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Copyright © 2022 Elsevier, Inc. All Rights Reserved. 15
Student Laboratory Manual for

WILSON & GIDDENS

Health Assessment for
Nursing Practice
Seventh Edition

Student Laboratory Manual prepared by

Susan Fickertt Wilson, PhD, RN
Emeritus Associate Professor
Harris College of Nursing and Health Sciences
Texas Christian University
Fort Worth, Texas
ELSEVIER
3251 Riverport Lane
St. Louis, Missouri 63043

STUDENT LABORATORY MANUAL FOR HEALTH ASSESSMENT FOR

NURSING PRACTICE, SEVENTH EDITION ISBN: 978-0-323-76323-3

Copyright © 2022 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher’s permissions
policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright
Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contrib-
utors for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.

Previous editions copyrighted 2017, 2012, and 2008

Library of Congress Control Number: 9780323763233

Executive Content Strategist: Lee Henderson

Senior Content Development Manager: Lisa P. Newton
Content Development Specialist: Sara Hardin
Publishing Services Manager: Shereen Jameel
Project Manager: Manikandan Chandrasekaran
Design Direction: Brian Salisbury

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Preface
The purpose of this Laboratory Manual is to provide structure for students as they practice with classmates acting as
patients to obtain health histories and perform physical examinations.

• The History contains questions about the patient’s Present health state, Past health history, Family history, Personal
and psychosocial history, and Review of Systems with space to document findings. In addition to learning how to
obtain a health history, students learn medical terminology, such as documenting “edema” when patients report
“swelling.”

A table is provided at the end of Chapter 2 to help students learn this terminology. Also, the Review of Systems in
chapters containing a health history uses lay terminology followed by medical terminology in parentheses to help
students learn these terms.

• The Examination section in Chapters 6–17, and 19–22 provides techniques performed in the left column with
space for documenting findings in the right column. Techniques for Special Circumstances have been integrated
within the Routine Techniques. Each examination technique is numbered to facilitate discussion of the skills by
number rather than naming the entire skill. These skills are written to direct the student; thus, the verbs are second
person with an implied “you,” e.g., (You) PERFORM hand hygiene.

• The Clinical Judgment that follows the history and examination sections uses the first two layers of the Clinical
Judgment Measurement Model to help students analyze data. These include: 1) Recognize cues for this patient.
Identify relevant findings from the history and examination and 2) Analyze cues. Organize and link the recognized
cues to the patient’s clinical presentation.

• A Performance Check List for examination skills has been added following each examination section in Chapters
7–17 and 22 as a structure to evaluate students. There are four descriptors of performance: Correct (C), Incomplete
(Inc), Incorrect (I), and Not performed (NP). Skills in the Check List are numbered the same as those in the exam-
ination section. These skills are written to direct the evaluator; thus, the verbs are present tense, third person with
an implied “he or she”, e.g., (He/She) PERFORMS hand hygiene.

• Following the Skills Performance Check List is an Implementation checklist that allows an appraisal of the student’s
implementation of the examination including assembly and use of equipment, the organization of the examination,
the confidence demonstrated by the student, and the student’s interaction with the “patient.” These skills are written
to direct the evaluator who assesses the implementation of the examination; thus, the verbs are past tense, third
person with an implied “he or she”, e.g., (He/She) Assembled needed equipment.

• At the end of the Check List there is space to tally the number from each category of descriptors in each of the
categories in Examination and Implementation.

• There are no laboratory activities for Chapters 1, 18, 23, and 24.

iii
Contents

Chapter 2 Obtaining a Health History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 3 Techniques and Equipment for Physical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 4 General Inspection and Measurement of Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 5 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Chapter 6 Pain Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter 7 Mental Health Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Chapter 8 Nutritional Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 9 Skin, Hair, and Nails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Chapter 10 Head, Eyes, Ears, Nose, and Throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Chapter 11 Lungs and Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Chapter 12 Heart and Peripheral Vascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Chapter 13 Abdomen and Gastrointestinal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Chapter 14 Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Chapter 15 Neurologic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Chapter 16 Breasts and Axillae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Chapter 17 Reproductive System and the Perineum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Chapter 19 Assessment of the Infant, Child, and Adolescent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Chapter 20 Assessment of the Pregnant Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Chapter 21 Assessment of the Older Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Chapter 22 Conducting a Head-to-Toe Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

v
Student Name ____________________________________________________________    Date _________________________

CHAPTER 2   Obtaining a Health History

With your lab partner assuming the role of a patient, conduct a comprehensive history. Your “student patient” may role-play
a person with particular related symptoms and history.

HISTORY

BIOGRAPHIC DATA

Date Name Preferred name Sex Gender Identity

Male Male
Female Female
Both
Neither

Date of Age Race/Ethnicity Religion Language(s)

birth

Marital status Occupation

S M D W

REASON FOR SEEKING CARE (Presenting problem)

HISTORY OF PRESENT ILLNESS

Symptom Analysis of Presenting Problem (Onset, Location, Duration, Characteristics, Aggravating factors, Related
symptoms, Treatment, Severity)

PRESENT HEALTH STATUS

• Describe your current health conditions.

ο How long have you had these conditions?

ο How have these health conditions affected your daily activities?

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 1

2  Chapter 2 Obtaining a Health History

• What medications or supplements do you take? (Include prescription, over-the-counter, herbs, and vitamins)
(Document if no medications or supplements are taken)

Name of Drug/Supplement Dosage/Frequency Last Dose Taken Reason for Taking

• Describe any medical treatments you are receiving (e.g., breathing treatments, dialysis, wound dressing):
(Document if no medical treatments are received)

• Describe any allergies to medications, foods, medical products (e.g., latex, contrast, tape), or things in the environment.
Describe your symptoms and their frequency. (Document if there are no allergies)

Allergic To Reaction and frequency

PAST HEALTH HISTORY

Childhood Illnesses (Check all that apply):

Measles ❏ Mumps ❏ Rubella ❏ Chickenpox ❏

Pertussis ❏ Influenza ❏ Ear infections ❏ Throat infections ❏
Other (describe) ❏

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  3

List previous medical conditions, surgeries, hospitalizations, or injuries. (Document if none apply)

Name and Type Date Residual Problems

Immunization Date/s Immunization Date/s

Diphtheria, tetanus, acellular pertussis (DTaP) Haemophilus influenzae type b (Hib)
Hepatitis A (HepA) Hepatitis B (HepB)
Human papillomavirus (HPV) Influenza (IIV)
Inactivated poliomyelitis (IPV) Influenza live attenuate vaccine (LAIV)
Meningococcal serogroups A, C, W, Y Meningococcal serogroup B (MenB)
(MenACWY)
Measles, mumps, rubella (MMR) Pneumococcal conjugate vaccine (PCV13)
Pneumococcal polysaccharide vaccine (PPS23) Zoster recombinant (RZV)
Rotavirus (RV) Tetanus toxoid (Td)
Tetanus, diphtheria, acellular pertussis (Tdap) Varicella (VAR)
Zoster live (ZVL) Other
www.cdc.gov/vaccines/schedules. Accessed 1/27/20.

