Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date Chapter 1 Identify steps of Nursing Process: Evaluation The evaluation step in the nursing process involves reassessing the patient and determining whether the goals of care have been met. This step is crucial for adjusting interventions as needed and ensuring patient-centered outcomes. Identify tasks in Nursing Process: Diagnosis During the diagnosis phase, nurses compile patient data to identify a NANDA diagnosis. Data is clustered, and irrelevant information is discarded to accurately define the patient’s health problem. Types of Databases: Problem Centered A problem-centered database focuses on a limited or short-term problem, often involving one complex problem or a specific body system. It is used in all healthcare settings for efficient and targeted assessment. Type of Database Characteristics Setting Problem-Centered Limited scope, short-term, focuses on one problem All settings Chapter 9 Identify Components of the General Survey The general survey involves a study of the whole person and begins upon entry to the room. Key components include: Physical Appearance: Body Structure: Mobility: Behavior: Chapter 10 Differentiate the grading of Pulse Force Grade Description 3+ Full, bounding pulse 2+ Normal 1+ Weak, thready 0 Absent Identify Hypotension Occurrences and Rationales Recognize how to Count Respirations Recognize the Effects of Smoking on Blood Pressure Smoking contributes to hypertension. Chapter 11 Identify Physiologic Changes: Acute Pain Responses Acute pain manifests through guarding, grimacing, moaning, agitation, restlessness, stillness, diaphoresis, and changes in vital signs. Chapter 13 Recognize the ABCDEF of Skin Lesions Assessing Clubbing Technique Indication Patient makes a heart with hands Look for gap between nails Profile sign Nail base should be ~160° Detect Color Changes in Light and Dark Skin Skin Type Pallor Cyanosis Erythema Jaundice Light Generalized/localized Dusky blue, nail beds dusky Red, bright pink Yellow in sclera, hard palate, mucous membranes Dark Yellow-brown, ashen gray Dark, dull; check conjunctiva, oral mucosa, nail beds Purplish tinge; palpate warmth Hard/soft palate junction, palms Characteristics of Pressure Injuries Stage Description I Non-blanchable redness II Partial-thickness skin loss, open blister, red-pink bed III Full-thickness skin loss, crater, subcutaneous fat visible IV Full-thickness tissue loss, exposes muscle/tendon/bone, slough/eschar Chapter 14 Neck Assessment Techniques: ROM Manifestations of Hypothyroidism Chapter 18 Clinical Manifestations of Breast Cancer Complications of Mastectomy Chapter 19 Thorax and Lung Inspection Techniques Adventitious Breath Sounds Sound Characteristics Wheezes High-pitch: musical, squeaking; Low-pitch: snoring, moaning, may clear by coughing Crackles Fine: high-pitch, discontinuous, inspiration, not cleared by cough; Coarse: low-pitch, bubbling, may decrease by coughing Clinical Examples Crackles Condition Fine Pneumonia, heart failure, interstitial fibrosis, chronic bronchitis, asthma, emphysema Coarse Pulmonary edema, pneumonia, pulmonary fibrosis, terminally ill Tachypnea Indications Pulmonary Embolism Manifestations Method Findings Subjective Chest pain on inspiration, dyspnea Inspection Apprehension, restlessness, cyanosis, tachypnea, cough Palpation Diaphoresis, hypotension Auscultation Tachycardia, crackles, wheezes NR 304 Final Exam Concepts Asthma Manifestations Method Findings Inspection Increased RR, SOB with wheeze, accessory muscle use, cyanosis, barrel chest (chronic) Palpation Decreased tactile fremitus, tachycardia Auscultation Diminished air movement, prolonged expiration, bilateral wheezing Chapter 20 Heart Failure Manifestations Health Promotion Tips Acute Coronary Syndrome Symptoms Chapter 21 Peripheral Vascular System Assessment Assessment Findings Subjective Leg pain/cramps, skin changes, swelling, lymph node enlargement, smoking, medications Inspection/Palpation Pulses, capillary refill, clubbing Nursing Diagnosis for Lymphedema Alleviating Factors for Venous Insufficiency Varicose Veins Manifestations Type Findings Subjective Aching, heaviness, fatigue, restless legs, burning, throbbing, cramping Objective Dilated, tortuous veins DVT Manifestations Type Findings Subjective Sudden intense deep muscle pain Objective Warmth, swelling, redness, tenderness Venous Return Mechanisms Chronic Venous Symptoms Edema Grading Grade Description 1+ Mild pitting, slight indentation, no swelling 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, short-lasting indentation, swollen leg 4+ Very deep pitting, prolonged indentation, grossly swollen Chronic Arterial Symptoms Peripheral Vascular Changes: Aging Adult Chapter 22 Abdominal Distension Assessment: Obesity Method Findings Inspection Uniformly rounded, sunken umbilicus Auscultation Normal bowel sounds Palpation Normal, may be hard through thick wall Hypoactive Bowel Sound Causes Intestinal/Bowel Obstruction Findings Type Findings Laboratory Dehydration, electrolyte loss, possible sepsis Radiology Fluid/gas accumulation proximal to obstruction Physical Exam Restless, ill-appearing, distended abdomen, hyperactive early, hypoactive late, tenderness, hypovolemic shock Clinical Manifestations Positive Murphy