3. Ашиглах Материалууд
• Насанд хүрэгчдийн эрүүл мэндийн үнэлгээ,
Ч.Энхтуул, Я.Энхжаргал, Л.Баатар, Р.Оргилмаа, Тод Бичиг, 2017
• Дотор өвчин судлал, Б.Гомбосүрэн, Мөнхийн Үсэг, 2013
• Дотор өвчний онош зүй, Б.Гомбосүрэн, Мөнхийн Үсэг,
2010
• Bates’ Guide to Physical Examination and History
Taking, 12th ed. Bickley, L.S, Wolters Kluwer, 2017
• Bates’ Guide to Physical Examination and History Taking,
Bickley, L.S, Wolters Kluwer, 2007
• Physical Examination and Health Assessment, Jarvis, Carolyn,
2004
• Mosby’s Guide to Physical Examination, Seidel, H.M, 2006
3
4. Ашиглах Материалууд
• (1) Korean Textbook: Che Kong Ok (2003). Health
Assessment, Hyong Mun Sa, Korea.
• (2) Fauci, A., Braunwald, E., Isselbacher, K., Wilson, J.,
martin, J., Kasper, D., Hauser, S., Longo, D. (1998)
Harrison’s Principles of Internal Medicine, 14th ed., New
York, USA: McGraw-Hill.
• (3) Seidel, H., Ball, J., Dains, J., Benedict, G.W., (1999).
Mosby’s Guide to Physical Examination, 4th Ed. Mosby:
America.
• (4) Swartz, M. (1994). Textbook of Physical Diagnosis, 2nd
Ed., Saunders: America.
• Scanned pictures from: Che Kong Ok (2003). Health
Assessment, Hyong Mun Sa, Korea. (pictures) (B)
-Mercier, L. (1995). Practical Orthopedics, 4th ed., St.
Louis, Mosby. (x-rays, scoliosis and dupuytren’s
contracture) (A)
4
5. I. ЭРҮҮЛ МЭНДИЙН ҮНЭЛГЭЭНИЙ СУУРЬ ОЙЛГОЛТУУД
I. ЭРҮҮЛ МЭНДИЙН ҮНЭЛГЭЭНИЙ СУУРЬ
ОЙЛГОЛТУУД
6. How do you know if someone is healthy?
• What is health?
6
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7. Health Assessment
• What is a health assessment?
– An evaluation of a person’s health.
– The foundation of all medical and nursing
interventions and treatments
• If the health assessment is wrong, it is likely
the treatments will also be wrong.
• If the patient gets the wrong treatments, the
patient won’t get better.
7
8. Health Assessment
• Health assessments must be an accurate and
complete assessment of the patient’s
problems.
• A complete health assessment should be done
the first time the patient is seen for treatment
or evaluation.
• It is also important to make ongoing
assessments of the patient’s problems.
8
9. Health Assessment
• A complete health assessment has many parts.
• Generally, the health assessment starts with a
patient health history.
• During the patient health history, the nurse
asks the patient about all areas of the person’s
health.
9
10. Patient Health History
• The patient health history is a very, very important
part of the health assessment.
• If the patient history is completed correctly and
accurately, the history will tell you much of the
information you need to make an accurate
diagnosis of the patient’s problem.
• After the history, an examination of the person’s
body can confirm that information from the health
history is accurate and the suspected diagnosis is
correct.
10
11. Health Assessment: Introduction
• What is a health history?
• What things are included in a health history?
• What is a physical assessment?
• What things are included in a physical assessment?
• Why is the health history and physical assessment
important?
• How do you perform a health history and physical
assessment?
11
12. Health History
• What is a health history?
–A health history is a task that the nurse
completes before performing a physical
assessment on a patient.
–A health history involves asking a patient
questions about every part of life that
affects health in order to find and
understand the cause of any health
problems the patient has.
12
13. Parts of a Health History
• Ерөнхий мэдээлэл:(Biographical Information)
• Үндсэн зовиур
• Одоогийн өвчлөлийн түүх
• Өнгөрсөн үеийн эрүүл мэндийн түүх
• Гэр бүлийн эрүүл мэндийн түүх
– Хувь хүн болон нийгмийн эрүүл мэндийн түүх:
• Сувилахуйн түүх
• Эрхтэн тогтолцооны үзлэг
• Сүүлчийн асуулт
13
15. Үндсэн зовиур
• Main reason for seeking health care at this
time (“What is the reason you came to the
hospital today?”)
