Advanced Health Assessment and Differential Diagnosis

Advanced Health Assessment and Differential DiagnosisEssentials for Clinical Practice

Karen M. Myrick DNP, APRN, FNP-BC, ANP-BCLaima M. Karosas PhD, APRN, FNP-BC, ANP-BC

Suzanne C. Smeltzer EdD, RN, ANEF, FAANExpert Consultant

The first advanced assessment textbook to target the scope of practice for both advanced practice nurses and physician assistants.

With a focus on promoting sound clinical decision-making and a streamlined and highly accessible approach, this text delivers up-to-date primary care health assessment techniques for individuals throughout the life span.

Each chapter offers a concise overview of anatomy and physiology; an in-depth review of normal, focused, and holistic assessment; and comprehensive coverage of special populations, including patients with disabilities; pediatric, pregnant, and elderly patients; and transgender and veteran populations. Chapters include differential diagnosis tables, illustrations, images, and case studies. A robust ancillary package includes an Instructor Manual with chapters summaries, case studies, and discussion questions; test bank; image bank; and PowerPoint slides.

www.springerpub.com/3PDecember 2019 | 9780826162496

512 pp | Paperback

MEET THE EDITORS

Laima M. Karosas PhD, APRN, FNP-BC, ANP-BCClinical Professor of Nursing, Chair of Graduate Nursing Programs, and Director of Online Nursing Programs, Quinnipiac University, Hamden, Connecticut

“Our hope is that this resource proves to be a valuable resource for students, instructors, and all practicing healthcare practitioners.”

Streamlined approach meets the

needs of busy students and professionals

Provides up-to-date assessment

techniques for individuals throughout the

life span

Fosters development of

critical-thinking and clinical decision-

making skills

Suzanne C. Smeltzer EdD, RN, ANEF, FAAN Expert Consultant

Karen M. Myrick DNP, APRN, FNP-BC, ANP-BCCoordinator of Interdisciplinary Research, School of Interdisciplinary Health and Science, University of Saint Joseph, West Hartford, Connecticut; Clinical Associate Professor of Medical Sciences, School of Medicine, Quinnipiac University, Hamden, Connecticut

Director of Nursing Research and Evaluation, The Richard and Marianne Kreider Endowed Professor in Nursing for Vulnerable Populations, College of Nursing, Villanova University, Villanova, Pennsylvania

466 12 • Advanced Health Assessment of the Musculoskeletal System

With this information taken into consideration, you will have the ability to appropriately assess the musculoskeletal system of the patient.

Assess the potential for risk of falls, balance issues, muscle weakness, secondary conditions such as sequelae from poorly fitting prosthetic devices, decreased ability to exercise, and pres-sure ulcers. Understand what accommodations the patient has in place in the home and in his or her work or active life.

VETERAN POPULATION

A detailed history of your patient’s military expe-rience, including deployments and service, should be obtained. Pay particular attention to locations that have exposure to known toxic chemicals or hazardous materials, and any vibratory or trau-matic injuries that may have been sustained. Depending upon the job title and experience, assess the likelihood of risk and risk level of

exposure to certain repetitive activities or chem-ical agents. For example, do you have a veteran whose job was repetitive jumping (out of heli-copters), or were other repetitive activities part of his or her job? The physical assessment of the veteran should include evaluating for diseases and conditions related to the potential exposure of conditions or agents that may cause cancer, arthritis, or long-term disability. Ask the veteran about his or her perceived health and needs. Be particularly aware of inquiring about injuries and chronic pain, as well as substance abuse and mental health.

ELITE ATHLETE POPULATION

The elite athlete is considered to be one who has competed at a varsity, professional, international, or national level. This level of athlete would be at risk for overuse injuries and would also have unique return to play criteria.