Sign Indication Involuntary Rigidity vs Voluntary Guarding Chapter 23 Late Rheumatoid Arthritis Manifestations Osteoarthritis Spinal Deformities Osteoporosis Risks Chapter 24 Cranial Nerve I-XII Assessment Nerve Test I Present familiar scent, eyes closed II Visual fields by confrontation III, IV, VI Pupils, light reaction, gaze positions V Motor: palpate masseter/temporal; Sensory: cotton wisp touch VII Facial mobility: smile, frown, raise eyebrows, show teeth, puff cheeks VIII Whispered voice test IX, X Tongue depressor, say “ahhh”; uvula rises, tonsillar pillars move XI Raise shoulders, turn head against resistance XII Inspect tongue, say “light, tight, dynamite” Glasgow Coma Scale Score FAST Plan for Stroke Stroke Risks and Manifestations Type Findings Risks Hypertension, smoking, heart disorders Manifestations Weakness/numbness on one side, confusion, vision changes, dizziness, loss of balance, severe headache Positive Romberg Test Chapter 25 Urinary Retention Manifestations Chapter 26 BPH Manifestations Type Findings Subjective Urinary frequency, urgency, hesitancy, weak/intermittent stream, incomplete emptying, nocturia Objective Symmetric, nontender enlargement, smooth/rubbery/firm surface, occurs midlife males Chapter 27 Older Adult UTI Symptoms References Jarvis, C. (2020). Physical examination and health assessment (8th ed.). Elsevier. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care (8th ed.). Elsevier. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (9th ed.). F.A. Davis Company. NR 304 Final Exam Concepts Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2017). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Wolters Kluwer.

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date iHuman Patients: Ray Williams Reflection Social Determinants of Health When assessing social determinants of health (SDOH) that could impact a patient’s ability to manage diabetes, nurses should evaluate multiple factors including access to healthcare services, economic stability, education level, social support networks, and living environment. Each of these can influence the patient’s ability to manage their condition effectively. For instance, limited access to healthcare may prevent the patient from attending regular check-ups or obtaining necessary medications. Economic instability can hinder the purchase of healthy foods or diabetes management supplies. Education level may affect the patient’s understanding of proper diabetes management strategies. A lack of social support may contribute to feelings of isolation and reduce adherence to treatment plans. Additionally, challenging living environments, such as unsafe housing or food insecurity, can further complicate diabetes management. NR 304 iHuman Patients: Ray Williams Reflection Factor Impact on Diabetes Management Access to healthcare Difficulty in attending check-ups, obtaining medications Economic stability Inability to afford healthy food or diabetes supplies Education level Limited understanding of diabetes management Social support Increased isolation, difficulty adhering to treatment plans Living environment Unsafe housing, food insecurity affecting self-care Environmental and Individual Factors Environmental factors that can influence a patient’s ability to perform diabetes self-care include access to healthy food, safe and stable housing, and opportunities for physical activity. Individual factors include the patient’s health literacy, motivation to follow treatment plans, and the support received from family or friends. Both sets of factors play a crucial role in determining the patient’s ability to manage diabetes successfully. Type of Factor Examples Influence on Diabetes Management Environmental Healthy food access, safe housing, physical activity availability Provides the conditions necessary for effective self-care Individual Health literacy, motivation, family/friend support Affects adherence to treatment plans and self-care behaviors Simulation Question Does the simulation consider any cultural or socioeconomic factors that may also affect a patient’s ability to self-care with diabetes? Understanding a patient’s background and unique circumstances, including cultural beliefs and economic status, can significantly influence the care plan and overall health outcomes. Considering these factors ensures that the patient receives personalized, effective support for managing diabetes. References Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(1_suppl2), 19–31. https://doi.org/10.1177/00333549141291S206 NR 304 iHuman Patients: Ray Williams Reflection Healthy People 2030. (n.d.). Social determinants of health. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/social-determinants-health American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement_1), S1–S196. https://doi.org/10.2337/dc23-S001

