Chapter 21

The cardiovascular system is highly complex, consisting of the heart and closed system of blood
vessels. The examiner must have a thorough understanding of the structure and function of the heart,
the great vessels, the heart's electrical conduction system, the cardiac cycle, the creation of heart
sounds, cardiac output (CO), and the neck vessels in order to gather accurate data and accurately
interpret it.

The heart is a hollow, muscular, four-chambered organ located in the middle of the thoracic
cavity between the lungs in the space called the mediastinum. Heart is about the size of a clenched fists
and weighs approximately 255g in women and 310g in men. Great vessels are the large VEINS and t
arteries leading directly to and away from the heart. Superior and inferior vena cava return blood to the
right atrium from the upper and lower torso, respectively.

Subjective data collected about the heart and neck vessels helps the nurse to identify abnormal
conditions that may affect the client’s ability to perform activities of daily living (ADL’s) and to fulfill his
or her role and responsibility.

To conclude, data collection provides information on the client’s risk for cardiovascular disease
and helps to identify areas for which health education is needed and major purpose of the assessment is
to identify any sign of heart disease and initiate early referral and treatment.

Chapter 22

The nurse needs to understand the structure and function of the arteries and veins of the arms
and legs, the lymphatic system, and the capillaries to perform a thorough peripheral vascular
assessment and to be able to differentiate normal vascular findings from normal variations and
abnormalities.

Arteries are the blood vessels that carry oxygenated, nutrient-rich blood from the heart to the
capillaries. Blood is propelled under pressure from the left ventricle to the heart. Each heartbeat forces
blood through the arterial vessels under high pressure creating a surge, this surge of blood is the arterial
pulse. Veins are the blood vessels that carry deoxygenated, nutrient-depleted, waste-laden blood from
the tissues back to the heart. Veins differ from arteries in that there is no force that propels forward
blood flow, the venous system is a low pressure system.

Disorder of the peripheral vascular system may develop gradually. Severe symptoms may not
occur until there us extensive damage.

Therefore, it is important for the nurse to ask questions about symptoms that the client may
consider inconsequential. These questions provide the nurse with an avenue for discussing healthy
lifestyles that can prevent or minimize peripheral vascular disease (PVD).
 Chapter 23

The abdomen is bordered superiorly by the costal margins, inferiorly by the symphysis
pubis and inguinal canals, and laterally by the flanks. To perform an adequate assessment of the
abdomen, it is necessary to understand the anatomic divisions knows as the abdominal quadrants, the
abdominal wall muscles, and the internal anatomy of the abdominal cavity in order to perform an
adequate assessment of the abdomen.

For the purpose of examination, the abdomen can be described as having four quadrants, the
right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant
(LLQ). Familiarization with the organs and structures in each quadrant is essential to accurate data
collection, interpretation and documentation of findings.

Abdominal assessment findings are commonly allocated to the quadrant in which they are
discovered, or their location may be described according to the nine abdominal regions that some
practitioners may still use as reference marks.

Overall, the nurse may collect subjective data concerning the abdomen as part of a client’s
overall health history interview or as a focused on symptoms of particular abdominal complaint. The
data focus on symptoms of particular abdominal organs and the function of the digestive system along
with aspects of nutrition, usual bowel habits and lifestyle.

Chapter 24

The body’s bones, muscles, and joints compose the musculoskeletal system. The purpose of the
musculoskeletal system is to provide structured and movement for body parts and is controlled and
innervated by the nervous system. Assessment of the musculoskeletal system helps to evaluate the
client’s level of functioning with activities of daily living (ADL’s). This system affects the entire body, from
head to toe, and greatly influences what physical activities a client can and cannot do.

Bones provide structure and protection, serve as levers, store calcium, and produce blood cells.
A total of 206 bones make up the axial skeleton (head and trunk) and the appendicular skeleton
(extremities, shoulders, and hips). The joint (or articulation) is the place where two or more bones meet.
Joints provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous,
cartilaginous, or synovial.

Physical assessment of the musculoskeletal system provides data regarding the client’s posture,
gait, bone structure, muscle strength, and joint mobility, as well as the client’s ability to perform ADLs.