• Use the patient’s own words
• Include symptoms
15
16. Одоогийн өвчлөлийн түүх
• A record of the situations and symptoms
leading up to, resulting in, or associated with
the chief complaint.
– “What are the main symptoms?”
– “Where is the pain/problem?”
– “When did it begin?”
– “How did it begin?”
– “How long do symptoms last?”
– “What makes it better/worse?”
16
17. Өнгөрсөн үеийн эрүүл мэндийн
түүх
• Negative information? What is NOT happening?
• Acute onset of new problems?
• Changes to chronic health problems?
• Exposure to infection/toxins?
• Impact on lifestyle?
• What treatments have already been tried and what have
been the results?
17
19. Өнгөрсөн үеийн эрүүл мэндийн
түүх
• Урьд нь өвдөж байсан өвчин/Past illnesses: (childhood
and adult): physical and emotional (example: pneumonia as
child, hypertension x 4 years; depression after childbirth)
• Хийлгэж байсан хагалгаа/Past surgeries: (example:
appendectomy, 1998)
• Гэмтэл, бэртэл/Past injuries (example: fracture to left femur,
2005)
• Хийлгэж байсан процедур (үр дүн)/Цус сэлбэлт/Past
procedures & results/transfusions: type and date: (example:
stress test (negative) 2003; received 2 units of blood after hip surgery
in 2000).
19
20. Өнгөрсөн үеийн эрүүл мэндийн
түүх
• Халдварт өвчин тусч байсан эсэх/Exposure to
communicable diseases: (example: mother has TB)
• Байгалын гамшигт өртөж байсан эсэх/Exposure
to environmental hazards: (example: works in coal
mine)
• Өсөлт хөгжил ба хөгжлийн
бэрхшээл/Developmental Stage and Problems:
(Examples: toddler with delayed speech abilities)
20
21. ӨНГӨРСӨН ҮЕИЙН ЭМ ТҮҮХ: Өсөлт
хөгжил ба хөгжлийн бэрхшээл
• Pediatric:
– history often provided by parent,
– need to assess for appropriate developmental
stage for age,
– be aware of age related anatomical differences,
– adjust communication skills/explanations for
parents/patient
21
22. ӨНГӨРСӨН ҮЕИЙН ЭМ ТҮҮХ: Өсөлт
хөгжил ба хөгжлийн бэрхшээл
• Adolescent:
– deal with increasing autonomy and decision making;
– relationship issues with family and friends
• Pregnancy:
– two patients in one- always be aware of BOTH,
– monitor for appropriate growth/changes in pregnancy of
mother and baby,
– monitor for complications
22
23. ӨНГӨРСӨН ҮЕИЙН ЭМ ТҮҮХ: Өсөлт
хөгжил ба хөгжлийн бэрхшээл
• Elderly:
– be aware of possible
• decreased hearing,
• poor vision,
• loss of memory,
• decreased mobility
• Patients with disabilities:
– be aware of limitations with:
• sight or hearing,
• mobility,
• understanding, etc 23
24. ГЭР БҮЛИЙН ЭРҮҮЛ МЭНДИЙН ТҮҮХ
• Parents/siblings/children: alive/dead; age and
illnesses (or cause of death): (examples: mother
died at 66yrs from lung cancer, father alive, age 61,
has hypertension)
• Charting information
•
female male female male
alive alive dead dead
24
26. ХУВИЙН БОЛОН НИЙГМИЙН ТҮҮХ
• Гэрлэлтийн байдал: single, married, divorced, separated-
(example: divorced last year, 2 children living with wife)
• Амьдралын нөхцөл байдал: who patient lives with, # of
children & where they live- (example: wife and 1 child at
home)
• Ажил- occupation, work schedule- (example: engineer, works
6 days per week)
• Боловсрол/бичиг үсэг тайлагдсан байдал: (example:
college graduate)
• Итгэл үнэмшил/Cultural, spiritual issues: (examples: Russian,
Korean; Buddhist, Christian, Muslim…; lacking meaning &
purpose in life)
26
27. ХУВИЙН БОЛОН НИЙГМИЙН ТҮҮХ
Хоолны дэглэм:
Usual eating habits?