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date 1. Which of the following are risk factors for deep vein thrombosis (DVT)? (Select all that apply) A. Oral contraceptive use ✅B. Immobility ✅C. Venous insufficiency ✅D. Physical activityE. Calcium intake 2. Facial asymmetry and sagging during a cranial nerve assessment indicates dysfunction of which nerve? A. Motor component of CN VII (7) ✅B. Motor and sensory components of CN XI (11)C. Motor component of CN X (10)D. Motor component of CN IV (4) 3. Which client statement about genital herpes indicates a need for further teaching? A. “Abstaining from sexual activity reduces the risk of transmission of the disease”B. “The use of condoms will reduce the risk of transmission”C. “Antiviral medications will not cure the infection”D. “Transmission of the disease will not occur when my lesions are gone” ✅ 4. What is the primary function of the thymus, spleen, and lymph nodes? A. These organs assist vitamin absorptionB. These organs are used in digestionC. These organs regulate electrolyte balanceD. These organs support immunity ✅ 5. Which findings are associated with urinary retention due to prostatic hypertrophy? (Select all that apply) A. Voiding small amounts of urine frequently ✅B. Report of feeling pressure ✅C. Distended bladder ✅D. Dysuria ✅E. Tenderness over the symphysis pubis ✅ 6. Which is a manifestation of deep-vein thrombosis (DVT)? A. Decreased pedal pulsesB. Pain in the ankle and footC. Coolness of the leg or legsD. Unilateral leg edema ✅ 7. Which finding indicates that peristalsis is returning post abdominal surgery? A. Abdominal distentionB. Hypoactive bowel sounds in two quadrantsC. Passage of flatus ✅D. Request for a cup of tea and some toast 8. Which is a risk factor for the development of osteoporosis? A. Long-term use of diureticsB. ObesityC. Sedentary lifestyle ✅D. Prolonged stress 9. What action should a nurse take to prevent infection in a client with a urinary catheter? A. Replace the catheter every 3 daysB. Check the catheter tubing for kinks or twisting ✅C. Irrigate the catheter once each shiftD. Clean the perineal area with an antiseptic solution daily 10. Which client has a contraindication for oral contraceptives? A. A 38-year-old client that reports smoking one pack of cigarettes every day ✅B. A 28-year-old client with a history of pelvic inflammatory diseaseC. A 32-year-old client with benign breast diseaseD. A 26-year-old client with migraine headaches at the start of each menstrual cycle 11. Which of the following is a sign of hypoglycemia? A. Flushed skinB. BradycardiaC. Diaphoresis ✅D. Decreased respirations 12. What is the most accurate method for verifying placement of a nasogastric (NG) tube? A. Aspirating stomach contentsB. Injecting air and listening with a stethoscopeC. Checking pH of aspirateD. Chest x-ray ✅ 13. Which type of isolation precaution is required for a client with tuberculosis? A. Droplet precautionsB. Contact precautionsC. Protective environmentD. Airborne precautions ✅ 14. A nurse should monitor a client receiving furosemide for which of the following? A. HyperkalemiaB. Hypokalemia ✅C. HypercalcemiaD. Hypernatremia 15. Which finding is most important to report to the provider for a client taking warfarin? A. Occasional headachesB. Bleeding gums ✅C. Urinary frequencyD. Nausea NR 304 Exam 3 16. Which electrolyte imbalance is associated with muscle weakness and dysrhythmias? A. HypernatremiaB. Hypokalemia ✅C. HypocalcemiaD. Hypermagnesemia 17. A client reports abdominal pain and vomiting. Which finding requires immediate intervention? A. Bowel sounds present in all quadrantsB. Soft, non-tender abdomenC. Hematemesis ✅D. Nausea after meals 18. Which is an expected finding in a client with right-sided heart failure? A. Pulmonary congestionB. Pink frothy sputumC. Peripheral edema ✅D. Orthopnea 19. Which position promotes drainage from a lobectomy site in the right lung? A. Left side-lying ✅B. SupineC. Right side-lyingD. High Fowler’s 20. What is an adverse effect of levothyroxine? A. ConstipationB. BradycardiaC. Insomnia ✅D. Weight gain 21. Which of the following foods should a client taking MAOIs avoid? A. YogurtB. Cottage cheeseC. Aged cheddar ✅D. Milk 22. A client with COPD is receiving oxygen therapy. Which oxygen delivery device is most appropriate for long-term use? A. Non-rebreather maskB. Simple face maskC. Nasal cannula ✅D. Venturi mask 23. Which lab value should a nurse monitor for a client receiving heparin therapy? A. INRB. Platelet countC. aPTT ✅D. Hemoglobin 24. Which is a common side effect of opioid analgesics? A. DiarrheaB. InsomniaC. Constipation ✅D. Hypertension 25. What is the priority action when a client experiences an anaphylactic reaction to a medication? A. Start IV fluidsB. Give diphenhydramineC. Administer epinephrine ✅D. Provide emotional support 26. A client is prescribed lithium. Which of the following should be reported to the provider? A. Weight gainB. Fine hand tremorC. PolyuriaD. Vomiting and diarrhea ✅ 27. Which assessment finding is expected in a client with left-sided heart failure? A. Jugular vein distensionB. Crackles in the lungs ✅C. HepatomegalyD. Peripheral edema 28. Which of the following indicates digoxin toxicity? A. HypertensionB. Yellow-tinged vision ✅C. Increased appetiteD. Tachycardia 29. What is the purpose of incentive spirometry? A. Increase oxygen saturationB. Promote alveolar expansion ✅C. Reduce mucus productionD. Treat bronchospasms 30. What dietary recommendation is appropriate for a client with celiac disease? A. Low fatB. High fiberC. Gluten-free ✅D. High protein NR 304 Exam 3 31. Which of the following is a manifestation of hyperthyroidism? A. Cold intoleranceB. Weight gainC. Tachycardia ✅D. Constipation 