Abdomen Case Study Essay

Abdomen Case Study Essay
The sequencing that I will be using to assess the abdomen would be inspection, auscultation,
percussion, and palpation. I would inspect the abdomen for the shape of the abdomen, skin masses
and abnormalities. Inspection will give me clues whether I should percuss or palpate the abdomen.
Then, I would auscultate the abdomen for altered bowel sounds. It is important to auscultate the
abdomen first. Percussion and palpation tends to intensify peristalsis which can result to false
interpretation of bowel sounds (Jarvis, 2012). When I proceed to the patient's abdominal
examination, it is important to know the anatomy of the abdomen where each organ is located. I
would percuss M.M's abdomen and check for abnormal fluid and masses. According to Jarvis
(2012), flank dullness upon percussion may indicate fluid in the abdomen or ascites. I would do
palpation last if not contraindicated. Palpation is used for detection of masses and tenderness, but
because of the pain that palpation may trigger, it should be done in a careful manner. In M.M's case,
I would still ... Show more content on Helpwriting.net ...
I would listen for abdominal bowel sounds to listen for air or fluid activity eliminating bowel
obstruction in my assessment. It is common for someone who has a ascites to have a normal bowel
sounds, but diminished bowel sound over the ascitic area (Jarvis, 2012). I would do percussion to a
patient who have ascites and listen for dull sound. I would do a light palpation of the abdomen if the
patient tolerates. It is important that I check his mental status, because the buildup of toxins in the
brain is common to someone who has a history of alcohol abuse. I would watch the patient for
hepatic encephalopathy. Since the liver is unable to remove toxins from the blood and accumulates
in the blood resulting in confusion or decreased mental function. I would also look for signs of
ascites, because liver failure can cause fluid buildup and
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Work Related Trauma Case Study
DOI: 7/2/2010. The patient is a 57–year old female claims examiner who sustained a work–related
cumulative trauma injury to multiple body parts that include head/cervical spine, shoulders, arms
knees, and left hip. As per progress report dated 7/11/16, the patient reports neck and low back pain.
IT was noted that the pain is associated with left lower extremity numbness, tingling, and weakness.
The patient has tried and failed multiple anti–inflammatories, which causes gastrointestinal upset,
except for Celebrex. Her psychiatrist, Dr. Nehoryan has recommended her current regimen
including Cymbalta and Restoril intermittently for sleep. It was mentioned that the patient had a fall
in early 2/2016 due to left lower extremity numbness and is continuing ... Show more content on
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Conservative treatment notes included aquatic physical therapy, acupuncture, narcotic pain
medications, Transcutaneous electrical nerve stimulation (TENS or TNS), psychologist, and
hypnosis. The patient also has tried and failed multiple over–the counter and prescription remedies
for her opioid induced constipation including diet modification, stool softeners, and laxatives
including Miralax, Senokot, Metamucil. Ducalax. It was noted that Movantik is being provided to
help her with this situation. As per interval changes, the patient complains of ongoing neck and left
upper extremity pain, and an increase in low back and left lower extremity pain. Patient states that
she fell at home 2 weeks ago. She states that she injured her right arm and it has been swollen for 2
weeks. The pain score is 10 without medications and 2 with medications. The medications
prescribed are keeping the patient functional, allowing for increased mobility, and tolerance of
activities of daily living, and home exercises. Current medications incldue Nucynta, Percocet,
Restoril as necessary for insomnia, Cymbalta, Neurontin, Cselebrex, Robaxin, Prilosec, Singulair,
Vagifem, and

Carotid Palpation
Introduction
Most endurance trained athletes and participants in a group exercise class monitor their exercise
intensity through palpation of the carotid or radial artery. Heart rate (HR) is used as an indictor of
exercise intensity because of the linear relation between HR and oxygen consumption (Cotton &
Dill, 1935). The researchers of this study have decided to use pule rate palpation to monitor exercise
intensity because the procedure is described in many textbooks and it is common in various exercise
settings (American Collage of Sports Medicine, 2000). However most chronic exercisers have a
rapid recovery of HR following the cessation of exercise, and therefore carotid or radial palpation
could underestimate exercise HR. Also, endurance trained individuals have a greater arterial
baroreflex sensitivity and are more responsive to carotid palpation. Therefore, the palpation of the
carotid artery may unload arterial baroreceptors and elicit feedback reductions in HR (Heidorn &
McNamera, 1956). The primary aim of this study was to determine the accuracy of carotid and
radial palpation in estimating exercise HR and the effect of carotid palpation HR in chronic
exercisers. The secondary aim was to determine the association between the magnitude of
reductions in HR ... Show more content on Helpwriting.net ...
However for the results to be more meaningful and valid, a certified fitness trainer should have
taken the pulse rates. One study looked at the ability of certified fitness trainers and participants to
accurately palpate post–exercise HR. The post–exercise HR obtained by the trainers was 134 +/– 38
bpm and the participants obtained 140 +/– 25 bpm (Garner & Wagner, 2013). Having trainers obtain
pulse rates could avoid any bias from the participants; in other words, the researchers would know
that the pulse rates are accurate and not falsified or

Physical Therapy : Spine ( Lumbar / Cervical Thoracic )
1. Physical Therapy 3X6 – Spine (Lumbar/Cervical/Thoracic) Regarding Physical Therapy 3X6–
Spine (Lumbar/Cervical/Thoracic); CA MTUS supports an initial course of physical therapy with
objective functional deficits and functional goals. The claimant has basically whole body pain with
limitations in range of motion and tenderness in most all body parts. Medical necessity has been
established. However, initial 6 visits are given. Additional requests should include functional
improvement, discussion of functional goals and patient's progress in meeting these goals.
Recommend modified certification of PT 2X3 Spine (Lumbar/Cervical/Thoracic). 2. MRI – Spine
(Lumbar/Cervical/Thoracic) Regarding MRI–Spine (Lumbar/Cervical/Thoracic); the ... Show more
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However, plain films were not obtained. There is no clear rationale for the indication of shoulder
MRI with unequivocal objective findings and absence of plain films. In addition, there is no focal
neurological deficit on the exam. There are no sensory or motor deficits noted. Medical necessity
has not been established. Recommend non–certification. 4. MRI – right wrist Regarding MRI right
wrist; CA MTUS criteria for hand/wrist MRI include normal radiographs and acute hand or wrist
trauma or chronic wrist pain with a suspicion for a specific pathology. However, as noted above, no
plain films were obtained. There is no documentation or indication of an acute trauma to the wrist.
Recommend non–certification. 5. MRI – Left knee Regarding MRI left knee; CA MTUS
recommends MRI for an unstable knee with documented episodes of locking, popping, giving way,
recurrent effusion, clear signs of a bucket handle tear, or to determine extent of ACL tear
preoperatively. In addition, ODG criteria include acute trauma to the knee, significant trauma,
suspect posterior knee dislocation; nontraumatic knee pain and initial plain radiographs either
nondiagnostic or suggesting internal derangement. This is a chronic injury patient. There is no
documentation of any acute injury to the knees. In addition, there is no documentation of locking,
giving away, recurrent effusion, or signs of a bucket handle tear

