Name
Purdue University Globle
NU581 FNP II Clinical – Children and Adolescent Health Focus
Prof. Name
Date
A comprehensive focused nursing assessment for Ms. Rose should combine therapeutic communication, systematic physical examination, accurate documentation, interdisciplinary collaboration, health promotion, and individualized discharge planning. Key priorities include evaluating skin and peripheral circulation, cardiovascular and neurological status, thyroid and breast health, abdominal findings, chronic disease risks, and home safety. Using evidence-based assessment techniques enables nurses to recognize potential complications early and coordinate appropriate care.
A focused health assessment is an essential nursing process used to identify a patient’s immediate concerns, recognize potential complications, and guide individualized care. Although the assessment is focused on specific concerns, the nurse should consider the patient’s physical, psychological, social, and environmental needs.
For Ms. Rose, the assessment should include a focused interview, physical examination, review of relevant health history, evaluation of abnormal findings, preventive health counseling, and discharge planning. Clear documentation and communication with the healthcare team are also essential for maintaining continuity and safety of care.
Therapeutic communication helps nurses establish trust, obtain accurate health information, and encourage patients to participate in their care. During Ms. Rose’s interview, the nurse should use open-ended questions, active listening, empathy, appropriate nonverbal communication, and respect for privacy and individual preferences.
An appropriate opening question is:
“Tell me, Ms. Rose, what are your concerns and preferences regarding this interview?”
An open-ended question such as this allows Ms. Rose to describe her concerns in her own words rather than limiting her response to a yes-or-no answer. It also provides an opportunity to identify cultural, emotional, personal, and healthcare-related preferences that may influence the assessment and plan of care.
The skin is the body’s largest organ and serves several important protective and regulatory functions. Skin assessment is particularly important in patients with chronic diseases, impaired circulation, diabetes, reduced mobility, or wounds.
The major functions of the skin include:
Protecting the body against microorganisms, chemicals, and physical injury.
Limiting fluid and electrolyte loss.
Providing sensory information related to touch, pressure, pain, and temperature.
Helping regulate body temperature through sweating and changes in cutaneous blood flow.
Protecting deeper tissues from ultraviolet radiation.
Participating in vitamin D production when skin is exposed to ultraviolet B radiation.
Contributing to immune defense and overall homeostasis.
A thorough skin assessment should consider color, temperature, moisture, integrity, lesions, wounds, edema, and signs of infection.
Accurate nursing documentation should objectively describe assessment findings and provide enough detail for other healthcare professionals to understand the patient’s condition and monitor changes over time.
Ms. Rose’s right lower leg assessment includes an erythematous ulcer, surrounding skin discoloration, a cool extremity, and a palpable dorsalis pedis pulse. Her heart rate is 76 beats per minute.
These findings require continued assessment because a cool extremity, skin discoloration, and ulceration can occur with vascular or circulatory problems. The presence of a palpable pedal pulse does not, by itself, rule out clinically significant vascular disease. The nurse should document wound characteristics, including location, size, depth, drainage, odor, surrounding skin condition, pain, temperature, edema, and peripheral pulses as appropriate.
Further vascular assessment may be indicated based on the patient’s history and overall clinical presentation.
Patients with multiple chronic or complex health conditions often benefit from coordinated interdisciplinary care. The specific professionals involved should be determined by Ms. Rose’s diagnoses, assessment findings, treatment needs, and functional status.
The primary care provider or internist can coordinate Ms. Rose’s overall medical management, evaluate chronic conditions, order diagnostic testing, and coordinate referrals.
A cardiologist may be involved when Ms. Rose has cardiovascular disease, symptoms of heart failure, significant hypertension, abnormal cardiac findings, or suspected cardiovascular complications.
An endocrinologist may assist with complex diabetes management or other endocrine disorders when routine management is insufficient or specialized evaluation is needed.
