independent municipalities “seceded” from
city and county government to form exclusive and homogenous
suburban communities.
The emerging pattern of freeway construction ensured the
vitality of suburban society in the Southland: a radial pattern
extending outward from downtown like spokes, and a concen-
tric pattern, encircling the downtown in a series of rings. The
concentric pattern of development undermined both the spa-
tial and symbolic importance of downtown. The arc of the 405
Freeway is a good example of this kind of development because
it bears no relation to the historic center of the city. It emerged
during the late 1950s and early 1960s as a corridor through
the affluent Westside, connecting the postwar centers of sub-
urban whiteness in Orange County and the San Fernando
Valley. Developments like the 405 Freeway assisted the popular
perception that Los Angeles was a centerless city, despite the
thousands of people who actually lived in that center. Unlike
systems of mass transportation in other American cities, which
were developed to serve the downtown area, the Los Angeles
freeways bolstered decentralized development and vitiated
downtown.
Early on, public officials in East Los Angeles identified the
economic hardship the freeway brought to their communities.
Recalling J. B. Priestly’s famous description of turn-of-the-
century Los Angeles as “sixteen suburbs in search of a city,”
Ninth District Assembly Member Edward F. Elliot modified the
maxim in 1961, describing postwar Los Angeles as “sixteen
freeways in search of a ~ u b u r b . ” ~ Elliot deplored the
decline

17
Avila
of downtown as an economic center of the region, pointing to
the severe loss of downtown retail sales. In 1950, 75 percent
of all retail sales in the city of Los Angeles occurred in the
downtown district. By 1960, with the completion of suburban
shopping malls and regional shopping centers, that number
had dwindled to a mere 18 percent. In response to such fig-
ures, Elliot concluded that “the suburbs have taken the rest
of the business.” Although a complex of factors is to be held
accountable for this development, the assembly member
pointed to the freeways, arguing that they had become “speed-
ways to carry the buying public through instead of into the
central business area.”
Elliot also decried the way in which downtown “had be-
come encircled, cut u p and glutted by freeways,” recognizing
that the impact of the freeways upon the Eastside was not only
economic, but also physical. Certainly, the construction pro-
cess itself unleashed massive destruction and chaos upon the
inner-city communities of East and South Central Los Ange-
les. Because property values in those areas were dispropor-
tionately lower than in the suburbs, East and South Central
Los Angeles became prime locations for massive interchanges
consuming vast amounts of property. In Boyle Heights alone,
the freeways displaced one tenth of the local population, an
especially devastating statistic in light of the vast influx of new
residents to the Eastside and the desperate shortage of hous-
ing in the area.8
Of course, the state was aware that people were not going

to welcome freeway construction in their backyards. Through-
out the 1950s and 1960s, an official publicity campaign em-
phasized the importance of the freeways to Los Angeles and
claimed overwhelming public support for freeway construction.
Even those who were displaced by the freeway, according to
the state, gladly abandoned their homes and communities to
make way for its construction. In the process of building the
Harbor Freeway through a neighborhood of East and South
Central Los Angeles, for example, the California Division of
Highways lauded the people of that community:
Southerly of Exposition Boulevard, the freeway lo-
cation is through a n area of older houses that some
of the occupants have owned for thirty years or
more. Some of the occupants are older people who
expected to live in their homes for the rest of their
18
lives. It would be assumed, in approaching owners
of this type that one would meet with tears, hesita-
tion, reluctance and perhaps outright defiance when
asked to move. This is not the case. The older folks
seemed to have resigned themselves to the fact that
they should not stand in the way of progress and
gladly cooperate. This is the rule rather than the
exception. We have met wholehearted cooperation
and support many times where least e ~ p e c t e d . ~
Through such allegations, the state justified the building of
freeways in older, downtown neighborhoods. (Sources from
those neighborhoods, tell much different stories, as I shall