Fundamental Case Study Essay examples
1. Mr. Dunner is admitted to his room accompanied by his wife. Before the nurse can begin the
admission assessment, Mr. Dunner states that he needs to "throw up." The nurse helps him sit up and
provides an emesis basin.
Mr. Dunner vomits into the emesis basin and then remains sitting on the side of the bed, stating he
may need to "throw up" again.Which assessment should the nurse complete first?
A. Auscultate the bowel sounds.
Another assessment should be completed before assessing the client's bowel sounds.
B. Palpate for abdominal distention.
Another assessment should be completed before assessing for distention.
C. Correct Observe the color of the emesis.
Since the client is vomiting, the nurse should first observe the color ... Show more content on
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H. When does the client develop his intolerance to spicy foods.
Other information is more useful in assessing the client's inability to eat spicy foods.
After completing the client interview, where Calvin reports that he gets severe indigestion and
heartburn after eating Mexican foods, the nurse is ready to begin the physical assessment of the
abdomen.
5. The nurse prepares Calvin for the physical assessment of the abdomen. Before assisting him to a
supine position, what action should the nurse take?
A. Correct Encourage the client to empty his bladder.
Emptying the bladder will help promote relaxation of the abdominal wall.
B. Ask the client to breathe deeply several times.
Breathing exercises may help relax the abdominal wall but should be done just prior to and during
the examination, not prior to client positioning.
C. Darken the room lights and lower the thermostat.
A brightly lit room aids the nurse in accurate assessment. A chilled environment can increase muscle
tension.
D. Instruct the client to place his hands over his head.
Placing the hands over the head can cause the abdominal muscles to tense.
After completing the preparations, the nurse assists Calvin to a supine position on the bed.
6. To assess the symmetry of the abdomen, what action should the nurse take?
E. Note pattern of hair growth.
The pattern of hair growth does not provide information related to the

Evaluation Of The Standardized Patient Experience
Reflective Evaluation
The standardized patient experience was useful and interesting for me because I became more
confident and active during nursing practice after that practice exam. This practical exam helped me
recall my professional experience from year 2012 and 2013 when I worked as a nurse in my country.
After that practice exam, I knew how staff nurses deal and communicate with patients from a
different culture and spoke different language. My specialization is nursing education, but I wanted
to take more practical classes during the course or study to obtain first hard experience and
confidence in dealing with patients.
I had the opportunity to elicit a comprehensive health history by using skillful interviewing
techniques. However, I was nervous and panicky because I thought the time will be not adequate to
complete the practical exam. I applied my skills and experience during health history section, but
the problem was I did not deal with any real patient during nursing practical about two years ago.
After I introduced myself to the patients, I started to ask and write patient name, age, and chief
complaint. Then, I started to ask patients about subjective data which included a history of present
illness, past medical history, family history, and personal and social history. I did an appropriate job
with subjective data. I did not ask patients about sexual history during subjective data based on their
situation and age. Also, according to my previous experience

Anatomy: Abdominal Assessment
Abdominal Assessment: Abdominal assement is a method to provide a comprehensive information
about the safe and accurate functioning of abdomen. Components: There are certain componenets
that are essential to be examined these include; inspection of shape, skin and umbilicus, palpation to
check for any tenderness, rigidity or masses, Auscultation to assess the bowel sounds and bruits and
percussion. Inspection: The first component is inspection. To perform onpection the patient should
be exposed from the xiphoid process till the pubic symphysis. After proper exposure first check the
shape of the abdomen from different angles. The normal shape of abdomen is scaphoid. Note any
change of shape. Check for any abnormal depression, or scar or mass

Comprehensive Medical Report Essay
Data: 06/03/09 Identifying Data: Name: J. Smith Sex: female Age: 44 Occupation: community
college administration assistant Reliability: good CC: bilateral shoulder stiffness, right elbow pain
HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right
arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed
gradually after she started using her computer more at her work place; she had to hold her telephone
between her shoulder and head while typing information on computer. The pain in right elbow stated
about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and
elbow. She has been diagnosed as tennis ... Show more content on Helpwriting.net ...
oots for HPB in April 2009 Cancer prevention: annual OBGYN checkup including mammogram, no
abnormality detected on last checkup in February 2009 Vision screening: regular screening every 6
months, no abnormality detected on last checkup in February 2009 Dental care: regular screening
every 6 months, no abnormality detected on last checkup in February 2009 ROS: General: no
history of weight change, fever or chills, weakness, fatigue, or change in appetite; occasional
difficulty falling asleep, mostly associated with stress from work Integument: N/A Hematopoietic:
N/A Eyes: N/A Ears: N/A Nose/throat/sinuses: N/A Mouth: N/A Pulmonary: N/A Breasts: N/A
Cardiovascular: N/A Gastrointestinal: occasional heartburn and bloating, especially after
consumption of Indian foods; no history of nausea, vomiting, bowel changes, melena, hematochezia,
dysphagia, jaundice, abdominal pain reported Urinary: N/A Geniral/Reproductive: N/A Menses: 26–
27 days of cycle duration, 3 days of actual bleeding and 1–2 days of spotting afterword, moderate
flow of bright red blood, no clots; mild increase in appetite 2–3 days prior to periods, no other PMS
symptoms; no history of dysmenorrhea or abnormal bleeding; no menopausal symptoms Endocrine:
N/A Musculoskeletal: bilateral shoulder stiffness and lateral elbow pain in right arm (see HIP)
Neuro: rarely experiences headache; no history of syncope,

Symptoms And Treatment Of Injury Essay
This is a 52–year–old female with a 4/1/2002 date of injury. A specific mechanism of injury has not
been described.
DIAGNOSIS: Cervicalgia, Contracture right shoulder, long term (current) use of opiate analgesic.
01/25/16 Progress Report indicated that the patient has continued pain in the cervical spine, which
radiates down to the right arm above the elbow. There is some aching at the cubital tunnel with no
distal numbness in the forearm and hand. She takes OTC ibuprofen to reduce pain. She presented
with a pain of 2/10–level. The ongoing neck pain is located diffusely. It is described as burning.
ROS was positive for insomnia, anxiety and depression. The exam revealed cervical spine
tenderness. There is decreased ROM on flexion, extension, rotation and left lateral bending. Right &
Left Shoulder: there was tenderness to palpation at the subacromial space and pain with restricted
ROM on abduction. Lumbar: there was tenderness to palpation over the facet joint. The ROM was
decreased on flexion, extension and lateral bending. Treatment Plan: continue Ibuprofen;
recommend MRI; and Electro diagnostic studies of the right upper extremity. Follow–up is on
04/18/16.
10/26/15 UDT Report was negative for all drugs, including amphetamines, barbiturates,
benzodiazepine, cocaine metabolite, methadone, and Opiates.
10/26/15 UDT Report described that the patient has neck pain located centrally. It is described as
aching and is constant. The symptom is ongoing. The pain is rated

