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Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Why is a skin assessment important? What general information about the body as a whole is obtained through a skin assessment? Know important issues to ask when taking a history about the skin.

A
  • You can gather clues about health problems through the skin.
  • Information about body’s circulation, nutrition & signs of systemic disease.
  • Past history of skin disease, change in pigmentation/color, change in mole size/shape/color/tenderness, dryness/moisture, pruritus, bruising, rash/lesion, hair loss, change in nails, etc & Rx medication
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2
Q

What is pallor

A
  • Extreme or unusual paleness; skin takes color of connective tissue (collagen); common in anxiety or fear.
  • Observe in mucous membranes, lips & nail beds
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3
Q

What is Erythema

A
  • Intense redness from excess blood from dilated superficial capillaries
  • Expected with fever, local inflammation or emotional reactions in vascular flush areas
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4
Q

What is cyanosis

A
  • Bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
  • Best seen in lips, nose, cheeks, ears & oral mucous membranes.
  • Most conditions causing this also cause decreased oxygenation of the brain
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5
Q

What is jaundice

A
  • Yellowing of skin; indicates rising amounts of bilirubin in blood.
  • First noted in junction of hard & soft palates in mouth and in sclera of eye
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6
Q

How should we effectively assess skin temp

A

use backs of hand to palpate person; skin should be warm and temperature should be bilaterally equal

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7
Q

What is diaphoresis and what can it indicate

A
  • profuse sweating (perspiration) - accompanies increased metabolic rate
  • can indicate anxiety, pain or low BP
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8
Q

What is dehydration and what are some signs

A
  • A serious reduction in the body’s water content
  • dry mucous membranes, lips, decreased skin turgor
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9
Q

How to assess for turgor

A
  • Infants: test mobility of skin over abdomen
  • Adults: punch a large fold of skin on anterior of chest under clavicle
  • Can be affected by dehydration, extreme weight loss and age
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10
Q

Why is an infant more susceptible to dehydration

A
  • Higher body water content along with higher metabolic rates
  • They require greater volumes of water to maintain fluid equilibrium
  • Skin is thin, smooth & elastic therefor much more permeable than an adult’s
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11
Q

What is a papule

A
  • small (less than 1 cm in diameter), solid, raised lesion on surface of the skin
  • something you can feel
  • caused by superficial thickening of dermis

ex: mole, wart

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12
Q

What is a nodule

A
  • solid, round or oval elevated lesion 1 cm or more in diameter
  • may extend deeper into dermis than papule
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13
Q

What is a tumor

A
  • larger than a few centimeters in diameter

-firm or soft

  • deeper into dermis; may be benign or malignant
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14
Q

What is a wheal

A
  • superficial, raised, transient, and erythematous
  • slightly irregular shape from edema
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15
Q

What is a pustule

A

raised spot on the skin containing pus

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16
Q

What are the abcde danger signs of lesions

A
  • Asymmetry: not regularly round or oval
  • Border Irregularity: ragged edges
  • Color variation: areas of brown, tan, black, blue, red or combination
  • Diameter: greater than 6 mm
  • Elevation/enlargement
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17
Q

Describe skin developmental considerations of infant

A

newborns with brown/black skin have lighter skin tone than parents because of immature pigment formation; full melantonic color event in nail beds & scrotal folds

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18
Q

Describe skin developmental considerations of adolescence

A
  • increased sebaceous gland activity which creates oiliness and acne
  • acne lesions may appear as early as 7-8 years and peak at 14-17 in girls and 16-19 in boys.
  • facial hair appears on boys first on lip, then cheeks and below lip, last on chin
  • noticeable enlargement of thyroid cartilage causing deeper voice
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19
Q

Describe skin developmental considerations of pregnant women

A
  • striae appear during 2nd trimester on abdomen, breasts and sometimes thighs
  • vascular “spiders” are common because of increased estrogen
  • thyroid gland enlarges slightly because of hyperplasia of tissue & increased vascularity
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20
Q

Describe skin developmental considerations of the elderly

A

-senile lentigines (liverspots): clusters of melanocytes appearing after extensive sun exposure on forearms & back of hand

  • more prominent facial bones & orbits
  • sagging facial skin as a result of decreased elasticity
  • decreased subcutaneous fat & moisture in skin
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21
Q

