Intimate partner violence (IPV) and sexual assault are common violent crimes perpetrated on women. Obstetric (OB) complications associated with trauma include miscarriage, preterm labor, and placental abruption. Ongoing mental health issues, including depression and anxiety, are more prevalent in pregnant women subjected to any form of IPV, whether or not direct physical violence is involved. One study showed that pregnant women subjected to verbal threats were twice as likely to deliver low-birth-weight infants. All women who present to an OB triage unit or an emergency department (not just those who present with an injury or complication) must be screened for IPV. An organized plan for providing the victim with resources must be readily available when a screen is positive. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, clinical management and follow-up care of IPV and sexual assault.

The physical assessment of the pediatric obese patient is similar, yet different, to that of an adult obese patient. It is important to include family in the interview and assessment, as the goal needs to be a collaborative effort for evaluation, assessment, and treatment. Similar to an adult assessment, key skills, including critical thinking, scientific knowledge bases, experience, clinical competencies, attitude, and standard of care, need to be utilized. The health history should be taken directly from the patient and a family member. It is important to use any previous medical records for a complete review. A physical examination should start with the head and progress downward to the toe. Variations in the obese pediatric patient’s physical examination can be seen in multiple areas. Pediatric variations also need to be considered in physical examination. Differential diagnoses should be considered with pediatric obesity. This includes hypothyroidism, Down syndrome, or Prader-Willi syndrome.

During the past several years, simulation pedagogy has taken off in leaps and bounds. The breadth of simulation design and implementation has become woven into the fabric of the majority of nursing education in the United States and beyond. As faculty members who teach in both graduate and undergraduate courses, the authors of this chapter find that simulation can be challenging to both the novice and seasoned educator. This chapter focuses on the use of simulation in the fundamental physical assessment course. The use of simulation technology is especially useful in creating the equivalent of “muscle memory” for the students because of the ability to do frequent and repetitive exercises using this technology. It is especially useful in assisting students to learn, develop, and mature their assessment skills. The chapter briefly describes specific objectives for simulation usage within a specific course and the overall program.

Critical thinking is required in performing an accurate physical assessment. Critical thinking encompasses analysis of data using the scientific knowledge base, experience, clinical competencies, attitude, and standard of care. These specific areas allow the advanced practice nurse (APN) to hone in on the health assessment and physical examination. Prior to the physical examination, a thorough health history needs to be taken. The health history or history of present illness (HPI) provides the patient’s reason for seeking out the APN and documents the chronological signs and symptoms of the problem from beginning to end. The APN should complete a head-to-toe physical assessment and review vitals and measurements. A complete physical examination for the obese patient should be similar to a normal physical examination with some slight variations. A head-to-toe physical examination includes four basic skills: inspection, palpation, percussion, and auscultation.

Infectious Keratitis

Basic assessment skills of observation, interview, and examination can aid in differentiating normal from abnormal findings and identifying changes. In addition to using these skills when completing the Minimum Data Set (MDS), nurses can incorporate them into general nursing activities so that every nurse–resident interaction provides an opportunity for assessment. This chapter describes the basic skills used in assessment and outlines the components and skills used in conducting a comprehensive physical assessment. Physical examination utilizes several major skills, such as: inspection, auscultation, percussion, and palpation. The chapter also explains the method of conducting a mental status assessment. Mental status is examined by: observations of general attention to grooming, appropriateness of dress, body language, and general behavior, language and speech, affect, responses to questions, and the use of standardized assessment tools.

Diverticulitis

Infectious Peritonitis

Cholecystitis

Hematopoietic Stem Cell Transplant Infections