Sij Dysfunction Reflection
Examining patients with suspected SIJ dysfunction, I first begin with the examination with the
lumbar segments to evaluate any instability or dysfunctions. I would check first CPR stenosis, then
Zygapophyseal joint problems using Revel's criteria, especially absence of pain by cough/sneezing;
no pain when the patient is rising from body flexion to extension position, and no pain by extension
rotation criteria's would rule out facet problems.
Tests like Slump, PA springing test, SLR, Crossed SLR, passive lumbar extension and prone spine
instability tests, active lumbar repeated movements test would help me to rule out the LS
pathologies. Next step, I would skip pelvic and move to the hip segment to clear intra–articular and
extra–articular ... Show more content on Helpwriting.net ...
Altogether using cluster of findings including provocation testing, pain location, palpation, strength
testing, and mobility testing would help me to diagnose of painful SIJ pathology.
There are new tests and measures in the monolith that I will definitely like to add to my evaluation
for SIJ. The integrate mobility tests; stork test, lumbo–pelvis rhythm, sacral and Ilium motion
evaluations, I did not use in the past. Measuring spine, Ilium, sacrum, hip motion and movement
patterns trough palpation and observation, I believe, would add value on my evaluation. Also,
McGill's endurance tests (core ratio) are new for me to use with PGP patients. But I can see the
correlation pelvic pain and the strength level of the abdominals.
Overall, it is difficult to evaluate and diagnose pelvic joint dysfunction. The problem is that there is
no accepted reference standard for SIJ movement dysfunction. The anatomy of functional pelvic–
girdle, load transfer system, and structural relationship and the pattern of intra pelvic motion during
stance and swing phase are important in evaluation a SIJ patient as their pain and

Snellen Case Studies
Eyes The eyes and eyebrows are symmetrical. There is even hair distribution among the eyelashes.
She is able to close her eyelids completely. Upon inspection, the conjunctiva is clear over the sclera
and pink in the lower lid area. The sclera is white. The eyes are not sunken in (enophthalmos) nor
protruding (exophthalmos). The patient's eyes are glossy, and the pupils are 4 mm in diameter at
resting. The pupils are round, equal, and symmetrical. Both pupils react to light both direct and
consensual. Both pupils demonstrate accommodation. A Snellen chart was not available to test
acuity. The patient does report wearing contacts and needing to use glasses. She states her last eye
exam was November 2017. Testing of the extraocular fields was ... Show more content on
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There are 5 flat brown macules noted on her back: one on the lower left border of the right scapula 2
mm in diameter, one near the right shoulder 2mm in diameter, one midline between the shoulder
blades 3 mm in diameter, one near the left shoulder 1mm in diameter, and one higher near the neck
area 2 mm in diameter. All macules are symmetrical. The posterior chest is symmetrical with
symmetric muscle development and tone. Chest expansion was assessed posteriorly with adequate
symmetrical equal expansion noted. Tactile fremitus was assessed posteriorly with symmetrical
vibrations noted in all ten areas. Auscultation of the posterior chest reveals clear lung sounds in all
18 areas. The patient does not complain of pain or tenderness with palpation of the costovertebral
angle. She does not complain of pain or tenderness with palpation of the scapula or of the spinal
column down to the lumbar region. The spine was unable to be fully assessed due to doctor's orders
of bedrest. The patient has a normal AP diameter 1:2. Upon inspection of the anterior chest the skin
is appropriate for ethnic background with pinkish undertones. There is effortless rise and fall of the
chest with respirations. Respiratory rate is 18 breaths per minute and are effortless and unlabored.
There are no pulsations noted over the five key landmarks (aortic, pulmonic, tricuspid, erb's point,
and mitral). The patient

Carotid Artery Essay
The pathological changes of the carotid artery can affect the brain and on another hand the
hemodynamic changes at the heart, aorta and brain can be detected at carotid artery. For example, if
the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of
atherosclerotic plaque breaks off and obstructs blood flow to the brain, a stroke may develop.
Therefore, this is a strong rationale to consider that cardiovascular event may ultimately be more
closely related to carotid artery rather than brachial artery [5]. Carotid arteries, the major vessels
supplying the brain are directly connected to aorta closer than peripheral arteries such as brachial
and radial artery (Figure 1). Currently research is more focused on non–invasive determination of
pressure waveform measured at carotid artery [12].
The pulse examination of the human artery has been practiced in assessing health since the history
of Traditional Chinese Medicine in the 6th century BC [13]. Pulse palpation is an important part of
the vascular physical examination. The pulse can be palpated in any place that allows an artery to be
compressed against a bone, such as carotid artery at the neck, brachial artery on the inside of the
elbow, radial artery at the wrist and femoral artery at the ... Show more content on Helpwriting.net
...
The technique of non–invasive pulse wave analysis, as described here, depends on different
principles and type of the pulse wave. Pulse wave analysis in clinical practice is commonly used by
the hand–held tonometry probe. It is simple to use, a non–invasive and accurate method using a
small strain gauge sensor detects the force on the artery wall [2]. The principal of applanation
tonometry is a partial compression of a pulsating carotid artery against muscle and vertebral body of
the neck and its pulse wave spreading in the skin impacts the

A Case Study Of The Diagnosis Of Managed Care
The patient is a 54–year–old individual who sustained an injury on 03/07/17 due to a fall.
The recent diagnoses included a sprain/strain of the cervical, thoracic, and lumbar spine, a
sprain/strain of the right shoulder, rule out rotator cuff tear, a sprain/strain of the right elbow, rule
out cubital tunnel syndrome, a sprain/strain of the right wrist, rule out carpal tunnel syndrome, De
Quervain's disease, and a sprain/strain of the right hand, knee, ankle, and foot.
Treatments rendered to date included medications.
The most current medication regimen included Cyclobenzaprine and Acetaminophen. Her past
medical history was significant for pre–diabetes, hypertension, and high cholesterol.
Medical records reviewed included Doctor's ... Show more content on Helpwriting.net ...
The Soto–Hall's test was positive. Her thoracic spine examination documented tenderness to
palpation in the spinous processes of the thoracic spine. Lumbar spine examination revealed
tenderness to palpation in the paralumbar muscles associated with spasm. The lumbar spine range of
motion revealed a flexion of 45°, an extension of 20°, and lateral bending of 20°, with pain in all
planes. Bechterew's test was positive for low back pain. Her right shoulder examination documented
tenderness to palpation in the upper trapezius and rotator cuff muscles. The Drop arm test was
questionably positive. Her right shoulder range of motion revealed a flexion of 160 degrees, an
extension of 40°, abduction of 160°, adduction of 50°, external rotation of 80° and internal rotation
of 80°, with pain in all planes. Her right elbow examination revealed tenderness to palpation. Her
range of motion revealed flexion of 140°, extension of 0°, forearm supination of 70°, with pain in all
planes. The tennis elbow test was questionably positive. Tinel's sign was also positive. Her right
wrist examination revealed tenderness to palpation. Right wrist range of motion revealed a palmar
flexion of 50°, dorsiflexion of 50°, as well as radial and ulnar deviation of 20°,with pain in all
planes. The Tinel's sign was questionably positive and the Finkelstein's