Last Examination Date Outcome

Last Physical
Last Vision
Last Dental
Other (describe)
Women Only
Last Pap Test
Last Mammogram
Men Only
Prostate Exam

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

4  Chapter 2 Obtaining a Health History

Obstetric history

Last menstrual period (LMP) Date Outcome

Pregnancies Dates Gravida (number of pregnancies) ________

Para (number of births) ________

Abortion/miscarriage ________

FAMILY HISTORY
(Document age and current health of family members. If deceased, indicate age and cause of death.)

Person Age Current Health Person Age Current Health

Mother Father

Sister Brother

Sister Brother

Daughter Son

Daughter Son

Draw a genogram for your lab partner’s family history.

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  5

PERSONAL AND PSYCHOSOCIAL HISTORY

Personal Status
• How would you describe yourself? or How do you feel about yourself?

• Describe your cultural/religious affiliations and practices.

• Describe your education, occupational history, and work satisfaction.

• Describe your perception of adequate time for leisure and rest, hobbies and interests.

Family and Social Relationships

• Describe your satisfaction with interpersonal relationships including significant others, individuals in home, and
your role within family.

• Describe the state of health of these individuals. Describe social interactions with friends, social organizations, or
religious groups.

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

6  Chapter 2 Obtaining a Health History

Diet/Nutrition
• Describe your appetite, typical food and fluid intake, and caffeine intake.

• Do you have any dietary restrictions or food intolerances?

• Have you had any changes in appetite or weight; changes in taste of food; problems while eating, e.g., indigestion,
pain, difficulty chewing or swallowing? If yes, describe.

• Have you had experiences with overeating, sporadic eating, or intentional fasting? If yes, describe.

Functional Ability
Do you need any assistance performing any of the following activities?†
Dressing ❏ Toileting ❏ Bathing ❏ Eating ❏ Ambulating ❏

Shopping ❏ Cooking ❏ Housekeeping ❏ Managing finances ❏

If unable to perform independently, describe.

†

Mental Health
• Describe your sources of stress. How do you cope with these stresses?

• Have you had feelings of anxiety, depression, irritability, or anger? If yes, describe.

Tobacco, Alcohol, and Illicit Drug Use

Tobacco use:    Y ❏ N ❏ Type:            Daily use:

Alcohol intake:    Y ❏ N ❏ Type:            Drinks per day:
Illicit drug use:    Y ❏ N ❏ Describe:          Frequency:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  7

Health Promotion Practices

• What activities do you perform regularly to maintain your health?

Exercise (type/frequency):

Stress management:

Sleep habits:

Use of seat belts:

Other:

Environment (Include living and work environments)

• Describe actions do you take to main your environmental safety? (Circle hazards below and add others as warranted.)

Potential hazards within home e.g., lack of fire or smoke detectors, poor lighting, steep stairs, inadequate
heat, open gas heaters, inadequate pest control, violent behaviors, firearms

Potential hazards within e.g., noise, water or air pollution, heavy traffic, overcrowding, violence,
neighborhood firearms, sale/use of street drugs

Potential hazards within work e.g., inhalants, noise, heaving lifting, machinery, psychological stress
environment
Any travel outside the United Describe locations and dates
States

REVIEW OF SYSTEMS
• Remember to ask questions using lay terms the patient understands, but document using medical terminology. For
example, ask the patient if he has shortness of breath; if he says “yes,” perform and document a symptom analysis
and document that the patient “reports dyspnea.” (See the Learning Activity at the end of this chapter for a listing
of lay and medical terms.)

• Check all boxes that apply and add additional data below each section.

• Document if no symptoms are reported.

General Symptoms
Pain ❏ Fatigue ❏ Weakness ❏ Fever ❏
Unexplained changes in
Problems sleeping ❏
weight ❏
Additional data:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

8  Chapter 2 Obtaining a Health History

Integumentary System
Skin lesions (wounds,
sores, growths) ❏
Change in a mole ❏ Sore that does not heal
Frequent bruising ❏
Changes in texture, color,
or shape of nails ❏
Additional data:
Excessive dryness ❏ Excessive sweating or Changes in skin
odors ❏ temperature, texture,
color ❏
❏ Rashes ❏ Itching (pruritus) ❏
Changes in amount, texture, Hair loss (alopecia) ❏ Itching scalp ❏
distribution of hair ❏
Use of sunscreen ❏ Skin self-examination ❏ Types and frequency of
nail care ❏

Head
Headaches ❏ Significant trauma ❏ Dizziness ❏ Fainting (syncope) ❏
Use of protective head gear ❏
Additional data:

Eyes
Discharge ❏ Redness ❏ Itching (Pruritis) ❏ Excessive tearing ❏

Eye pain (Ophthalmalgia) ❏ Change in vision ❏ Difficulty reading ❏ Blurred vision ❏

Sensitivity to bright lights Blind spots ❏ Floaters ❏ Halo around lights ❏

(Photophobia) ❏

Double vision (Diplopia) ❏ Do you wear Do you wear contact Use protective
eyeglasses? ❏ lenses? ❏ eyewear? ❏

Additional data:

Ears
Ear pain (otalgia) ❏ Excessive earwax ❏ Discharge ❏ Recurrent infections ❏
Decreased hearing ❏ Sensitivity to noises ❏ Ringing in the ears (tinnitus) ❏ Use of hearing device ❏
Protect ears from excessively loud noises ❏

Additional data:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  9

Nose, Nasopharynx, Sinuses

Nasal discharge ❏ Nose bleeds (epistaxis) ❏ Sneezing ❏ Nasal obstruction ❏
Sinus pain ❏ Postnasal drip ❏ Change in ability to smell ❏ Snoring ❏
Additional data:

