case analysis 3

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Nursing Assessment for the Practicing Nurse

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Assessment of Male/Female Genitalia, Breasts, Lymphatic and Musculoskeletal Systems
Everything from a successful prostate cancer screening to a potentially life-saving HPV vaccine relies on the assessment of these key systems. This lesson details
structure and function, as well as possible abnormal findings.
After completing this lesson, you should be able to:
Identify and describe the structure and function of the male and female genitalia, breasts, lymphatic, and musculoskeletal systems
Identify the components necessary for a successful prostate cancer screening
Discuss the benefits of the HPV vaccine
Compile a list of questions based on subjective and objective data in order to be able to better assess the patient
Identify the different types of abnormal findings that can result from your assessment
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Reading
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Read the following chapters in the Jarvis textbook. Click each link to view a PDF outlining the specific chapter.
Chapter 17
Chapter 24
Chapter 26
Chapter 22
Case Analysis 3
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The purpose of the case analyses is to assist in learning the key components from the assigned reading and other adjunct learning tools. Case analyses will focus on a
variety of topics incorporating assessment across the lifespan (pediatric, geriatric, obstetric, etc.).
Read each case analysis and choose two to complete
S. D. was discharged yesterday after treatment for heart failure. She appears short of breath when she answers the door for the home health nurse. The nurse also
notices crackles that are unrelieved by coughing, +2 edema in both lower extremities, and a third heart sound.
B. L., age 65 years, has come to the emergency department with complaints of increasing chest discomfort over the last few weeks, the worst episode happening this
morning. History includes type I diabetes mellitus since age 7 years.
A 13-month-old boy is brought to the clinic by his mother. She says that she has noticed that he “turns blue” when he cries and, although he walks, he quickly squats
to rest between spurts of activity. His mother is worried that he does not seem to be as “far along” as his older sister was at this age.
P. P., age 52 years, is in the clinic because she has had “waves of nausea and chest burning” off and on for 24 hours. Her father died of a heart attack at age 47
years.
Choose two cases from the list above and complete the following:
5 review of systems (ROS) questions
5 physical assessment techniques that would be conducted in a focused physical exam
Each case is worth 10 points
Each case must include 5 ROS questions and 5 physical assessment techniques for full credit
Submit your cases as a Word document to the digital. please follow direction. P.D. is an 18 month old, Caucasian, male toddler brought to the health practitioner by
his mother. He appears listless as he is leaning into his mother’s shoulder, while she supports him with both her arms, laying her chin upon his head. Practitioner
speaks to P.D.’s mother, “Good afternoon Mrs. D I am Mrs. W., how long has P.D. been like this?”
Parental bonding is being demonstrated positively by this child and parent. “Parental bonding, the child’s interactions with the parents, show mutual response and are
warm and affectionate, appropriate to the child’s condition.” (Jarvis, 2011, p. 143) Communication with a toddler P.D.’s age consists of, “nonverbal communication as
the primary method, since older infants have anxiety toward strangers. They are more cooperative when the parent is kept in view.” (Jarvis, 2011, p. 39) As P.D.
progresses through Erickson’s theory of psychosocial development he should be nearing the end of “trust verse mistrust stage and beginning the autonomy verse shame and
doubt stage”. (About.com, 2012) This may be difficult to assess at this time due to current illness and listlessness of the toddler.
Practitioner continues with questioning the mother regarding P.D.’s current illness, past medical and postnatal history. At completion of obtaining health history the
toddler is assessed on the mother’s lap.
Subjective questions asked in a review of systems would include:
1. Has he had any fever and when did it start?
2. Has he had any nasal congestion, runny nose or cough?
3. How much is he drinking and eating, compared to his normal intake?
4. How many times has he urinated, had a bowel movement or vomited in the last 12 hours? Please describe the consistency of the stool, color or the urine and quantity
of emesis.
5. Did you notice P.D. in any pain, pulling at his ears or any rashes on his body?
Assessment techniques that would be conducted in a focused physical exam would include the following:
1. Inspection: “Begin by greeting the child and the accompanying parent by name, but focus more on the parent”, to allow the child time to warm up to you. (Jarvis,
2011, p. 123) Keep the child dressed for as long as you can and have the parent undress the child one part at a time. (Jarvis, 2011, p. 124) Looking at the child for
visible skin moisture, color and rashes.
2. Measurements: Obtain respiratory rate for full minute, first, while listening to the parent, this is to ensure accurate respiratory rate while allowing time for the
child to remain calm. Remember to watch for use of accessory muscles and nasal flaring. Followed by the heart rate, using a brachial pulse for 30 seconds x 2, tympanic
temperature, length, weight and head circumference. Leaving the more invasive procedures for last.
3. Auscultation: Listen to the child’s lungs and heart with stethoscope while the child sits on the mother’s lap. The practitioner should listen in a Z pattern taking
care to listen to all areas of the heart auscultating for murmurs, extra beats and any other abnormalities.
4. Examination: Assess the child’s mouth, throat and ears with otoscope/ophthalmoscope while the child is sitting on his mother’s lap. Gently pulling the top of the
ear upward for best view of the tympanic membrane. Unless he becomes uncooperative then lay child on the examination table while the mother assists in keeping child
still. Keeping safety in mind at all times.
5. Focused Assessment: Assess the child for dehydration. Check skin turgor and mobility over the abdomen by slightly pinching the skin and observing the skin
retraction time, assess mucus membranes and tear production when crying. Also refer back to the subjective response from his mother in regards to oral intake and
urination pattern. (Jarvis, 2011)
Note: For grading purposes, please be sure that ROS and PE are pertinent to the case study. For the review of systems, do not list singly: pain assessment,
aggravatoring factors, rating, medications, etc. This is one question as PQRSTU. For the physical assessment, do not include diagnostic/laboratory testing. Points will
be deducted.

References
Jarvis, C. (2011). Physical examination & health assessment (6th Ed.). St. Louis, Missouri: Elsevier
About.com. (2012). Erickson’s Psychosocial Stages Chart. Retrieved January 26, 2012, from https://psychology.about.com/library/bl_psychosocial_summary.html
Braswell, R., Carcione, J., Halsey, J.H. & Talavera, F. (Eds). (2005). Migraine Headaches, Visual Effects. Retrieved January 27,2012, from
www.emedicinehealth.com/migraine_vision_effects.htm