In conclusion, assessment of the musculoskeletal system will provide the nurse with information
about the client’s daily activity and exercise patterns that promote either healthy or unhealthy
functioning of the functioning of the musculoskeletal system.
Chapter 25

The very complex neurologic system is responsible for coordination and regulating all body
functions. It consists of two structural components, the central nervous system (CNS) and the peripheral
nervous system. Neurological assessment is important as it helps to recognize and therefore manage
diseases earlier in their course. A complete neurologic examination contains an assessment of
sensorium, cognition, cranial nerves, motor, sensory, cerebellar, gait, reflexes, meningeal irritation, and
long tract signs.

The CNS encompasses the brain and spinal cord, which are covered by meninges, three layers of
connective tissue that protect and nourish the CNS. The CNS contains upper motor neurons that
influence lower motor neurons, located mostly in the peripheral nervous system. Carrying information
to and from the CNS, the peripheral nervous system consists of 12 pairs of cranial nerves and 31 pairs of
spinal nerves.

All in all, problems with other body systems may affect the neurologic system, and neurologic
system disorders can affect all other body systems. Regardless of the source of the neurologic problem,
the client’s total lifestyle and level of functioning are often affected.

Chapter 26

A basic understanding of the normal structures and functions of the external and internal male
genitalia, anus, rectum, and prostate are necessary to perform an effective assessment. In addition to an
understanding of the genitalia, anus, rectum, and prostate, the nurse needs to be familiar with the
inguinal (or groin) structures because hernias are common in this area.

The penis the male reproductive organ, the penis is freely movable, it’s shaft is composed of
three cylindrical masses of vascular erectile tissue that are bound together by fibrous tissue. The inguinal
area is contained between the anterior superior iliac spine laterally and the symphysis pubis medially.
The external inguinal ring is the exterior opening of the inguinal can, which can be palpated above and
lateral to the symphysis pubis. The femoral canal is another potential spot for a hernia. The anal canal is
the final segment of the digestive system. The rectum is the lowest portion of the large intestine and is
approximately 12 cm long, extending from the end of the sigmoid colon to the anorectal junction. The
prostate gland secretes a thin, milky substance that promotes sperm motility and neutralizes female
acidic vaginal secretions.

Lastly, when interviewing the male client for the information of his genitalia, anus, rectum, and
prostate, it’s necessary to remember that it may be a very sensitive topic and can be embarrassing for
the client and as well as for the examiner. A trusting relationship is the key to a successful interview. It is
important to always keep in mind that serious or life-threatening problems may be present.
Chapter 27

The examiner must have a knowledge base of the structure and function of the female genitalia
(external and internal structures) and the anus and rectum in order to perform an adequate assessment.
When interviewing the client about genital, reproductive, anal and rectal health, it is important to keep
in mind the sensitivities of the client as well as your own feelings regarding body image fear of cancer,
sexuality, and the like.

External genitalia include those structures that can be readily identified through inspection. The
area is sometimes referred to as the vulva or pudendum and extends from the mon pubis to the anal
opening. The internal genital structures function as the female reproductive organs. They include the
vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. The anal canal is the final segment of
the digestive system, it begins at the anal sphincter and ends at the anorectal junction. The rectum is the
lowest portion of the large intestine and is approximately 12 cm long, extending from the end of the
sigmoid colon to the anorectal junction.

In conclusion, the physical examination of the female genitalia, anus, and rectum may create
client anxiety, and the client may be very embarrassed about exposing her genitalia and nervous that an
infection or disorder will be discovered so it is important to explain in detail what will be happening
throughout the examination and explain the significance of each portion of the examination.

Chpater 28

Focused body systems assessments are useful when a client seeks care for a particular health
concern, comprehensive assessments are completed in such instances as the client’s first visit to a
health care provider, to obtain an overall impression and baseline data. A head-to-toe approach is more
convenient for performing a comprehensive assessment, which integrates the assessment of all body
systems. When using a head-to-toe approach, some body systems may be assessed in combination.

There is more than one correct way to integrate the entire health history and physical
examination. However, it is important to develop a consistent and logical routine to avoid omitting
significant data collection from the assessment.

It is wise to break up the assessment into segments to allow both the nurse and the client short
rest periods. The client’s physical and mental status will determine how much of the total examination
the nurse may perform at one time.

To conclude, for a comprehensive assessment, a head-to-toe approach is more convenient. It’s a

good idea to break up the evaluation into sections so that both the nurse and the client can get some
rest. The nurse’s ability to conduct the whole test would be determined by the client’s physical and
mental state.