Work Related Injury Case Summary
DOI: 9/30/1997. The patient is a 50–year–old female reservation clerk who sustained a work–related
injury to her back and bilateral lower extremities when she tripped and fell.
Based on the medical report dated 03/29/16 by Dr. Riley, the patient complains of increased pain to
both heels, left greater than the right. She states that the pain is most severe with the 1st step in the
morning or after periods of rest. She is requesting new custom orthotics, as her existing pair have
become very worn. They are more than 2 years old. Additionally, she sustained a trip and fall Injury
on 2/2 with her knee "giving out." Two days prior to this visit, patient is with pain and swelling to
the left great toe joint. She is unclear if the injury occurred with the fall, or in the process of ... Show
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There is a soft tissue mass to the left lateral ankle overlying the sinus tarsi, consider with lipoma.
There is collapse of the medial arch with calcaneal valgus with weight bearing. The IW functions in
end range pronation throughout midstance of gait. There is tenderness upon palpation to the
posterior plantar aspect of the left heel at the insertion of the calcaneus. There is mild pain with deep
palpation to the right foot in the same location. She has pain with dorsiflexion and plantar flexion of
the dorsal aspect of the left 1st metatarsophalangeal joint. There is no pain with active dorsiflexion
and plantar flexion with resistance.
Current medications include Tylenol #3, Voltaren, Norco and Zoloft.
Of note, anteroposterior and lateral views of the left foot taken on this visit reveal no evidence of
fracture or dislocation. There is mild periarticular osteophyte formation, however, no Joint space
narrowing is noted.
Assessments are 1st metatarsophalangeal left foot joint sprain, plantar fasciitis, left greater than the
right and symptomatic lipoma of the left

What A Postnatal Abdominal Palpation Is Important For A...
This essay will first describe partnership and how a midwife working in the continuity of care model
develops and maintains it. Secondly, this essay will describe what a postnatal abdominal palpation
is, why it is done and what the outcomes may be. It will also describe the anatomy and physiology
of a uterus and involution. Lastly, a description of how the assessment is conducted and how during
this partnership and cultural safety is maintained by the midwife.
The partnership between a woman and her midwife is the key to a successful birth experience. This
partnership is a professional friendship that allows midwives to get to know women and their
bodies.
This model identifies midwifery partnership as a relationship of 'sharing' between the women and
the midwife, involving trust, shared control and responsibility and shared meaning through mutual
understanding. It is the sharing relationship which constitutes midwifery and it is one which spans
the life experience of pregnancy and childbirth. (Guilliland, K., & Pairman, S, 2010, p. 7).
This partnership is formed throughout the continuity of care Model. According to Leap & Pairman
(2010) "The development of this partnership relationship relies on midwives being able to work in
continuity–of–care models so that mutual trust and understanding between midwives and women
can evolve over time"(p. 338). The continuity of care model that lead maternity carers work with, is
where midwives support woman from the day they find out

Bilateral Hip Flexion Report
Hip ROM
Bilateral hip flexion, internal rotation and external rotation ROM was measured using goniometric
methods as defined by Norkin and White.24 Bilateral hip internal and external rotation were
goniometrically measured in sitting (Figure 3 & 4), while hip flexion was measured with the patient
in supine (Figure 5).
Manual Muscle Testing Bilateral LE muscle strength was determined using the manual muscle test
(MMT) "break test." In sitting, the patient was requested to perform bilateral hip flexion, internal
and external rotation, knee flexion and extension, and ankle dorsiflexion against graded manual
resistance applied by the examiner.27 To assess bilateral planterflexion, the patient was asked to
stand on one leg at a time and raise herself onto her toes with only fingertips touching the mat
table.27 ... Show more content on Helpwriting.net ...
The psychometrics of each special test has been summarized in Table 2.
The straight leg raise (SLR) test was administered to confirm the diagnosis and symptoms.28–30
The SLR was performed in supine position as described by Cook et al.30 The patient was instructed
to individually lift each straight leg up as high as she could. Once the patient reported her
symptoms, a goniometric measurement at the hip was taken. This was completed bilaterally.
Additionally, the standard SLR revealed a positive result for crossed SLR (XSLR) in which the
patient experienced symptoms in the contralateral leg with the SLR

Work Related Injury: A Case Study
DOI: 2/12/2014. The patient is a 67–year–old female janitor who sustained a work–related injury to
her bilateral feet, lower extremities, hands, and wrists due to constant walking and cleaning.
Per AME dated 04/14/2016, the patient had reached Maximum Medical Improvement and was noted
to be Permanent and Stationary.
Based on the progress report dated 09/13/16, the patient reports unchanged intermittent moderate
left foot pain. Patient also notes of intermittent moderate low back pain and left hand pain, that
bothers her most. The patient went to a foot specialist last week, who administered an injection that
increased pain and seems to have not taken effect yet.
Examination of the left hand reveals diffuse tenderness to palpation. Grip

Neck: A Case Study
Head was inspected for size, shape, position and symmetry. Scalp noted clean and well maintain, no
dryness, or lesions were noted. No sign of hair loss were observed. Facial structure were
symmetrical, no skin discoloration, rashes, swollen or lesion were noted. No involuntary movement
of the face were perceived. Neck was inspected, good symmetry were noticed, and no scar or lesions
were perceived. No large lymph nodes or mass detected during palpation, patient denies pain or
tenderness. Thyroid gland was not visible, during palpation no mass or nodule were identified. No
bruit was perceived during auscultation of the thyroid lobes. Trachea was noted to be in the midline,
no deviation was noted. Visual acuity, visual field, extraocular movement,

Essay on Reflective Nursing Case Study
Case Study One
In this case study I will use Gibbs (1988) model of reflection to write a personal account of an
abdominal examination carried out in general practice under the supervision of my mentor, utilising
the skills taught during the module thus far.
What happened
During morning routine sick parade I was presented with a 21 year old male soldier experiencing
severe acute, non specific, abdominal pain. Under the supervision of the medical officer (MO) I
proceeded to carry out a full assessment and abdominal examination, using Byrne and Long's (1976)
model to structure the consultation. I requested the patients' consent before conducting the
examination, as is essential before commencement of any medical procedure, be it a ... Show more
content on Helpwriting.net ...
Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation,
and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute
abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with
abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects
of the physical examination and had to be prompted by the MO. Although with more practice such
incidence would be reduced.
Analysis
I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the
examination to collect data, analyse it, and use the results to make an appropriate decision (Schon,
1984). However, had I performed the examination without assistance I may not have gained all the
information required to confirm diagnosis, as I did forget some aspects.
Conclusion
The MO seemed happy with my diagnosis and care plan, though he did highlight the importance of
practicing the physical examination skills in order to become a more competent practitioner. Overall
I feel gaining knowledge and skills in translating a patients' history and physical examination
results, has enabled me to become more confident in making a diagnosis and has improved my
decision making skills.
Action Plan
In order to become a more capable and effective practitioner I must continue to

