Advanced Assessment-Interpreting Findings and Formulating Different Diagnosis

Abdomen
abdominal pain, 189
constipation, 217
diarrhea, 207
epigastric pain, 197
gastrointestinal bleeding, 225
jaundice, 221
left lower quadrant pain, 203, 206
left upper quadrant pain, 195
lower abdominal pain, 200
nausea and vomiting, 207
pelvic or suprapubic pain, 206
periumbilical pain, 205
right lower quadrant pain, 202, 203
right upper quadrant pain, 190
Breasts
breast discharge, 178
breast mass, 172
breast pain, 175
male breast enlargement or mass, 180
Cardiac and Peripheral Vascular
Systems
bacterial endocarditis, 145
chest pain, 128
heart murmur, 132
hyperlipidemia, 140
hypertension, 138
irregular pulse, 126
leg pain, 148
palpitations or arrhythmia, 124
peripheral edema, 146
shortness of breath and dyspnea, 142
Concerns of Elderly Patients
advanced planning needs, 503
cognitive changes, 483
driving safety, 494
falls, 493
functional problems, 483
nutritional changes, 500
Ear, Nose, Mouth, and Throat
decreased hearing and hearing loss, 90
ear discharge, 88
ear fullness, 95
ear pain, 84
epistaxis or nose bleed, 96
hoarseness, 114
loss of smell, anosmia, or olfactory deficit,
102
mouth pain (without obvious lesions), 108
mouth sores (with pain and without pain), 102
nasal congestion and nasal drainage, 100
sore throat or throat pain, 109
tinnitus or ringing, 94
Eye
double vision or diplopia, 74
eye discharge, 71
eye pain, 69
ptosis, 72
reddened eye, red eye, or eye redness, 64
visual disturbances, 57
Female Reproductive
abnormal pap smear, 307
amenorrhea, 312
dysfunctional uterine bleeding, 308
dysmenorrhea, 315
female infertility, 319
labial lesions, 304
mass and/or swelling at the introitus, 295
ovarian mass, 316
sexual dysfunction, 318
vaginal discharge, 299
Genitourinary
anuria and oliguria, 242
flank pain and renal colic, 237
hematuria, 240, 244
incontinence, 256
nocturia, 255
prostate disease, 245
proteinuria, 247
renal failure, 242
suprapubic pain, 242
urinary tract complaints, 248
urination difficulties, 252
Head, Face, and Neck
dysphagia, 47
facial numbness, 41
facial swelling, 39
head pain and headache, 33
jaw pain and facial pain, 35
neck fullness, mass or pain, 43
scalp and face pruritis, 42
Male Reproductive
curvature of the penis, 280
ejaculatory dysfunction, 285
erectile dysfunction, 277
SYMPTOMS INDEX
(Continued on inside back cover)
00Goolsby sym(F)-Index 06/23/2005 7:05 PM Page 2

hematospermia, 287
inability to retract or advance foreskin, 273
low testosterone, 282
male infertility, 284
penile or genital lesions, 270
prolonged erection, 279
scrotal mass, 269
testicular mass, 266, 268
testicular or scrotal pain, 264
undescended or absent testicle, 275
Mental Health
anxiety and panic disorders, 400
eating disorders, 411
mood disorders and depression, 402
substance-related disorders, 408
thought disorders, 414
Musculoskeletal
ankle pain and foot pain, 349
elbow pain, 342
hip pain, 344
isolated joint pain, 338
joint pain, 327
knee pain, 346
low back pain, 335
myalgia, 351
neck pain, 331
polyarthralgia, 327
shoulder pain, 339
wrist and hand pain, 343
Neurological
altered mental status, 369
dizziness and vertigo, 373
headache, 359
Nonspecific Complaints
fatigue, 379
fever of unknown origin, 389
unexplained weight loss, 391
weakness, 386
Pediatric
abdominal variations and complaints, 429
breast variations and complaints,
429
ear variations and complaints, 425
eye and vision variations and complaints, 424,
443
genitourinary variations and complaints, 430
growth and development, 436
head variations and complaints, 424
hearing and speech variations and com-
plaints, 442
heart variations and complaints, 427
mouth and throat variations and complaints,
426
musculoskeletal variations and complaints,
431
neurological variations and complaints, 434
nose and sinus variations and complaints, 425
nutrition, 444
respiratory variations and complaints, 426
safety, 446
skin variations and complaints, 434
teething, 446
Pregnant Patients
abdominal pain, 458
circulatory complaints, 463
fatigue, 462
gastrointestinal (GI) complaints, 456
genitourinary complaints, 462
gestational diabetes, 466
hypertension, 468
musculoskeletal complaints, 458
pregnancy-related complaints and discom-
forts, 456
preterm labor, 473
related anemia, 464
respiratory complaints, 460
size not equal to dates, 471
urinary tract infections (UTI), 471
vaginal bleeding, 469
vaginal infections, 470
Respiratory
cough, 157
hemoptysis, 165
pleuritic pain, 165
shortness of breath and dyspnea, 162
wheezing and chest tightness, 164
Skin
blisters, 17
brown skin lesions, 25
bullae, 20
eczematous skin lesions, 30
inflammatory skin lesions, 26
keratotic skin lesions, 21
pustules, 20
raised skin-colored lesions, 22
vesicles, 17
white skin lesions, 24
SYMPTOMS INDEX (Continued)
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From
Advanced
Assessment
to
Differential
Diagnosis
00Goolsby(F) FM 06/23/2005 7:05 PM Page i