Number of meals per day? Snacks?
Food eaten in the last 24 hours?
History of nutritional or eating problems?
Weight gain/loss?
27
28. ХУВИЙН БОЛОН НИЙГМИЙН ТҮҮХ
• Variety and amount of basic food nutrients
/groups: carbohydrates, fats, protein, water
(meat, dairy, fruits, vegetables, breads)
• Use of supplements
• Energy intake versus expenditure
• Measurements: height, weight, body
mass index [BMI]: kg/(height in m)²
28
29. Personal and Social History
• Body Mass Index (BMI)
Weight in Kg/ (Height in meters)²
<18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
>30.0 = obese
29
30. Personal and Social History
• Travel: recent or unusual (example: spent 6 months
in South Africa)
• Амралт/Нойр: hours and quality of sleep at
night (example: sleeps 6 hours per night, usually
wakes up once during the night but returns to sleep
quickly)
• Биеийн тамирын дасгал: type and amount
(example: walks 30 minutes 4 days a week)
30
31. Personal and Social History
• Архи, тамхи, хар тамхи хэрэглэдэг эсэх
(хэмжээ ба давтамж)
• Examples:
– Drinks 1 glass of wine with supper
– Drinks 4 beers on weekends
– 2 packs of cigarettes a day for 10 years (“pack-
year” is # of packs x years smoking: 2 x 10 = 20
pack years
31
32. Сувилгааны түүх
a. Эрүүл мэндийн талаарх ойлголт-эрүүл мэндийн
менежмент
1. Эрүүл мэндийн талаарх ойлголт
2. Эрүүл мэндийн менежмент
b. Хөдөлгөөн ба амралт
c. Хоол тэжээл, ялгаруулалт, зохицуулалт
d. Танин мэдэхүй/ ойлголт
e. Өөрийнхөө талаарх ойлголт/бодол
f. Үүрэг/хувийн харилцаа
g. Стресс, даван туулалт
h. Үнэт зүйл/амьдралын зарчим
i. Бэлгийн амьдрал /нөхөн үржихүй
48. Physical Exam
• What is a physical exam?
• A physical exam is an examination of a
patient’s body to evaluate the level of a
person’s health and discover any physical
problems or abnormalities.
48
49. Physical Exam
• What things are included in a physical exam?
• A complete physical exam involves examining
ALL parts of the body in an ORGANIZED,
SCIENTIFIC manner in order to determine the
health of each body system and the health of
the whole body.
49
50. Health History and Physical Exam
• Why are the health history and physical exam
important?
• The health history and physical exam are the
data collection portions of planning and
providing health care. In order to know what
care to give, you have to know what problems
you need to treat.
50
51. The Physical Exam
• How do you perform a physical exam?
• In adults and older children, physical exams
are generally performed by body systems,
starting with the patient’s HEAD and moving
toward the patient’s TOES.
• There are FOUR techniques used in a physical
exams…
51
53. Physical Assessment Skills
• Remember standard precautions and aseptic
technique:
– Always clean & dry hands before and after performing a
physical exam.
– Wear a waterproof Band-Aid over any cuts on your hands
to protect from the transmission of bacteria or viruses
through the cut.
– Wear gloves when touching any blood or body fluids:
drainage from a wound, nose, mouth, eyes, ears, etc.
– Use only clean (sterile or disinfected as required)
equipment when examining a patient.
53
54. Ажиглалт Inspection
• Do first
• Do carefully
• Use your senses (vision, hearing, smell…)
• General inspection- starts when you meet the
patient: posture, behavior
• Specific inspection- looks at each body part
54
55. тэмтрэх Palpation
• Touching or moving the body to determine
normal or abnormal areas
• Light-өнгөц (1 cm) or deep-гүн(4 cm)
• Able to detect mass, texture, fluid, crepitus
• Vibration: fingertips, ulnar surface of hand
• Temperature: dorsal surface of hands (3)
• Palpate painful areas last
55
56. Тогших Palpation
• Producing sound waves by striking one object
against another
• Tympany: loud, high pitch, drumlike, (abdomen)
• Hyperresonance: loud, low pitch, boomlike
(emphysema)
• Resonant: loud, low pitch, hollow (healthy lung)
56
58. Чагнах Auscultation
• Listening to a part of the body with a stethoscope
• Put the stethoscope on the patient’s skin (not over
clothing)
• Listen for pitch, intensity, duration, timing
• Listen to: heart beats, murmurs, bruits, lung sounds,
abdominal sounds….