Mouth/Oropharynx
Sore throat ❏ Tongue or mouth lesions Bleeding gums ❏ Dental prosthesis
(abscess, sore, ulcer) ❏ (dentures, bridges) ❏
Altered taste ❏ Difficulty swallowing Trouble chewing ❏ Change in voice ❏
(dysphagia) ❏
Oral hygiene practice (frequency of brushing/flossing) ❏
Additional data:

Neck
Lymph node Edema or mass in Neck pain ❏ Neck stiffness/limitation in
enlargement ❏ neck ❏ movement ❏
Additional data:

Breasts
Pain ❏ Swelling (edema) ❏ Lumps or masses ❏ Breast dimpling ❏
Nipple discharge ❏ Change in nipples ❏
Additional data:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

10  Chapter 2 Obtaining a Health History

Respiratory System
Cough, nonproductive Coughing up blood Frequent colds ❏ Shortness of breaths
or productive ❏ (hemoptysis) ❏ (dyspnea) ❏
Night sweats ❏ Wheezing ❏ High pitched, musical sound Pain with breathing (inspiration/
when breathing (stridor) ❏ expiration) ❏
Handwashing Tuberculosis Smoking cessation ❏ Reducing secondhand smoke ❏
frequency ❏ screening ❏
Additional data:

Cardiovascular System
Sensation of heart fluttering
or racing (palpitations) ❏
Periodic shortness of breath
during sleep (paroxysmal
nocturnal dyspnea) ❏
Varicose veins ❏
Changes in color of
extremities ❏
Additional data:
Chest pain ❏ Shortness of breath Difficulty breathing unless
(dyspnea) ❏ sitting up (orthopnea) ❏
Coldness in extremities ❏ Numbness ❏ Swelling (edema) of hands
or feet ❏
Leg pain with activity Leg pain with activity Abnormal sensation
relieved by rest (intermittent not relieved by rest in extremities
claudication) ❏ (rest pain) ❏ (paresthesia) ❏
Limit salt and fat intake ❏ Blood pressure
screening ❏

Gastrointestinal System
Pain ❏ Heartburn ❏ Nausea/vomiting ❏ Vomiting blood
(hematemesis) ❏
Yellowing of sclera/skin Increased abdominal size due to Changes in usual bowel Painful defecation ❏
(jaundice) ❏ fluid accumulation (ascites) ❏ habits ❏
Passing gas (flatus) Change in color or consistency of Constipation ❏ Diarrhea ❏
excessively ❏ stools ❏
Blood in stools Hemorrhoids ❏ Dietary analysis ❏ Colon cancer
(hematochezia) ❏ screening ❏
Additional data:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  11

Urinary System
Changes in color, Difficulty initiating urine Repeated need to urinate Sudden, almost
contents, or odor of flow (hesitancy) ❏ (frequency) ❏ uncontrollable need to
urine ❏ urinate (urgency) ❏
Change in urine Excessive urination during Pain with urination Pain in back between ribs
stream ❏ the night (nocturia) ❏ (dysuria) ❏ and ilium (flank pain) ❏
Blood in urine Inability to control urination Excretion of abnormally large Decreased urine output
(hematuria) ❏ (incontinence) ❏ volumes of urine (polyuria) ❏ (oliguria) ❏
Plan to prevent urinary Performing Kegel
tract infections ❏ exercises ❏
Additional data:

Reproductive System
Male: Lesions ❏ Pain in penis or Masses in penis or Penile discharge ❏
testicles ❏ testicles ❏
Hernia ❏
Female: Lesions ❏ Pain ❏ Vaginal discharge/ Absent menstruation
odor ❏ (amenorrhea) ❏
Excessive Painful menstruation Irregular Pelvic pain ❏
menstruation (dysmenorrhea) ❏ menstruation
(menorrhagia) ❏ (metrorrhagia) ❏
Sexual Activity
Are you currently ❏ No
involved in a sexual ❏ Yes Is the nature of the relationship heterosexual, homosexual, or bisexual?
relationship(s)?
What is the type and Type:    ❏Vaginal ❏Anal ❏Oral ❏Oher _____________________________
frequency of sexual Frequency:
activity?
Number of sexual
partners in last 3
months?
Do you protect ❏ No
yourself from sexually ❏ Yes, what method is used?
transmitted infections
(STIs)?
Do you use birth ❏ No
control? ❏ Yes, what method is used?
Problems with sexual activity
Change in sex Infertility ❏ Exposure to Females: Pain Females: Bleeding after
drive ❏ sexually transmitted intercourse intercourse (postcoital
infections ❏ (dyspareunia) ❏ bleeding) ❏
Males: Inability to Males: Premature
achieve erection ejaculation ❏
(impotence) ❏
Additional data:

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

12  Chapter 2 Obtaining a Health History

Musculoskeletal System
Muscle twitching ❏ Muscle cramping/pain ❏ Muscle weakness ❏ Joint swelling (edema) or
redness (erythema) ❏
Joint pain ❏ Joint stiffness/ Noise with joint movement Limitations in range of
deformity ❏ (crepitus) ❏ motion ❏
Back pain ❏ Amount and kind of Osteoporosis screening ❏
weekly exercise ❏
Additional data:

Neurologic System
Headache ❏ Seizures ❏ Fainting/loss of consciousness Changes in movement ❏
(syncope) ❏
Inability to coordinate muscle Change in Difficulty swallowing Difficulty communicating
movement (ataxia) ❏ sensation ❏ (dysphagia) ❏ (dysphasia) ❏
Use seat belts in a vehicle ❏ Wear helmet ❏
Additional data:

CLINICAL JUDGMENT

1. Recognize cues for this patient. Identify relevant and important data from the history. (Which information is
relevant/irrelevant? Which information is most important? What is of immediate concern?)

2. Analyze cues. Organize and link the recognized cues to the patient’s clinical presentation. (Why is a particular cue or
subset of cues of concern? What other information would help establish the significance of a cue or subset of cues?)

3. Using the analysis above, develop a problem list for this patient.

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

 Chapter 2 Obtaining a Health History  13

LEARNING ACTIVITY: With your lab partner, quiz each other on the lay terms and medical terms used to document a
health history. For example, ask your partner (from the left side of the table), “What is the medical term for swelling?” or
work from the other side by asking, “If you want to know if the patient has had syncope, what term do you use with the
patient?”