00Goolsby(F) FM 06/23/2005 7:05 PM Page ii

From Advanced
Assessment to
Differential Diagnosis
Mary Jo Goolsby, EdD, MSN, ANP-C, FAANP
Director of Research and Education
American Academy of Nurse Practitioners
Austin, Texas
Laurie Grubbs, PhD, MSN, ANP-C
Professor
Florida State University
School of Nursing
Tallahassee, Florida
F.A. Davis Company • Philadelphia
00Goolsby(F) FM 06/23/2005 7:05 PM Page iii

F. A. Davis Company
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Philadelphia, PA 19103
www.fadavis.com
Copyright © 2006 by F. A. Davis Company
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without written permission from the publisher.
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As new scientific information becomes available through basic and clinical research, recommended treat-
ments and drug therapies undergo changes. The author and publisher have done everything possible to
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The author, editors, and publisher are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in regard to the contents of the
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using new or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
From advanced assessment to differential diagnosis/ [edited by] Mary
Jo Goolsby Laurie Grubbs.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8036-1363-6 (alk. paper)
1. Diagnosis, Differential. 2. Nursing assessment. 3. Nurse practitioners.
I. Goolsby, Mary Jo. II. Grubbs, Laurie, 1951-
[DNLM: 1. Nursing Assessment—methods. 2. Diagnosis, Differential.
3. Nurse Practitioners. WY 100.4 F931 2006]
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00Goolsby(F) FM 06/23/2005 7:05 PM Page iv

v
The idea for this book evolved over several years, while teaching an advanced health
assessment course designed primarily for nurse practitioner (NP) students. Although
many health assessment texts have been available, they have lacked an essential com-
ponent—the information needed to arrive at a reasonably narrow differential diag-
nosis of a patient who presents with one of the almost endless possible complaints.
We hope that this book will be helpful to advanced practice students, new practi-
tioners, and experienced practitioners faced with new presentations.
As NPs increasingly become the providers of choice for individuals seeking pri-
mary and specialty care, the need for expertise in the assessment and diagnostic
processes remains essential. In spite of the growth in available technology and diag-
nostic studies, performing assessment skills correctly, obtaining valid data, and
interpreting the findings accurately are necessary for the safe, high-quality, and cost-
effective practice for which NPs are known.
Even once these skills are accomplished, accurate diagnosis remains a difficult
aspect of practice. However, we noticed that students and practicing clinicians rarely
referred to their health assessment book after completing their assessment course.
Instead, they tended to turn to clinical management texts, which focus on what to
do once the diagnosis is known. This supported our belief that although assessment
texts cover common findings for a limited range of disorders, they are not perceived
as helpful in guiding the diagnostic process. Novice practitioners often spend much
energy, expense, and time narrowing their differential diagnosis when they have no
clear guidance that is driven by the patient and/or complaint. For this reason, our
aim has been to develop a text that serves as a guide in the assessment and diagnos-
tic process, is broad in content, and is suitable for use in varied settings.
From Advanced Assessment to Differential Diagnosishas been designed to serve as
a textbook during advanced health assessment course work, and as a quick reference
for practicing clinicians. We believe that studying the text will help students develop
proficiency in performing assessment and interpreting findings, and to recognize the
range of conditions that can be indicated by specific findings. Once in practice, we
believe that the text will be an aide to guide the assessment and the narrowing of dif-
ferential diagnosis.
The book consists of three parts. Part 1 provides a summary discussion of assess-
ment and some matters related to clinical decision-making. In addition to discussing
the behaviors involved in arriving at a definitive diagnosis, the chapter discusses
some pitfalls that clinicians often experience and the types of evidence-based
resources that are available to assist in the diagnostic process.
Part 2 serves as the core of the book and addresses assessment and diagnosis using
a system and body region approach. Each chapter in this part begins with an
overview of the comprehensive history and physical examination of a specific system,
as well as a discussion of common diagnostic studies. The remainder of the chapter
Preface
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vi
is then categorized by chief complaints commonly associated with that system. For
each complaint, there is a description of the focused assessment relative to that com-
plaint, followed by a list of the conditions that should be considered in the differ-
ential diagnosis, along with the symptoms, signs, and/or diagnostic findings that
would support each condition.
Finally, Part 3 addresses the assessment and diagnosis of specific populations:
those at either extreme of age (young and old) and pregnant women. This part is
designed to include a heavy emphasis on the assessments that allow clinicians to eval-
uate the special needs of individuals in these populations, such as growth and devel-
opment in children and functionality in older patients.
To aid the