• Be aware of correct timing for ausculation (before
or after palpation?)
58
61. References
• Bickley, L. & Szilagyi, P. (2007). Bate’s Guide to
Physical Exam and History Taking, 9th ed.
Lippincott Williams & Wilkins, Philadelphia,
USA.
61
62. Introduction to History Taking
• During the History & Physical Exam you will be
collecting assessment information- (data).
These data will be either subjective or
objective.
– Subjective: What the patient says: “My arm hurt
all day”
– Objective: What you find with your senses: what
you see, smell, feel: left arm cut is 3 cm long.
62
63. Before the History
• Prepare yourself:
– THINK about what you will be doing
– What problems might you find (cancer, depression,
anger…)
– How do you FEEL about this patient? (Conflict
during a previous meeting? Friends with a family
member?)
– Remember the value of human life
63
64. Before the History
• Review the Medical Records: learn about
– name,
– age,
– sex,
– past health problems
– medications
64
65. Before the History
• Check you Appearance
– Neat hair
– Clean uniform/lab coat
– Washed hands
– Clean, short finger nails, no artificial nails
– Nonverbal behavior showing respect and concern
– Professional behavior showing confidence and a
positive attitude
65
66. Before the History
• Prepare the Environment:
– Quiet
– Confidential
– Comfortable temperature
– Patient has glasses, hearing aids as needed
– Comfortable sitting places where you are not
standing over the patient looking down at him
66
67. Before the History
• Take notes:
– Be prepared to take brief notes during the exam
– Have a good pen and paper ready
– Do not take long notes during the interview- this
will take up too much time.
– Don’t focus on your notes. Focus (and keep good
eye contact) on the patient.
67
68. At the Start of the History
• Greet the patient by name with a respectful title. If you
are not sure how to pronounce the patient’s name, ask
them to pronounce it for you.
• Introduce your name and title and let them know your
task (health history & physical exam)
• Make sure you know who anyone else in the room is
(family, friends).
– Ask the patient if they want others to stay or leave prior to
beginning the exam: “Would you like to be alone during the
exam, or do you want your friend to stay in the room with you?”
68
69. At the Start of the History
• Make sure the patient is comfortable.
• Never assume you know why the patient is
really here- ASK!
• Often your first question will be open ended:
“Why did you come to the hospital today?”
• FOCUS on the patient and LISTEN to what he
says.
69
70. At the Start of the History
• Establish priority for the patient’s problems
(breathing before hair loss)
• Get more information: OPQRST
– Onset (when did the problem begin?)
– Provoking/palliative factors (what makes it better or
worse)
– Quality (what is it like: sharp or dull?)
– Radiation (does pain start one place and move to
another?)
– Site (where is it?)
– Timing (when does it happen?)
70
71. Communication During the Health History
• Listen carefully- give eye contact
• Note nonverbal behavior: Your’s
– Posture
– Hands/gestures
– Tone of voice
• Note nonverbal behavior: Their’s
– Posture
– Hands/gestures
– Tone of voice
71
72. Communication During the History
• It is important to know WHAT information you
need to complete the patient’s health history
and give you all the information you need to
make a diagnosis for the patient.
• When you understand what information you
need, this will help you know what types of
questions to ask.
72
73. History Questions
• Open ended: “How do you feel today?” Lets
the patient direct the information
• Focused: “Tell me about your ear pain” Gets
information on a specific topic.
• Graded: “On a scale of 0-10, how bad is your
pain now?” Measures severity of symptoms
73
74. History Questions
• Series: Ask about symptoms one at a time.
Instead of: “Have you ever had asthma,
diabetes, heart problems or bronchitis?” Ask:
“Have you ever had asthma? Diabetes? Heart
problems?...”