When the patient reports these symptoms: → You document symptoms using these terms:

Skin, Hair, and Nails

Itching Pruritus
Tiny red or purple spots on the skin surface formed by Petechiae
minute hemorrhages
Swelling Edema
Hair loss Alopecia

Head, Eyes, Ears, Nose, Throat

Brief loss of consciousness, fainting Syncope
Eye pain Ophthalmalgia
Double vision Diplopia
Increased sensitivity to light Photophobia
Ear pain Otalgia
Ear wax Cerumen
Ringing in the ears Tinnitus
Nose bleed Epistaxis
Difficulty swallowing Dysphagia

Respiratory system
Coughing up blood Hemoptysis
Short of breath Dyspnea
High-pitched, musical sound when breathing Stridor

Cardiovascular system
Sensation that the heart is racing or fluttering Palpitations
Difficulty breathing unless sitting up Orthopnea
Periodic shortness of breath during sleep Paroxysmal nocturnal dyspnea
Leg pain during activity relieved with rest Intermittent claudication
Leg pain during activity not relieved with rest Rest pain
Abnormal sensations in extremities Paresthesia

Gastrointestinal system
Vomiting blood Hematemesis
Yellowish color of skin or sclera Jaundice
Increased abdominal size due to fluid accumulation Ascites

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14  Chapter 2 Obtaining a Health History

When the patient reports these symptoms: → You document symptoms using these terms:
Passing gas Flatus
Blood in the feces/stool Hematochezia

Urinary system
Difficulty initiating urine flow Urinary hesitancy
Repeated need to urinate Urinary frequency
Sudden, almost uncontrollable need to urinate Urinary urgency
Painful urination Dysuria
Pain in the back between ribs and ilium Flank pain
Blood in the urine Hematuria
Inability to control urination Incontinence
Excretion of abnormally large volumes of urine Polyuria
Excessive urination during the night Nocturia
Decreased urine output Oliguria

Reproductive system – Female

Absent menstruation Amenorrhea
Excessive menstruation Menorrhagia
Painful menstruation Dysmenorrhea
Irregular menstruation Metrorrhagia
Painful intercourse Dyspareunia
Bleeding after intercourse Postcoital bleeding

Reproductive system – Male

Inability to achieve an erection Impotence

Musculoskeletal system
Noise with joint movement Crepitus
Redness (e.g., of joints) Erythema

Neurologic system
Inability to coordinate muscle movement Ataxia
Difficulty communicating Dysphasia

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Student Name ____________________________________________________________    Date _________________________

CHAPTER 3  Techniques and Equipment for

Physical Assessment

Equipment Provided by Student Equipment Provided by School Lab

• Penlight • Empty cardboard box and fluid-filled bag for percussion
• Stethoscope • Sphygmomanometer
• Ruler • Thermometer(s)
• Pulse oximeter
• Scale to measure weight and height
• Skin-fold calipers
• Ruler or tape measure
• Visual acuity charts
• Ophthalmoscope
• Otoscope with specula
• Audioscope with specula
• Tuning fork
• Nasal speculum
• Doppler
• Goniometer
• Percussion hammer or neurologic hammer
• Monofilament
• Vaginal speculum
After performing hand hygiene, perform these examination techniques with a lab partner.

Examination Techniques Document Findings

Inspection
Inspect the skin on the forearm of your lab partner.
What is the overall color? Do you see any variations in color? Color:
Notice the hair on the arm—amount, color, patterns. Hair color/distribution:
Do you see a lesion (scar, mole) on the forearm? If so,
where is it located, what color is it, and what size is it? Lesions:
Does using a pen light to create tangential lighting
improve the inspection?
Using a penlight, inspect our lab partner’s pupillary Pupil reactivity and equality
constriction and equality.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 15

16   Chapter 3 Techniques and Equipment for Physical Assessment

Examination Techniques Document Findings

Palpation Palpate a radial pulse.
With your lab partner, practice light palpation with deep  light
your fingertips and deep palpation with your hands. In
the column to the right, indicate the type of palpation
appropriate for the example given.
Palpate the texture of skin.
deep  light
Palpate the abdomen.
deep  light
Palpate tenderness over a muscle.
deep  light
Touch the skin of your lab partner. Notice the
temperature, moisture, and skin texture. Skin Palpation
Temperature:
Moisture:
Texture:
Percussion Empty cardboard box:
Practice indirect finger percussion using the surface of
the following three objects: an empty cardboard box, a
Table surface:
table surface, and a liquid-filled plastic container.
   Can you hear percussion tones?
  Can you hear differences in the tones of the various Liquid-filled plastic container:
objects?
Practice indirect finger percussion with your lab partner.
Percuss over the following places: abdomen over the Abdomen-stomach:
stomach; abdomen over the liver; chest over the lung
field; and chest over the sternum. Abdomen-liver:
Can you hear percussion tones?
Chest-lung:
 an you hear differences in tones as you percuss the
C
different areas? Chest-sternum:
Auscultation
Identify the following parts of your stethoscope: earpiece,
tubing, head (bell and diaphragm) (See Fig. 3.8A.) If your
stethoscope has a two-sided head, turn it to the bell and then
to the diaphragm. How can you tell which side is engaged?
Place the earpieces in your ears, pointing forward. Gently
rub or tap the head of the stethoscope to sound.
With your lab partner, listen with your stethoscope for
sounds at the following locations: Yes No
abdomen Abdomen ❏ ❏
carotid artery Carotid artery ❏ ❏
lungs Lungs ❏ ❏
heart Heart ❏ ❏
brachial artery Brachial artery ❏ ❏
Indicate “Y” or “N” whether you can hear sounds.
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 Chapter 3 Techniques and Equipment for Physical Assessment  17

USING EQUIPMENT
With a lab partner, complete the following activities using the equipment available in your lab.

Thermometers
Electronic thermometer:
• Put a disposable sheath over the probe. See Fig. 3.7A for an example. What is the temperature? _______________
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏

Tympanic thermometer:
• Put a disposable sheath over the probe. See Fig. 3.7B for an example. What is the temperature? _______________
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏

Temporal artery thermometer:

• Depress the scan button on the thermometer and slide across one side of the lab partner’s forehead to behind the
ear. See Fig. 3.7C for an example. What is the temperature? _______________________
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏

Sphygmomanometer/Cuffs
• Practice placing and removing a cuff on your lab partner’s arm. See Fig. 3.9A for an example.

