Health/ H2T Physical Assessment- Head & Neck Flashcards
LOC means
Refers to if a person is ….
Level of consciousness
Awake, Alert, and Oriented
Examples of LOC
Attentive
Cooperative
Alert and Awake
Sleepy and Arousable
Lethargic
Orientation refers to
confusion
Oriented x1 means
WHO/PERSON
patient knows who they are
Oriented x2
WHO/WHERE
Person knows who they are and where they are
Oriented x3
WHO/WHERE/TIME
Assessment of cognition includes
LOC
Orientation
Mood
Language & Memory
Speech deficits
What is aphasia?
Loss of ability to understand or express language/ speech
How do you assess a persons orientation?
Ask simple questions about person, place, time
receptive aphasia
inability to receive communication/ cannot understand directiob but have ability to express communication
expressive aphasia
inability to express communication/ can understand but cannot express their understanding to you
Skin, hair nails are examined through ____
inspection and palpation
How do we asssess for skin conditions?
Color
Temp
Moisture
Texture
Hygiene
What is cyanosis?
Peripheral vs Central
What is it a sign of?
Grayish, bluish, or purplish skin tone
Central - mouth, tongue, chest wall
Peripheral- localized
Sign of Poor Oxygenation/ Circulation
What is juandice?
Yellowish tone to the skin that is also observed in liver disease
What is erythema?
Redness, usually from irritation or inflammation
What is skin turgor?
Tension/ elasticity or rigidness of the skin; clinical indicator of hydration status
Tenting of the skin shows
dehydration; rigid skin (skin remains elevated after being pinched) poor skin turgid is indicator of dehydration or sig fluid loss
How to describe skin lesions?
Size (width and circumference) color, drainage, odor, redness
Assessment for head & neck & mouth
Trachea- feel for pain, swelling
Lymph Nodes- Feel for pain, swelling tenderness
Assessment for Sensory Functions include
Sensory Aids (Glasses, contacts, hearing aids)
Visual Acuity
Pupil and Pupillary Reflexes
Auditory Assessment
PEARLA checks for ____
PEARLA means
Pupil/ Pupillary Reflexes
Pupils Equal and Reactive to Light Accomodation
WHat to look for when assessing eyes?
Color of sclera (should be clear)
Conjunctiva (should be pink)
Normal Ocular Movements
Drainage
Swelling, etc
What does a normal assessment of the ear look like?
Normal ear color is pearly gray
How is accomodation in vision tested?
HAve pt look at a close object, then look at a distant object.