• Multiple choice: “Do you cough more at night
or during the day?” Clarifies specific
symptoms
74
75. History Questions
• Clarify: “What do you mean by saying you
“couldn’t think”? Helps you understand
unclear statements
• Reflection/Echoing: Patient: “I hardly slept last
night!” Nurse: “You hardly slept last night?”
Invites patient to explain statement further.
75
76. Communication in the History
• Nonverbals- don’t cross arms, don’t pace
• Show empathy- show concern for the patient’s
problems “I’m sorry you’ve had this pain so
long…”
• Validate- confirm the appropriateness of the
patient’s thoughts or feelings: “It certainly
would be sad to watch your friend die like
that…”
76
78. Different Types of Patients
• Some patients are easy to talk to.
• Some patients are very challenging to talk to….
78
79. Types of Patients
• Silent Patients-
• Give patients time to think about answers to your
questions.
• Watch nonverbals (anger, fear, sadness…)
• Ask focused questions.
• Ask about sadness or depression if needed.
• Ask the patient if they are upset about something.
79
80. Types of Patients
• Confusing Patients: (many, multiple symptoms)
• If someone has a problem with everything, try
to assess how the patient is functioning.
• Assess for mental of emotional problems.
• Ask the patient what he thinks his greatest
problem is.
80
81. Types of Patients
• Altered Mental Status:
• For patients who are not able to answer
questions or provide information, try to find a
family member or care giver who can answer
your questions
81
82. Types of Patients
• Talkative Patients-
• Some patients like to talk- a lot. Nurses have
many patients, and often can not spend unlimited
time with one patient.
• Be polite.
• Ask close ended questions. Direct the conversation.
• Let the patient know there is a time limit because
of your other responsibilities.
82
83. Types of Patients
• Crying-
– Show empathy.
– Give the patient time to express emotions.
• Angry-
– Stay calm, don’t respond in anger
– Listen and be empathetic if possible.
– Never let an angry patient get between you and
the door..
83
84. Types of Patients
• Language Barrier-
• Find a good interpreter, if possible.
• Before you begin, if possible, let the
interpreter know what topics will be discussed
(chest pain, depression, cancer, etc…)
• Ask simple, short questions.
• Speak to the patient, not to the interpreter.
84
85. Types of Patients
• Have the translator sit/stand next to the
patient (so you don’t have to move your head
back and forth when talking).
• Introduce the interpreter to the patient
• Clarify understanding
85
86. Types of Patients
• Hearing Problems:
• Use a sign language interpreter if needed. Use written
information/white boards for communication
• Room should be quiet- no TV or radio
• If patient has a hearing aid, make sure it is in his ear
and turned on
• Face patient with so he can see your lips (light should
shine on your face.)
• Don’t put your hand over your mouth when speaking
86
87. Types of Patients
• Vision Problems-
• Introduce yourself and the purpose of the
interview,
• Tell patient about the room (where the chair is,
where you will be sitting),
• Make sure he is wearing glasses if he has them
87
88. Types of Patients
• Limited Intelligence:
– Note their education- where and how much
– What can they do by themselves?
– What do they need help to do?
– Complete mental status exam
– Identify contact person (family, care giver)
88
89. Special Subjects
• Some topics are easy to discuss with your
patient.
• Other times, your patient may hesitate to tell
you information you need to know about their
health in order to care for them because they
think you will judge them or dislike them.
89
90. Special Subjects
• However, if there is something that affects the
patient’s health, then it is important for you to
know about it so you can take better care of
your patient- especially in this matter.
• Topics that may be ignored or avoided include
sexual activity, mental health problems, abuse,
use of illegal drugs, or thoughts about death.
90
91. Special Subjects
• How to talk to you patient about these topics
– Keep your comments nonjudgmental. Remember
that regardless of what you think about your
patient’s behavior or choices, your role as a nurse
is to give them the best possible health care
– Be aware of your thoughts and feelings about the
topic
91
92. Special Subjects
– Establish a relationship with the patient before
asking about these topics
– Explain how the information is important to you
(Mental health is an important area affecting
everyone’s life, so I always ask my patients about
their mental health…)
92
93. Special Subjects
• Sexual activity-
– This topic is important because sexual activity can
greatly affect a person’s life and health, including
issues like pregnancy and sexually transmitted
infections, such as HIV.