• Compare various sizes of cuffs. See Fig. 3.10 for an example. Practice steps involved in determining a correct fit on
your lab partner.

• Holding the cuff tightly wrapped in your hand, practice inflating the cuff with the inflation bulb, then slowly deflate
the cuff using the control knob next to the inflation bulb.

• If your lab has one, examine an automated blood pressure device. (See Fig 3.9B for an example.) How does the
procedure for placing a cuff differ compared with the manual BP cuffs?

• Determine how to turn the device on and off. Identify the display for blood pressure measurement. What other
information is displayed?

Pulse Oximeter
• Turn on the device, place the probe on the finger of your lab partner, and record the oxygen saturation of arterial
blood (SaO2). See Fig. 3.11 for an example.

Level = ______%

• What does this mean?

Scale to measure body weight and height

• Calibrate the weight on a standing platform scale to 0 (zero) before weighing your lab partner. See Fig. 3.12A for an
example.

• Determine the weight of your lab partner by balancing the weights. ______________lb.

• Determine the height of your lab partner ________ft, ______In.

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18   Chapter 3 Techniques and Equipment for Physical Assessment

Skin-Fold Calipers
• What are the calibrations of the calipers? See Fig. 3.13 for an example.

• Manipulate the calipers. Measure the thickness of your lab partners triceps skin fold. See Fig. 8.11 for an
example of the technique.

• Use Table 8.6 to determine the percentile. Document your findings,

Average of measurements:_______________________________mm.

Percentile: _______________________________

Ruler and Tape Measure

• Notice the units of measurement on your ruler:     Tape measure:

• Measure the following spots with your ruler. Write your measurements in the space provided.

a. in./cm.

b. in./cm.

c. in./cm.

• Measure the circumference of your lab partner’s left wrist and his or her left forearm, 4 inches below the elbow.

Record your measurements. Left wrist __________   Left forearm __________

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 Chapter 3 Techniques and Equipment for Physical Assessment  19

Visual Acuity Charts

• Distance vision. Using a Snellen visual acuity chart at a distance of 20 feet from your lab partner, test distance vision
and screen for color and field perceptions of each eye with glasses off and on. (See Figs. 3.15A-D for examples.)
Document your findings.

Eye glasses off glasses on

Left eye /20 /20
Right eye /20 /20

_________ Correctly Identified red and green lines.

_________ Identified green line as longer.

• Near vision. While your lab partner holds a Rosenbaum or similar tool 14 Inches from the face, test near vision of
each eye. See Fig. 3.16 for an example. Document your findings.

Eye glasses off glasses on

Left eye /20 /20
Right eye /20 /20

Ophthalmoscope
• Practice attaching and removing the head of the ophthalmoscope. See Fig. 3.17A for an example.

• Turn on the power switch to your instrument. Shine the light from the instrument against your hand. Turn the
aperture dial and observe the various settings: large light, small light, red-free filter, slit light, and grid light. As you
shine these on your hand, identify each setting.

• Locate the lens selector dial. Turn the lens and observe the red and black numbers.

• Look through the eyepiece at your hand (or another object) and slowly turn the lens selector dial. Become familiar
with adjusting the magnification while looking through the eyepiece.

Otoscope
• Practice attaching and removing the head of the otoscope. See Fig. 3.18A for an example.

• Compare adult and pediatric speculums (black, cone-shaped pieces).

• Place a speculum on the head of the otoscope.

• Turn on the power switch to your instrument. Shine the light from the instrument against your hand.

• Look through the lens at your hand or another small object.

Audioscope
• Select a speculum that snuggly fits the ear canal of your lab partner and attach the speculum to the audioscope.
See Fig. 3.19 for an example.

• Instruct your lab partner: After the speculum is placed in the external auditory canal, he or she should raise an
index when a tone is heard.

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20   Chapter 3 Techniques and Equipment for Physical Assessment

• Turn on the audioscope by sliding the switch to the desired screening level. A light appears when the audioscope is
ready for use.

• As tones are delivered at each frequency or Hertz, the patient indicates the tone can be heard, providing objective
measurement of hearing.

Tuning Fork
• Identify the type or types of tuning forks available in your lab. See Fig. 3.20 for an example.

• Strike the tuning fork against the palm of your hand. Place the vibrating tuning fork on your sternum, clavicle,
styloid process of your radius (wrist), and/or lateral or medial malleolus (ankle).

• Are you able to hear and feel vibrations?

Nasal Speculum
• Use the simple nasal speculum with a penlight to visualize the lower and middle turbinates of both sides of the nose
of your lab partner. See Fig. 3.21 for an example of a nasal speculum.

• Describe your findings.

Doppler
• Turn the Doppler on and listen to the vascular tones over the radial or brachial artery of your lab partner. See Fig. 3.22
for an example. What sounds do you hear over the vessel?

Goniometer
• See Fig. 3.23 for an example of a goniometer. Refer to Box 14.1 for How to Use a goniometer and Fig. 14.21 for an
example of its use.

• What is the calibration for measurement?

• Set the goniometer at the following angles: 90°, 60°, 110°, 45°

• Practice using the goniometer by measuring your lab partner’s flexed elbow. Document your findings.

• Right elbow ________0 Left elbow _________0

Percussion hammer and neurologic hammer

• Notice the different designs of each hammer. The percussion hammer as a triangular shape, while the neurologic
hammer is rounded on both sides. See Fig. 3.24 for an example of a percussion hammer.

• With your lab partner sitting on a table with legs hanging free, use the pointed surface of the percussion hammer to
strike the patella tendon to test the deep tendon reflex. See Fig. 15.22D for an example.

• Document your results using Box 15.3 for Scoring Deep Tendon Reflexes (DTRs)

• Patellar reflex score ____________________

• With your lab partner in the same position, passively flex the foot and strike the Achilles tendon with the flat surface
of the percussion hammer. See Fig. 15.22E for an example. Document your findings using Box 15.3.

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 Chapter 3 Techniques and Equipment for Physical Assessment  21

• Achilles reflex score ____________________

Monofilament

• Out of your lab partner’s line of vision, place the monofilament on the ball of your lab partner’s bare foot and apply
slight pressure so that the wire bends.

• Ask your lab partner to indicate when and where the wire is felt. Repeat the procedure on the other foot.

• Repeat the procedure at other sites: plantar aspect of the foot, great toe, and heel of each foot.

