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LABORATORY MANUAL
CAROLYN JARVIS, PhD, APN, CNP

Professor of Nursing
School of Nursing
Illinois Wesleyan University
Bloomington, Illinois
and
Family Nurse Practitioner
Bloomington, Illinois
Physical
Examination
& Health
Assessment
Seventh Edition
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

7
Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
3251 Riverport Lane
St. Louis, Missouri 63043
LABORATORY MANUAL FOR PHYSICAL EXAMINATION AND ISBN: 978-0-323-26541-6

HEALTH ASSESSMENT, EDITION SEVEN
Copyright © 2016 by Elsevier Inc. All rights reserved.

Copyright © 2012, 2008, 2004, 2000, 1996, by Saunders, an affiliate of Elsevier Inc. All rights reserved.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such as the
Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.
com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for
whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
International Standard Book Number: 978-0-323-26541-6
Content Strategist: Lee Henderson

Content Development Manager: Laurie Gower
Senior Content Development Specialist: Heather Bays
Publishing Services Manager: Deborah L. Vogel
Senior Project Manager: Brandilyn Flagg
Design Direction: Julia Dummitt
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributor/Reviewer
CONTRIBUTOR REVIEWER
Maria Lauer-Pfrommer, PhD, RN, APN-C, CNE Kathryn Schartz, MSN, RN, PPCPNP-BC
Assistant Professor Assistant Professor
Holy Family University School of Nursing
Philadelphia, Pennsylvania Baker University
Review Questions Topeka, Kansas

Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved. iii
Preface
This Laboratory Manual is intended for you, the student, as a study guide and laboratory manual to accom-
pany the textbook Physical Examination & Health Assessment, 7th edition. You will use it in two places: in
your own study area and in the skills laboratory.
As a study guide, this workbook highlights and reinforces the content from the text. Each chapter cor-
responds to a chapter in the textbook and contains exercises and questions in varying formats to synthesize
and master content from the text. Fill out the lab manual chapter and answer the questions before coming
to the skills laboratory. This will reinforce your lectures, expose any areas in which you have questions for
your clinical instructor, and prime you for the skills laboratory/clinical experience.
Once in the skills laboratory, use the Laboratory Manual as a direct clinical tool. Each chapter contains assess-
ment forms on perforated, tear-out pages. Usually you will work in pairs and perform the regional physical
examinations on each other under the tutelage of your instructor. As you perform the examination on your peer,
you can fill out the write-up sheet and assessment form to be handed in and checked by the instructor.
FEATURES
Each chapter is divided into two parts—cognitive and clinical—and contains:
• Purpose—a brief summary of the material you are learning in the chapter.
• Reading Assignment—the corresponding chapter and page numbers from the Physical Examination &
Health Assessment textbook.
• Suggested journal articles—these are current and choice readings for critical thinking and for interventions.
• Media Assignment—the corresponding video assignment from the Physical Examination and Health
Assessment DVD Series, which is adapted from the Physical Examination & Health Assessment textbook.
• Glossary—important or specialized terms from the textbook chapter with accompanying definitions.
• Study Guide—specific short-answer and fill-in questions to help you highlight and learn content from
the chapter. New critical thinking questions are included to coordinate the reading and video
assignments. Important illustrations, now in full color, of human anatomy have been reproduced from
the textbook with the labels deleted so you can identify and fill in the names of the structures yourself.
• Review Questions—new and revised multiple-choice questions, matching, and short-answer questions
so you can monitor your own mastery of the material. Take the self-exam when you are ready and
then check your answers against the answer key provided in the back of the book.
• Clinical Objectives—behavioral objectives that you should achieve during your peer practice in the
regional examinations.
• Regional Write-Up Sheets—complete yet succinct physical exam forms that you can use in the skills
lab or in the clinical setting. These serve as a memory prompt, listing key history questions and
physical examination steps, and as a means of recording data during the patient encounter.
• Narrative Summary Forms—SOAP format, so you can learn to chart narrative accounts of the history
and physical exam findings. These forms have accompanying sketches of regional anatomy and are
especially useful for those studying advanced practice roles. Chapters 27 and 28 have additional new
assessment forms for use in ambulatory settings.
Learning the skills of history taking and physical examination requires two types of practice: cognitive and
clinical. It is my hope that this manual will help you achieve both of these learning and practice
modalities.
CAROLYN JARVIS

iv Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Acknowledgments
I am grateful to those on the team at Elsevier who worked on the Laboratory Manual. My thanks extend
to Lee Henderson, Content Strategist; Laurie Gower, Content Development Manager; Heather Bays, Senior
Content Development Specialist; and Brandi Flagg, Senior Project Manager. Thanks also to my colleague,
Ann Eckhardt, who contributed critical thinking exercises to Chapter 9.

Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved. v
Contents
UNIT I: ASSESSMENT OF THE WHOLE PERSON

1 Evidence-Based Assessment, 1
2 Cultural Competence, 7
3 The Interview, 17
4 The Complete Health History, 25
5 Mental Status Assessment, 37
6 Substance Use Assessment, 45
7 Domestic and Family Violence Assessments, 53
UNIT II: APPROACH TO THE CLINICAL SETTING

8 Assessment Techniques and Safety in the Clinical Setting, 59
9 General Survey, Measurement, Vital Signs, 63
10 Pain Assessment: The Fifth Vital Sign, 73
11 Nutritional Assessment, 79
UNIT III: PHYSICAL EXAMINATION

12 Skin, Hair, and Nails, 85
13 Head, Face, and Neck, Including Regional Lymphatics, 97
14 Eyes, 105
15 Ears, 117
16 Nose, Mouth, and Throat, 127
17 Breasts and Regional Lymphatics, 137
18 Thorax and Lungs, 149
19 Heart and Neck Vessels, 161
20 Peripheral Vascular System and Lymphatic System, 175
21 Abdomen, 187
22 Musculoskeletal System, 197
23 Neurologic System, 209
24 Male Genitourinary System, 223
25 Anus, Rectum, and Prostate, 233
26 Female Genitourinary System, 241

vi Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CONTENTS vii
UNIT IV: INTEGRATION: PUTTING IT ALL TOGETHER

27 The Complete Health Assessment: Adult, 253
28 The Complete Physical Assessment: Infant, Child, and Adolescent, 265
29 Bedside Assessment and Electronic Health Recording, 275
30 The Pregnant Woman, 281
31 Functional Assessment of the Older Adult, 297
Appendix A Answers to Review Questions, 307

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UNIT I: ASSESSMENT OF THE WHOLE PERSON
CHAPTER
1
Evidence-Based Assessment
PURPOSE
This chapter discusses the characteristics of evidence-based practice, diagnostic reasoning, the nursing
process, and critical thinking. This chapter also introduces the concept of health, helps you understand that
it is the definition of health that determines the kinds of factors that are assessed, and shows you that the
amount of data gathered during assessment varies with the person’s age, developmental state, physical
condition, risk factors, and culture.
READING ASSIGNMENT
Jarvis: Physical Examination and Health Assessment, 7th ed., Chapter 1, pp. 1-9.
Suggested reading:
Swarbrick MA, Cook J, Razzano L. (2013). Health Screening Dialogues. J Psychosoc Nurs Ment Health Serv
15(12): 22-28.
GLOSSARY
Study the following terms after completing the reading assignment. You should be able to cover the defini-
tion on the right and define the term out loud.
Assessment. . . . . . . . . . . . . . . . . the collection of data about an individual’s health state
Biomedical model. . . . . . . . . . . the Western European/North American tradition that views health as the
absence of disease
Complete database . . . . . . . . . . a complete health history and full physical examination
Critical thinking . . . . . . . . . . . . simultaneously problem solving while self-improving one’s own thinking
ability
Diagnostic reasoning . . . . . . . . a method of collecting and analyzing clinical information with the follow-
ing components: (1) attending to initially available cues, (2) formulating
diagnostic hypotheses, (3) gathering data relative to the tentative hypoth-
eses, (4) evaluating each hypothesis with the new data collected, and
(5) arriving at a final diagnosis
Emergency database. . . . . . . . . rapid collection of the database, often compiled concurrently with lifesav-
ing measures

Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1
2 UNIT I Assessment of the Whole Person
Environment . . . . . . . . . . . . . . . the total of all the conditions and elements that make up the surroundings
and influence the development of a person
Evidence-based practice. . . . . . a systematic approach emphasizing the best research evidence, the clini-
cian’s experience, patient preferences and values, physical examination,
and assessment
Focused database . . . . . . . . . . . used for a limited or short-term problem; concerns mainly one problem,
one cue complex, or one body system
Follow-up database. . . . . . . . . . used in all settings to monitor progress of short-term or chronic health
problems
Holistic health. . . . . . . . . . . . . . the view that the mind, body, and spirit are interdependent and function
as a whole within the environment
Medical diagnosis . . . . . . . . . . . used to evaluate the cause and etiology of disease; focus is on the function
or malfunction of a specific organ system
Nursing diagnosis. . . . . . . . . . . used to evaluate the response of the whole person to actual or potential
health problems
Nursing process. . . . . . . . . . . . . a method of collecting and analyzing clinical information with the follow-
ing components: (1) assessment, (2) diagnosis, (3) outcome identification,
(4) planning, (5) implementation, and (6) evaluation
Objective data . . . . . . . . . . . . . . what the health professional observes by inspecting, palpating, percussing,
and auscultating during the physical examination
Prevention . . . . . . . . . . . . . . . . . any action directed toward promoting health and preventing the occur-
rence of disease
Subjective data. . . . . . . . . . . . . . what the person says about himself or herself during history taking
Wellness . . . . . . . . . . . . . . . . . . . a dynamic process and view of health; a move toward optimal
functioning
STUDY GUIDE
After completing the reading assignment, you should be able to answer the following questions in the spaces
provided:
1. The steps of the diagnostic reasoning process are listed below. Consider the clinical example given for
“cue recognition,” and fill in the remaining diagnostic reasoning steps.
Stage Example
A.J., 62-year-old man, appears pale, diaphoretic, and anxious
Cue recognition
Hypothesis formulation
Data gathering for hypothesis testing
Hypothesis evaluation

CHAPTER 1 Evidence-Based Assessment 3
2. One of the critical-thinking skills is identifying assumptions. Explain how the following statement
contains an assumption. How would you get the facts in this situation? “Ellen, you have to break up
with your boyfriend. He is too rough with you. He is no good for you.”
3. Another critical-thinking skill involves validation, or checking the accuracy and reliability of data.
Describe how you would validate the following data.
Mr. Quinn tells you his weight this morning on the clinic scale was 165 lb.
The primary counselor tells you Ellen is depressed and angry about being admitted to residential
treatment in the clinic.
When auscultating the heart, you hear a blowing, swooshing sound between the first and second
heart sounds.
4. List the barriers to evidence-based practice, both on an individual level and on an organizational level.
5. Differentiate subjective data from objective data by placing an S or an O after each of the following:
complaint of sore shoulder ________; unconscious ________; blood in the urine ________; family
has just moved to a new area ________; dizziness ________; sore throat ________; earache ________;
weight gain ________.
6. For the following situations, state the type of data collection you would perform (i.e., complete
database, focused or problem-centered database, follow-up database, emergency database).
OxyContin overdose ______________; ambulatory, apparently well individual who presents
at outpatient clinic with a rash ______________; first visit to a health care provider for a
checkup ______________; recently placed on antihypertensive medication ______________.

7. Discuss the impact that racial and cultural diversity of individuals has on the U.S. health care system.
8. List three health care interactions you have experienced yourself with another person from a culture
or ethnicity different from your own. You may have been the patient or the provider—it makes no
difference.
9. Using one sentence or group of phrases, how would you describe your own health state to someone
you are meeting for the first time?
REVIEW QUESTIONS
This test is for you to check your own mastery of the content. Answers are provided in Appendix A.
1. The concept of health and healing has 2. Which would be included in the database for
evolved in recent years. Which is the best a new patient admission to a surgical unit?
description of health?
a. All subjective and objective data gathered
a. Health is the absence of disease. by a health practitioner from a patient
b. Health is a dynamic process toward b. All objective data obtained from a patient
optimal functioning. through inspection, percussion, palpation,
c. Health depends on an interaction of mind, and auscultation
body, and spirit within the environment. c. A summary of a patient’s record, including
d. Health is the prevention of disease. laboratory studies
d. All subjective and objective, and data
gathered from a patient and the results of
any laboratory or diagnostic studies
completed

CHAPTER 1 Evidence-Based Assessment 5
3. You are reviewing assessment data of a 7. Which best describes evidence-based nursing
45-year-old male patient and note pain of 8 practice?
on a scale of 10, labored breathing, and pale
a. Combining clinical expertise with the use
skin color on the electronic health record.
of nursing research to provide the best
This documentation is an example of:
care for patients while considering the
a. Hypothetical reasoning patient’s values and circumstances
b. Diagnostic reasoning b. Appraising and looking at the implications
c. Data cluster of one or two articles as they relate to the
d. Signs and symptoms culture and ethnicity of the patient
c. Completing a literature search to find
4. A patient is in the emergency department relevant articles that use nursing research
with nausea and vomiting. Which would you to encourage nurses to use good practices
include in the database? d. Finding value-based resources to justify
nursing actions when working with
a. A complete health history and full physical
patients of diverse cultural backgrounds
examination
b. A diet and GI history
8. What can be determined when the nurse
c. Previously identified problems
clusters data as part of the critical-thinking
d. Start collection of data in conjunction
process?
with lifesaving measures
a. This step identifies problems that may be
5. A patient has recently received health urgent and require immediate action.
insurance and would like to know how often b. This step involves making assumptions in
he should visit the provider. How do you the data.
respond? c. The nurse recognizes relevant information
among the data.
a. “It would be most efficient if you visit on
d. Risk factors can be determined so the
an annual basis.”
nurse knows how to offer health teaching.
b. “There is no recommendation for the
frequency of health care visits.”
9. A patient says she is very nervous and
c. “Your visits may vary, depending on your
nauseated, and she feels like she will vomit.
level of wellness.”
This data would be what type of data?
d. “Your visits will be based on your
preference.” a. Objective
b. Reflective
6. You are reviewing concepts related to steps in c. Subjective
the nursing process for determining d. Introspective
prioritization and developing patient
outcomes. To what are these actions 10. The expert nurse differs from the novice
attributed? nurse by acting without consciously thinking
about the actions. This is referred to as:
a. Planning
b. Assessment a. Deductive reasoning
c. Implementation b. Intuition
d. Diagnosis c. The nursing process
d. Focus assessment

11. Which would be considered a risk diagnosis? 14. Which is an example of objective data?
a. Identifying existing levels of wellness a. Patient’s history of allergies
b. Evaluating previous problems and goals b. Patient’s use of medications at home
c. Identifying potential problems the c. Last menstrual period 1 month ago
individual may develop d. 2- × 5-cm scar present on the right lower
d. Focusing on strengths and reflecting an forearm
individual’s transition to higher levels of
wellness 15. During the evaluation phase of the nursing
process, which action would be included?
12. Which would be included in a holistic model
a. Validating the nursing diagnosis
of assessment?
b. Establishing priorities related to patient
a. Nursing goals for the patient care
b. Anticipated growth and development c. Providing information to the patient and
patterns family members
c. A patient’s perception of his or her health d. Establishing a timeline for planned
status outcomes
d. The nurse’s perception of disease related
to the patient
13. The nurse uses health promotion activities

with a new patient. What would this focus
include?
a. The nurse would try to change the
patient’s perceptions of disease.
b. The nurse would search for identification
of biomedical model interventions.
c. The nurse would help to identify negative
health acts of the patient.
d. The nurse would empower the patient to
choose a healthier lifestyle.