– Use clear language in a matter-a-fact way.
– Always act professionally and treat the patient with
respect
– Discuss behavior- what they do that could put them at
risk for health problems
93
94. Special Subjects
• Mental Health-
– Depression and anxiety can be frequent patient
problems, but they can also be ignored by the
health care providers.
– Note physical symptoms that may indicate
emotional problems: loss of sleep, weight gain or
weight loss, tiredness, crying..
94
95. Special Subjects
• If someone tells you that they are depressed, always ask
about suicide:
• Ask if they have thought about killing or harming themselves
• If they have, ask them if they have a plan. If they have thought
of suicide but don’t have a plan, try to get them to make a
“contract” with you promising you they will not commit suicide
and that they will call you if they ever start thinking about
suicide. Notify the doctor immediately
• If they have a plan, they are at very high risk for suicide. Be
calm, try not to leave them alone (get someone to be with them
if possible), notify the doctor immediately
95
96. Special Subjects
• Illegal Drugs and Alcohol-
• These are issues that can greatly affect the
lives of the patient, his finances, family, job,
etc.
• Often, it is easy to ask about these issues after
asking the patient if he smokes.
96
97. Special Subjects
– Ask about WHAT the person drinks, HOW much
they drink, and WHEN they drink (one person may
drink 4 oz of wine every evening, another person
may drink 24 beers on a weekend.
– Excessive alcohol can be very damaging to the
body, finances, relationships, etc, and yet often
people deny that they have a drinking problem.
Try to find out how alcohol is affecting their life.
97
98. Special Subjects
• Ask about what types of non-prescribed drugs
the patient takes: name, route, (smoking, IV,
oral, etc), amount and frequency.
• Note that cocaine can cause serious heart
problems even in young people.
• Be aware that the answers you get may not be
correct….
98
99. Special Subjects
• Abuse by friends or family:
• This is a big problem throughout the world.
• If you think the patient is being abused, get
them alone before you ask them about the
problem.
99
100. Special Subjects
• Suspect abuse if you see:
– The patient has an injury but the explanation of
how it happened is not logical
– The patient frequently has injuries
– The patient has waited a long time before coming
for help with an injury
– The patient is around people with alcohol or drug
problems
100
101. Special Subjects
• Some time you may be with a patient who is dying.
• Remember Kubler-Ross’ 5 stages of dying:
– Denial
– Anger
– Bargaining
– Sadness
– Acceptance
101
102. Charting
• Write down your assessment findings in an
organized manner. Sometimes there are
special forms for assessment information.
Other times the nurse writes a narrative note.
102
103. Charting
• In charting the Health History and Physical
Exam, write your assessment by body systems:
• general survey, VS, skin, hair, nails, head (eyes,
ears, nose, mouth), neck, breasts, lungs, heart,
peripheral vascular/lymphatic system,
abdomen, musculoskeletal, neurological,
reproductive systems).
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104. Charting
• NEVER use the word normal
• Use very precise words (“3 mm” instead of
“short”)
• Write clearly
• Do not repeat information
• Do not write anything you would not want the
patient to read
• Write objective data, not your interpretation
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105. The Physical Exam
• Once you have completed the health history
the physical exam begins with the general
survey and vital signs.
• Remember: each patient has a LEFT and
RIGHT side of the body!!!! Look at BOTH
sides!!!!! Assess for SYMMETRY or
DIFFERENCES!
105
107. Ерөнхий үзлэг/General Survey
• This is what you want to notice (inspection):
– Gender: Male/Female [personal profile]
– Alertness: level of consciousness & orientation
– Appearance/build: well nourished or poorly nourished,
clothing neat and clean or dirty?
(weight loss may indicate cancer, diabetes, stomach or
intestine problems, thyroid problems, adrenal problems,
infections, heart, lung or kidney disease, depression,
anorexia/bulimia; it may also mean denture problems,
memory loss, alcoholism, or other problems)
– Developmental level: infant, young adult, elderly???