32. A client with a spinal cord injury at T6 is at risk for which complication? A. Autonomic dysreflexia ✅B. Pulmonary embolismC. Cardiac tamponadeD. Diabetic ketoacidosis 33. Which of the following lab values is consistent with renal failure? A. Decreased creatinineB. Decreased BUNC. Increased potassium ✅D. Increased calcium 34. Which is a priority intervention for a client with a suspected stroke? A. Monitor blood glucoseB. Assess swallowingC. Maintain airway patency ✅D. Apply oxygen 35. Which condition is treated with levodopa-carbidopa? A. SeizuresB. Parkinson’s disease ✅C. SchizophreniaD. Multiple sclerosis 36. Which finding is expected in a client with diabetes insipidus? A. OliguriaB. Low serum sodiumC. High urine output ✅D. Edema 37. What teaching is important for a client taking alendronate? A. Take with foodB. Lie down after takingC. Take with full glass of water and remain upright ✅D. Take at bedtime 38. Which of the following vaccines is safe during pregnancy? A. MMRB. VaricellaC. Influenza (inactivated) ✅D. HPV 39. What is a common symptom of meningitis in

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date PDevelopmental Breast Changes During Puberty Puberty is marked by notable physiological changes, with breast development being a key milestone in females. The onset of breast development, or thelarche, typically occurs between ages 8 and 10 (Jarvis, 2020). When girls express concern about delayed breast growth compared to peers, healthcare providers should offer reassurance based on developmental norms. It is important to avoid dismissive responses and provide factual information, noting that breast development varies widely and usually precedes menarche by approximately two years. According to Tanner’s staging, progression from stage 2 to stage 5 can take one to six years (Tanner, 1962). Clinical Scenarios in Pediatric and Adolescent Breast Assessment Early breast budding—before age 8 in Black girls or age 10 in White girls—requires clinical evaluation, including assessment of body mass index (BMI), due to the association between early breast development and obesity (Kaplowitz, 2008). This evaluation can help identify risks for precocious puberty or early menarche. For adolescent girls concerned about delayed menarche, healthcare providers should inquire about the age at onset of breast development since menarche typically follows within two years. Table 1: Developmental Events in Female Puberty Developmental Event Typical Age Range Thelarche (breast budding) 8–10 years Menarche ~12 years Pubic hair appearance Around thelarche Axillary hair appearance ~2 years after pubic hair Breast Changes During Pregnancy During pregnancy, breasts undergo visible and physiological changes. The areolae darken and enlarge, and Montgomery’s tubercles become more prominent. Visible venous patterns reflect increased blood supply. Around the fourth month, colostrum, an antibody-rich early milk, may be expressed to provide vital immunity for the newborn (Riordan & Wambach, 2010). Exclusive breastfeeding is recommended for the first six months to ensure optimal nutrition and immune protection. Patient education should address misconceptions, emphasize benefits such as bonding, and highlight the reduction of infant infections (WHO, 2020). Breast Changes in Aging Women Postmenopausal hormonal changes result in atrophy of glandular tissue, replaced by connective and fatty tissue. This causes sagging and flattening of the breasts, which is a normal physiological change unrelated to exercise or protein intake (Jarvis, 2020). Nurses should explain these age-related transformations when older women express concerns about breast shape or elasticity, emphasizing that these changes are expected due to declining estrogen levels. Breast Cancer Statistics and Cultural Disparities Breast cancer incidence and survival rates vary by ethnicity. In the U.S., Black women are more frequently diagnosed with aggressive subtypes, such as triple-negative breast cancer, and often at later stages. Consequently, their 5-year survival rate is 83%, compared to 92% for White women (American Cancer Society, 2022). Asian/Pacific Islander women exhibit the highest survival rates across all stages. Ashkenazi Jewish women demonstrate a significantly higher prevalence of BRCA1 and BRCA2 mutations, placing them at increased genetic risk. Breast Self-Examinations (BSE) Although monthly BSEs are no longer universally recommended, women should be familiar with the normal appearance and feel of their breasts. Intermittent self-checks can help detect changes between mammograms. Most breast tumors occur in the upper outer quadrant near the axillary tail of Spence (Jarvis, 2020). NR 304 Exam 2 Table 2: Clinical Importance of Breast Areas Breast Area Clinical Importance Upper outer quadrant Common site for tumors Nipple and areola Check for retraction or discharge Axillary tail (Spence) Palpate due to lymphatic connections Supernumerary Nipples and Other Variants A supernumerary nipple may appear along the embryonic milk line and is usually benign. These findings should be documented but rarely require intervention unless other abnormalities are present. Lymph Node Response to Breast Pathologies Over 75% of breast lymphatic drainage occurs through