What is a mongolian spot

A
  • common variation of hyperpigmentation in newborns Black (90%), Asian (80%), American Indian (80%)
  • blue/black to purple area at sacrum, buttocks and sometimes abdomen, thighs, shoulders or arms due to deep dermal melanocytes
  • gradually fades in first year, frequently still lightly visible in adulthood
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22
Q

What is a stork bite (salmon patch)

A
  • nevus simplex
  • flat, irregularly shaped red/pink patch found on forehead, eyelid or upper lip but most commonly at back of neck
  • usually fades in first year
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23
Q

What is a linea nigra

A

dark line of pigmentation from the umbilicus extending to the pubic area

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24
Q

What are striae

A

(lineae albicantes) silvery white or pink scar tissue formed by stretching of abdominal, breast and sometimes thigh skin with pregnancy (2nd trimester) or obesity

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25
Q

Describe the capillary refill test

A
  • Pressure is applied to the nail bed until it turns white (called blanching) and once the tissue has blanched, pressure is removed while the patient holds their hand above their heart. Return of blood is indicated by the nail turning back to a pink color.
  • healthy return is 1-2 seconds
  • indicates status of peripheral circulation
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26
Q

Describe normal shape and contour of nails

A
  • surface is slightly curved or flat; posterior & lateral folds are smooth and rounded
  • 160 degrees
  • firm to palpation
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27
Q

Describe clubbing

A
  • occurs with congenital heart disease and neoplastic & pulmonary diseases which cause release of growth factors & promote vessel growth
  • angle straightens out to 180 degrees, nail base feels spongy
  • can reverse if primary disease is treated
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28
Q

What is pruritus and what can it indicate

A

itching; most common skin symptom.

  • occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, lice etc
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29
Q

What is diaper rash and what can cause it

A
  • diaper dermatitis
  • red, moist maculopapular patch with poorly defined borders in diaper area extending along inguinal & gluteal folds
  • infrequent diaper changes or occlusive coverings
  • inflammatory diseased caused by skin irritation from ammonia, heat, moisture & occlusive diapers
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30
Q

What is acne

A
  • increase in sebaceous gland activity creating increased oiliness & acne
  • in milder form of open comedones (blackheads) & closed comedones (whiteheads)
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31
Q

Describe herpes zoster (shingles). What can it pose a risk to

A
  • caused by varicella-zoster virus
  • small grouped vesicles emerge along root of cutaneous nerve, then pustules then crust.
  • accuse appearance, unilateral, doesn’t cross midline
  • commonly on trunk but can be anywhere
  • most common in adults 50+
  • can pose risk to eye if on CN V
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32
Q

Describe petechiae

A

tiny punctate hemorrhages 1-3 mm; round & discreet; dark red, purple or brown in color.

  • caused by bleeding from superficial capillaries
  • may indicate abnormal clotting factors
  • most diseases that cause bleeding & micro embolism formation are characterized by petechiae in mucous membranes & on skin.
  • inspect in mouth, especially buccal mucosa, and conjunctivae
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33
Q

Describe purapura

A
  • confluent & extensive patch of petechiae & ecchymoses; >3 mm, flat
  • seen in scurvy & thrombocytopenia
  • occurs in old age as blood leaks from capillaries in response to minor trauma and diffuses through dermis
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34
Q

Describe hematoma

A

a bruise you can feel; elevates skin & seen as swelling

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35
Q

Describe ecchymosis

A

purplish patch resulting from extravasation of blood into skin, >3mm

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36
Q

Describe how to assess and what is the function of CN V

A
  • trigeminal nerve
  • facial sensation of pain or touch are mediated by 3 branches
  • assess by gently touching 3 sections on each side of patient’s face & have them tell you when they feel it
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37
Q

Describe how to assess and what is the function of CN VII

A
  • facial nerve
  • forms expressions by facial muscles
  • facial muscle function is bilaterally symmetric except for occasional quirk or wry expression
  • assess by having patient smile, wrinkle forehead, pucker lips, show teeth & puff out cheeks; both sides of face should move the same way
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38
Q

Describe how to assess and what is the function of CN XI

A
  • spinal accessory
  • have patient shrug his or her shoulders and turn his or her head each way against resistance
39
Q

Describe infant head growth

A
  • Circumference grows 0.5inches/mo until 6mo, then 0.2 inches/mo until 1year
  • bones of neonatal skull are separated by sutures & fontanels which allow for growth of brain during first year & gradually ossify
40
Q

When does the anterior fontanel close?

