Question

When assessing an adolescent, which structures would the nurse examine last? a. Head, eyes, ears, nose, and throat b. Neurological c. Musculoskeletal d. Genitourinary

Short answer

d. Genitourinary

Step-by-step solution

- Understanding the Question

The question is asking which body structures a nurse would examine last when assessing an adolescent. It's important to consider which examinations might be the most uncomfortable or invasive for the patient, which are usually done at the end of an assessment.

- Analyze the Options

Examine each option to identify the level of discomfort or invasiveness. a. Head, eyes, ears, nose, and throat: These areas are typically assessed early in the examination process as they are non-invasive. b. Neurological: This involves tests like checking reflexes and mental status, which are also generally not too uncomfortable. c. Musculoskeletal: This includes checking muscles and bones through movement and palpation and is usually not too invasive. d. Genitourinary: This involves examination of the genital and urinary systems, which is often more invasive and uncomfortable, especially for adolescents.

- Determine the Most Appropriate Answer

Since the Genitourinary examination is the most invasive and uncomfortable for adolescents, it should logically be the last part of the physical assessment to minimize ongoing discomfort or anxiety during the overall examination.

Key concepts

Examination Prioritization

When assessing adolescents, it is essential to prioritize the order in which different body structures are examined. As a rule of thumb, start with less invasive and more comfortable procedures to build rapport and ease any anxiety.
Begin with non-invasive checks such as:

• Head
• Eyes
• Ears
• Nose
• Throat

progressively moving to more invasive procedures. Next, assess neurological aspects which might require the patient to perform simple tasks or reflex tests that are generally non-invasive.
Then, proceed with musculoskeletal assessments involving palpations and movement tests. Finally, the genitourinary examination should be done last because it can be particularly uncomfortable or invasive, especially for adolescents.
By following this order, we ensure the adolescent's comfort and cooperation, making for a smoother and more efficient examination.

Invasive vs Non-Invasive Procedures

Understanding the difference between invasive and non-invasive procedures is critical in nursing assessments. Non-invasive procedures do not break the skin or enter body cavities. They include visual inspection and physical palpation of areas like:

• Head
• Eyes
• Ears
• Nose
• Throat

In contrast, invasive procedures involve entering the body, which can include anything from injections to internal examinations. For adolescents, genitourinary exams are considered more invasive because they involve inspecting private areas, potentially causing discomfort or embarrassment. Recognizing which procedures are invasive helps in planning the assessment sequence to promote patient comfort and minimize anxiety.

Nursing Physical Assessment

A thorough nursing physical assessment involves systematically checking various body systems to identify any health issues. For adolescents, this typically involves:

• Head
• Eyes
• Ears
• Nose
• Throat
• Neurological
• Musculoskeletal
• Genitourinary

Begin with superficial and non-invasive checks such as the head and eyes, gradually moving to more involved procedures. Neurological assessments may include reflex tests and cognition evaluations. Musculoskeletal evaluations assess the strength, movement, and structure of bones and muscles. Finally, perform the genitourinary assessment, which is more invasive and should be completed last. Follow this step-by-step approach to ensure a comprehensive and patient-friendly physical assessment.