Bates' Guide to Physical Examination and History Taking by Lynn S Bickley, Peter G. Szilagyi, Peter G Szilagyi

From the Publisher

The Tenth Edition of the pre-eminent textbook on physical examination and history taking contains foundational content to guide students' approaches to history taking, interviewing, and other core assessment concepts, as well as fully illustrated, step-by-step techniques that outline correct performance of physical examination. The comprehensive content is intended for high-level nursing education and practice markets, medical students, and related health professions such as physician assistants. Text includes free head-to-toe assessment and techniques of communication videos. "Doody's Core Titles™ 2009."

Doody Review Services

Reviewer: Carole A. Kenner, RNC, DNS, FAAN(University of Oklahoma College of Nursing)
Description: This text is as the title suggests a guide to physical examination and history taking. It is aimed at the student that is just learning the foundational assessment, physical examination skills. This is the ninth edition with the previous one published in 2003.
Purpose: The purpose is to assist the beginning level health professional student with conducting history and physicals. It is meant to help the student apply clinical reasoning through its pedagogy. These are worthy objectives and are met.
Audience: The audience is the student in the health professions. This is according to the author and reviewer. The author is well known and highly credible.
Features: The book begins with the foundations of physical examination and moves into the regional examinations, and finally ends with life span examinations. The chapters are according to body systems and follow a head to toe approach. The list of tables at the beginning of the text helps the reader find specific information quickly. The companion CD is a wonderful addition to supplement the print material. Use of color photos help reinforce the content and are great for visual learners.
Assessment: The other book on the market that is similar is Seidel's Guide to Physical Examination, 6th edition, 2006, published by Elsevier. The Bates' book offers test generator and comprehensive manual including an image bank accompanying ready materials in a learning management system whereas Seidel's has a fully integrated online package. However, Bates' bookis very good and the newest edition more information on the older adult and the pediatric client-two very needed areas. It also increased the content on the skin and mental status. Again, these are needed areas. All and all this text is a very good beginning guide for students and is easy to use for faculty. It would be a welcomed addition to a student's library.

Product Details

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Table of Contents

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Chapter 20: Clinical Thinking: From Data to Plan

Difficulties and Variations

Limitations of the Medical Model. Although medical diagnosis is based rimarily on identifying abnormal structures, disturbed processes, and specific causes, you will frequently see patients whose complaints do of fall neatly into these categories. Some symptoms defy analysis, and you may never be able to move beyond simple descriptive categories such as "fatigue" or "anorexia." Other problems relate to the patient's ' e rather than to the body. Events such as loss of a job or loved one eaten a person and may increase the risk of subsequent illness. Iden- ing such life events, evaluating a person's responses to them, and or king out a plan to help the person cope with them are just as apropriate as dealing with the pharyngitis or duodenal ulcer. Health maintenance has become an increasingly important and legitimate item problem lists for patients. Plans may include, for example, updating immunizations, advice on nutrition, exploring feelings about an import life event, and recommendations for seat belts or exercise.

Single Versus Multiple Problems. One of the greatestdifficulties faced y the student is deciding whether to cluster the patient's symptoms d signs into one or into several problems. The patient's age may help, ' ce young people are more likely to have single diseases while older people tend to have multiple ones. The timing of symptoms is often use1. An episode of pharyngitis 6 weeks ago is probably unrelated to ver, chills, chest pain, and cough today. To use timing effectively, you need to know the natural history of various diseases. A yellowish disarge from the penis followed in 3 weeks by a painless penile ulcer, for ample, suggests two problems, gonorrhea and primary syphilis. A pee ulcer followed in 6 weeks by a maculopapular skin rash and generalized lymphadenopathy, on the other hand, suggests two stages of the me problem: primary and secondary syphilis.

Involvement of different body systems may help you to cluster the items of data. While symptoms and signs within a single system can often be exlpained by one disease, manifestations in different, apparently unrelated stems often require more than one explanation. Again, a knowledge of 's ease patterns is necessary. You might decide, for example, to group a tient's high blood pressure and sustained thrusting apical impulse tother with the flame-shaped retinal hemorrhages, place them in the cardiovascular system, and label the constellation "hypertensive cardiovascular disease with hypertensive retinopathy" You will probably develop another explanation for the diarrhea and left lower quadrant tenderness.

Some diseases affect more than one body system. As you gain in knowledge and experience, you will become increasingly adept at recognizing such multisystem conditions and at building plausible explanations that link together their seemingly unrelated manifestations. In trying to explain the productive cough, hemoptysis, and weight loss reported by a 60-year-old man who has smoked cigarettes for 40 years, you probably even now would postulate lung cancer as a likely cause. You might even support this hypothesis by your observation of clubbed fingernails. With time you will also recognize that his other symptoms and signs can be linked to the same diagnosis. The dysphagia is caused by extension of the cancer to his esophagus; the pupillary inequality is a Horner's syndrome caused by pressure on the cervical sympathetic chain; and the jaundice results from metastases to the liver.

In another case of multisystem disease, a man's fever, weight loss, chronic diarrhea, dysphagia, white-coated tongue, generalized lymphadenopathy, and purplish skin nodules can all be explained by AIDS. The clinician who has not already explored the patient's risk factors for this disease should do so.

An Unmanageable Array of Data. In trying to understand a patient's problems, the clinician often is confronted with a relatively long list of symptoms and signs and an equally long list of potential explanations or labels. As already suggested, you can tease out separate clusters of observations and deal with them one cluster at a time.

You can also analyze a given group of observations by asking key questions, the answers to which steer your thinking in one direction and allow you to ignore others temporarily. For example, you may ask what produces and relieves a person's chest pain. If the answer is exercise and rest, respectively, you can concentrate on the cardiovascular system (and possibly the musculoskeletal system as well) and put aside the gastrointestinal tract. If the pain results from eating quickly and is relieved by regurgitating the food, you logically concentrate on the upper gastrointestinal tract. A series of such discriminating questions forms a branching logic tree or algorithm and is helpful in collecting data, analyzing them, and reaching conclusions that probably explain them.

Quality of the Data. Virtually all the information with which the clinician works is subject to error. Patients forget symptoms, misremember the sequence in which they occurred, hide important but embarrassing facts, and shape their stories toward what interviewers seem to want to hear. Clinicians misunderstand their patients, overlook some relevant information, fail to ask the one key question, jump to premature diagnostic conclusions, or forget to examine the genitals of a patient with asymptomatic testicular carcinoma. You can avoid some of these errors by being thorough, by keeping an open mind as you gather data, and by analyzing any mistakes that you might make...