Effects Of Musculoskeletal Palpation On Athletic Training...
To evaluate injuries, musculoskeletal palpation is taught in many athletic training programs.
Oftentimes, the focus is on accuracy of surface anatomy landmarks instead of the ability to
discriminate qualitative information such as, tissue tone, spasm, or pain response from the soft
tissue. Palpation is a large foundation for evaluation and intervention, a need to further the
development of this skill exists. Due to this the integration of tasks to improve palpation skills
throughout athletic training curriculum may help improve student confidence, accuracy and
precision while performing patient evaluation and manual medicine interventions. Recent research
has proven that stereognosis drills can improve student's palpation skills and provide advanced
training to better refine palpation skills. Below, the definition of stereognosis will be defined, as well
as, altering techniques to perform these drills. 1
The use of manual medicine has become increasingly popular in the profession of athletic training.
This occurs because athletic trainers are seeking new ways to rehabilitate their patients. Typically,
these techniques require the athletic trainer to palpate superficial and deep structures of the body
with great accuracy and discrimination. Ironically, many athletic trainers and students report
difficulty with their personal abilities to feel and discriminate the local soft tissue. Stereognosis is a
concept first introduced by Hoffman, as an individual's ability to

Bp Psychology Case Study
Bozena Czekalski
John is a 16 year old African American male. He presents for a pre–participation physical exam for
football. He has been in good health since his last PE 1 year ago. He lives with his mom and 12 year
old sister. He will be a sophomore in high school this fall.
PMH: Last tetanus at 11 years of age Last Menactra 11 years of age
PSH: none
Nutrition/exercise: No breakfast, Lunch – fast food from school cafeteria, Dinner – what mom cooks
– meat/potatoes; Snacks – chips, milk
Home: Lives with mom & sister – good relationship
Education: 11th grade, plays football, gets C's in most classes. Wants to be a pro football player
Activities: Plays soccer and runs track
Drugs/Drinking: Tried marijuana 3 X this summer with ... Show more content on Helpwriting.net ...
al., 2013, p. 114).
What guidance do you offer for John's mother?
Johns is an inexperienced adolescent in negotiation and he may often argue a point to excess.
Arguing is a normal behavior for teenagers that reflect their use of more abstract thinking skills.
Discuss the need for clear rules, expectations and consequences before trouble has occurred.
Discuss the need of parents to be involved in John's life to be there to answer questions and
concerns when they arise.
Discuss the importance of being involved in John's school (meet his teachers and stay in touch with
them to help John succeed).
Continue involving John in family activities, even if he is not interested.
Encourage to keep promises made to teenagers (that will help with establishing trust, respect and
being a role model).
Be a role model.
Continue to supervise John's

Medical Case Report: 48 Year-Old Patient
DOI: 6/20/2008. Patient is a 48–year–old male foreman who incurred a work–related injury on
6/20/2008 when he was struck from behind while at stopped on red light.
MRI of the lumbar spine without contrast dated 5/22/14 revealed degenerative disc disease at L3–4
through L5–S1; large central and right paracentral disc herniation and extruded disc at L4–5; there is
severe stenosis of the right neural foramen at L4–5 entrapping the right L4 nerve; and severe right
and left neural foraminal stenosis at L5–S1 entrapping the right and left L5 nerves.
As per office notes dated 4/21/16, the patient complains of neck pain on the left side, radiating to the
left shoulder and between shoulder blades. The pain is constant (90–100% of the time). It is sharp
and throbbing. The pain becomes worse with ... Show more content on Helpwriting.net ...
The pain is better with rest. The upper neck pain is radiating around the skull and triggering frequent
headaches, low back pain is radiating to the right posterolateral thigh and calf wrapping around and
including dorsum of the right foot and middle toes. The patient also has left wrist pain. Current
medications include Menthoderm, Flexeril, Naproxen, hydrocodone–acetaminophen, Bactrim,
bupropion "Sr", and Ventolin "Hfa". Physical examination revealed that the patient's gait has a left–
sided antalgic gait. He does not use assistive devices. Cervical spine examination revealed
asymmetry or abnormal curvature noted on inspection. There is also tenderness and trigger point (a
twitch response was obtained along with radiating pain on palpation) is noted on both sides. Lumbar
spine examination revealed loss of normal lordosis with straightening of the lumbar spine. Lumbar
range of motion is has limited flexion of 60 degrees and limited extension of 10 degrees. The range
of motion is limited by pain.

Hip Pain Case Studies
This is a 38–year–old male with a 3/14/2014 date of injury. He sustained the injury while
performing his regular job duties. He was backing up while carrying a bucket of fire–proofing
material, when he tripped and fell over some stacked plywood.
DIAGNOSIS: Radiculopathy, lumbar region; other dorsalgia, unspecified inflammatory
spondylopathy, lumbar region
12/18/15 Progress Report indicated that the patient presents with back pain radiating down his right
leg; lower backache and right hip pain. The pain is 10/10–scale level without medications and 9/10–
scale level with medications. His quality of sleep is poor. His activity level has remained the same.
Current medications include Lidocaine 5 % patch, Cymbalta 30 mg and Vimovo Dr 500–20 mg. ...
Show more content on Helpwriting.net ...
The patient presents with chronic low back pain recalcitrant to activity modification, physical
therapy, and medication. The patient has low back pain that radiates down his leg. The exam
revealed Trigger point and twitch response on palpation at the lumbar para–spinal muscles on right.
Sensations were decreased to light touch over L4 lower extremity dermatome on the right side. Per
ODG, Radiculopathy is not an indication (however, if a patient has MPS plus radiculopathy a TPI
may be given to treat the MPS). In this case the patient clearly has radiculopathy and MPS; a TPI
may be given to treat his MPS. Medical necessity of TPI has been established. Recommend

Chronic Acalculous Cholecystitis
When a patient comes with abdominal pain, it can be due to different causes. The pain may be
visceral, somatoparietal or referred pain as an indicator of a wide variety of systemic and local
causes. Visceral pain is from abdominal distention or stretching of the muscle fibers, carried by
sympathetic nerve fibers, presents as dull, poorly localized pain in the mid areas of the abdomen.
Somatic pain occurs once the parietal peritoneum is inflamed or irritated, and passed by sensory
fibers. Somatic pain is better defined and more localized, high intensity, and also associated with
tenderness and spasm of the localized muscle groups.
Differential diagnosis
Chronic Acalculous Cholecystitis: Here Ms. G presented with right upper abdominal pain, ... Show
G: Ms. G appears ill–looking, uncomfortable and clutching her abdomen, as she is experiencing
pain, she rated her pain as eight on the scale of 0 to 10 as 10 being the worse pain. The pain of Ms.
G is in her upper abdomen and radiating to her upper right back and right scapular tip consistent
with Collins sign. The pain initially stated as achy but changed to colicky in nature and became
more constant. The pain started after she ate and vomited few times before arrival. Percussion of
Ms. G's abdomen is significant for tenderness to palpation towards her upper right quadrant a
positive murphy's sign, without rebound tenderness. Bowel sounds are normal. Ms. G's clinical
presentation is consistent with Cholecystitis. The pain for Cholecystitis usually starts within an hour
post food; it can last from one to five hours and increases steadily over ten to twenty minutes along
with Collins sign, and the pain doesn't relieve after vomiting.
Diagnostic tests
CBC with differential
Leukocytosis with a left sided shift is the common abnormality in Cholecystitis. A high white blood
cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder.
Gall bladder ultrasound
Gall bladder ultrasound typically helps in establishing the diagnosis of Cholecystitis. A sonographic
Murphy's sign, (when the ultrasound probes the ultrasound patient will have pain) is a useful
diagnostic