Diagnostic Reasoning

Common Differential Diagnoses: General Musculoskeletal System

Diagnosis Key History or Physical Examination Differentiators

Dislocation A dislocation is a complete loss of joint articulation

Osteoarthritis Crepitation, decreased range of motion, and progressive symptoms that are worse after being sedentary or immobile; somewhat better with movement

Recurvatum deformity Increased hyperextension of a joint, typically seen in the knee or elbow

Subluxation Slippage of a joint within its articulation

Valgus deformity The distal part of the limb is directed away from the body midline

Varus deformity The distal part of the limb is directed toward the midline of the body

ENHANCED LEARNING FEATURES

Differential diagnosis tables foster diagnostic

reasoning

Overview of Anatomy and Physiology 405

SPINE

The spine is responsible for stability and motion of the trunk and back.

BONES AND LIGAMENTS OF THE SPINE

The 24 bones, the vertebrae, articulate with each other in slightly mobile cartilaginous joints (Figure 12.21). At the junction of the sacrum, the

vertebrae are virtually immobile. The vertebrae are connected by ligaments between the spinous pro-cesses, between anterior vertebrae and posterior vertebrae, and between the lamina of each adjacent vertebrae (Figure 12.22).

MUSCLES AND TENDONS OF THE SPINE

The muscles that work with the spine include the deep intrinsic or core muscles, the superficial mus-cles of the back, and the abdominal wall musculature.

Vertebral foramen

Pedicle

Lamina

Transverse process

Superior articularprocess

T12

Intervertebral foramen

Superior articular process

Inferior articular process

L1

Occipital bone

Vertebra prominens

Thoraciccurvature

Cervicalcurvature

Superior articular facet

Facet for tubercle of rib

Intervertebral discDemifacets for heads of ribsBody of vertebra

Spinous process

Inferior vertebral notch

Superior articular process

Lumbarcurvature

Promontory

Sacrum (5 fused vertebrae)Sacralcurvature

Coccyx(4 rudimentary fused vertebrae)

Spinal nerve

C-1C-2

C-3C-4

C-5

C-6

C-7T-1

T-2

T-3

T-4

T-5

T-6

T-7

T-8

T-9

T-10

T-11

T-12

L-1

L-2

L-3

L-4

L-5

FIGURE 12.22 Vertebral anatomy.

Heavily illustrated to demonstrate anatomy and physiology, normal and abnormal findings, and advanced assessment techniques

Connect with your regional sales rep at [email protected] springerpub.com/3p

BONUS FEATURES

456 12 • Advanced Health Assessment of the Musculoskeletal System

KNEE

INSPECTION

On the patient’s anterior aspect of his or her knees, look for effusion, varus or valgus deformity, or mus-cle atrophy. On the patient’s posterior aspect of the knee, evaluate for varus or valgus deformity, atro-phy, or hypertrophy.

PALPATION

Fullness in the popliteal fossa—Baker’s cyst; pain with palpation over the anserine bursa—bursitis; pain with palpation over the patellar tendon—tendinitis.

SPECIAL TESTS

Apprehension sign (Figure 12.113): Once seated, have the patient extend his or her knee, attempt

to displace patella laterally, and flex knee to 30 degrees. A positive test is indicated by the patient exhibiting apprehension with this maneuver.

Flexion pinch test (Figure 12.114): Accurate test, with increased accuracy with posterior horn tears (which are most common). A flexion pinch test is performed by fully flexing the patient’s knee (135 degrees). A positive test is indicated by the patient experiencing pain when the knee is flexed.

Valgus stress test (Figure 12.115): Evaluates the patient for MCL laxity.

At 0 and 30 degrees of knee extension, exert a valgus stress to the knee joint. Opening of the joint is considered a positive test, and opening at 0 degrees indicates that more than the MCL is dam-aged; usually, the ACL is injured as well.

Varus stress test (Figure 12.116): Evaluates the patient for an LCL injury. At 0 and 30 degrees of knee extension, exert a varus stress to the knee joint. Opening of the joint is considered an abnor-mal test.

Lachman’s test (Figure 12.117): Performed with the patient’s knee in 30 degrees of flexion. The femur is stabilized with one hand, and the other

FIGURE 12.113 Apprehension sign.