107
108. Ерөнхий үзлэг/General Survey
– Distress? (yes/no)
– Activity/Posture:
• If in heart failure, patients will get short of breath lying
down- they prefer to sit;
• with COPD, patients breathe better sitting up/forward;
• with hyperthyroidism, patients may be active;
• with hypothyroidism, patients move slowly;
• with Parkinson's, patients often have tremor
108
109. Example
• This is an alert and oriented 46 year old well
dressed, well developed, well nourished male
in no acute distress who is sitting calmly
during the exam
109
111. References
• (1) Korean Textbook: Che Kong Ok (2003). Health Assessment,
Hyong Mun Sa, Korea.
• (2) Fauci, A., Braunwald, E., Isselbacher, K., Wilson, J., martin, J.,
Kasper, D., Hauser, S., Longo, D. (1998) Harrison’s Principles of
Internal Medicine, 14th ed., New York, USA: McGraw-Hill.
• (3) Seidel, H., Ball, J., Dains, J., Benedict, G.W., (1999). Mosby’s
Guide to Physical Examination, 4th Ed. Mosby: America.
• (4) Swartz, M. (1994). Textbook of Physical Diagnosis, 2nd Ed.,
Saunders: America.
• (5) Garg, A. & Otremba M. 2002. Respiratory. DigiDoc Sights &
Sounds of Internal Medicine.
111
112. References
• 6. Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher,
L. (2007). Medical-Surgical Nursing: Assessment and
Management of Clinical Problems. Delaware: Mosby Elsevier.
• (7) Geiter, H. (n.d.) Basic Heart and Lung Sounds. Retrieved
October 21, 2009 from
http://www.nurse411.com/Heart_Lung_Sounds.asp
• (8) Wikipedia. (2009) Heart click. Retrieved October 21 from
http://en.wikipedia.org/wiki/Heart_click
• (9) Wikipedia. (2009). Heart Sounds. Retrieved October 21
from: http://en.wikipedia.org/wiki/Click_(heart_sound)
• (10) Sinisalo, Rapola, Rossinen, Kupari. (2007). Simplifying the
estimation of jugular venous pressure. The American Journal
of Cardiology. 100 (12). 1779-1781 retrieved October 22, 2009
from http://cat.inist.fr/?aModele=afficheN&cpsidt=19958708
112
113. References
• (11) Wikipedia. (2009). Capilary refill time. Retrieved October 22 from
http://en.wikipedia.org/wiki/Capillary_refill
• (12) Weiss, R. (2009). Rh factor in Prenancy. About.com. Retrieved
October 22, 2009 from
http://pregnancy.about.com/cs/rhfactor/a/aa050601a.htm
• (13) Nursing 352: Assessment for Practicing Nurses. (n.d.) Week 6:
Assessment of Special Populations. Retrieved October 29, 2009 from
http://classes.kumc.edu/son/nurs352/Module_6/printable.htm
• (14) O’Reilly, M. (2008). Examination of the Obstetric Patient.
Retrieved October 29, 2009 from
http://www.ohsu.edu/pcmonline/docs/Obstetrical%20pt%20H&P%2
0for%20MSIIs-LSB.pdf
• (15) Bickley, L. & Szilagyi, P. (2007). Bate’s Guide to Physical Exam and
History Taking, 9th ed. Lippincott Williams & Wilkins, Philadelphia,
USA.
113
114. References
• Scanned pictures from:
-Che Kong Ok (2003). Health Assessment,
Hyong Mun Sa, Korea. (pictures) (B)
-Mercier, L. (1995). Practical Orthopedics, 4th
ed., St. Louis, Mosby. (x-rays, scoliosis and
dupuytren’s contracture) (A)
-pdclipart.com at
http://www.pdclipart.org/index.php (c)
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115. Vital Signs
• температур Temperature: how warm a person is (°C)
• цусны даралт Blood pressure: force of blood against
the walls of the arteries (both arms)
• Pulse: number of heart beats per minute, Apical &
Radial (regular/irregular, strong/weak)
• амьсгал Respirations: number of breaths per minute,
respiratory pattern (even/uneven, unlabored/labored?)
• өндөр Height: how tall a person is (cm)
• жин Weight: how heavy a person is (kg)
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