CHAPTER
2
Cultural Competence
PURPOSE
This chapter reviews the demographic profile of the United States, the National Standards for Culturally
and Linguistically Appropriate Services in Health Care, traditional health/illness beliefs and practices,
and the steps to cultural competency. At the end of the chapter, you will be able to perform a cultural
assessment.
READING ASSIGNMENT
Suggested reading:
Saccomano SJ, Abbatiello GA. (2014). Cultural considerations at the end of life. Nurse Pract 39(2):24-31.
GLOSSARY
Acculturation. . . . . . . . . . . . . . . process of social and psychological exchanges with encounters between

persons of different cultures, resulting in changes in either group
Cultural and linguistic
competence. . . . . . . . . . . . . . . . . a set of congruent behaviors, attitudes, and policies that come together in
a system among professionals that enables work in cross-cultural
situations
Cultural care. . . . . . . . . . . . . . . . professional health care that is culturally sensitive, appropriate, and
competent
Culture. . . . . . . . . . . . . . . . . . . . . the nonphysical attributes of a person—the thoughts, communications,
actions, beliefs, values, and institutions of racial, ethnic, religious, or social
groups
Ethnicity . . . . . . . . . . . . . . . . . . . a social group within the social system that claims to possess variable traits
such as a common geographic origin, migratory status, and religion
Ethnocentrism. . . . . . . . . . . . . . tendency to view your own way of life as the most desirable, acceptable,
or best and to act superior to another culture’s way of life

Folk healer . . . . . . . . . . . . . . . . . lay healer in the person’s culture apart from the biomedical or scientific
health care system
Health or illness. . . . . . . . . . . . . the balance or imbalance of the person, both within one’s being (physical,
mental, and/or spiritual) and in the outside world (natural, communal,
and/or metaphysical)
Religion. . . . . . . . . . . . . . . . . . . . the belief in a divine or superhuman power or powers to be obeyed and
worshiped as the creator(s) and ruler(s) of the universe and a system of
beliefs, practices, and ethical values
Socialization. . . . . . . . . . . . . . . . the process of being raised within a culture and acquiring the character-
istics of that group
Spirituality. . . . . . . . . . . . . . . . . a person’s personal effort to find purpose and meaning in life
Title VI of the Civil
Rights Act of 1964. . . . . . . . . . . a federal law that mandates that when people with limited English profi-
ciency (LEP) seek health care in health care settings such as hospitals,
nursing homes, clinics, daycare centers, and mental health centers, services
cannot be denied to them
Values. . . . . . . . . . . . . . . . . . . . . . a desirable or undesirable state of affairs and a universal feature of all
cultures
STUDY GUIDE
provided:
1. Describe the provisions of Title VI of the Civil Rights Act of 1964.
2. Describe the rationale and components of cultural care.
3. List the basic characteristics of culture.

CHAPTER 2 Cultural Competence 9
4. List and describe factors related to socialization.
5. List and define 3 major theories about how people view the causes of illness.
6. Define the yin yang theory of health and illness, and relate this to different types of foods.
7. Define the hot and cold theory of health and illness, and relate this to different types of foods and
illnesses.
8. List at least 5 names for various folk healers and the culture they represent.
9. Describe five methods of complementary interventions.

REVIEW QUESTIONS
This test is for you to check your own mastery of the content. Answers are provided in Appendix A.
1. Which statement best describes religion? 4. You are the triage nurse in the emergency
department and perform the initial intake
a. An organized system of beliefs concerning
assessment on a patient who does not speak
the cause, nature, and purpose of the
English. Based on your understanding of
universe
linguistic competence, which action would
b. Belief in a divine or superhuman spirit to
present as a barrier to effective
be obeyed and worshiped
communication?
c. Affiliation with one of the 1200 recognized
religions in the United States a. Maintaining a professional respectful
d. The following of established rituals, demeanor
especially in conjunction with health- b. Allowing for additional time to complete
seeking behaviors the process
c. Providing the patient with a paper and
2. The major factor contributing to the need pencil so he or she can write down the
for cultural care nursing is: answers to the questions that you are
going to ask
a. An increasing birth rate
d. Seeing if there are any family members
b. Limited access to health care services
present who may assist with the interview
c. Demographic change
process
d. A decreasing rate of immigration
5. Which culture would describe illness as hot
3. The term culturally competent implies that
and cold imbalance?
the nurse:
a. Asian-American heritage
a. Is prepared in nursing.
b. African-American heritage
b. Possesses knowledge of the traditions of
c. Hispanic-American heritage
diverse peoples.
d. American Indian heritage
c. Applies underlying knowledge to
providing nursing care.
d. Understands the cultural context of the
patient’s situation.

6. Of what does the patient believe the amulet 9. Which statement is true in regard to pain?
is protective?
a. Nurses’ attitudes toward their patients’
a. The evil eye pain are unrelated to their own
b. Being kidnapped experiences with pain.
c. Exposure to bacterial infections b. The cultural background of a patient is
d. An unexpected fall important in a nurse’s assessment of that
patient’s pain.
7. Which statement best illustrates the c. A nurse’s area of clinical practice is most
difference between religion and spirituality? likely to determine his or her assessment
of a patient’s pain.
a. Religion reflects an individual’s reaction to
d. A nurse’s years of clinical experience and
life events whereas spirituality is based on
current position are a strong indicator of
whether the individual attends religious
his or her response to patient pain.
services.
b. Religion is characterized by identification
10. Which factor is identified as a priority
of a higher being shaping one’s destiny
influence on a patient’s health status?
while spirituality reflects an individual’s
perception of one’s life having worth or a. Poverty
meaning. b. Lifestyle factors
c. Religion is the expression of spiritual c. Legislative action
awakening whereas spirituality is based on d. Occupational status
belief in divine right.
d. Religion is the active interpretation of 11. Which statement is most appropriate to use
one’s spirituality. when initiating an assessment of cultural beliefs
with an older American Indian patient?
8. The first step to cultural competency by a
a. “Are you of the Christian faith?”
nurse is to:
b. “Do you want to see a medicine man?”
a. Identify the meaning of health to the c. “How often do you seek help from
patient. medical providers?”
b. Understand how a health care delivery d. What cultural or spiritual beliefs are
system works. important to you?”
c. Develop a frame of reference to traditional
health care practices.
d. Understand your own heritage and its
basis in cultural values.