• Document the findings:

Ball of foot Plantar aspect Great toe Heel

Right foot

Left foot

Vaginal Speculum
• All specula are composed of two blades and a handle and are available as either reusable metal or disposable plastic
models (Fig. 3.26). Plastic and metal specula differ slightly in the ease of use and positioning.

• Examine the blades and handle of the speculum and practice opening and closing the blades.

• Practice is necessary in order to use these confidently and ensure patient comfort.

• There are three types of vaginal specula: Graves, Pederson, and pediatric or virginal.

 The Graves speculum is available in a variety of sizes. The bottom blade is slightly longer than the top blade to
conform to the longer posterior vaginal wall and aid in visualization.

 The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrow and flatter.

 The pediatric or virginal speculum is smallest in all dimensions of width and length.

• The metal speculum has two positioning devices. The top blade is hinged and has a thumb lever attached. When
the thumb level is pressed down, the distal end of the top blade rises and opens the speculum. The blade can be
locked open at that point by tightening the screw on the thumb lever. The proximal end of the speculum can also be
opened wider if necessary by loosening and then tightening another thumb screw on the handle.

• The bottom blade of a disposable plastic speculum is fixed to a posterior handle, and the upper blade is fixed to the
anterior lever handle. When the lever is pressed, the distal end of the top blade opens; at the same time the base
of the speculum widens. As the speculum opens, it goes through a series of clicking sounds until it snaps into the
desired position. The patient should be forewarned about the clicking and snapping sounds. In addition, some of
the plastic models have a port through which a light source can be inserted directly into the speculum.

Copyright © 2022 Elsevier, Inc. All Rights Reserved.

Student Name ____________________________________________________________    Date _________________________

CHAPTER 4  General Inspection and

Measurement of Vital Signs

GENERAL INSPECTION
With your lab partner assuming the role as a patient, document a general inspection using the guide in the left column. Document
your findings in the right column or use a marker to highlight data in the left column that accurately describes the patient.

Examination Techniques Findings (document findings below)

Physical Appearance Physical Appearance

Is the appearance consistent with stated age?
Are there signs of physical distress, shortness of breath,
anxiety or pain? If yes, describe.
Describe the patient’s general color and condition of skin
and general hygiene.

Body Structure and Position Body Structure and Position

What is the patient’s stature (height, body size)?
Describe the patient’s body symmetry.
What is the patient’s posture? Is it straight, comfortable, and
relaxed or uncomfortable, e.g., in a tripod or fetal position?

Body Movement Body Movement

Observe the patient’s movement. Does the patient move
and walk with ease?
Describe the gait and movement of extremities.
Describe any assistive devices used.
Does the patient move easily from standing to sitting or
from sitting to lying? If no, describe.
Does the patient move all extremities? If no, describe.
Describe any limitations to range of motion?
Is there any indication of pain with movement? If, yes,
describe.
Describe any involuntary movements.

Emotional/Mental Status and Behavior Emotional/Mental Status and Behavior

Describe patient’s level of consciousness. Is he/she alert?
Describe the patient’s eye contact.
Does the patient converse appropriately? If no, describe.
Are facial expressions and body language appropriate for
the conversation? If no, describe.
Is the dress appropriate for the weather? If no, describe.
Is the behavior appropriate? If no, describe.

Copyright © 2022 Elsevier, Inc. All Rights Reserved. 23

Another random document with
no related content on Scribd:
terrible gossip and busybody was she, talking perpetually and doing
all the mischief that lay in her power. She was the terror and torment
of all cats and kittens; for, wary and watchful as they might be, Polly
was always surprising them by attacks in the rear, and cunning
ambuscades and flank movements. Nothing more still and soft-
footed could be imagined than her approaches; nothing more sly,
sudden, and sharp than the nips she gave with her horrid hooked
bill. A cat’s extended tail was especially tempting to her. She
generally fought the battle out on that line. “In maiden meditation
fancy free,” this parrot roamed about the yard, and laughed and
railed at patient sitting hens, and the proud mothers of newly
hatched chicks and ducklings. Sometimes she would follow a brood
about, sneering and advising, until the poor mother was in an agony
of worriment. At last she came to grief in this way. A spirited
speckled hen, with a fine brood of young ones, tired of being
snubbed and of hearing her offspring depreciated, and shocked at
seeing the domestic virtues set at naught by a flaunting foreign fowl
of infidel sentiments, turned upon her, sprang upon her back, and
began pecking and tearing at her sleek plumage like mad! The
feathers fell all around, like a shower of green snow; and the parrot
began screaming with all her might: “Let up! Let up! Poor Polly! Poor
Polly!”
Her mistress came to the rescue, and Polly skulked away to her
cage, where she remained several days, sullen and deeply
humiliated; but when she emerged from her retirement she gave the
hens and chickens a wide berth.
Several parrots, the pets and companions of religious persons, have
been distinguished by their piety, or what passed for such. These
have usually belonged to devout Catholics. I have read of one,
named Vert-Vert,—the inmate of a convent in France, and taught by
the holy nuns,—who was esteemed a most blessed and
miraculously gifted bird. His fame spread far and wide. Many made
pilgrimages to the convent to be edified by his pious exhortations;
and at last the nuns of another convent, in a distant province,
solicited the loan of him for a few months, for the good of their souls.
He went forth as a sort of feathered apostle, followed by the prayers
and blessings of the bereaved sisters, and looking very solemn and
important. But, unfortunately, on his journey, he was compelled to
spend a night on a steamer; and being kept awake by such new
scenes, and perhaps a little sea-sickness, he listened too much to
the unprofitable and profane talk of the sailors and some soldiers
who were on board. And so it happened that, when he reached the
convent, where he was received with great joy and impressive
religious ceremonies, instead of edifying the good sisters with
exhortations and chants, delivered in a grave, decorous manner, he
horrified them by shouting like a rough old sea-captain and swearing
like a major-general, while he assumed the most knowing, rollicking
air imaginable. Those saintly women stopped their ears, and fled
from him as though he had been a demon-bird, and he was
immediately sent home in utter disgrace. There, through fasts and
penances, he was brought round to more correct habits and
behavior; but he never became the shining light he had been before
his sudden fall. No more pilgrimages were made to his perch.
Though grown a sadder and a wiser bird, it was impossible to tell
whether he most sorrowed for his fault or regretted the wicked world
of which he had had a taste. Still he made a good end, I believe,
within the convent’s hallowed cloisters.
A certain pious cardinal in Rome once gave a hundred crowns in
gold for a parrot that could repeat the Apostles’ Creed. Another
religiously trained parrot once served as a chaplain on board of a
ship,—actually reciting the service for the sailors, who listened and
responded with becoming solemnity. I have never seen a clerical
parrot; but I have seen clergymen who suggested parrots. By the
way, the parrot would make a very economical sort of minister. After
the first cost of the bird, his education, and a respectable cage or
parsonage, there would be no demands on the congregation for
increase of salary. As he would have no scruples about repeating old
sermons, he would not desire new fields of labor. Parrots seldom
have any family, so he would expect no donation-parties. They never
have dyspepsia, so he would require no trips to Europe. He would
not, I fear, be very popular in the sewing-circles and Dorcas
societies,—for he would talk down all the ladies.
A dear young friend of ours has a lovely pair of turtle-doves, that are
constantly making love to each other, these soft spring days, in that
delicious, drowsy honey-moon coo, “most musical, most
melancholy.”
Awhile ago the disastrous experiment was tried, of putting these
doves into the cage with a parrot. Miss Polly did not fancy her dainty
visitors in the least. She glared at them as they cuddled together in a
corner, eying her askance, and murmuring in the sweet dove dialect,
—Madame Columba very timidly, and Monsieur in a tender,
reassuring tone. Miss Polly abominated such soft, love-sick voices,
and such a parade of matrimonial bliss and affection just
exasperated her; so she pitched into them, scolding fearfully at first,
but soon coming to blows with her wings, then to scratching and
pecking with her steel-like claws and fearful, hooked bill. When the
hapless pair were rescued, it was found that the husband, who had
fought gallantly to protect his wife, had met with a serious loss, in the
upper part of his bill, which had been quite bitten off by that
inhospitable old termagant, who had doubtless thought thus to put
an end to his billing and cooing.
The poor fellow lost some glossy feathers in this encounter. They
have been replaced, but the broken beak has never been restored.
Thus maimed, he is only able to drink from a perfectly full cup, and
his loving mate invariably stands back till his thirst is satisfied. She
also feeds him when he has difficulty in eating, and always carefully
plumes him, as he can no longer perform that service for himself.
Indeed, she attends to his toilet before her own. No fond wife of a
disabled soldier could surpass her in watchful care and devotion.
What a touching little lesson is this, of tender, faithful love! I wonder if
he would have done as much for her. Let us hope so.