A dermatologist can evaluate complex skin conditions, suspicious lesions, or wounds when the diagnosis or treatment requires specialized dermatologic assessment.
A vascular surgeon or other vascular specialist may evaluate suspected arterial or venous insufficiency, particularly when lower-extremity circulation or wound healing is a concern.
A wound care nurse or specialized wound-care team can assess wound characteristics, develop evidence-based wound-management strategies, and monitor healing.
Registered nurses provide ongoing assessment, medication education, wound care, patient teaching, care coordination, and monitoring for changes in condition. Counselors, social workers, dietitians, pharmacists, physical therapists, and other professionals may also contribute when their expertise addresses Ms. Rose’s individual needs.
A thyroid assessment evaluates the gland’s size, symmetry, consistency, tenderness, mobility, and the presence of nodules or enlargement. Understanding the underlying anatomy helps the nurse perform the examination systematically.
Important structures include:
Thyroid cartilage
Cricoid cartilage
Cricothyroid membrane
Trachea
Thyroid gland
Thyroid isthmus
The thyroid isthmus normally crosses the anterior surface of the upper tracheal rings.
The examiner may assess the thyroid from either the front or behind the patient, depending on the examination technique being used. When using a posterior approach, the nurse should:
Position the patient comfortably with the neck slightly flexed.
Identify the thyroid cartilage and cricoid cartilage.
Locate the trachea and thyroid gland.
Ask the patient to swallow while palpating the thyroid.
Assess both thyroid lobes systematically.
Evaluate the gland for symmetry, enlargement, tenderness, consistency, and nodules.
Document any abnormal findings and determine whether additional evaluation is necessary.
Thyroid enlargement, a palpable nodule, significant tenderness, or asymmetry should be documented and evaluated according to the patient’s clinical situation.
Breast and axillary assessment is an important component of a comprehensive health examination. The nurse should use a respectful, trauma-informed, culturally sensitive approach and explain the examination before beginning.
The examination should include the:
Upper outer quadrant
Upper inner quadrant
Lower outer quadrant
Lower inner quadrant
Nipple and areola
Axillary tail of Spence
Axillary lymph nodes
During inspection, assess for:
Breast asymmetry or changes in contour.
Skin discoloration or thickening.
Dimpling or retraction.
Nipple inversion or recent changes in nipple position.
Visible masses.
Spontaneous nipple discharge.
Other changes from the patient’s usual breast appearance.
A new or persistent breast change should be assessed further rather than interpreted in isolation.
If a breast mass is identified, the nurse should document characteristics such as:
Location
Size
Shape
Consistency
Mobility
Tenderness
Relationship to surrounding tissue
Changes reported by the patient
A hard, irregular, fixed, or otherwise concerning mass requires appropriate diagnostic evaluation. Physical examination alone cannot establish whether a mass is malignant.
The axillary region should be palpated for lymph-node enlargement and other abnormalities. Findings should include characteristics such as size, tenderness, consistency, and mobility.
Enlarged lymph nodes may occur because of infection, inflammation, or malignancy. Additional evaluation depends on the patient’s history and examination findings.
A focused breast history helps place physical findings in context and identifies symptoms or risk factors requiring additional assessment.
The nurse may ask whether Ms. Rose is currently menstruating or when her last menstrual period occurred. Breast tissue can become more tender or nodular during certain phases of the menstrual cycle, which can affect examination comfort.
The nurse should also ask about:
New breast lumps or areas of thickening.
Breast pain or tenderness.
Nipple discharge.
Changes in nipple appearance.
Skin changes.
Previous breast problems or procedures.
Personal history of breast cancer.
Family history of breast or ovarian cancer.
Previous breast imaging and biopsy results.
Known genetic or hereditary cancer risk.
Breast cancer screening should be individualized according to age, personal risk, family history, genetic risk, previous findings, and patient preferences.