Cholecystitis Case Study Essay
Presenting symptom:
A 28–year old Caucasian female patient is presenting with a new breast lump found on self–
examination at home. The patient describes this breast lump located in the left upper quadrant of her
breast and states that it is approximately the size of a pea and is hard.
The physical examination would include a thorough breast examination. The patient should be
covered for decency and exposing one breast at a time should be done. Breasts are divided into four
quadrants based on horizontal and vertical lines crossing at the nipple (Bickley, 2013). Palpation of
lymph nodes in the lateral, central, subscapular, pectoral, supraclavicular and infraclavicular areas
should be palpated to determine any further lumps. A thorough health ... Show more content on
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Patients may be more apt to take breast cancer seriously and do monthly examinations knowing that
they have a BRCA mutation. This may help to save lives and prevent future health declines
associated with breast cancer. There are also many cultural considerations with breast cancer. For
example, Latinas are usually diagnosed with breast cancer in advanced stages (Kingsley, 2010). This
may be because it can be taboo to talk about cancers or perhaps those born to poor economic status
do not have access to adequate health care screenings. However, Latinas have a lower incidence of
breast cancer compared to Caucasians (Kingsley, 2010). No matter the race, age, ethnicity, culture or
religion breast cancer is a serious illness and getting immediate medical attention may just save
someone's

Trigger Point Of Muscle Demographics
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in
skeletal muscle that are associated with palpable nodules in taut bands of muscle fiber. These very
localized areas in muscle tissues and/or their tendinous attachments are often felt as taut bands when
palpated, which elicits pain. A trigger point is a very circumscribed region in which relatively few
motor units seem to be contracting. So it is localized spot of tenderness in a nodule of a palpable taut
band of contractured muscle fibers The exact nature of a trigger point is not known. It has been
suggested that certain nerve endings in the muscle tissues may become sensitized by algogenic
substances that create a localized zone of hypersensitivity

Informatic Cancer Case Write Up
DOI: 9/18/2000. Patient is a 59–year–old female technician who sustained a work–related injury due
to being jostled and jolted in the back of a golf cart which ran over a pothole. As per OMNI, she was
diagnosed with post cervical protrusions, facet syndromes with headaches, lumbar facet syndrome
and status post right shoulder repair/resection.
Urine drug screen obtained on 05/02/16 showed positive for hydrocodone, norhydrocodone,
Zolpidem, gabapentin, meprobamate and caffeine.
Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with
medications and 10/10 without medications. Current medications include Ambien 10mg; Maxalt–
MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg. ... Show
Quality of sleep is fair. Activity level has remained the same.
On examination of the cervical spine, there is tenderness and tight muscle band is noted on both the
sides of the paravertebral muscles. There is pain with extension and palpation of right facets.
Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90
degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin's test, Neer's test,
Shoulder crossover test, Empty Cans test, Lift–off test, and Apprehension test is positive. On
palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Identifying The Components Of A Client 's Health History
2. Identify the components included in a client's health history. Biographic Data–The client's
demographic data, should include the name, address, age, sex, marital status, occupation, religion,
health care financing, and their primary care provider. Chief Complaint–The reason for the visit
should be obtained and documented in the client's own words. History of Present Illness–Gather
more information about the present illness by asking questions such as: When did the symptoms
start? Did it occur suddenly or gradually or increased over time? How often does the problem occur?
What is the intensity of the pain? Can you rate it from 0 to 10? How much sputum, vomit, or
discharge came up or out? What color was it? Was it watery, thick, or ... Show more content on
Helpwriting.net ...
Moreover, diseases that require particular attention includes: heart disease, cancer, diabetes,
hypertension, obesity, allergies, arthritis, tuberculosis, bleeding, alcoholism, and mental health
disorders. Lifestyles–Ask the client about their personal habits such as the amount of tobacco,
alcohol, caffeine, or recreational drugs consumed. Also, obtain their normal daily diets, special diets,
or ethnic food patterns; and the amount of meals and snacks per day. Likewise, who cooks and do
the shopping? In addition, ask about the client's sleep pattern. What time do you go to bed/ what
time do you wake up? Any you having any problems sleeping? Have you tried anything to correct
this problem? Furthermore, ask about the daily living activities. Are you having any problems
performing basic activities such as eating, grooming, dressing, elimination, or locomotion? Are you
having any problems with preparing foods, shopping, transportation, housekeeping, laundry, or the
ability to use the telephone, handle finances, or manage your medication. Finally, ask the client do
you exercise and how well do you tolerate the activity? Do you have any other hobbies? Social
Data–Ask the client who helps them during times of stress? What effects have your illnesses had on
the family and are there any family problems affecting your illness? Do you have any religion or
beliefs that could affect your health or recovery? Moreover, find out about the client's education.

Identifying The Components Of A Client 's Health History
1. 2. Identify the components included in a client's health history. Biographic Data–The client's
demographic data, should include the name, address, age, sex, marital status, occupation, religion,
health care financing, and primary care provider. Chief Complaint–The reason for the visit should be
obtained and documented in the client's own words. History of Present Illness–Gather more
information about the present illness by asking questions such as: When did the symptoms start?
Did it occur suddenly or gradually increased over time? How often does the problem occur? What is
the intensity of the pain? Can you rate it from 0 to 10? How much sputum, vomit, or discharge came
up or out? What color was it? Was it watery, thick, or bloody? ... Show more content on
Helpwriting.net ...
Moreover, diseases that require particular attention includes: heart disease, cancer, diabetes,
hypertension, obesity, allergies, arthritis, tuberculosis, bleeding, alcoholism, and mental health
disorders. Lifestyles–Ask the client about their personal habits such as the amount of tobacco,
alcohol, caffeine, or recreational drugs consumed. Also, obtain their normal daily diets, special diets,
or ethnic food patterns; and the amount of meals and snacks per day. Likewise, who cooks and do
the shopping? In addition, ask about the client's sleep pattern. What time do you go to bed/ what
time do you wake up? Any you having any problems sleeping? Have you tried anything to correct
this problem? Furthermore, ask about the daily living activities. Are you having any problems
performing basic activities such as eating, grooming, dressing, elimination, or locomotion? Are you
having any problems with preparing foods, shopping, transportation, housekeeping, laundry, or the
ability to use the telephone, handle finances, or manage your medication. Finally, ask the client do
you exercise and how well do you tolerate the activity? Do you have any other hobbies? Social
Data–Ask the client who helps them during times of stress? What effects have your illnesses had on
the family and are there any family problems affecting your illness? Do you have any religion or
beliefs that could affect your health or recovery? Moreover, find out about the client's education.
What is