address later).
The Popular Culture of Progress
In the best tradition of world’s fairs, expositions, and wild west
shows, which glossed over the horrors of nineteenth-century
industrialization and expansion, the dark side of freeway con-
struction was sublimated by an affirmative regional popular
culture. Walt Disney, for example, went to great lengths to
celebrate the construction of the freeway in southern Califor-
nia. Disney not only shared the popular faith in the promise
of unrestricted automobility, but also realized that the free-
way, the Santa Ana freeway in particular, was crucial to the
success of his enterprise, Disneyland. Following the advice of
the Stanford Research Institute, Disney strategically situated
his theme park alongside the proposed route of the Santa Ana
Freeway and built a parking lot twice the size of the park-
the largest in the nation in the mid-1950s. In fact, Disney built
a miniature road system inside his theme park and called it a
“ride.” The Autopia Ride was a mile-long “freeway” upon
which
one could safely drive miniature gasoline-powered cars. That
the line for the Autopia Ride in Disneyland today is among
the shortest in the park is not surprising, given the techno-
logical savvy of American audiences at the end of the twenti-
eth century. Nonetheless, the inclusion of the Autopia Ride
among the thirteen original attractions in 1955 suggests that
as Iittle as forty years ago it was possible to imagine the Los
Angeles freeways as a ride-an attraction for popular fun and
amusement. Indeed, freeways were attractive to Disney’s sub-
urban audiences, who readily accepted his representation of
the freeway as a symbol of American progress and modernity.
19

Avila
Along with a rocket ship ride and a simulated lunar expedi-
tion, the freeway in 1955 seemed at home in Tomorrowland,
that section of the theme park dedicated to postwar idealiza-
tions of a bright American future.
Autopia was not the earliest attempt to link the freeway
to the course of American progress from sea to shining sea.
In 1939, various civic officials gathered to dedicate the Pasa-
dena Freeway, the first to open in Los Angeles. As in earlier
celebrations of progress in American history, this one was ex-
plicitly racialized. Present a t the ceremony, along with the
mayor of Los Angeles, the governor of California, and the
reign-
ing queen of the 1941 Tournament of Roses Parade was a man
described by local newspapers as “Chief Tahachwee.”’* The so-
called chief (photographs of the event suggest he was white)
dressed in a costume that resembled not the modest apparel
of southern California’s indigenous populations, but rather the
wildly elaborate costume of a n Indian in a Hollywood west-
ern. As if the massive feathered bonnet and excessive costume
jewelry were not enough to convey authentic “Indianness,” a
photograph in a state publication reveals the Indian seated
“Indian-style” with the state director of Public Works.
Together,
the Indian and the bureaucrat smoke a peace pipe. By 1941,
stereotypical images of the “White Man’s Indian” were all too
familiar. The presence of a “primitive” or “savage” Indian a t
the opening ceremony of a freeway, however, makes clear that
it belonged to a n unambiguously Anglo-American progress,
much like its predecessor-the railroad. The presence of the
friendly Indian may also have signaled the final surrender of
Native Americans to the encroachment of Anglo-American civi-
lization. Indeed, official coverage of the ceremony smugly de-
clared, “to the beating of tribal drums, Chief Tahachwee

relinquished the rights of his people in the Arroyo and formally
transferred the property to the State” (5).
The symbolic exploitation of Native Americans in the open-
ing ceremony of the Pasadena Freeway is appropriate, given
the fate of southern California’s indigenous populations. The
freeway, after all, materializes the Anglo-American world view,
which saw history as a highway-an unbroken path of linear
progress toward distant horizons. Such a world view clashed
with that of the Indians, who viewed the cosmos as cyclical
and lived according to a principle of regenerative growth. U1-
timately, that clash proved fatal for the Indian, who was un-
able to survive not only the degenerative forces of guns,
20
disease, and alcohol but also the linear conception of progress
in which history pushed relentlessly forward, often over the
peoples who stood in its path. “Thrown onto the highway of
history,” Indians could not withstand the force of Anglo-Ameri-
can progress, symbolized in the freeway.” Long after their
conquest in southern California, Indians could safely return
as a figment of the Anglo-American imagination to commemo-
rate such civic works as the freeway.
Throughout the history of American popular culture,
progress has been defined as “American” in contrast to the
“un-Americanness” of the Other. Often, that contrast is
racialized. The opening ceremony of the Pasadena Freeway
demonstrated the way public space is implicated in the con-
trast of white and nonwhite, using Indians as the racialized
Other. Such popular signifiers of progress legitimized the

