HESI HEALTH ASSESMENT DOCUMENT WITH WELL ELABORATED QUESTIONS AND ANSWERS. PASSING WITH FLYING COLOURS GUARANTEED!
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Course
NUR2092 Health Assessment
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Rasmussen College
1.Interviewing skills and documentation (open ended questions)
The open-ended question asks for narrative information. It states the topic to be discussed but only in general terms. Use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new top...
1interviewing skills and documentation open ended questions the open ended question asks for narrative information it states the topic to be discussed but only in general terms use it to begin th
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NUR2092 Health Assessment
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Hesi Topics Health assessment
1. Interviewing skills and documentation (open ended questions)
The open-ended question asks for narrative information. It states the topic to be discussed but
only in general terms. Use it to begin the interview, to introduce a new section of questions, and
whenever the person introduces a new topic. “Tell me how I can help you.” “What brings you to
the hospital?” “You mentioned shortness of breath. Tell me more about that.” “How have you
been feeling since your last appointment?” The open-ended question is unbiased; it leaves the
person free to answer in any way. This question encourages the person to respond in
paragraphs and give a spontaneous account in any order chosen. It lets the person express
himself or herself fully. As the person answers, make eye contact and listen. Typically he or she
will provide a short answer, pause, and then look at you for direction on whether to continue.
How you respond to this nonverbal question is key. If you pose new questions on other topics,
you may lose much of the initial story. Instead lean forward slightly toward the client and make
eye contact, looking interested. With your posture indicating interest, the person will likely
continue his or her story. If not, you can respond to his or her statement with, “Tell me about it,”
or “Anything else?”
Comparison of Open-Ended and Closed Questions
OPEN-ENDED DIRECT, CLOSED
Used for narrative Used for specific information
information
Calls for long Calls for short one- to two-word
paragraph answers
answers
Builds and enhances rapport Limits rapport and leaves interaction
neutral
Tell me all about Are your headaches on one side or both?
your
headaches.
2. Palpate pulses
the pads of your first three fingers, palpate the radial pulse at the flexor aspect of the wrist
laterally along the radius bone (Fig. 9-4). If the rhythm is regular, count the number of beats in
30 seconds and multiply by 2. Although the 15-second interval is frequently practiced, any one-
beat error in counting results in a recorded error of 4 beats/min. The 30-second interval is most
accurate and efficient when heart rates are normal or rapid and when rhythms are regular.
However, if the rhythm is irregular, count for a full minute. As you begin the counting interval,
start your count with “zero” for the first pulse felt. The second pulse felt is “one,” and so on.
Assess the pulse, including (1) rate, (2) rhythm, and (3) force
usually is not necessary to palpate the ulnar pulses. If indicated, reach your hand under the
person's arm and palpate along the medial side of the inner forearm (Fig. 20-9), although the
,ulnar pulses often are not palpable in the healthy person.
Palpate the brachial pulses if you suspect arterial insufficiency—their force should be equal
bilaterally
Palpate these peripheral arteries in both legs: femoral, popliteal, dorsalis pedis, and posterior
tibial. Grade the force on the three-point scale. Locate the femoral arteries just below the
inguinal ligament halfway between the pubis and anterior superior iliac spines (Fig. 20-15). To
help expose the femoral area, particularly in obese people, ask the person to bend his or her
knees to the side in a froglike position. Press firmly and then slowly release, noting the pulse tap
under your fingertips. If this pulse is weak or diminished, auscultate the site for a bruit.
The popliteal pulse is a more diffuse pulse and can be difficult to localize. With the leg extended
but relaxed, anchor your thumbs on the knee and curl your fingers around into the popliteal
fossa (Fig. 20-16). Press your fingers forward hard to compress the artery against the bone (the
lower edge of the femur or the upper edge of the tibia). Often it is just lateral to the medial
tendon
For the posterior tibial pulse, curve your fingers around the medial malleolus (Fig. 20-18). Press
softly. You will feel the tapping right behind it in the groove between the malleolus and the
Achilles tendon. If you cannot, try passive dorsiflexion of the foot to make the pulse more
accessible
The dorsalis pedis pulse requires a very light touch. Normally it is just lateral to and parallel with
the extensor tendon of the big toe (Fig. 20-19). Do not mistake the pulse in your own fingertips
for that of the person.
Do not palpate carotid artery pulses at the same time; can lead to syncope.
3. Apical pulse
Aortic-2nd incs right medial sternal, pulmonic-2nd incs left medial sternal, erb’s-3 incs medial
sternal, tricuspid-4/5 incs medial sternal, mitral-5 incs mid clavicular.
When you notice any irregularity, check for a pulse deficit by auscultating the apical beat while
simultaneously palpating the radial pulse. Count a serial measurement (one after the other) of
apical beat and radial pulse. Normally every beat you hear at the apex should perfuse to the
periphery and be palpable. The two counts should be identical. When different, subtract the
radial rate from the apical, and record the remainder as the pulse deficit.
Count apical pulse for a full minute.
4. Cardiac sounds S1 and S2
S1 is the start of systole and thus serves as the reference point for the timing of all other cardiac
sounds. You must learn to distinguish systole from diastole before you can attach meaning to all
other sounds. Usually you can identify S1 instantly because you hear a pair of sounds close
together (lub-dup) and S1 is the first of the pair. This guideline works, except in the cases of the
tachydysrhythmias (rates >100 beats/min). Then the diastolic filling time is shortened, and the
beats are too close together to distinguish.