The American Cancer Society recommends that women at average risk may begin annual mammography between ages 40 and 44 if they choose to do so. Women ages 45 to 54 are recommended to receive annual mammography, while women age 55 and older may continue annual screening or switch to screening every two years as long as they remain in good health and are expected to benefit from screening.
Women at increased risk because of genetic factors, strong family history, previous chest radiation, or other risk factors may require a different screening strategy.
A focused nursing assessment should be adapted to Ms. Rose’s presenting symptoms and current condition. Nurses should prioritize potentially life-threatening problems before addressing less urgent concerns.
When clinically indicated, the nurse should rapidly evaluate:
Airway
Breathing
Circulation
Level of consciousness
Vital signs
Oxygen saturation
General appearance
If Ms. Rose reports shortness of breath, difficulty breathing, chest pain, severe fatigue, cyanosis, or rapidly worsening symptoms, these findings require prompt clinical evaluation.
Symptoms such as gasping for air or new cyanosis can indicate significant respiratory or cardiovascular compromise and should not be treated as routine findings.
Health promotion is an important part of nursing care because preventive interventions can reduce the risk of complications and support long-term health.
For Ms. Rose, appropriate interventions may include:
Smoking cessation support when applicable.
Diabetes self-management education.
Medication adherence education.
Nutrition counseling when appropriate.
Physical activity appropriate to her functional and medical status.
Routine preventive screenings.
Regular follow-up appointments.
Wound-care education when a wound is present.
Social and recreational activities that support overall well-being.
Education about symptoms that require urgent medical attention.
Health-promotion strategies should be individualized rather than presented as a one-size-fits-all plan.
The third heart sound, or S3, is a low-frequency sound that occurs during rapid ventricular filling in early diastole. An S3 can be a normal finding in children, adolescents, and some young adults, but its clinical significance changes with age and the patient’s overall condition.
In an older adult, a newly detected S3 may be associated with increased ventricular filling volume or pressure and can occur with conditions such as heart failure and ventricular dysfunction.
An S3 should therefore be interpreted together with other clinical findings, including symptoms, lung sounds, peripheral edema, jugular venous pressure, blood pressure, and cardiac history. A single auscultatory finding should not be used alone to diagnose heart failure.
The Glasgow Coma Scale (GCS) assesses level of consciousness using three components:
Eye opening
Verbal response
Motor response
Based on the findings provided for Ms. Rose, the score should be calculated carefully according to the exact GCS descriptors.
If Ms. Rose:
Opens her eyes in response to verbal stimulation: Eye = 3
Is able to speak but is disoriented to place: Verbal = 4 (confused conversation)
Obeys verbal commands: Motor = 6
Her total GCS would therefore be 13/15, assuming the verbal response is best characterized as confused conversation.
| GCS Component | Finding | Score |
|---|---|---|
| Eye Opening | Opens eyes to verbal stimulation | 3 |
| Verbal Response | Confused/disoriented conversation | 4 |
| Motor Response | Obeys commands | 6 |
| Total | 13/15 |
A GCS score of 13 indicates an alteration in level of consciousness that warrants continued neurological assessment and evaluation of the underlying cause.
If the patient’s speech is actually classified as inappropriate words rather than confused conversation, the verbal score would be different. Therefore, nurses should document the patient’s specific response rather than recording only a numerical score.
The abdominal examination follows a specific sequence because palpation and percussion can stimulate bowel activity and potentially alter auscultatory findings.
The standard sequence is:
Inspection
Auscultation
Percussion
Palpation
Auscultation should occur before percussion and palpation. The nurse should assess bowel sounds for their presence, frequency, and character and should listen systematically across the abdomen.
The nurse may also auscultate for vascular bruits when clinically indicated, including over major abdominal vessels.
Bowel sounds vary among individuals and can be influenced by recent food intake, medications, illness, and gastrointestinal activity. Therefore, they should be interpreted together with other abdominal findings rather than using a single numerical frequency as a definitive diagnostic criterion.