physical and economic destruction wrought upon the inner-
city communities of Blacks and Latinos. Although the pro-
cess hardly needed legitimization-the freeway would have
punctured those communities in any case-official Los An-
geles (vested in such political authorities as the mayor of Los
Angeles and the governor of California, and in such cultural
authorities as Walt Disney) took great measures to gild the
freeway with the cultural legacy of Anglo-American progress
in southern California. Beneath the optimistic gloss, however,
the experience of destruction and dislocation informed the
cultural production of other social groups in Los Angeles dur-
ing the age of the freeway.
The Hegemony of the Freeway
The Autopia Ride of Disneyland and the opening ceremony of
the Pasadena Freeway underscore a hegemonic interpretation
of the freeway, in which oppression and domination are le-
gitimized through the production of culture. Hegemony, how-
ever, often says more about the dominator than the dominated.
To end the story here would be disingenuous. More important,
it would ignore those historical actors whose words and deeds
complicate a facile understanding of the freeway as a n incon-
testably hegemonic or oppressive device. Citizens of East Los
Angeles (predominantly Chicano), for example, registered for-
mal protests against the construction of the freeway through-
out the 1950s. They packed public hearings with the California
Division of Highways to voice their opposition; they met in
21
Avila
neighbor’s homes to organize community opposition; and they
formed several community groups to fight the onslaught of the

freeway, such as the Eastside Citizen’s Committee Against the
Freeway and the Freeway Fighters. They also wrote to local
papers, which routinely published the letters of a n angry com-
munity. One such letter poignantly asked the question, “Five
freeways now slash through Boyle Heights, namely the San
Bernardino, the Santa Ana, the Golden State and now the
Pomona. Question is, how do you stop the freeways from con-
tinuing to butcher our town?”12
Chicanos and Chicanas took action against the freeway
through other means besides the institutional networks of
committee hearings, community activism, and newspaper edi-
torials. Folklore, after all, is as complex and contradictory as
the people who create it. Sometimes folklore underscores the
dominant perceptions of a society, other times it is a venue
for alternative ones. While theme park attractions and manu-
factured Indians represent popular understandings of the free-
way in the 1940s and 1950s, they are but one aspect of the
folklore of the freeway. Chicanos and Chicanas of Los Ange-
les enriched that folklore by drawing upon traditional and non-
traditional cultural forms to record their experience of the
freeway and its construction. Such cultural productions do
not summarize the perceptions of Chicanos and Chicanas in
Los Angeles, but they do enlarge our understanding of the
complex cultural responses to modernization in the age of the
freeway.
In the Tujunga W a s h of the Los Angeles River, Judi th
Baca’s mural, “The Great Wall of Los Angeles,” depicts the
struggle of freeway construction during the 1950s. In that sec-
tion of the mural entitled “Division of the Barrios,” a Chicano
family is divided-mother and son on one side, father and
daughter on the other. In between, the freeway writhes, im-
posing a wide gulf between them. Baca’s image plays on the
word itself, taking the “free” out of “freeway.” In her image,
the freeway is instead a n oppressive monolith dividing and

constricting instead of unifying and mobilizing. The rnurulistu
personifies the freeway as a serpentine, parasitic force, prey-
ing upon Chicano families and asphyxiating the old Los An-
geles barrios.
Nostalgia, even melancholy, marks other Chicano and
Chicana recollections of life before the freeway. For many who
grew u p in the cities of southern California, the freeway
plowed
22
over backyards, churches, and schoolhouses-now just debris
in the path of progress. In the poem, “The Journey,’’ by Patricia
Preciado Martin, the narrator walks with her grandmother
through the old barrio where she grew up. Little is left from
the days of her youth, however, save the sparse geraniums
that grow in the cracks of the pavement. At the heart of the
old barrio, the freeway stands, indifferent to childhood memo-
ries of family and community. Walking through a much-
changed barrio, the grandmother recalls a river that ran
through the town. The freeway, however:
had cut the river from the people.
The freeway blocks the sunshine
The drone of traffic buzzes like a giant sleeping bee
A new music in the barrio.13
The “new music” of the barrio also resonates in the poetry
of Lorna Dee Cervantes. In her poem, “Beneath the Shadow
of the Freeway,” Cervantes implicates the freeway in the
gendered oppression of Chicana women by men-Anglo and