12. Which statement best describes 14. Which health belief practice is associated with
ethnocentrism? patients who are of American Indian heritage?
a. The government’s description of various a. Wearing bangle bracelets to ward off evil
cultures spirits
b. A central belief that accepts all cultures as b. Eating compatible foods in one’s diet
one’s own c. Using swamp root as a traditional home
c. The tendency to view your own way of life remedy
as the most desirable d. Believing in a shaman as a traditional
d. The tendency to impose your beliefs, healer
values, and patterns of behaviors on an
individual from another culture 15. Which statement best reflects the
Magicoreligious causation of illness?
13. Which category is appropriate in a cultural
a. Each being is but a part of a larger
assessment?
structure in the world of nature as it
a. Family history relates to health and illness.
b. Chief complaint b. Causality relationship exists leading to
c. Past medical history expression of illness.
d. Health-related beliefs c. Belief in the struggle between good and
evil is reflected in the regulation of health
and illness.
d. Illness occurs as a result of disturbances
between hot and cold reactions.
CRITICAL THINKING EXERCISE

Read and reflect on the Saccomano and Abbatiello article listed on p. 7, “Cultural Considerations at the
End of Life.” Form a discussion with a partner or with a small group. Of course you cannot generalize the
examples in the article to all members of a racial or ethnic group. However, discuss some of these examples.
How does your own family face end-of-life care from your own cultural perspective? How do you respond
if the article’s examples are different from your own culture? How would you tailor your end-of-life nursing
care for persons from a culture different from your own?
SKILLS LABORATORY AND CLINICAL SETTING

You are now ready for the clinical component of this chapter. The purpose of the clinical component is to
collect data for a heritage assessment on a peer in the skills laboratory or on a patient in the clinical setting.
Although you may not yet have been assigned chapters on the health history, the questions in the heritage
assessment tool are clearly defined and should pose no problem. The best experience would be for you
to pair up with a peer from a cultural heritage different from your own. If this is not possible, you still
will gain insight and sensitivity into the cultural dimensions of health and will gain mastery of the
assessment tool.

BOX 2-1 SPECTOR’S HERITAGE ASSESSMENT

1. Where were you born? ______________________________________________________________
2. Where were your parents and grandparents born?
a. Mother: ________________________________________________________________________
b. Father: _________________________________________________________________________
c. Mother’s mother: ________________________________________________________________
d. Mother’s father: _________________________________________________________________
e. Father’s mother: _________________________________________________________________
f. Father’s father: __________________________________________________________________
3. How many brothers _________ and sisters ________ do you have?
4. In what setting did you grow up? Urban ______ Rural _______ Suburban _______
Where? ___________________________________________________________________________
5. In what country did your parents and grandparents grow up?
a. Mother: ________________________________________________________________________
b. Father: _________________________________________________________________________
c. Mother’s mother: ________________________________________________________________
d. Mother’s father: _________________________________________________________________
e. Father’s mother: _________________________________________________________________
f. Father’s father: __________________________________________________________________
6. How old were you when you came to the United States? ____________________________________
7. How old were your parents and grandparents when they came to the United States?
a. Mother: ________________________________________________________________________
b. Father: _________________________________________________________________________
c. Mother’s mother: ________________________________________________________________
d. Mother’s father: _________________________________________________________________
e. Father’s mother: _________________________________________________________________
f. Father’s father: __________________________________________________________________
8. When you were growing up, who lived with you? _________________________________________
9. Have you maintained contact with:
a. Aunts, uncles, cousins? _________ Yes _________ No
b. Brothers and sisters? _________ Yes __________ No
c. Parents? _________ Yes __________ No
d. Grandparents? _________ Yes _________ No
10. Does most of your family live near you? _________ Yes ________ No
11. Approximately how often do (did) you visit your family members who lived outside your home?
______ Daily ______ Weekly ______ Monthly ______ Less than once a year ______ Never
12. Was your original family name changed? ______ Yes ______ No

13. What is your religious preference? ________ Catholic _________ Jewish

______ Protestant (denomination): ______________ Other ______ None
14. Is your significant other of the same religion? ________ Yes _______ No
15. Is your significant other of the same ethnic background as you? _________ Yes ________ No
16. What kind of school did you attend? ______ Public ______ Private ______ Parochial
17. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic
background as you? ______ Yes ______ No
18. Do you belong to a religious institution? ______ Yes ______ No
19. Would you describe yourself as an active member? ______ Yes ______ No
20. How often do you attend your religious institution? ______ More than once a week ______ Weekly
______ Monthly ______ Special holidays only ______ Never
21. Do you practice your religion or other spiritual practices in your home? ________ Yes ______ No
If yes, please specify: ______ Praying ______ Bible reading ______ Diet ______ Celebrating
religious holidays ______ Meditating ________ Other _______
22. Do you prepare foods of your ethnic background? ______ Yes ______ No
23. Do you participate in ethnic activities? ______ Yes ______ No
If yes, specify: ______ Singing ______ Holiday celebrations ______ Dancing ______ Costumes
______ Festivals ______ Other
24. Are your friends from the same religious background? ______ Yes ______ No
25. Are your friends of the same ethnic background as you? ______ Yes ______ No
26. What is your native (non-English) language? _____________________________________________
Do you speak this language? ______ Prefer ______ Occasionally ______ Rarely
27. Do you read in your native language? ______ Prefer ______ Occasionally ______ Rarely
(You may score this assessment by giving 1 point to each positive answer from the yes/no questions 9
through 27. An exception is that if a person’s name was not changed, he or she gets the point. The higher
the score, the more likely the person is to use health practices relevant to his or her traditional heritage.)
From Spector, R.E. (2013). Cultural diversity in health and illness (8th ed., pp. 376-378). Upper Saddle River, NJ: Prentice Hall.

HEALTH AND ILLNESS BELIEFS AND PRACTICES DETERMINATION

The next set of questions relates to your own personal health and illness beliefs and practices.
1. How do you define health?
2. How do you rate your health? (Circle 1)

a. Excellent
b. Good
c. Fair
d. Poor
3. How do you describe illness?
4. What do you believe causes illness? (Circle all that apply.)

a. Environmental change h. Not enough work
b. Evil eye i. Overwork
c. Exposure to drafts j. Poor eating habits
d. God’s punishment k. Viruses, bacteria
e. Grief and loss l. Witchcraft
f. Hexes and spells m. Other
g. Incorrect food combinations
5. What did your mother and father do to maintain and protect your health?
6. How do you maintain and protect your health?

7. What home remedies did your mother use to restore your health?
8. What home remedies do you use?
9. Healing and curing are the same. _________ Yes _________ No
10. What do you believe brings healing?