Discussion Questions

Test Bank

Case Studies

Chapter Summaries

Chapter PowerPoint

Slides

Image Bank

This text is accompanied by an Instructor’s Manual and comprehensive bonus resources, including:

SSCCRREEEENNIINNGG HHEEAALLTTHH AASSSSEESSSSMMEENNTT AANNDD NNOORRMMAALL FFIINNDDIINNGGSS OOFF TTHHEE MMUUSSCCUULLOOSSKKEELLEETTAALL SSYYSSTTEEMM

© Springer Publishing Company, LLC. 35

• ASSESSMENT OF THE FOOT AND ANKLE

• Inspection

• Look for bony deformities, symmetry, or swelling.

• Palpation

• Palpate for areas of tenderness. Note landmarks and correlate the clinical findings with the underlying anatomy.

• Muscle Strength Testing (Figures 12.86–12.88)

Figure 12.88

Figure 12.86

Figure 12.87

FFOOCCUUSSEEDD HHEEAALLTTHH AASSSSEESSSSMMEENNTT AANNDD AABBNNOORRMMAALL FFIINNDDIINNGGSS OOFF TTHHEE MMUUSSCCUULLOOSSKKEELLEETTAALL SSYYSSTTEEMM

© Springer Publishing Company, LLC. 36

• ASSESSMENT OF THE GENERAL MUSCULOSKELETAL SYSTEM

• Inspection

• Assess for deformities, asymmetry, limitations in motion, change in movement patterns or gait, and skin abnormalities (e.g., rashes, erythema, edema, ecchymosis).

• Palpation

• Palpate the areas of tenderness and anatomical structures that correlate with the patient’s chief complaint, condition, or injury. With inflammation, areas of warmth are palpable.

• Areas of step off, palpated as a loss in continuity, may be felt, indicating a joint separation, a tendinous or ligamentous disruption, or a muscle tear.

• Perform muscle strength testing—patients will likely display loss of muscle strength associated with their musculoskeletal injury or condition. Grade the muscle strength of the muscles that move the involved joint and compare this strength to the contralateral, or uninvolved, side.

PREVIEW PROOFS / FOR INTERNAL USE ONLY

Visit springerpub.com/MORE3P for a sample PowerPoint

presentation

TABLE OF CONTENTS CONTRIBUTORS1. Health History, the Patient Interview, and

Motivational Interviewing

2. Advanced Health Assessment of the Head, Neck, and Lymphatics

3. Advanced Health Assessment of the Nose, Mouth, and Throat

4. Advanced Health Assessment of the Eyes and Ears

5. Advanced Health Assessment of Skin, Hair, and Nails

6. Advanced Health Assessment of the Cardiovascular System

7. Advanced Health Assessment of the Respiratory System

8. Advanced Health Assessment of the Abdomen, Rectum, and Anus

9. Advanced Health Assessment of the Male Genitourinary System

10. Advanced Health Assessment of the Female Reproductive System

11. Advanced Health Assessment of the Neurological System

12. Advanced Health Assessment of the Musculoskeletal System

Alexandra Armitage MS, CNL, APRN

Erin Fusco DNP, FNP-BC, RN

Kristen Marie Guida DNP, ANP-C, ACNP-BC, AGACNP-BC, FNP-C

Laima M. Karosas PhD, APRN, FAANP

Jensen Lewis PA-C

Jacquelyn McMillian-Bohler PhD, CNM, CNE

Karen M. Myrick DNP, APRN, FNP-BC, ANP-BC

Susanne A. Quallich PhD, ANP-BC, NP-C, CUNP, FAANP

Angela Richard-Eaglin DNP, MSN, FNP-BC, CNE, FAANP

Dale Robertson PA-C, MCHS

Allison Rusgo MHS, MPH, PA-C

Adrienne Small DNP, FNP-C, CNE

Suzanne C. Smeltzer EdD, RN, ANEF, FAAN

Lindita Vinca DNP, APRN

POWER THROUGH THE 3PSvisit www.springerpub.com/3P

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