Chicano alike. The narrator of the poem remembers life with
her “woman family”-her mother and grandmother, as well as
the fleeting men. Wayward men are in stark contrast to the
sanctuary of her grandmother’s home, “the house she built
with her own hands,” a central image of the poem. More strik-
ing, however, is the contrast between the home and the free-
way, the “blind worm wrapping u p the valley from Los Altos
to Sal si Puedes.” The freeway fills the author with dread: “Ev-
ery day at dusk as Grandma watered geraniums the shadow
of the freeway lengthened.” The “cocky disheveled carpentry”
of her grandmother’s home is juxtaposed against the inhuman
symmetry of the freeway monolith. The freeway, the poet sug-
gests, was built by men; men infatuated with movement, mo-
bility, and most of all, escape. Two central oppositions gird
“Beneath the Shadow of the Freeway”-men’s movement ver-
sus women’s anchoring, and the freeway’s movement versus
the house’s stability. Wrapped in such contradictions, the
narrator concludes, “In time, I plant geraniums, I tie my hair
in braids, and trust only what I have built with my own
hand^."'^
The freeway has invoked a complex range of emotions
among Chicana poets and artists-defiance, nostalgia, suspi-
cion, and dread. Some Chicano writers even bring the free-
23
Avila
way into their fantastic and surreal imagination. In The Road
to Tanazunchule, by Ron Arias, the freeway frames the fanta-
sies of Don Fausto, a very old man on the verge of death who
lived in the barrio of Los Angeles. The freeway is such a promi-
nent part of his daily environment that he invokes the free-

way in one of his many fantasies-a Peruvian shepherd leading
his herd of alpacas onto the Los Angeles freeway. The scene
is loaded with Bufiuelian illusions and ambiguities:
“What’s that?” Mario said, jumping up.
Fausto hurried to the sidewalk. “Vente, don’t be
afraid,” he told Mario, then stepped off the curb into
the mass of bobbing, furry heads. The shepherd,
lagging behind, seemed confused by the traffic lights
and horns. At the intersection leading to the free-
way on-ramp the frightened alpacas blocked a row
of funeral cars, headlights on. Fausto, shouting and
waving his hoe, stumbled up the ramp and tried to
turn the herd from disaster. Mario ran after him,
catching a glimpse of the motorcycle escort, racing
to the head of the funeral p r o c e s ~ i o n . ~ ~
Drawing upon the imagery of Garcia Marquez, Vargas
Llosa, and Carpentier, Arias makes the freeway a link between
the Los Angeles barrio and Latin American cultural expres-
sion. Although Arias wrote The Road to Tumazunchale in 1987,
long after the freeway hacked its way through the barrio, his
reference to it demonstrates another way Chicanos derived
meaning from that process: by immersing the freeway in the
cultural currents of Mexico and South America. The author
skillfully defamiliarizes an ordinary, yet prominent, structure
of the barrio landscape, rendering it part of the make-believe
world of Don Fausto. Although the freeway is not of the bar-
rio, Arias shows how it is woven into the fabric of his commu-
nity. He does not accept the freeway for what it is, but strips
it of its functionalism and uses it as a magical stage for dream
and fantasy.
While theme parks and public ceremonies affirmed the
dominant perception of the freeway, Chicanos and Chicanas

contradicted such official paeans to progress through a
counterfolklore that assigned a very different meaning to the
freeway. Their endeavors, however, were more than a Pavlov-
ian response to oppression. The work of Baca, Martin,
Cervantes, and Arias demonstrates the ways in which Chicano
24
artists and writers have exploited the freeway as a source of
creative inspiration, and, in that process, imparted their own
identity upon the public spaces of the city. Chicanos and
Chicanas could not change the course of the freeway, but they
could change its meaning. Such a contrast between the domi-
nant meaning of the freeway and the Chicano meaning of the
freeway illuminates the larger cultural conversation between
the intentions of cultural producers and the uses of cultural
consumers. Chicanos and Chicanas used the freeway to con-
struct a discourse of resistance to its imposition upon their
world, and in doing so, defied the intended meanings of city
engineers, public officials, and cultural impresarios.
A more contemporary example of this dialogue around the
built environment recalls another cultural practice that thrives
in the Los Angeles barrio. During the late 1970s and early
1980s, a graffiti writing explosion hit the Bronx in New York.
There, most of the work was painted on the sides of subway
cars. With no subways to bomb, however, Los Angeles taggers
aimed for the freeways. In the words of one local tagger, “Ev-
erybody takes the freeways. Everybody, everybody and their
mother sees this. This is like the subways in New York, ex-
cept that you move past it instead of having it move past
you.”16