CHAPTER
3
The Interview
PURPOSE
This chapter discusses the process of communication; presents the techniques of interviewing, including
open-ended versus closed questions, the 9 types of examiner responses, the 10 “traps” of interviewing, and
nonverbal skills; and considers variations in technique that are necessary for individuals of different ages,
for those with special needs, and for culturally diverse people.
READING ASSIGNMENT
Suggested reading:
Dickens C., & Piano, M. (2013). Health literacy and nursing: an update. Am J Nurs 113(6), 52-58.
GLOSSARY
Ad hoc interpreter. . . . . . . . . . . using a patient’s family member, friend, or child as interpreter for a patient
with limited English proficiency (LEP)
Animism. . . . . . . . . . . . . . . . . . . imagining that inanimate objects (e.g., a blood pressure cuff) come alive
and have human characteristics
Avoidance language. . . . . . . . . . the use of euphemisms to avoid reality or to hide feelings
Clarification. . . . . . . . . . . . . . . . examiner’s response used when the patient’s word choice is ambiguous or
confusing
Closed questions. . . . . . . . . . . . questions that ask for specific information and elicit a short, one- or two-
word answer, a “yes” or “no,” or a forced choice
Confrontation . . . . . . . . . . . . . . response in which examiner gives honest feedback about what he or she
has seen or felt after observing a certain patient action, feeling, or
statement
Distancing . . . . . . . . . . . . . . . . . the use of impersonal speech to put space between one’s self and a threat
Elderspeak . . . . . . . . . . . . . . . . . infantilizing and demeaning language used by a health professional when
speaking to an older adult

Electronic health recording. . . direct computer entry of a patient’s health record while in the patient’s
presence
Empathy . . . . . . . . . . . . . . . . . . . viewing the world from the other person’s inner frame of reference while
remaining yourself; recognizing and accepting the other person’s feelings
without criticism
Ethnocentrism. . . . . . . . . . . . . . the tendency to view your own way of life as the most desirable, acceptable,
or best and to act in a superior manner to another culture’s way of life
Explanation . . . . . . . . . . . . . . . . examiner’s statements that inform the patient; examiner shares factual and
objective information
Facilitation. . . . . . . . . . . . . . . . . examiner’s response that encourages the patient to say more, to continue
with the story
Geographic privacy. . . . . . . . . . private room or space with only the examiner and patient present
Interpretation . . . . . . . . . . . . . . examiner’s statement that is not based on direct observation, but is based
on examiner’s inference or conclusion; links events, makes associations, or
implies cause
Interview. . . . . . . . . . . . . . . . . . . meeting between the examiner and patient with the goal of gathering a
complete health history
Jargon . . . . . . . . . . . . . . . . . . . . . medical vocabulary used with a patient in an exclusionary and paternal-
istic way
Leading question. . . . . . . . . . . . a question that implies that one answer would be better than another
Nonverbal communication . . . message conveyed through body language—posture, gestures, facial
expression, eye contact, touch, and even where one places the chairs
Open-ended question. . . . . . . . asks for longer narrative information; unbiased; leaves the person free to
answer in any way
Reflection . . . . . . . . . . . . . . . . . . examiner response that echoes the patient’s words; repeats part of what
the patient has just said
Summary. . . . . . . . . . . . . . . . . . . final review of what examiner understands patient has said; condenses
facts and presents a survey of how the examiner perceives the health
problem or need
Telegraphic speech . . . . . . . . . . speech used by age 3 or 4 years in which three- or four-word sentences
contain only the essential words
Verbal communication. . . . . . . messages sent through spoken words, vocalizations, or tone of voice

CHAPTER 3 The Interview 19
STUDY GUIDE
provided:
1. List 8 items of information that should be communicated to the client concerning the terms or
expectations of the interview.
2. Describe the points to consider in preparing the physical setting for the interview.
3. List the pros and cons of note-taking during the interview.
4. Contrast open-ended versus closed questions, and explain the purpose of each during the interview.
5. List the 9 types of examiner responses that could be used during the interview, and give a short
example of each.

6. List the 10 traps of interviewing, and give a short example of each.
7. State at least 7 types of nonverbal behaviors that an interviewer could make.
8. State a useful phrase to use as a closing when ending the interview.
9. Discuss special considerations when interviewing an older adult.
10. How you would modify your interviewing technique when working with a
hearing-impaired person?

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And I so sorrowed at her sorrowes eft,
That, what with griefe, and feare, my wits were reft.
19.
I stretcht my selfe, and strayt my hart reuiues,

That dread and dolour erst did so appale,
Like him that with the feruent feuer striues,
When sicknesse seekes his castell[1507] health to skale:
With gathred sprites[1508] so forst I feare to auale:[1509]
And, rearing her, with anguish all foredone,
My sprits returnd,[1510] and then I thus begon:
20.
“O Sorrow, alas, sith Sorrow is thy name,

And that to thee this drere doth well pertayne,
In vayne it were to seeke to cease the same:
But, as a man himselfe with sorrow slayne,
So I, alas, doe comfort thee in payne,
That here in sorrow art forsunke so deepe,
That at thy sight I can but sigh and weepe.”
21.
I had no sooner spoken of a syke,[1511]

But that the storme so rumbled in her brest,
As Eölus could neuer roare the like,
And showers downe raynde from her eyes[1512] so fast,
That all bedreint the place, till, at the last,
Well eased they the dolour of her minde,
As rage of rayne doth swage the stormy winde:
22.
For forth shee paced in her fearefull tale:

“Come, come,” quod shee, “and see what I shall showe,
[1513]
Come, heare the playning and the bitter bale
Of worthy men, by fortune’s[1514] ouerthrowe:
Come thou, and see them rewing all in rowe,
They were but shades, that erst in minde thou rolde:
Come, come with mee, thine eyes shall them beholde.”
23.
What coulde these wordes but make mee more agast,

To heare her tell whereon I musde while ere?
So was I mazde therewith, till, at the last,
Musing vpon her words, and what they were,
All sodaynly well lessoned was my feare:
For to my minde retourned, how shee teld
Both what shee was, and where her wun shee helde.
24.
Whereby I knewe that she a goddesse was,

And, therewithall, resorted to my minde
My thought, that late presented mee the glas
Of brittle state, of cares that here wee finde,
Of thousand woes to seely[1515] men assynde:
And how shee now bid mee come and beholde,[1516]
To see with eye that earst in thought I rolde.
25.
Flat downe I fell, and with all reuerence

Adored her, perceiuing now, that shee,
A goddesse, sent by godly prouidence,
In earthly shape thus shewd her selfe to mee,
To wayle and rue this world’s vncertainty:[1517]
And, while I honourd thus her godhead’s might,
With plaining voyce these words to mee shee shright.
26.
“I shall thee guyde first to the griesly lake,

And thence vnto the blissfull place of rest,
Where thou shalt see, and heare, the playnt they make
That whilome here bare swinge among the best:
This shalt thou see: but greate is the vnrest
That thou must byde, before thou canst attayne
Unto the dreadfull place where these remayne.”
27.
And, with these words, as I vpraysed stood,

And gan to followe her that straight forth paste,[1518]
Ere I was ware, into a desert woode
Wee now were come: where, hand in hand imbraste,
[1519]
Shee led the way, and through the thicke so traste,[1520]

As, but I had bene guided by her might,
It was no way for any mortall wight.
28.
But, loe, while thus amid the desert darke

Wee passed on, with steps and pace vnmeete,
A rumbling roare, confusde with howle and barke
Of dogs, shoke all the ground vnder our feete,
And stroke the din within our eares so deepe,
As, halfe distraught, vnto the ground I fell,
Besought retourne, and not to visite hell.
29.
But shee, forthwith, vplifting mee a pace,

Remoude my dread, and, with a stedfast minde,
Bad mee come on, for here was now the place,
The place where wee our trauail’s end[1521] should finde:
Wherewith I rose,[1522] and to the place assignde
Astoinde I stalkt, when strayght wee approached nere
The dreadfull place, that you will dread to here.
30.
An[1523] hideous hole, all vaste, withouten shape,