THE BENEVOLENT SHANGHAI.

I have long wished to record the admirable behavior of a certain
Shanghai rooster, once belonging to a relative of ours in the West.
This fowl was old, but he was tender; he was ugly, but he was
virtuous, as you shall see. One of the hens of his flock died suddenly
and mysteriously,—of too many family cares, perhaps, for she left a
brood of twelve hearty, clamorous young chickens. One of the
children, the poet of the family, said:—
“Grandfather Shanghai
Stood sadly by,
And saw her die,
With a tear in his eye.”
Perhaps he received her last instructions,—her dying bequest. If so,
never was a legatee more burdened with responsibilities; for from
that hour the good rooster adopted all those chickens, and devoted
himself to them. When the fowls were fed, he guarded their portion;
he watched over them when hawks were hovering near; he
scratched and fought for them and stalked around after them all day,
and at night, after leading the other fowls to roost, he would descend
from the old pear-tree, gather those poor sleepy little things under
him, and do his best to brood them. His legs were so long and stiff
that it was a difficult job. First he would droop one wing down to
shelter them; then, seeing that they were exposed on the other side,
would let down the other. Then, finding that he could not keep both
down at once, he would try to crouch lower, and would sometimes tip
himself entirely over. It was a laughable sight, I assure you. But
somehow he managed to keep them warm, to feed them, and bring
them up in the way they should go; and I hope they always loved
him, and never made fun of their gaunt, ungainly old guardian, when
they grew up, and went among the other young people of the farm-
yard, especially when chatting with the foreign fowls, the proud
Spanish hens, and the pretty Dorking pullets.

THE GALLANT BANTAM.

I have observed that while the Bantam pullet is a quiet, modest, little
pantaletted lady, the Bantam cockerel always makes up in big feeling
for what he lacks in size. A gentleman farmer owned a Bantam of
this sort, that was always full and bubbling over with fight. He would
go at any gentleman-fowl in the yard, with beak and spur. He would
defy the fiercest old gander, and challenge the biggest “cock of the
walk” to mortal combat. At last he grew so uncomfortably
quarrelsome, and presented such a disreputable appearance,—
having had the best part of his tail-feathers torn out, and his spurs
broken off,—that his master was obliged to put him out to board with
a nice old lady who had no fighting fowls for him to contend with. It
was hoped that he would be content to tarry in that Jericho until his
tail-feathers should be grown; but one day, when his master paid a
visit to his good neighbor, he found the little Bantam with his head
badly swollen, and with a patch over one eye and across his beak,
placed there by the kind old lady. He had gone outside the yard, and
picked a quarrel with a strange rooster, only about six times his size,
and been pretty badly punished.
A short time after, a big turkey gobbler was added to the feathered
community of that farm-yard, the old lady not dreaming of the
Bantam cock daring to make hostile demonstrations against such a
potentate. But she had done our little hero injustice. As soon as he
saw the mighty spread the arrogant old fellow was making, he just
gathered himself up, and “went for him,” if I may use a slang
expression, which I know boys, at least, will understand only too
well.
The big gobbler looked down upon him at first in contemptuous
astonishment, as much as to say, “What fooling is this?” But when he
saw that the fiery little fellow was in earnest, he just struck him one
blow with his terrible wing, and—well, the gallant Bantam went “on
his raids no more.” He was served as another savage Turkey served
poor Crete. This is a world of tragedies and downfalls.
On a late visit to the Central Park, we noticed, among the collection
of fowls there, a Bantam cock, of the very smallest pattern, that yet
seemed to have a big, gallant heart. We saw him in one of his soft
moments, when, in fact, he was making love. He had been very
ambitious in selecting the object of his adoration, for he was actually
paying his addresses to a full-sized Shanghai hen, who was in a
large cage, separated from him by a light lattice. He would strut up
and down before her, ruffling his fine feathers, and making eyes at
her. Sometimes he would dance up sideways, declaring his passion
with a soft, musical murmur, that sounded like “coort, coort,” which it
would seem she could hardly resist; but she did,—not so much as a
feather on her breast was stirred by his appeal; she regarded him in
placid disdain. Indeed, it was almost as funny to watch the tiny,
strutting little creature making love to that superior fowl, as it would
be to see Commodore Nutt courting Miss Swan, the giantess.
“So daring in love and so dauntless in war,
Have ye e’er heard of knight like the young Lochinvar?”

