HealthAssessment4 Flashcards
Skin Moisture/Dryness
seborrhea = oily
xerosis = dry
dehydration-oral mucous membranes-dry, lips parched and cracked, skin fissured
diaphoresis-increased metabolic rate as with fever, exercise; thyrotoxicosis, stimulation of the nervous system=anxiety, pain
Pruritis
Itching-dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice
Scratching-causes excoriation
ABCDE
- Asymmetry
- Border irregularity, poorly defined margins
- Color variation
- Diameter greater than 6mm
- Elevation or enlargement
Other-rapidly changing lesion, a new pigmented lesion, development of itching, burning, or bleeding in a mole-suspect malignant melanoma-warrant referral.
Skin Color Changes
- pigmentation should be even and consistent with genetic background
- pallor
- erythema
- cyanosis
- jaundice
Pallor
When the red-pink tones from oxygenated hemoglobin are lost skin takes on the color of connective tissue (collagen) which is mostly white
Common in high stress states-anxiety/fear because of peripheral vasoconstriction-sympathetic nervous system
Vasoconstriction also occurs with cold exposure and cigarette smoking, and in the presence of edema
Brown skin-will appear more yellow
Black skin-will appear ashen or gray
Generalized pallor can be observed in the mucous membranes, lips and nail beds
Pallor of anemia-palpebral conjuctiva and nail beds
Pallor of impending shock presents with rapid pulse rate, oliguria, apprehension, restlessness
Erythema
Intense redness of the skin
Expected with fever (increased rate of blood flow), local inflammation, emotional reactions (blushing - cheeks, neck, upper chest)
Occurs with polycythemia, venous stasis, carbon monoxide poisoning, petechiae, eccymosis, hematoma
Dark Skin-palpate the skin for increased warmth, taut or tightly pulled surfaces that may indicate edema and hardening of deep tissues or blood vessels
Cyanosis
Bluish mottled color that indicates decreased perfusion.
A person who is anemic bc of lack of HgB may be hypoxemic without ever looking blue
A person with polycythemia may look ruddy blue at all times and may not be hypoxemic.
Mediterranean descent-normal bluish tone on the lips
Dark skin-difficult to observe-look for other signs of decreased oxygenation to the brain=changes in LOC and signs of respiratory distress
Cyanosis-indicates hypoxemia–occurs with shock, heart failure, chronic bronchitis, congenital heart disease.
Jaundice
- yellowish skin color-indicates rsing amounts of bilirubin in the blood
- First noted in the junction of the hard and soft palate in the mouth and sclera-extends up to edge of iris-check sclera for yellow near limbus. also-palms of hands
- do not confuse normal yellow subconjuctival fatty deposits common in outer sclera of dark-skinned people.
- higher levels of serum bilirubin-evident in the skin over the rest of the body
- calluses on palms and soles often look yellow-not jaundice
- occurs with hepatitis, cirrohosis, sickle-cell disease, transfusion rxn, hemolytic disease of the newborn
- light or clay-colored stools and dark golden urine in both light and dk skinned people
Hypothermia
- localized hypothermia is expected with an immobilized extremity, Reynauds, peripheral arterial insufficiency
- generalized hypothermia accompanies central circulatory problems-shock
Hyperthermia
- generalized hyperthermia occurs with an increased metabolic rate-fever, heavy exercise
- localized-trauma, infection, sunburn
- hyperthyroidism=increased metabolic rate-causing warm, moist skin.
Edema
- fluid accumulation in the intercellular spaces
- imprint thumbs firmly against the ankle melleolus or tibia
- rate pitting from 1+ to 4+ (deep pitting, indentation lasts long time, leg is very swollen)
- edema masks normal skin color and obscures pathalogical conditions-jaundice or cyanosis bc fluid lies bt surface and pigmented vascular layer
- makes skin look lighter
- most evident in dependent parts of the body
- makes hair follicles more prominent (peau d’orange)
- unilateral=local cause
- bilateral=generalized (anasarca)-considered a central problem such as heart failure or kidney failure.
Turgor
pinch a large fold of skin under the clavical
reflects the elasticity of the skin
poor turgor with severe dehydration, or extreme weight loss
pinched skin recedes slowly or “tents”
Medications causing Photosensitivity
- sulfonamides
- thiazide diuretics
- oral hypoglycemic agents
- tetracycline
Eldery Skin Conditions
- Lentigines=liver spots-small, flat, brown macules. Circumscribed areas=clusters of melanocytes that appear after extensive sun exposure; forearms and dorsa of hands. not malignant. require no treatment
- seborrheic keratosis-raised thickened areas of pigmentation that look crusted, scaly, warty, greasy, stuck on. Develop mostly on the trunk but also face and hands-sun exposed and unexposed-do NOT become cancerous.