Abnormal findings may include:
Absent or markedly diminished bowel sounds: May occur with conditions such as ileus, although prolonged listening is necessary before documenting sounds as absent.
Hyperactive or high-pitched sounds: May occur with increased intestinal activity and can be present in some cases of bowel obstruction.
Abdominal bruit: May indicate turbulent blood flow and can occur with certain vascular conditions.
After inspection, auscultation, and percussion, palpation should begin with light pressure and progress to deeper palpation when appropriate.
The nurse should assess for:
Tenderness
Guarding
Rigidity
Masses
Organ enlargement
Abdominal distention
Pain location and characteristics
If Ms. Rose reports abdominal pain, the painful area should generally be assessed after less painful areas to reduce discomfort and avoid unnecessarily aggravating symptoms.
Discharge planning should begin early and should be based on Ms. Rose’s health status, functional abilities, medications, wound-care needs, mobility, support system, and home environment.
Important home-safety measures may include:
Maintaining adequate lighting, particularly on stairs and in hallways.
Removing loose rugs, clutter, and other fall hazards.
Keeping frequently used items within easy reach.
Using prescribed assistive devices correctly.
Keeping medications organized and reviewing the medication schedule with the patient and caregiver.
Teaching the patient and caregiver how to perform wound care correctly when applicable.
Keeping emergency contact information readily available.
Teaching warning signs that require immediate medical attention.
Confirming follow-up appointments before discharge.
Assessing whether additional home-health or community resources are needed.
For patients with impaired sensation or circulation, education should also address protection of vulnerable areas from burns, pressure, trauma, and other injuries.
Ms. Rose’s case demonstrates why focused nursing assessment must extend beyond a single physical finding. The nurse should integrate subjective symptoms, objective findings, medical history, risk factors, and functional needs.
The major priorities include:
Establishing therapeutic communication and patient trust.
Completing a systematic physical assessment.
Monitoring the lower-extremity wound and circulation.
Evaluating cardiovascular and neurological findings.
Performing appropriate thyroid, breast, axillary, and abdominal assessments.
Recognizing abnormal findings that require further evaluation.
Coordinating care with appropriate healthcare professionals.
Providing individualized disease-prevention education.
Preparing Ms. Rose and her caregivers for safe discharge.
The NU581 H2T case study demonstrates the importance of combining focused assessment with patient-centered nursing care. Ms. Rose’s care requires more than identifying individual physical findings; the nurse must interpret those findings within the context of her overall health, risks, symptoms, functional status, and support system.
Therapeutic communication improves the quality of health-history data, while systematic physical assessment helps identify abnormal findings early. Accurate documentation, interdisciplinary collaboration, preventive health education, and individualized discharge planning further support safe and coordinated care. By applying evidence-based assessment principles, nurses can promote patient safety, identify potential complications, and support better long-term health outcomes.
American Cancer Society. (2025). American Cancer Society recommendations for the early detection of breast cancer. https://www.cancer.org/cancer/screening/breast-cancer-screening-guidelines.html
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Hinkle, J. L., & Cheever, K. H. (Eds.). (2025). Brunner & Suddarth’s textbook of medical-surgical nursing (16th ed.). Wolters Kluwer. https://shop.lww.com/Brunner—Suddarth-s-Textbook-of-Medical-Surgical-Nursing/p/9781975191369
Jarvis, C. (2024). Physical examination and health assessment (9th ed.). Elsevier. https://www.elsevier.com/books/physical-examination-and-health-assessment/jarvis/978-0-323-83037-0
National Library of Medicine. (n.d.). Glasgow Coma Scale. MedlinePlus Medical Encyclopedia. https://www.ncbi.nlm.nih.gov/
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Your skin. https://www.niddk.nih.gov/health-information
World Health Organization. (n.d.). Health promotion. https://www.who.int/health-topics/health-promotion