The tagger has named a very important cultural practice, that
of taking public space and using it as a means of self-expres-
sion. Graffiti is a good example of what anthropologist James
Scott calls “hidden transcripts”-jokes, songs, folklore, graf-
fiti, and other cultural expressions that manifest a dissident
political culture. l7
On the freeway, however, such transcripts are not so hid-
den. True, freeways eliminate the kind of cultural encounters
that were routine in the “democratic” spaces of older Ameri-
can cities (Olmsted’s Central Park is perhaps the most cel-
ebrated example). High above (and sometimes below) the
landscape of human activity, the freeway removes the driver
from social contact. For many, the freeway is a safe passage
through the ghetto or the barrio that (by design, many would
argue) maintains the social distance between separate and
unequal worlds. Even so, graffiti works against the “out of
sight, out of mind” principle of urban design. It is a highly
visible reminder of the Other-inner city Chicano and Black
youth. While the city spends 150 million dollars a year in its
war on graffiti, and while homeowners and public officials rail
against graffiti as “visual pollution,”18 such well-funded efforts
25
Avila
are unable to stop the expressions of power sprayed onto the
wall, which articulate presence, convey identity, and person-
alize the impersonal universe of the sprawling metropolis.
Despite the trend toward the privatization of public life in the
postindustrial metropolis, graffiti on the freeway is a reminder
that “they” are still here. Cultural dialogues are still a t work
in the spaces of the city, even in a “city of quartz” like Los

Angeles. While urban scholars and theorists rightly dispar-
age the “destruction of public space,” “the militarization of city
life,” and the “South Africanization of Los Angeles,”lg such
criticisms often obscure the counternarratives, counter-
strategies, and counterexpressions that assert and maintain
humanity, even in a space as inhuman and alienating as the
Los Angeles freeway.
Beyond the Barrio
The use of the freeway as an urban canvas for the expression
of diverse Chicano identities compels a more balanced perspec-
tive of the relationship between the Los Angeles freeway and
the Chicano community. To say that that relationship can only
be characterized by conflict, defiance, and resistance would
be specious, as other aspects of the Chicano experience shed
a more ambiguous light upon the freeway. The folklore of the
freeway, for example, is complicated by the work of Gil
Cuadros, another Chicano writer who understands the inner
contradictions of the Los Angeles freeway. In his novel, City
ofGod, Cuadros reminisces about his childhood in the barrio
and his adult life as a gay man searching for sex in the boozy
discos of West Hollywood, “Rage, Revolver, Motherlode and
Mickey’s.”20 West Hollywood is far from his home in City Ter-
race, where he grew u p with a homophobic father and an abu-
sive mother, but it is the place where he can momentarily forget
the whispers and dirty looks of his old neighborhood. Not that
he is “at home” in West Hollywood-the author recounts the
racism and condescension of the “West Hollywood bar types-
blond hair, blue eyes,” who crave “hot Latin, brown-skinned,
warm, exotic, dark, dark, d a r k men. His identity is as frac-
tured and fragmented as Los …
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DQ-1
A focused assessment is a problem-oriented assessment. It is
done on an already established patient and is, therefore, smaller
in scope and more targeted than a comprehensive assessment. It
is designed to address focused concerns and symptoms and is
generally restricted to a specific body system (Bickley &
Szilagyi, 2017, p. 5). For example, if I were seeing a
hospitalized trauma patient who was a few days post surgery for
a femur fracture who was complaining of chest pain, shortness
of breath, and anxiety, my history taking and examination
would focus primarily on the patient’s respiratory and
cardiovascular systems. I would want an ABG done to see if the
patient was hypoxemic or hypo/hypercapnic. I would also order
lab work that included a CBC, CMP, troponin, and a D-dimer.
The troponin will identify stress to the heart muscle while the
D-dimer will help rule out a venous thromboembolism (VTE). A
D-dimer is a degradation product that is increased in the
presence of a VTE (Hadžić et al., 2020). I would also order an
EKG to rule out myocardial ischemia or myocardial infarct, and
a chest x-ray and chest CT to rule out pulmonary embolism or
other pulmonary diseases. A V/Q scan can also be done to
detect a mismatch between the patient’s ventilation and
perfusion; however, pulmonary angiography is the definitive
test for a pulmonary embolus (Toplis & Mortimore, 2020).
References:
Bickley, L. S., & Szilagyi, P. G. (2017). Foundations of clinical
proficiency. In Bates' guide to physical examination and history
taking (12th ed., pp. 3-43). Wolters Kluwer.