A

between 9 months & 2 years; is also diamond shaped

41
Q

When does the posterior fontanelle close?

A

1-2 months; is also triangular shaped

42
Q

Normal findings if infant head & face

A
  • head size should measure 32-38 cm & is 2 cm larger than chest circumference
  • symmetric head contour
  • skull should feel smooth & fused except for fontanels which feel firm, slightly concave & well defend against edges of cranial bones
  • symmetry of wrinkling when crying or smiling
43
Q

Normal finding of adult head & face

A
  • skull should be normal and symmetric, along with facial features (eyebrows, palpebral fissures, nasolabial folds & sides of mouth)
44
Q

How to palpate thyroid gland

A

Tilt head back to stretch skin against thyroid, inspect neck as person sips water and swallows. Thyroid tissue moves up then falls into resting position

45
Q

Where is periauricular

A

in front of ear

46
Q

Where is posterior auricular (mastoid)

A

superficial to the mastoid process (behind the ear)

47
Q

Where is occipital

A

base of skull

48
Q

Where is submental

A

midline, behind the tip of the mandible

49
Q

Where is submandibular

A

halfway between the angle and the tip of the mandible

50
Q

Where is jugulodigastric

A

Under angle of mandible (tonsillar)

51
Q

Where is superficial cervical

A

overlying the sternomastoid muscle

52
Q

Where is deep cervical

A

deep under the sternomastoid muscle

53
Q

Where is posterior cervical

A

in the posterior triangle along the edge of the trapezius muscle

54
Q

Where is superclavicular

A

just above and behind the clavicle, at the sternomastoid muscle

55
Q

What does an enlarged lymph node mean

A

infection, inflammation, HIV, neoplasm

56
Q

What is an acute infection

A

an infection characterized by symptoms that develop fairly quickly and last a relatively short time, < 14 days; nodes are bilateral, enlarged, warm tender & firm but freely movable

57
Q

What is a cancerous node

A

rock-hard, > 3cm, unilateral, contender, matted & fixed to adjacent structures

58
Q

What is the direct light reflex

A

constriction of the pupil when exposed to bright light

59
Q

What is the indirect light reflex

A

(consensual light reflex) when one eye exposed to bright light, simultaneous contrition of other pupils occurs

60
Q

What is the proper procedure for using the opthalmoscope

A

darken room to dilate pupils, select large round aperture with white light for routine examination, tell person to keep looking at mark on wall, match sides with person. begin 15 cm away from person at 15 degree lateral angle

61
Q

Describe how to use the snellen eye chart

A
  • one of several charts used in testing visual acuity; letters, numbers, or symbols are arranged on the chart in decreasing size from top to bottom
  • postion person 20 ft from chart & cover one eye with opaque card.
  • ask person to read smallest line of letters possible
  • abnormal findings: hesitancy, squinting, leaning forward, misreading letters
62
Q

Describe how to use the hand held vision screener

A

normally used at bedside for people older than 40, test near vision with various sizes of print, hold card in good light about 35 cm from eye, test each eye separately

63
Q

Describe the corneal light reflex (Hirschberg test)

A

Assess the parallel alignment of the eye axes by shining a light toward the person’s eyes. Note reflection of light on corneas should be exactly the same on each eye

64
Q

Describe the EOM/diagnostic positions test

A

leading eye through 6 cardinal positions of gaze elicits any muscle weakness during movement

65
Q

What is accommodation

A

adaption of eye for near vision; ask person to focus on distant object, which dilates pupils, then shift gaze to near object

66
Q

What are normal findings on fundoscopic examination

A
  • internal eye exam
  • optic disc will be creamy yellow-orange to pink, round or oval, distinct & sharply demarcated
  • distinctness caries on cup-disc ratio; when visible. cup is a brighter yellow-white than rest of disc
67
Q

What are normal findings when examining cornea and lens

A

No opacities (cloudiness), no abrasions, crus seniles (gray-white arc around limbus) is normal in older adults