Of endles depth, orewhelmde with ragged stone,
With ougly mouth, and griesly iawes doth gape,
And to our sight confounds it selfe in one:
Here entred wee, and, yeeding forth, anone
An horrible lothly[1524] lake wee might discerne,
As blacke as pitch that cleped is Auerne.
31.
A deadly gulfe: where nought but rubbish grows,

With fowle blacke swelth in thickned lumps that lies,
Which vp in th’ayre[1525] such stinking vapors throws
That ouer there, may flie no fowle, but dyes
Choakt with the pestilent[1526] sauours that arise:
Hither wee come, whence forth wee still did pace,
In dreadfull feare amid the dreadfull place:
32.
And, first, within the porch and iawes of hell

Sate deepe Remorse of Conscience, all bee sprent
With teares: and to her selfe oft would shee tell
Her wretchednes, and, cursing, neuer stent
To sob and sighe: but euer thus lament,
With thoughtfull care, as shee that, all in vaine,
Would weare, and waste continually in payne.
33.
Her[1527] eyes vnstedfast, rolling here and there,

Whurld on each place, as place that vengeaunce
brought,
So was her minde continually in feare,
Tossed[1528] and tormented with the[1529] tedious thought
Of those detested crymes which shee had wrought:
With dreadfull cheare, and lookes throwne to the skie,
Wishing for death, and yet shee could not die.
34.
Next, sawe wee Dread, all trembling how hee shooke,

With foote, vncertayne, profered here and there:
Benomd of speach, and, with a ghastly looke,
Searcht euery place, all pale and dead for feare,
His cap borne vp with staring of his heare,
Stoynde and amazde at his owne shade for dreede,
And fearing greater daungers then was neede.
35.
And, next, within the entry of this lake,

Sate fell Reuenge, gnashing her teeth for ire,
Deuising meanes how shee may vengeaunce take,
Neuer in rest, till shee haue her desire:
But frets within so farforth with the fire
Of wreaking flames, that now determines shee
To dy by death, or vengde by death to bee.
36.
When fell reuenge, with bloudy foule pretence

Had showde her selfe, as next in order set,
With trembling lims wee softly parted thence,
Till in our eyes another sight wee met:
When fro my heart a sigh forthwith I fet,
Rewing, alas, vpon the woefull plight
Of Misery, that next appeard in sight.
37.
His face was leane, and somedeale pynde away

And eke his hands consumed to the bone,
But what his body was, I cannot say,
For on his carkas rayment had hee none,
Saue clouts and patches pieced one by one,
With staffe in hand, and scrip on shoulder[1530] cast,
His chiefe defence agaynst the winter’s blast.
38.
His foode, for most, was wilde fruites of the tree,

Unlesse sometime some crums fell to his share,
Which in his wallet long, God wot, kept hee,
As one the which full daintely would fare:[1531]
His drinke, the running streame, his cup, the bare
Of his palme cloasde, his bed, the hard cold ground:
To this poore life was Misery ybound.
39.
Whose wretched state when wee had well beheld,

With tender ruth on him, and on his feres,
In thoughtfull cares forth then our pace wee held:
And, by and by, another shape apperes
Of greedy Care, still brushing vp the breres,
His knuckles knobde, his flesh deepe dented in,
With tawed hands, and hard ytanned skin.
40.
The morrowe gray no sooner hath begon

To spreade his light, euen peping in our eyes,
When[1532] hee is vp, and to his worke yrun:
But let the night’s blacke misty mantles rise,
And with foule darke neuer so mutch disguise
The fayre bright day, yet ceasseth hee no while,
But hath his candels to prolong his toyle.
41.
By him lay heauy Sleepe, the[1533] cosin of Death,

Flat on the ground, and still as any stone,
A very corps, saue yelding forth a breath:
Smale kepe tooke hee, whome fortune frowned on,
Or whom shee lifted vp into the throne
Of high renoune, but, as a liuing death,
So, dead aliue, of life hee drew the breath.
42.
The bodie’s rest, the quiet of the hart

The trauailes ease, the still night’s feere was hee:
And of our life in earth the better part,
Reuer of sight, and yet in whom wee see
Things oft that tyde,[1534] and oft that neuer bee:
Without respect, esteming[1535] equally
King Crœsus’ pompe, and Irus’ pouertie.
43.
And next, in order sad, Old Age wee found,

His beard all hoare, his eyes hollow and blind,
With drouping chere still poring on the ground,
As on the place where nature him assinde
To rest, when that the sisters had vntwynde
His vitall thred, and ended with their knyfe
The fleting course of fast declyning lyfe.
44.
There heard wee him with broke[1536] and hollow plaint

Rewe with him selfe his end approching fast,
And all for nought his wretched mind torment,
With sweete remembraunce of his pleasures past,
And fresh delytes of lusty youth forewast:
Recounting which, how would hee sob and shrike?
And to bee yong agayne of loue beseke.
45.
But, and[1537] the cruell fates so fixed bee,

That tyme forepast cannot retourne agayne,
This one request of Ioue yet prayed hee:
That, in such withred plight, and wretched paine,
As eld, accompanied with his[1538] lothsome trayne,
Had brought on him, all were it woe and griefe,
Hee might a while yet linger forth his liefe.
46.
And not so soone discend into the pit:

Where Death, when hee the mortall corps hath slayne,
With retchlesse hand in graue doth couer it,
Therafter neuer to enioy agayne
The gladsome light, but, in the ground ylayne,
In depth of darknesse wast and weare to nought,
As hee had nere[1539] into the world bene brought.
47.
But who had seene him, sobbing, how hee stoode,

Unto himselfe, and how hee would bemone
His youth forepast, as though it wrought him good
To talke of youth, all were his youth foregone,
Hee would haue musde, and meruaylde much, whereon
This wretched Age should life desire so fayne,
And knowes full well lyfe doth but length his payne.
48.
Crookebackt hee was, toothshaken, and blere eyde,
Went on three feete, and somtyme,[1540] crept on fowre,
With olde lame boanes, that ratled by his syde,
His scalpe all pild, and hee with eld forlore:
His withred fist still knocking at Death’s dore,
Fumbling, and driueling, as hee drawes his breath,
[1541]
For briefe, the shape and messenger of Death.
49.
And fast by him pale Malady was plaste,

Sore sicke in bed, her coulour all foregone,
Bereft of stomacke, sauour, and of taste,
Ne could shee brooke no meate, but broths alone:
Her breath corrupt, her kepers euery one
Abhorring her, her sicknes past recure,
Detesting phisicke, and all phisicke’s cure.
50.
But, oh,[1542] the dolefull sight that then wee see,

Wee tournd our looke, and, on the other side,
A griesly shape of Famine mought wee see,
With greedy lookes, and gaping mouth, that cryed
And roarde for meate, as shee should there haue dyed,
Her body thin, and bare as any bone,
Whereto was left nought but the case alone.
51.
And that, alas, was gnawne on euery where,

All full of holes, that I ne mought refrayne
From tears, to see how shee her armes could teare,
And with her teeth gnash on the bones in vayne:
When, all for nought, shee fayne would so sustayne
Her staruen corps, that rather seemde a shade,
Then any substaunce of a creature made.
52.
Great was her force, whome stone wall could not stay,
Her tearing nayles snatching at all shee sawe:
With gaping iawes, that by no[1543] meanes ymay
Be satisfide from hunger of her mawe,
But eates herselfe as shee that hath no lawe:
Gnawing, alas, her carkas all in vayne,
Where you may count ech sinew, bone, and veyne.
53.
On her while wee thus firmly fixt our eyes,