ipsilateral axillary nodes. Therefore, infections often cause enlargement of nearby axillary nodes, while distant node enlargement suggests alternate pathology. Male Breast Abnormalities and Cancer Male breast cancer is rare, accounting for less than 1% of cases. Gynecomastia, common in aging men due to hormonal imbalance, warrants evaluation to rule out pathology. Unilateral breast lumps require urgent investigation (American Cancer Society, 2022). Table 3: Characteristics of Cancerous vs. Benign Breast Masses Characteristics Type Description Nontender mass Malignant Usually painless Hard, dense, immobile Malignant Fixed to structures Irregular borders Malignant Poorly defined edges Rubbery texture Benign Soft and mobile Dull pain on palpation Benign Suggests benign breast disease Gynecomastia in Males: Related Health Conditions Bilateral gynecomastia may indicate underlying conditions such as liver disease, hyperthyroidism, alcohol abuse, malnutrition, and certain medications (ACE inhibitors, digoxin, estrogen therapy). It can also relate to Cushing syndrome or adrenal disorders (NIH, 2022). Table 4: Associated Conditions with Gynecomastia Condition Explanation Liver disease Alters hormone metabolism Hyperthyroidism Increases estrogen levels Alcohol abuse Hormonal imbalance Malnutrition Impairs gonadal function Medication use Includes ACE inhibitors, digoxin, estrogen therapy Musculoskeletal System and Range-of-Motion Table 5: Range-of-Motion Movements Movement Definition Example Adduction Toward midline Bringing arm to side Abduction Away from midline Raising arm sideways Flexion Bending at joint Bringing hand to mouth Extension Straightening joint Straightening elbow Circumduction Circular motion Jump rope shoulder motion Joints serve as functional units, allowing mobility, while bones provide structure, muscles generate movement, and tendons connect muscles to bones. Hematopoiesis occurs in bone marrow, not other organs like liver or spleen (Johns Hopkins Medicine, 2023). Table 6: Structure of Ankle Joint Component Description Tibia Weight-bearing bone Fibula Lateral stabilization Talus Articulates with tibia and fibula Ligaments stabilize joints, tendons connect muscles, and cartilage cushions. The knee allows flexion and extension but not circumduction, inversion, or pronation. Spinal Postural Changes and Abnormalities Pregnancy often causes lordosis due to a shifted center of gravity. Other spinal conditions include kyphosis (thoracic curvature), scoliosis (lateral curvature), and ankylosis (joint stiffness). Table 7: Vertebrae and Anatomical Landmarks Vertebra Type Count Cervical 7 Thoracic 12 Lumbar 5 Sacral 5 (fused) Coccygeal 3-4 (fused) Intervertebral disks with nucleus pulposus act as shock absorbers. Shoulder Anatomy and Rotator Cuff Injury The glenohumeral joint is stabilized by the rotator cuff muscles. Pain during abduction but not forward flexion may indicate a rotator cuff injury. Table 8: Joint Identification and Palpation Joint Location

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date Peripheral Arterial Disease (PAD) and Related Conditions Peripheral Arterial Disease (PAD) is a circulatory disorder caused mainly by atherosclerosis, where lipid-rich plaques accumulate along arterial walls. Over time, these plaques cause arteries to become rigid, irregular, and fragile, reducing the diameter of the lumen and restricting blood flow to tissues. PAD can involve inflow arteries such as the distal aorta and iliac arteries, or outflow arteries such as the femoral, popliteal, and tibial vessels. PAD results from a combination of modifiable and non-modifiable risk factors. Cigarette smoking is the most influential lifestyle risk factor, while systemic conditions such as diabetes mellitus, hypertension, and hyperlipidemia accelerate vascular injury. Clinical Assessment Subjective Findings A detailed patient history is crucial for PAD assessment. Patients often report leg pain or cramping during walking (intermittent claudication), which improves with rest. Other complaints may include skin changes, limb swelling, and palpable lymph nodes. Clinicians should also gather information about medication use and smoking habits, as these factors influence disease progression. Objective Findings The physical examination includes assessment of the upper extremities for skin color, temperature, texture, and turgor. Edema, clubbing, and capillary refill time should be evaluated. Radial and brachial pulses are palpated for elasticity and strength. The lower limbs should be inspected for skin color, hair distribution, size symmetry, and venous patterns. Femoral, popliteal, posterior tibial, and dorsalis pedis pulses should be palpated to identify circulatory compromise. Symptoms of PAD Patients with PAD may experience: Risk Factors and Special Populations Cigarette smoking is the most significant modifiable risk factor for PAD. Other contributors include high cholesterol, obesity, and physical inactivity. Women with depression have a higher risk, and African Americans are twice as likely to develop PAD compared to other ethnic groups. High-risk individuals benefit from comprehensive screening, and the Ankle-Brachial Index (ABI) remains the preferred non-invasive tool. Example of PAD: Raynaud’s Syndrome Raynaud’s