68
Q

Describe myopia

A

nearsightedness; lack of foresight. close objects are clearly seen but far away objects seemed blurred

69
Q

Describe Ptosis

A

drooping of upper lid

70
Q

What is aniscoria

A

unequal pupil size

71
Q

What is diplopia

A

double vision; 2 images of single object

72
Q

What is photophobia

A

inability to tolerate light

73
Q

What are floaters

A

Particles of cellular debris that float in the vitreous fluid and cast shadows on the retina; common with myopia or after middle age

74
Q

What is presbyopia

A

decrease in power of accommodation with aging

75
Q

What is different about children’s external auditory canal and adults

A

Infant’s eustachian tubes are shorter, wider & more horizontal so it’s easer for pathogens to travel to inner ear

76
Q

What are normal findings for otoscopic exam

A
  • external canal should be free of redness, swelling, discharge, lesions & foreign bodies
  • cerumen presence is normal
  • tympanic membrane should be translucent, pearly gray, oval, slightly concave
  • shorty process of malleus should be visible
77
Q

What is the purpose of a eustachian tube

A

connects middle ear with nasopharynx & allows passage of air; normally closed but opens with swallowing or yawning; equalizes pressure to prevent membrane rupture

78
Q

Which CN is responsible for hearing and equilibrium

A

CN VIII; acoustic/vestibulocochlear

79
Q

What is the whisper test

A

stand 1-2 ft in front of patient, cover mouth & whisper 2 two-syllable words; test one ear at a time while other is covered

80
Q

What are the signs and symptoms of Otis Media

A
  • (middle ear in fiction) patient will feel pain, persistence of fluid in middle ear; sticky yellow discharge
  • tympanic membrane will be a yellow-amber color in OM with effusion & red with acute OM
81
Q

How to test CN I and what is it

A

Olfactory nerve. Have patient close one nostril and then sniff a smell, repeat other nostril with a different smell

82
Q

Describe normal appearance and findings of inspection of nasal cavity

A

Inspect nasal mucosa, noting its normal red color and smooth moist surface
Observe nasal septum for deviation; deviated septum is common and is not significant unless air flow is obstructed
Inspect turbinates, the bony ridges curving down from lateral walls
Turbinates are quite vascular and tender if touched
Note any polyps, benign growths that accompany chronic allergy, and distinguish them from normal turbinates

83
Q

Describe management of epistaxis

A

Initial management includes compression of the nostrils (application of direct pressure to the septal area) and plugging of the affected nostril with gauze or cotton that has been soaked in a topical decongestant. Direct pressure should be applied continuously for at least five minutes, and for up to 20 minutes.

84
Q

How to test CN 12 and what is it

A

Hypoglossal nerve. cranial nerve is evaluated by asking the patient to extend the tongue and inspecting it for atrophy, fasciculations, and weakness (deviation is toward the side of a lesion)

85
Q

Describe normal appearance of the mouth

A

Begin with anterior structures and move posteriorly
Lips - color, moisture, cracking, or lesions
Teeth and gums
Number of teeth – for adult ask if they had wisdom teeth removed? (32 - 4= 28)
Normally, gums look pink or coral with a stippled (dotted) surface
Gum margins tight and well defined

86
Q

What is candidiasis and what does it look like

A

It is a fungus and presents as a thick looking white coat or film over the tongue

87
Q

What does tonsillitis look like

A

White pus pockets sitting on the tonsils

88
Q

Describe normal findings of the buccal mucosa

A

Check buccal mucosa for color, nodules, or lesions; looks pink, smooth, and moist, although patchy hyperpigmentation common in dark-skinned people – NO Cyanosis

89
Q

What does normal hard palate look like

A

anterior
White

90
Q

What does normal soft palate look like

A

posterior
Moist
Pink

91
Q

What does normal finding of uvula look like

A

Midline
“Rises on phonation”
Tests one function of CN X, the vagus nerve

92
Q

How to test CN IX and X (glossopharyngeal and vagus)

A

The gag reflex tests both the sensory and motor components of CN 9 & 10.

93
Q

Describe dysphagia and what is it associated with

A

It is difficulty swallowing. Associated with conditions that affect the nervous system, such as a stroke, head injury, or dementia.

94
Q
A

Health Assessment (5 decks)

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