That bled for ruth of such a drery sight,
Loe, sodaynly shee shrikt[1544] in so huge wise,
As made hell gates to shiuer with the might:
Wherewith, a dart wee sawe, how it did light
Right on her brest, and, therewithall, pale Death
Enthrilling it, to reue her of her breath.
54.
And, by and by, a dum dead corps wee sawe,

Heauy, and colde, the shape of death aright:
That daunts all earthly creatures to his lawe:
Against whose force in vaine it is to fight:
Ne peeres, ne princes, nor no mortall wyght,
No townes, ne realmes, cittyes, ne strongest tower,
But all, perforce, must yeelde vnto his power.
55.
His dart, anon, out of the corps hee tooke,

And in his hand (a dreadfull sight to see)
With great tryumph eftsones the same hee shooke;
That most of all my feares affrayed mee:
His body dight with nought but bones, perdye,
The naked shape of man there saw I plaine,
All saue the flesh, the sinow, and the vaine.
56.
Lastly, stoode Warre, in glittering[1545] armes yclad,

With visage grym, sterne lookes,[1546] and blackly hewed
In his right hand a naked sworde hee had,
That to the hilts was all with bloud embrued:
And in his left (that king[1547] and kingdomes rewed)
Famine and fyer he held, and therewithall
He razed townes, and threw downe towres and all.
57.
Cities hee sakt, and realmes (that whilome flowred

In honour, glory, and rule, aboue the best)
Hee ouerwhelmde, and all theire fame deuoured,
Consumde, destroyde, wasted and neuer ceast,
Tyll hee theire wealth, theire name, and all opprest:
His face forehewde with wounds, and by his side
There hung his targ, with gashes deepe and wide.
58.
In mids of which, depainted there, wee founde

Deadly Debate, all full of snaky heare,
That with a bloudy fillet was ybound,
Out breathing nought but discord euery where:
And round about were portrayde, here and there,
The hugy hostes, Darius and his power,
His kings, princes, his peeres,[1548] and all his flower.
59.[1549]
Whom great Macedo vanquisht there in sight,

With deepe slaughter, despoyling all his pryde,
Pearst through his realmes, and daunted all his might:
Duke Hanniball beheld I there besyde,
In Canna’s field, victor how hee did ryde,
And woefull Romaynes that in vayne withstoode,
And consull Paulus couered all in blood.
60.
Yet sawe I more the sight at Trasimene,

And Treby[1550] field, and eke when Hanniball
And worthy Scipio last in armes were sene
Before Carthago gate, to try for all
The world’s empyre, to whom it should befall:
There saw I Pompey, and Cæsar clad in arms,
Their hoasts allied and all their ciuill harms:
61.
With conquerers hands, forbathde in their owne bloud,

And Cæsar weeping ouer Pompey’s head:
Yet saw I Scilla and Marius where they stood,
Their greate crueltie, and the deepe bloudshed
Of frends: Cyrus I saw and his host dead,
And howe the queene with greate despite hath flong
His head in bloud of them shee ouercome.
62.
Xerxes, the Percian king, yet sawe I there,

With his huge host, that dranke the riuers drye,
Dismounted hills, and made the vales vprere,
His hoste and all yet sawe I slayne, perdye:
Thebes I sawe,[1551] all razde how it did lye
In heapes of stones, and Tyrus put to spoyle,
With walls and towers flat euened with the soyle.
63.
But Troy, alas, mee thought, aboue them all,
It made myne eyes in very teares consume:
When I behelde the woefull werd befall,
That by the wrathfull will of gods[1552] was come:
And Ioue’s vnmoued sentence and foredoome
On Priam king, and on his towne so bent,
I could not lin, but I must there lament.
64.
And that the more sith desteny was so sterne

As, force perforce,[1553] there might no force auayle,
But shee must fall: and, by her fall, wee learne,
That cities, towers, welth, world, and all shall quaile:
No manhood, might, nor nothing mought preuayle,
All were there prest full many a prince, and peere,
And many a knight that solde his death full deere.
65.
Not worthy Hector, worthyest of them all,

Her hope, her ioy, his force is now for nought:
O Troy, Troy,[1554] there is no boote but bale,
The hugie horse within thy walls is brought:
Thy turrets fall, thy knights, that whilome fought
In armes amid the field, are slayne in bed,
Thy gods defylde, and all thy honour dead.
66.
The flames vpspring,[1555] and cruelly they creepe

From wall to roofe, till all to cinders waste,
Some fyre the houses where the wretches sleepe,
Some rush in here, some run in there as fast:
In euery where or sword, or fyre, they tast:
The walls are torne, the towers whourld to the ground,
There is no mischiefe, but may there bee found.
67.
Cassandra yet there sawe I how they haled

From Pallas house, with spercled tresse vndone,
Her wrists fast bound, and with Greekes[1556] rout
empaled:
And Priam eke, in vayne how hee did ronne
To arms, whom Pyrrhus with dispite hath donne
To cruell death, and bathde him in the bayne
Of his sonne’s bloud, before the altare slayne.
68.
But how can I descriue the dolefull sight,

That in the shield so liuely[1557] fayre did shine?
Sith in this world, I thinke was neuer wight
Could haue set forth the halfe, not halfe so fyne:
I can no more, but tell how there is seene
Fayre Ilium fall in burning red gledes downe,
And, from the soile, great Troy, Neptunus’ towne.
69.
Here from when scarce I could mine[1558] eyes

withdrawe
That fylde with teares as doth the springing well,
We passed on so far forth till we sawe
Rude Acheron, a lothsome lake to tell,
That boyles and bubs vp swelth as blacke as hell,
Where griesly Charon, at theyr fixed tyde,
Still ferries ghostes vnto the farder side.
70.
The aged god no sooner Sorrow spyed,

But, hasting straight vnto the bancke apace,
With hollowe call vnto the rout hee cryed,
To swarue apart, and gieue the goddesse place:
Strayt it was done, when to the shoare wee pace,
Where, hand in hand as wee than linked fast,
Within the boate[1559] wee are together plaste.
71.
And forth wee launch full fraughted to the brinke,

Whan, with th’vnwonted[1560] waight, the rusty keele
Began to cracke as if the same should sinke,
Wee hoyse vp maste and sayle, that in a while
Wee fet the shoare, where scarsely wee had while
For to ariue, but that wee heard anone
A three sound barke confounded all in one.
72.
Wee had not long forth past, but that wee sawe
Blacke Cerberus, the hydeous hound of hell,
With bristles reard, and with a three mouth’d jawe,
Foredinning th’ayre[1561] with his horrible yell:
Out of the deepe darke caue where hee did dwell,
The goddesse straight hee knewe, and, by and by,
Hee peast, and couched, while[1562] that wee past by.
[1563]
73.
Thence come wee to the horrour and the hell,

The large great kingdoms, and the dreadfull raigne
Of Pluto in his throne where hee did dwell,
The wide waste places, and the hugie playne:
The waylings, shrikes, and sondry sorts of payne,
The sighes, the sobs, the deepe and deadly groane,
Earth, ayre, and all, resounding playnt and moane.
74.[1564]
Heare pewled[1565] the babes, and here the maydes
vnwed,
With folded hands theyr sory chaunce bewayld:
Here wept the guiltles slayne, and louers dead,
That slew them selues when nothing els auayld:
A thousand sorts of sorrows here, that waylde
With sighs, and teares, sobs, shrikes, and all yfeare,
That, oh,[1566] alas, it was a hell to heare.[1567]
75.[1568]
Wee staide vs strait, and with a rufull feare,