Syndrome is a vasospastic disorder affecting small arteries, particularly in the fingers and toes, and is often triggered by cold or emotional stress. It is more common in women and in colder climates. Common symptoms include: Developmental Considerations in Peripheral Health Infants and Children Palpable lymph nodes are common in healthy children. Lymphoid tissue is well developed at birth and grows until adolescence. Pregnant Women Pregnancy often causes bilateral pitting edema and varicose veins due to increased uterine pressure, which reduces venous return and increases venous pressure. Older Adults Older adults may have diminished dorsalis pedis and posterior tibial pulses. Trophic skin changes such as thinning, hair loss, and brittle nails are common. PAD prevalence increases with age, reaching 20% in people over 70 and 50% in those over 85. Symptoms may be masked by reduced activity or other conditions such as arthritis. Arterial vs. Venous Disorders Feature Venous Disease Arterial Disease Cause Valve incompetence, thrombi Atherosclerosis, calcification Pulse Normal (2+–3+) Diminished/absent (1+ or 0) Temperature Warm Cool Skin Thickened Shiny Edema Present Absent Hair Present Absent Color Red-brown Pallor (elevated), rubor (dependent) Pain Worse with standing/sitting Worse with exertion Pain relief Rest after prolonged standing Rest quickly Ulcer location Medial malleolus Toes, trauma points Ulcer moisture Moist, bleeding Dry Ulcer edges Uneven Smooth, well-defined Ulcer base color Red Pale Diagnostic Tests and Techniques The Ankle-Brachial Index (ABI) is a rapid, non-invasive test using Doppler ultrasound to compare ankle and arm systolic pressures. Formula:ABI = Highest ankle systolic pressure ÷ Highest arm systolic pressure ABI Score Range Interpretation 1.0 – 0.91 Normal 0.90 – 0.71 Mild PAD 0.70 – 0.41 Moderate PAD 0.40 – 0.30 Severe PAD < 0.30 Ischemia Lymphatic System Overview The lymphatic system maintains fluid balance, protects against pathogens, and absorbs lipids from the intestines. Poor lymphatic drainage causes edema due to protein-rich fluid accumulation. Key structures: Lymph node clusters: Associated organs: Lymphedema Lymphedema is swelling due to accumulation of protein-rich lymph fluid after lymph node damage or removal. It presents as non-pitting edema with thickened skin. Early management includes compression therapy (avoided in active PAD), manual lymphatic drainage, and targeted exercise. Abnormal Findings and Clinical Indicators Condition Indicator Example Thready pulse (1+) Shock, PAD Bounding pulse (3+) Hyperthyroidism, fever, anxiety Pitting edema (1+–4+) Heart failure, hepatic cirrhosis Unilateral swelling DVT, lymphatic obstruction Discoloration with ulcers Chronic PAD or venous insufficiency Trophic skin changes Aging, long-standing PAD Intermittent claudication Ischemic muscle pain from PAD Comparison of Ulcer Types Type of Ulcer Common Causes Characteristics Common Locations Risk Factors Arterial Ulcer Atherosclerosis, smoking Pale base, well-defined edges, dry, no bleeding Toes, heels, lateral ankle Smoking, diabetes, hypertension, hyperlipidemia Venous Ulcer DVT, venous insufficiency Shallow, moist, granulation tissue, pigmentation Lower legs, medial ankle Immobility, obesity, pregnancy, DVT Neuropathic Ulcer Diabetic neuropathy Painless, at pressure points, foot deformities Plantar surface Diabetes, neuropathy, deformities Other Vascular Disorders Superficial varicose veins are caused by valve incompetence from prolonged venous pressure, common in obesity and pregnancy.Deep vein thrombophlebitis (DVT) involves clot formation in deep veins, causing swelling, redness, warmth, and tenderness, with a risk of pulmonary embolism.Arterial occlusions result from narrowing of arteries, reducing oxygen delivery to tissues.Aneurysms are localized dilations of arteries caused by weakened vessel walls, most often affecting the aorta. Abdominal and Organ Examination The liver, spleen, kidneys, and aorta require careful palpation. Abnormal findings include tenderness, enlargement, and abnormal pulsations. An abdominal aortic aneurysm may be suspected with widened or laterally pulsating vessels. Ascites Evaluation Ascites is detected clinically through the fluid wave and shifting dullness tests, but ultrasound is the diagnostic gold standard. Causes include cirrhosis, heart failure, cancers, tuberculosis, and pancreatitis. Key Prevention and Management Principles References American Heart Association. (2020). Understanding Peripheral Artery Disease (PAD). https://www.heart.org/en/health-topics/peripheral-artery-disease Bickley, L. S. (2021). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer. NR 304 Exam 1 Centers for Disease Control and Prevention. (2021). Peripheral Arterial Disease (PAD). https://www.cdc.gov/heartdisease/PAD.htm Jarvis, C. (2020). Physical examination and health assessment (8th ed.). Elsevier. McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date Head-to-Toe Health Assessment Introduction Before initiating the assessment, the nurse should approach the patient with professionalism and respect to establish rapport and ensure informed consent. The process begins with a polite greeting and confirmation of patient identity. Example sequence: General Appearance Upon observation, the patient displays no signs of acute distress. The facial expression is relaxed, and the mood and affect are calm and appropriate to the situation. Speech is clear and coherent. To assess mental status and orientation: NR 304 Head to Toe Assesment Script Question Expected Normal Response Can you tell me your first and last name again? States both correctly Where are we right now? Identifies location accurately What time of day is it? Provides appropriate time frame Why are we here right now? Explains purpose of visit The patient is alert and oriented to person, place, time, and situation. Skin and Nails Inspection reveals skin coloration appropriate to ethnicity with no visible lesions, wounds, or incisions. Palpation of the upper and lower extremities bilaterally shows warm and evenly distributed temperature. Nail assessment demonstrates pink nail beds, a slight curvature of approximately 160 degrees, and capillary refill under two seconds—indicating adequate peripheral perfusion. Head, Face, and Neck The patient’s facial features are symmetrical, and the head is normocephalic. The scalp is clean, hair is evenly distributed, and no signs of infestation or lesions are noted. The trachea is midline without palpable masses. Cranial Nerve Assessments: Cranial Nerve Test Expected Findings V: Trigeminal Motor: Have patient clench jaw; apply resistance to chin. Sensory: Touch face lightly with cotton ball, asking for recognition. Strong, symmetrical jaw movement; intact sensation across face. VII: Facial Ask patient to close eyes tightly, raise eyebrows, smile, puff cheeks, and pout. Symmetrical movements; no drooping or weakness. XI: Spinal Accessory Shrug shoulders and rotate head against resistance. Full strength and symmetry noted. Eyes External ocular inspection reveals no redness, discharge, or swelling. The conjunctiva appears pink, and sclera is white. Pupils are equal, round, and approximately 3 mm in size, reacting briskly to light and accommodating with convergence on near objects. Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, Abducens) are assessed through the six cardinal fields of gaze—no nystagmus observed. Ears Inspection of the external auditory meatus shows no discharge. Whispered voice testing (with opposite ear gently occluded) from a distance of approximately 60 cm confirms intact cranial nerve VIII (Vestibulocochlear). Nose The nasal structures appear symmetrical, without deformities, inflammation, or drainage. Bilateral patency is confirmed by occluding one nostril at a time and asking the patient to inhale. Mouth and Throat The lips, tongue, and gums are moist and pink. Cranial Nerve Assessments: Cranial Nerve Test Expected Findings IX & X: Glossopharyngeal & Vagus Depress tongue, have patient say “ahh,” observe uvula rise; ask patient to swallow and speak. Midline uvula movement; clear voice; effective swallow. XII: Hypoglossal Ask patient to say “Light, tight, dynamite.” Clear articulation; tongue movements symmetrical. Respiratory System Inspection of the anterior chest shows unlabored breathing without accessory muscle use. Auscultation, performed in a side-to-side pattern, reveals vesicular and bronchovesicular sounds in appropriate anatomical locations, both anteriorly and posteriorly. No adventitious sounds (wheezes, crackles, rhonchi) are present. Cardiovascular and Peripheral Vascular System Carotid, radial, posterior tibialis, and dorsalis pedis pulses are regular in rhythm, +2 in strength, and approximately 72 beats per minute bilaterally. No peripheral edema is noted upon palpation. Cardiac auscultation at the aortic, pulmonic, Erb’s point, tricuspid, and mitral sites—first with the diaphragm, then the bell—reveals normal heart sounds with no murmurs. Gastrointestinal and Urinary System With the patient supine, the abdomen appears symmetrical and flat. Bowel sounds are present in all four quadrants (RLQ, RUQ, LUQ, LLQ). Light palpation (1 cm depth) detects no tenderness, guarding, or masses. Musculoskeletal System Inspection of upper and lower extremity joints (major and minor) reveals symmetry, no swelling, and no deformities. Joint Motion & Strength Testing: Joint Movements Tested Strength Grade Elbows Flexion, extension, pronation, supination 5/5 Wrists Flexion, extension, radial & ulnar deviation 5/5 Knees Flexion, extension 5/5 Ankles Dorsiflexion, plantar flexion, inversion, eversion 5/5 Bilateral upper and lower extremity strength is intact. Two-point discrimination from proximal to distal confirms sensory integrity. Gait assessment shows steady balance and coordination over a 10–20 foot walk. Closure Following the assessment, the nurse reassesses pain: “On a scale from 0 to 10, how is your pain now?” The bed is returned to the lowest position with side rails up and brakes engaged. The call bell is placed within reach, and the patient is invited to ask any questions. The session concludes with a polite thank-you and final hand hygiene. References Bickley, L. S., & Szilagyi, P. G. (2021). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer. Jarvis, C. (2020). Physical examination and health assessment (8th ed.). Elsevier. NR 304 Head to Toe Assesment Script Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2021). Fundamentals of nursing (10th ed.). Elsevier.