Hadžić, R., Maksimović, Ž. M., Stajić, M., & Lončar-
Stojiljković, D. (2020). D-Dimer: a Role in Ruling out
Pulmonary Embolism in an Emergency Care Department.
Scripta Medica, 51(1), 28–33. https://doi-
org.lopes.idm.oclc.org/10.5937/scriptamed51-25479
Toplis, E., & Mortimore, G. (2020). The diagnosis and
management of pulmonary embolism. British Journal of
Nursing, 29(1), 22–26. https://doi-
org.lopes.idm.oclc.org/10.12968/bjon.2020.29.1.22
DQ-2
The history and physical examination of a patient can inform
the healthcare provider of current problems and potential
problems. First step is to take the patient health history and
survey the patients for event leading to complaint. The second
step is to identify the patient age, gender and occupation as well
as marital status. The chief complaint, present illness and
allergies, past history, family history, personal and social
history and review the patient current symptoms. Family health
history is essential information in determining patient risk
factors and likelihood of the same illness affecting the patient
(Ginsburg,Wu,Orlando,2019). A comprehensive physical
examination is the next step to begin. This exam is
characterized by taking into account of the patients general
impression, vital signs, skin presentation, head, eyes, ears,
nose, throat, neck, back, posterior thorax, lungs, breast, axillae,
epitrochlear nodes, anterior thorax and lungs, cardiovascular
system, abdomen, lower extremities, upper extremities and
nervous system. This site should be inspected, percussion and
palpation. The adequacy of this assessment may influence and
guide decision making regarding treatment and patient care
management (Donnelly, Martin, 2016). Social and religious
practices as well as culture practices may be taken into account.
Laboratory orders are dependent on physical findings. I will
attempt to get a general understanding on patient general health
status by running blood work. I will provide a general

assessment of laboratory results such as CBC, CMP,
magnesium, phosphorus, TSH, hemoglobin A1c, UA, Xray, CT
only if necessary, BNP if indicated by history or physical exam.
I selected the indicated laboratory exam because they provided
a general impression of the patient cellular and organ status.
Donnelly, M., & Martin, D. (2016). History taking and physical
assessment in holistic palliative care. British Journal of
Nursing, 25(22), 1250.
Ginsburg, G. S., Wu, R. R., & Orlando, L. A. (2019). Family
health history: underused for actionable risk assessment.
LANCET, 394(10198), 596–603. https://doi.org/10.1016/S0140-
6736(19)31275-9
DQ-3
A focused assessment targets a specific patient problem that
involves information gathering and interpretation, which is
followed by a list of differential diagnoses and diagnostic tests.
.The focused interview includes leading the patient with guided
and open-ended questions to assist them in prioritizing their
concerns (Bickley & Szilagyi, 2017). For instance, a patient
with a chief complaint of productive cough for three weeks
would involve collecting a health history, such as whether they
have allergies, asthma, or COPD, along with determining if they
smoke, have been exposed to any illnesses or environmental
toxins. Subjective data would be assessed including whether
they experience any shortness of breath, indigestion,
congestion, fever, or chills. In addition to assessing vital signs,
objective data would be collected, which includes conducting a
general survey of their overall appearance to help rule out a
variety of other medical issues and then completing a
respiratory assessment (Asif, Mohiuddin, Hasan & Pauly, 2017).
Once a list of probable diagnoses is developed, further
information is obtained in the diagnostic process, which will
help narrow the potential options. According to Bhise et al.

(2017), a major factor to consider when ordering a test is the
time-dependent nature of the diagnostic process. Some
diagnoses may be more important to establish immediately than
others, leading to significant patient harm if not recognized,
diagnosed, and treated early. For the patient with a productive
cough, diagnostic testing would depend on their clinical
presentation and history. Coughing accompanied by tachypnea,
tachycardia, high fever, and pain on respiration points to
pneumonia, which would require a chest x-ray, blood cultures,
and a complete blood count. Whereas, if the history and clinical
findings are compatible with a cold or bronchitis, neither a
chest radiograph nor a chemistry panel would be necessary, if
there are no associated abnormal findings.
Asif, T., Mohiuddin, A., Hasan, B., & Pauly, R. R. (2017).
Importance Of Thorough Physical Examination: A Lost Art.
Cureus, 9(5), e1212. https://doi.org/10.7759/cureus.1212
Bhise, V., Rajan, S. S., Sittig, D. F., Morgan, R. O., Chaudhary,
P., & Singh, H. (2018). Defining and Measuring Diagnostic
Uncertainty in Medicine: A Systematic Review. Journal of
general internal medicine, 33(1), 103–115.
https://doi.org/10.1007/s11606-017-4164-1
Bickley, L. S., & Szilagyi, P. G. (2017). Foundations of
clinical proficiency. In Bates' guide to physical examination and
history taking (12th ed., pp. 3-43). Wolters Kluwer.

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