THE DISOWNED CHICKS.

I have a friend living in the very heart of the big city of Chicago, who
owns several hens of rare varieties, and a flock of young chickens of
remarkable promise. She keeps them in her back-yard, which they
utterly devastate, not suffering a green thing to live, making it look
like a small copy of the Desert of Sahara. Yet she says keeping them
reminds her of the country! She is a very poetic and imaginative lady.
It is very likely that a hand-organ reminds her of music, and fish-balls
of the mighty, briny deep.
One of this good lady’s hens is a handsome, stately fowl, dressed in
gray satin, and wearing a top-knot that is like a crown of silver. She
has one chicken, almost full-grown,—the last of many lively children,
the victims of rats and the pip. Of him she is very fond. There was, at
one time, great danger that he would be spoiled,—for she toiled for
him all day, trotting about everywhere with him “at her apron-strings,”
so to speak; and she actually broods him at night, though, do the
best she can in spreading herself, she can’t take in all of his tail,
unless she lets his head stick out somewhere. Thus he is content to
sleep ingloriously, when he ought to be roosting on some lofty perch,
ready to greet the first streak of dawn with a brave crow, prophetic of
the day.
A few weeks ago another hen, a young pullet, dressed gayly every
day in gold and brown, with a gorgeous top-knot, came, one
morning, triumphantly out from under the porch, with a large flock of
charming little chicklings, who toddled along after her, and glanced
up at the sky, and round on the earth,—that vast sandy plain of the
back-yard,—in a most knowing and patronizing manner. Nobody
would have guessed it was their first day out of the shell. They were
not going to show their greenness,—not they.
For a while those downy, yellow, cunning little roly-poly creatures
seemed to amuse their mother; she appeared fond of them, taking
pleasure in parading them before such of her neighbors as were
chickenless. But she was a giddy biddy, lazy and selfish; so, as soon
as she found that she must scratch to fill so many little crops, she
threw up maternity in disgust. She actually cast off her whole brood,
pecked at them, and scolded them till they ran from her in fright, and
huddled together in a corner of the fence, peeping piteously, and
doubtless wishing they had never been hatched. Perhaps some
were chicken-hearted enough to wish for death to end their troubles,
till they caught sight of some ugly old rat prowling about “seeking
whom he might devour,” when they reconsidered the matter, and
took a more cheerful view of life.
Well, it came to pass that the excellent gray hen, with the one big
chicken, seeing their forlorn condition, pitied them exceedingly, and
actually adopted the whole flock. Only think, children, it was as
though your mother should adopt a small orphan asylum, and all of
them twins!
She toils for them and protects them all day, treating them in all
respects as her own chicks, till sundown; then, not having room for
them under her wings without dislodging her only son and heir, she
always escorts them up the steps of the porch and sees them go to
bed in a little box, which has been prepared for them by their kind
mistress, with a cover of slats to guard them from rats and cats and
bats and owls, and every thing that prowls or lies in wait for small
fowls. Well, when she has seen the last chick tumble in, and cuddle
down to its place with a sleepy good-night “peep,” to be brooded
under the invisible wings of the soft summer night, that good,
motherly creature descends with stately dignity from the porch to her
own sleeping apartment underneath, when she mounts on a box,
and, calling her one long-legged darling, does her best to hover him,
and to make believe he is a baby-chicken still. In the morning she is
astir betimes, scratching and pecking for him and his adopted
brothers and sisters with wonderful impartiality. I must do this same
big chicken the justice to say that he has never made any violent
opposition to this sudden addition to the family; but he has rather a
haughty manner towards the little interlopers, and could we
understand the sort of Chickasaw language he speaks, we might find
him occasionally remonstrating with his maternal parent in this wise:
“Really, mother, it strikes me you are running your benevolence into
the ground, in scratching your nails off for a lot of other hen’s
chickens! such things don’t pay, ma’am; charity begins at home, and
one would think you had enough on your claws, in providing for the
wants of a growing young cockerel like me, without doing missionary
work. Besides, you are encouraging idleness and shiftlessness; it
just sticks in my crop to have you burden yourself with the cast-off
responsibilities of that impudent pullet, who goes cawking lazily
about, carrying her top-knot as high as ever.”
The conduct of that unnatural young mother is, indeed,
reprehensible. At meal-times she always comes elbowing her way
through the crowd of her virtuous neighbors, to secure the largest
share of corn-mush, not hesitating to rob her own children! She will
be likely to have a disturbing and demoralizing influence on the
female feathered community. She shirks her duties,—declines to lay
eggs lest chickens should come of them. She believes the chicken
population is too large already for the average supply of chickweed
and grubworms. She discourages nest-making, and despises her
weak-minded sisters, who, in spite of her warning, persist in laying,
sitting, and hatching; who really believe in the innocence of
chickenhood, and actually love to brood their chicks, to feel the soft
little things stir against their breasts, and to hear now and then, in the
still, dark night, their drowsy “peep, peep.” She goes against all such
silly sentiment and loving slavery. She pities any poor pullet who has
to spend her days in a coop, especially in Chicago. She is a sort of
hen-emancipator, and strolls about at “her own sweet will,” “in
maiden meditation, fancy free.”
If she could have the management of the hatchway, all chickens
would be hatched with equal rights to wear the spur, and with equal
gifts of crest and crow; all hatching would be done by steam, in a
general incubatorium at government expense, in a way to astonish
all grandmother Biddies; sittings would be abolished, coops levelled
to the earth, and the sound of the cluck be heard no more in the
land.
As for the poor cast-off chicks, they grow and thrive, get more steady
on their legs, and put out tiny tail-feathers, tinged with gold, as the
bright summer days go on. They doubtless think that their first
mother was a mistake, and that their second mother is the certain
true one, and honor her silver top-knot accordingly.
So you see, dear children, there is a Providence for little chickens,
as well as for little sparrows.
THE END.

Cambridge: Printed by Welch, Bigelow, & Co.

 TRANSCRIBER’S NOTES:
Obvious typographical errors have been corrected.
Inconsistencies in hyphenation have been
standardized.
Archaic or variant spelling has been retained.
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