Student Name Chamberlain University NR-304: Health Assessment II Prof. Name Date RUA Health History and Physical Assessment Health History: Subjective Data Patient OverviewP.B. is a 56-year-old African American male, born in March in Jamaica, who currently resides in New York. English is his primary language. He stands 6 feet 1 inch tall and weighs approximately 280 pounds. P.B. is married and presented for a routine annual physical examination without acute complaints. Perception of HealthP.B. defines health as the absence or presence of disease or medical conditions. He considers himself generally healthy and functional in daily activities. Lifestyle and HabitsP.B. smokes about five cigarettes daily and consumes alcoholic beverages approximately three times per week. He denies illicit drug use. His immunization record is current, including the COVID-19 vaccine in June 2021 and the influenza vaccine in October 2021. Medical and Family HistoryP.B. reports no known allergies, chronic illnesses, or prior surgeries. He takes no prescribed or over-the-counter medications. His father died of cancer in 2019, and his mother passed away from dementia in 2018. He does not have further details regarding his grandparents’ medical histories. System Review Responses Question and Answer Summary Question Patient Response Do you have any history of skin cancer, itching, rashes, or bruising? No Have you experienced headaches or head injuries? No Do you use glasses or contact lenses? No, and no vision changes reported Have you had any ringing in the ears, colds, or sore throat? No Any wheezing, cough, or shortness of breath? No Have you been diagnosed with heart problems such as murmurs or irregular rhythms? No Any blood clots, leg cramps, or varicose veins? No Have you noticed any changes in appetite, constipation, or rectal bleeding? No Do you have pain or burning with urination, difficulty urinating, or incontinence? No Any seizures, weakness, or history of strokes? No Have you had fractures or bone injuries? No fractures; occasional knee stiffness in cold weather When was your last prostate exam? May 2021 Psychosocial Development StageAccording to Erikson’s stages of psychosocial development, P.B. is in the Generativity vs. Stagnation stage, characterized by the desire to contribute to society and create a meaningful legacy. Cultural and Spiritual BeliefsP.B. maintains a family tradition of using rum mixed with honey to alleviate illness symptoms. He identifies as family-oriented, with strong values shaped by his upbringing. Although unaffiliated with formal religion, he believes in a higher power. NR 304 RUA Health History and Physical Assessment Physical Examination: Objective Data Vital Signs Vital Sign Measurement Interpretation Temperature 98.6°F (37°C) Normal Heart Rate 80 bpm Normal, regular Respirations 20/min Normal Blood Pressure 130/64 mmHg Prehypertensive O₂ Saturation 98% Normal Pain Scale 0/10 No pain reported General AppearanceP.B. is alert and oriented to person, place, time, and situation. He has a steady, balanced gait and appears in no acute distress. HEENT (Head, Eyes, Ears, Nose, Throat) Neck and LymphaticsThyroid and lymph nodes nonpalpable and non-tender. Cardiovascular SystemRegular rhythm, no murmurs, no peripheral edema. Respiratory SystemClear lung sounds bilaterally, no wheezes or rales, no use of accessory muscles. Gastrointestinal SystemAbdomen rounded and symmetrical, bowel sounds normal in all quadrants, no tenderness, distension, guarding, or rigidity. Musculoskeletal SystemFull range of motion in all extremities, muscle strength 4/5 bilaterally. Reports occasional knee stiffness during colder months. Neurological SystemCranial nerves intact; patient alert and oriented ×4. Needs Assessment Educating patients about their health needs is essential to promote awareness and prevention of chronic conditions. While P.B. is generally healthy, his prehypertension indicates the need for proactive measures. Recommendations Research shows that excessive alcohol consumption contributes to hypertension (Mostofsky et al., 2016) and smoking negatively affects lung function and respiratory muscle strength (Tantisuwat & Thaveeratitham, 2014). Addressing these factors early can improve long-term cardiovascular and respiratory health. Reflection The interaction with P.B. was professional and comfortable, facilitated by open communication and a respectful approach. Clinical skills from prior training were effectively applied, and no significant barriers were encountered. A limitation was the lack of detailed family health history beyond his parents. In future assessments, providing a pre-visit questionnaire could encourage patients to gather and provide more complete family health information. Overall, the assessment process was efficient, and the patient remained cooperative and engaged throughout. References Mostofsky, E., Mukamal, K. J., Giovannucci, E. L., Stampfer, M. J., & Rimm, E. B. (2016). Key findings on alcohol consumption and a variety of health outcomes from the Nurses’ Health Study. American Journal of Public Health, 106(9), 1586–1591. https://doi.org/10.2105/AJPH.2016.303336 NR 304 RUA Health History and Physical Assessment Tantisuwat, A., & Thaveeratitham, P. (2014). Effects of smoking on chest expansion, lung function, and respiratory muscle strength of youths. Journal of Physical Therapy Science, 26(2), 167–170. https://doi.org/10.1589/jpts.26.167