Beheld this heauy sight, while from myne eyes,
The vapored tears downe stilled here and there,
And Sorrowe eke in far more wofull wise,
Tooke on with plaint, vp heauing to the skies
Her wretched hands, that, with her cry, the rout
Gan all in heapes to swarme vs round about.
76.
“Loe here,” quoth Sorrow, “princes of renoune,

That whilom sate on top of fortune’s wheele,
Now layde full low, like wretches whurled downe,[1569]
Euen with one frowne, that slayde but with a smyle,
And now beholde the thing that thou, erewhile,
Saw onely in thought, and, what thou now shalt heere,
Recompt the same to kesar, king, and peere.”
77.
Then first came Henry duke of Buckingham,

His cloake of blacke all pilde, and quite forworne,[1570]
Wringing his hands, and fortune oft doth blame,
Which of a duke hath made him now her skorne:
With gastly lookes, as one in maner lorne,
Oft spred his armes, stretcht hands hee ioynes as fast,
With rufull cheare, and vapored eyes vpcast.
78.
His cloake hee rent, his manly brest hee beat,

His hayre all torne, about the place it lay,[1571]
My heart so molt to see his griefe so great,
As felingly me thought, it dropt away:
His eyes they whurld about withouten stay,
With stormy sighes the place did so complayne,
As if his heart at ech had burst in twayne.
79.
Thrise hee began to tell his dolefull tale,

And thrise the sighes did swallow vp his voyce,
At ech of which hee shriked so withall,
As though the heauens riued with the noyse:
Tyll at the last, recouering his voyce,
Supping the teares that all his brest beraynde,
On cruell fortune, weeping, thus hee playnde.
The Complaynt of Henry Duke of
Buckingham.
1.
Who trusts too much to[1572] honour’s highest throne,

And warely[1573] watch not sly dame fortune’s snares:
Or who in court will beare the swinge[1574] alone,
And wisely weigh not how to wield the care,
Behold hee mee, and by my death beware:
Whome flattering fortune falsely so beguylde,
That, loe, she slewe, where erst full smooth she
smilde.
2.
And, Sackuille, sith in purpose now thou hast

The wofull fall of princes to descryue,
Whom fortune both vplift, and eke[1575] downe cast,
To shew thereby th’vnshurty[1576] in this life,
Marke well my fall, which I shall shew belyue,
And paynt it forth, that all estates may knowe:
Haue they the warning, and be mine the woe.
3.
For noble bloud made mee both prince and peere,

Yea peereles too, had reason[1577] purchast place,
And God with giftes endowde mee largely heere:
But what auayles his giftes where fayles his grace?
My mother’s sire sprong of a kingly race,
And cald was Edmund duke of Somerset,
Bereft of life ere time by nature set.
4.
Whose faythfull heart to Henry sixt so wrought,

That neuer hee him in[1578] weale, or woe, forsooke,
Till lastly hee at Tewkesbury fielde was cought,
Where with an axe his violent death hee tooke:
Hee neuer could king Edward’s party brooke,
Tyll by his death hee voucht that quarell good,
In which his sire and graundsire spilt theyr bloud.
5.
And such was erst my father’s cruell chaunce,

Of Stafforde earle, by name that Humfrey hight,
Who euer prest did Henrye’s part auaunce,
And neuer ceast, till at S. Albane’s fight
Hee lost his life, as then[1579] did many a knight:
Where eke my graundsire, duke of Buckingham,
Was wounded sore, and hardly scapt vntane.
6.
But what may boote to stay the sisters three?

When Atropos perforce will cut the thred:
The dolefull day was come, when you might see
Northampton fielde with armed men orespred,
Where fate would algates haue my graundsire dead:
So, rushing forth amids the fiercest fight,
Hee liu’d[1580] and dyde there in his maister’s right.
7.
In place of whom, as it befell my lot,

Like on a stage, so stept I in straite way,
Enioying there, but woefully, God wot,
As hee that had a slender part to play:
To teach thereby, in earth no state may stay,
But as our partes abridge, or length our age,
So passe wee all, while others fill the stage.
8.
For of my selfe the drery fate to playne,

I was sometime a prince withouten peere,
When Edward fift began his rufull raigne,
Ay me, then I began that hatefull yeere,
To compasse that which I haue bought so deere:
I bare the swinge, I and that wretched wight
The duke of Glocester, that Richard hight.
9.
For when the fates had reft that royall prince

Edward the fourth, cheife miroure of that name,
The duke and I, fast ioyned euer since
In faithfull loue, our secret drifts to frame,
What hee thought best, to mee so seemde the same,
My selfe not bent so much for to aspyre,
As to fulfill that greedy duke’s desyre.
10.
Whose restlesse mynd, sore thirsting after rule,

When that hee sawe his nephewes both to bene
Through tender years as yet vnfit to rule,
And rather ruled by their mother’s kin,
There sought hee first his mischiefe to begin,
To plucke from them theire mother’s frends assynde,
For well hee wist they would withstand[1581] his mynde.
11.
To follow which hee ran so headlong swyft,

With egre thirst of his desired draught,

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Laboratory manual [to accompany]

Physical examination & health

CAROLYN JARVIS, PhD, APN, CNP

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

LABORATORY MANUAL FOR PHYSICAL EXAMINATION AND ISBN: 978-0-323-26541-6

Copyright © 2016 by Elsevier Inc. All rights reserved.

International Standard Book Number: 978-0-323-26541-6

Content Strategist: Lee Henderson

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

UNIT I: ASSESSMENT OF THE WHOLE PERSON

UNIT II: APPROACH TO THE CLINICAL SETTING

UNIT III: PHYSICAL EXAMINATION

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

UNIT IV: INTEGRATION: PUTTING IT ALL TOGETHER

Appendix A Answers to Review Questions, 307

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

13. The nurse uses health promotion activities

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Acculturation. . . . . . . . . . . . . . . process of social and psychological exchanges with encounters between

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

1. Describe the provisions of Title VI of the Civil Rights Act of 1964.

2. Describe the rationale and components of cultural care.

3. List the basic characteristics of culture.

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

4. List and describe factors related to socialization.

9. Describe five methods of complementary interventions.

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

CRITICAL THINKING EXERCISE

SKILLS LABORATORY AND CLINICAL SETTING

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

BOX 2-1 SPECTOR’S HERITAGE ASSESSMENT

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

13. What is your religious preference? ________ Catholic _________ Jewish

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

HEALTH AND ILLNESS BELIEFS AND PRACTICES DETERMINATION

1. How do you define health?

2. How do you rate your health? (Circle 1)

3. How do you describe illness?

4. What do you believe causes illness? (Circle all that apply.)

6. How do you maintain and protect your health?

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

8. What home remedies do you use?

9. Healing and curing are the same. _________ Yes _________ No

10. What do you believe brings healing?

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

3. List the pros and cons of note-taking during the interview.

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition,

6. List the 10 traps of interviewing, and give a short example of each.

7. State at least 7 types of nonverbal behaviors that an interviewer could make.

13. What is your religious preference? Catholic _ Jewish

9. Healing and curing are the same. _ Yes _ No