Symptoms And Treatment Of Medical Records
This is a 56–year–old female with a 1–11–2015 date of injury, when he tripped over some cables
and fell.
01/08/16 DWC Form RFA for Acupuncture; X–Rays C/S, T/S, Bilateral shoulders; Referrals FCE,
Ortho surgeon, pain management; medical records are requested; and re–evaluate.
01/08/16 Progress Report noted that the patient sustained an initial injury in June 2014, due to a
cumulative trauma. She sustained a new injury in January 2015 as well. She sustained an injury to
her neck, right shoulder, right arm, and right knee. She had X–rays and MRI post injury. Her right
knee swelled, but improved right after she received treatment for her right shoulder and right knee.
She received PT and chiropractic treatment twice a week, medications and surgery to her right
shoulder in May 2015. She has received no treatment for her neck or left shoulder. She has not
received acupuncture. The patient presented today with complaints of occasional, mild to moderate,
throbbing neck pain, stiffness and cramping. The physical exam of the cervical spine revealed
positive tenderness to palpation of the cervical paravertebral muscles and bilateral trapezii. There is
also a muscle spasm of the cervical paravertebral muscles. The cervical ROM is decreased and
painful. Shoulder depression causes pain. The exam of the thoracic spine showed tenderness to
palpation of the thoracic paravertebral muscles, right trapezius, T1–T2 spinous process, T2–T3
spinous process, right Rhomboid and right lateral

Accuvein Finder
Inserting an IV into a patient can be a painful experience, especially if the individual has veins that
are hard to visualize or palpate. Some reasons for difficulty inserting IV catheters include obesity,
veins that roll or blow easily, dark pigmented skin, and dehydration. With the help of modern
technology, devices called Accuvein finders have made it a less painful process for patients. The
author will discuss how these devices have compared to palpation and inspection on hospitalized
patients in the last five years. This paper will focus on three articles that tested the Accuvein finders
and the results of each. Accuvein is a device that uses infrared light to illuminate veins (Aulagnier et
al., 2014). It has been a preferred method over ultrasound because of its portability and easy
training. There are different brands of the vein illuminating devices, such as Vein Locator Universal,
which is used at Sharn Anesthesia in Tampa (Aulagnier et al., 2014). AccuVein has shown promise
in pediatric patients and illuminates the hemoglobin of the veins (Aulagnier et al., 2014). ... Show
The attempt was done to lessen cannulation times in emergency situations. Nurses performed IV
cannulation in both groups using a tourniquet with up to three attempts. The results revealed that
AccuVein surprisingly was not more successful than inspection and palpation. The study conducted
included 266 patients and revealed that patients moved more when the operator used AccuVein,
therefore making cannulation difficult. (Aulagnier et al., 2014). The study also revealed that
although not by much, IV cannulation was quicker than using the AccuVein device. The research
team believes while the device illuminates an image of the veins, it is hard to determine if it can be
used for cannulation without

Symptoms And Symptoms Of Diabetes Type 2
The patient that I will do a full head to toe assessment is a 55 year old who has just been diagnosed
with diabetes type 2, she also has a history of sinus infections, allergies, and smoking
Skin: The client's skin is even in color, unblemished and no presence of any foul odor. She has a
good skin turgor, and skin's temperature is within normal limit. There is good oxygen, circulation,
and nutrition with no tissue damage. Patient has concern about being lights skin, but no melanoma
noted to skin. Palms, sole of the feet, and lips show no signs of cyanosis. No erythema or redness
noted to skin.
Hair: The hair of the client is thin, dry and brittle, hair is evenly distributed and has a variable
amount of body hair. There is no signs of ... Show more content on Helpwriting.net ...
When palpating the head, the skull is round anteriorly and posteriorly, no masses or indentions noted
Skull: When palpating the head, the skull is round anteriorly and posteriorly and posteriorly, no
masses or indentions noted
Face: The face of the client appeared even and has unbroken evenness and with no presence of a
mass or large nodules.
Eyes and Vision Eyes and Vision
Eyebrows: on inspection the eyebrows are even, no missing hair and symmetrical to both sides.
When patient raise the eyebrows, they show movement equally when lowered. No courseness of the
hair or failure to extend beyound the temperal canthus
Eyelashes: Eyelashes seemed similarly distributed, with no missing hair through out
Eyelids: when ask the patient to blink the eyelids, they blink at the same time. Also inspected the
invlountary movement of the eyelid, which was normal, no discoloration or disharges noted to the
eyelid. No drooping noted to eyelid
Eyes o During the assessment of the eye, visual accuity tested by reading material outloud, No
problem noted, Inpecting the eye they both looks white in color, no edema or discharges noted to the
eyes, conjunctiva smooth, pink and shiny and appear normal, no excessive tears to lacramal gland
when palpate the lacramal gland, no tenderness noted. Cornea is transparent, no dryness noted, the
iris are visible. When the cornea is touched the patient blinks.When

Esi Right Shoulder Pain Case Study
Reason for visit: s/p ESI Right Shoulder Pain.
Vital Signs –
S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care
as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain;
the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and
Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help
to decrease her pain to 2–3/10. TM denies any loss of ROM or sensation of the right arm; denies any
tingling or numbness.
O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there
was no warmth noted; on deep palpation TM reports in some tenderness

Importance And Importance Of Physical Examination
1 build a relationship with your doctor
2.1 Significance in personal life:
It is very useful in our personal life as physical examination includes all the basic assessment which
can give you an idea about your own health. It is also very beneficial in terms of assessing your
family members when they are in need or sick. This examination also helps you to maintain your
and your family's health in terms of your growth and development which includes BMI, Nutritional
guidance etc.
2.2 Significance in Social Context:
Importance of Physical examination in society plays a great role in health promotion. Healthy life is
always been a motive of health promotion and In every society there are institutions which are
focusing of health promotion. Many ... Show more content on Helpwriting.net ...
In many cases I observe that people are getting their checkup of physical examination done in every
6 months which is a good thing, they are very much interested in healthy life style and are ready to
maintain their health status.
2.3 Application in current Job:
As we are in nursing profession and working in clinical setting all the day, we encounter many
patients and we used to do physical examination every shift as per our hospital policy and we report
document in their file the observations and then doctors revisit, so the continuity of care must be
provided.
This again helps us in building competency in our assessment skill which will be beneficial for us
and for the patients.
2.4 Current Research:
Many researches have been done on the importance of physical assessment and it also shows that
regular physical examination helps in decreasing morbidity and mortality rates. It also helps the
health care workers to detect the diagnosis earlier and to treat them with promptness. Early
identification of Cancers are also been treated effectively and increase patients prognosis.
Concept 3: Assessment of Integumentary System
Introduction:
Integumentary system comprises of the skin and its appendages which includes hairs, scales,