S1 is louder than S2 at the apex; S2 is louder than S1 at the base.
• S1 coincides with the carotid artery pulse. Feel the carotid gently as you auscultate at the
apex; the sound you hear as you feel each pulse is S1 (Fig. 19-23).
• S1 coincides with the R wave (the upstroke of the QRS complex) if the person is on an ECG
monitor.
First Heart Sound (S1). Caused by closure of the AV valves, S1 signals the beginning of
,systole. You can hear it over the entire precordium, although it is loudest at the apex (Fig. 19-
24). (Sometimes the two sounds are equally loud at the apex because S1 is lower pitched than
S2.)
● You can hear S1 with the diaphragm with the person in any position and equally well in
inspiration and expiration. A split S1 is normal, but it occurs rarely. A split S1 means that
you are hearing the mitral and tricuspid components separately. It is audible in the
tricuspid valve area, the left lower sternal border. The split is very rapid, with the two
components only 0.03 second apart.
Second Heart Sound (S2). The S2 is associated with closure of the semilunar valves. You can
hear it with the diaphragm over the entire precordium, although S2 is loudest at the base
● Splitting of S2. A split S2 is a normal phenomenon that occurs toward the end of
inspiration in some people. Recall that closure of the aortic and pulmonic valves is nearly
synchronous. Because of the effects of respiration on the heart described earlier,
inspiration separates the timing of the two valves' closure, and the aortic valve closes
0.06 second before the pulmonic valve. Instead of one DUP, you hear a split sound—T-
DUP (Fig. 19-26). During expiration, synchrony returns and the aortic and pulmonic
components fuse together. A split S2 is heard only in the pulmonic valve area, the
second left interspace.
● When you first hear the split S2, do not be tempted to ask the person to hold his or her
breath so you can concentrate on the sounds. Breath holding only equalizes ejection
times in the right and left sides of the heart and causes the split to go away. Instead,
concentrate on the split as you watch the person's chest rise up and down with
breathing. The split S2 occurs about every 4th heartbeat, fading in with inhalation and
fading out with exhalation.
Both heart sounds are diminished with conditions that place an increased amount of tissue
between the heart and your stethoscope: emphysema (hyperinflated lungs), obesity, pericardial
fluid.
Factors Examples
Loud (Accentuated) S1 1. Position of AV valve at start 1. Hyperkinetic states in which
of systole—Wide open and blood velocity is increased:
no time to drift together exercise, fever, anemia,
2. Change in valve structure hyperthyroidism
—Calcification of valve; 2. Mitral stenosis with leaflets
needs increasing ventricular still mobile
pressure to close the valve
against increased atrial
pressure
Faint (Diminished) S1 1.Position of AV valve— 1. First-degree heart
Delayed conduction from block (prolonged PR
atria to ventricles. Mitral valve interval)
drifts shut before ventricular 2. Mitral insufficiency
contraction closes it 3. Severe hypertension
, 2. Change in valve structure —Systemic or
—Extreme calcification, pulmonary
which limits mobility
3. More forceful atrial
contraction into noncompliant
ventricle; delays or
diminishes ventricular
contraction Severe
hypertension—Systemic or
pulmonary
Varying Intensity of S1 1. Position of AV valve varies 1. Atrial fibrillation—
before closing from beat to Irregularly irregular
beat irregular rhythm rhythm
2. Atria and ventricles beat 2. Complete heart block
independently with changing PR
interval
Split S1 Mitral and tricuspid Normal but uncommon
components are heard
separately
5. Carotid bruit
A carotid bruit is audible when the lumen is occluded by ½ to ⅔. Bruit loudness increases as the
atherosclerosis worsens until the lumen is occluded by ⅔. After that, bruit loudness decreases.
When the lumen is completely occluded, the bruit disappears. Thus absence of a bruit does not
ensure absence of a carotid lesion.A murmur sounds much the same but is caused by a cardiac
disorder. Some aortic valve murmurs (aortic stenosis) radiate to the neck and must be
distinguished from a local bruit.
Keep the neck in a neutral position. Lightly apply the bell of the stethoscope over the carotid
artery at three levels: (1) the angle of the jaw, (2) the midcervical area, and (3) the base of the
neck (see Fig. 19-17). Avoid compressing the artery because this could create an artificial bruit,
and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis.
Ask the person to take a breath, exhale, and hold it briefly while you listen so tracheal breath
sounds do not mask or mimic a carotid artery bruit. (Holding the breath on inhalation also tenses
the levator scapulae muscles, which makes it hard to hear the carotids.) Sometimes you can
hear normal heart sounds transmitted to the neck; do not confuse these with a bruit.
A carotid bruit is a benign murmur heard just above the clavicles. It is slightly harsh, early or
midsystolic, often louder on the left, and will disappear completely by carotid artery compression
A bruit indicates turbulence from a local vascular cause and is a marker for atherosclerotic
disease. This increases the risk of transient ischemic attack (TIA) and ischemic stroke.20
However, a bruit also occurs in 5% of those age 45 to 80 years who have no significant carotid
disease.
For people middle-age or older or who show symptoms or signs of CVD, auscultate each carotid
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