feathers, hooves, and nails.
Significance of the Integumentary

Head to Toe Essay
The head to toe physical assessment is the first step of the nursing process and is a systemic
approach of collecting objective (physical) and subjective (mental) data on the patient that will help
the nurse formulate nursing diagnoses and plan patient care. It is also used to confirm or question
data that was stated in the pt. previous history stated in the charts and to evaluate the effectiveness of
the nursing interventions that were carried out on the patient. The main focus of the head–to–toe
assessment is to focus on what the patient is currently presenting with; the patient's responses to
actual or potential problems.
In preparing for the assessment, it is important to explain the purpose of the assessment, explaining
why it is ... Show more content on Helpwriting.net ...
The head to toe physical assessment is to be performed in less than 10 minutes using a stethescope,
pen light, your hands, and observational skills. It comprises of four different techniques: IPPA
inspection, palpation, percussion, and auscultation. This sequence, in apparent order, is used for al
systems except for the abdominal assessment, which requires auscultation before palpation and
percussion. Inspection is visually examining the person, focusing on one area of the body at a time.
Palpation is using touch, feeling for texture, size, consistency, and location of body parts.
Auscultation is listening for sounds within the body, mainly listening the lungs, heart, as well as the
abdomen with the use of a stethoscope. Percussion is tapping an area of the body with the fingers
and is usually a special assessment skill that the RN or physician uses, not a practical student nurse.
The nurse must initially evaluate the patient's charts for any bacterial precautions and fall risks. As
the nurse walks into the patient's room, the nurse begins by making sure the environment is clean
and safe. The nurse would do this by gathering equipment, washing hands thoroughly, and wear
gloves. The nurse is then to greet the patient, introducing self, then let them know exactly what you
came to do. The nurse should first ask the patient for his or her name, birthdate, location of where
the patient is currently at, and the reason as to what

Lh Detection
The systematic review is aimed to determine what methods have been used to identify the presence
of LH in diabetes patients treated with insulin. The result of this review reveals that there is little
research evidence to support the formulation of recommendations regarding the method of detection
of LH. Forty–three papers (original articles and conference abstract) were included in the review.
Three detection methods for LH are in current use namely visual inspection, palpation and
ultrasound. Fourteen papers presented use of ultrasound to detect LH and found the prevalence of
LH in the range 14.5–86.5%, compared to thirty–one papers using palpation. The prevalence
identified by palpation ranged from 14.5% to 54.9%. The variation in ... Show more content on
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However, the current use of ultrasound to detect LH uncovers the need for further research, to build
up a scientific foundation for such methods. Strengths and Limitations of the study
This is the first systematic review focusing on LH in diabetes people treated with insulin. A specific
search strategy was design and and a rigorous approach to the literature search and critical appraisal
was followed. It included all published full papers and conference abstracts found in the four major
databases in medical and nursing science, with no limitations on time of publication nor language. It
also included cases from both type I and type 2 diabetes. It covered different study designs and
encompassed research in five continents. The review includes patients using pump, syringe or pen.
The major limitation was the inadequate information due to limited published articles about LH
related to diabetes. Furthermore, the quality of most papers was moderate to low. Forty percent of
material was conference abstracts and case studies, reducing the information content and overall
quality. Removing low quality studies would have caused an incomplete description of

Patient Case 35: 35 Year Old Regular Employee
DOI: 01/14/2011. Patient is a 35–year old male Spanish, regular employee who sustained a work–
related injury while bending over to pick up air hose off floor. Per OMNI, patient was diagnosed
with Right Knee Strain. MRI of the right knee dated 02/03/2011 revealed menisci, cruciate
ligaments, and collateral ligaments, small acute impaction injury with full–thickness cartilage defect
in medial femoral condyle, small displaced osteochondral lesion of the inferior medial trochlea, mild
diffuse patellar tendinosis, and moderate joint effusion without loose intra–articular chondral or
osteochondral body. As per office notes dated 3/24/16, the patient is an obese patient who suffers
from ongoing knee and lower back pain which indicates her for aquatic

What Are The Four Basic Techniques In Physical Assessment
16. Demonstrate the four basic techniques utilized in the pysical assessment. The four basic
techniques utilized in the physical assessment are inspection, palpation, percussion, and ascultation.
To begin the techniques I will first wash my hands, and then make the patient as comfortable as
possible. Then I will start by inspecting the patient. I will observe the patient's state of consciousness
by having the patient repeat their name and date of birth along with telling me where they are at, and
what the date is. If there are any abnoramalities their, I will document them. Next I will observe
their overall state of health, look for any signs of physical distress. I will then look for any
lacerations, bruises, visible lumps or bumps, or things such as moles and birth marks, and body
symmetry. Again, if anything is abnormal I will document my findings. Also when inspecting the
patient I will document any oders and note their nature and source. If everything is not in the normal
limits the assessment will be ... Show more content on Helpwriting.net ...
Before administering any medication to a patient I check to see if I have the right patient by
checking their bracelet, and have them repeat their name and date of birth, then compare the name
on the medication to the information on the bracelet, and to what the patient has stated and verify
any allergies. Once I have the right patient, I will verify that I have the right medication. First, I will
check the medication order, and if something is unclear then I would ask the prescribing physician
to clarify the order. The next thing I must do is triple check the medication label. The triple check
involves checking the label when you retreive the medication, prepare the medication, and before
administering the medication. A side note to include here is that a nurse must never administer
medication that was prepared by another

Medical Case Study: Mr. Smith's Vital Signs
Mr. Smith is a 60–year–old male complaining of weakness, increased tiredness, and headache
lasting a few days. He has self–treated with over the counter medications with no improvement. The
patient history includes diagnosis of prostate cancer for 5 years. After collecting his current
complaint and medical history, the provider will need to conduct a physical examination on Mr.
Smith. The exam will include taking his vital signs, auscultation, percussion and palpation. Each
area of the examination has a specific purpose. During the vital sign portion, the provider will take
Mr. Smith's heart rate, blood pressure, breathing rate and temperature. The provider will then
compare them to his previous vital sign history. Although there is a normal ... Show more content on
Helpwriting.net ...
Smith came in with the same complaint as before, but is now stating he is also having shortness of
breath. His vitals were taken and there was an additional concern. Mr. Smith's blood pressure was
taken manually with a blood pressure cuff and stethoscope and determined his blood pressure was
currently at 160/100 mmHg. The 160 or top number is the systolic blood pressure which is the
amount of pressure being pushed through the arteries to the rest of the body while the heart is
beating. The 100 or the bottom number is the diastolic blood pressure which is the amount of
pressure in the arteries while the heart is at rest. The normal range for an adult is 120/80 mmHg. Mr.
Smith had an MRI completed at it revealed metastasis of prostate cancer to osseous tissue. He also
had an abdominal CT and it showed an obstruction of the intestine due to nodular enlargement of the
adrenal glands. He was again admitted to the hospital and had additional labs ordered. He had to
repeat the complete blood count and blood and urine potassium check, a blood glucose test, and an
adrenal stress test to include serum aldosterone, 24 hour urinary aldosterone, renin,
adrenocorticotopic hormone(ACTH) and cortisol

Abdomen Case Study Essay

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