- xerosis-decline in size, number, and output of sweat glands and sebaceous glands
- acrochordons=skin tags
Clubbing
occurs with congenital cyanotic heart disease and neoplastic and pulmonary disease. COPD, emphysema
early clubbing angle straigtens (from 160 to 180) and nail base feels spongy to palpation. then the nail becomes convex
Signs of Physical Abuse
bruises in multiple stages (red/blue/purple-blue/purple-blue/green-yellow-brown) or that cannot be explained by normalevents. (hematoma is a bruise you can feel)
Pattern injuries which suggest a shape: Bite marks,
cigarette burns, belt marks, “socked hands or feet” from scalding water.
deformity of an untreated fracture.
Pressure Ulcers
I. intact skin-red but unbroken-will blanch (light skin, dk skin-does not blanch)
III. partial skin-thickness erosionII. with loss of epidermis or also dermis-looks shallow like an abrasion or open blister with red-pink wound bed.
III. full thickness pressure ulcer extending into the subQ tissue and resembling a crater. May see sub Q fat but NOT muscle, bone or tendon
IV. full thickness-involves all skin layers and extends into supporting tissue. Exposes muscle, tendon or bone, and may show slough or eschar-nerves are damaged-gone!!
Braden Scale-nutrition, meds, bedrest, age
ROM/Joint Movement
Flexion—bending a limb at a joint
Extension—straightening a limb at a joint
Abduction—moving a limb away from the midline of the body
Adduction—moving a limb toward the midline of the body
Pronation—turning the forearm so that the palm is down
Supination—turning the forearm so that the palm is up
Circumduction—moving the arm in a circle around the shoulder
Inversion—moving the sole of the foot inward at the ankle
Eversion—moving the sole of the foot outward at the
ankle
Rotation—moving the head around a central axis
Protraction—moving a body part forward and parallel to the ground
Retraction—moving a body part backward and parallel to the ground
Elevation—raising a body part
Depression—lowering a body part
The normal ranges of active and passive range of motion should be the same!
Myalgia
muscle pain-felt as cramping or aching
can be associated with intermittent claudication if it is alleviated with rest and with many viruses (fever and chills as well as myalgia)
claudication= pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest
Fracture
Sharp pain that increases with movement. Other bone pain usually feels dull and deep and is unrelated to movement.
Crepitation
An audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened as with rheumatoid arthritis.
Osteoporosis
New bone appears at a slower rate than the old bone disappears. Bones become spongy, weak and more likely to break.
Bones of the wrist, hip and spine are most often affected.
Prevention:
- Diet-milk, fish, leafy greens, soy, onions, limit caffeine.(vitamin D need to absorb Ca-found in dairy, oily fish; potassium and vit K in green leafy-help block Ca loss from bones; caffeine causes body to excrete Ca more readily; onions reduce bone breakdown process)
- Exercise-weight bearing-30 minutes 3x per week
- Lifestyle-no smoking, excess alcohol (smokers-more likely to have hip fx and fx heal slower; too much alcohol prevents absorption of Ca; clinical depression correlates with lower bone density)
- medical options-height loss of 1-2 inches is an early sign of undiagnosed vertebral fx and osteoporosis. conditions that threaten bone density=thyroid disease, intestinal and kidney diseases, some cancers. Meds that can cause bone loss=corticosteroids, anticoagulants, thyroid supplements, anticonvulsants.
- supplements-with vitamin D-most people do not get enough calcium
Bone density tests are the only way to predict fx risk and diagnose osteoporosis.
Carpal Tunnel Syndrome
Caused by chronic repetitive motion-bt age 30-60, 5X more common in women.
S/S=pain, burning, numbness, positive Phelan test, positive Tinel sign, often atrophy of thenar muscles.
Phelan test=hold both hands back to bak withile flexing the wrists 90 degrees for 60 seconds-no sx for normal hand; produces numbness and buring in person with carpal tunnel syndrome.
Tinel Sign=direct percussion of the location of the median nerve at the wrist-no sx in normal hand; produces burning and tingling along its distribution is positive tinel sign.
McMurray Test
- perform when the person has a hx of trauma followed by locking, giving way, or local pain in the knee.
- pt lying supine
- hold heel, flex knee and hip, other hand on knee
- rotate leg in and out to loosen joint
- externally rotate the leg and push inward stress on knee
- slowly extend the knee-should extend smoothly with no pain
- if you hear or feel a click=positive McMurray test=torn meniscus
Hip
- lying supine-raise leg with knee extended (straight)-expect hip flexion=90 degrees
- bend knee up to chest-expect hip flexion=120 degrees
- flex knee and hip to 90 degrees-swing foot outward, inward-expect internal rotation 40 degrees, external rotation 45 degrees.
- let straight-swing laterally, then medially-expect abd of 40-45, add of 20-30
- while standing-swing straight leg back behind body-expect hyperextension of 15 degrees
Abnormal findings=limited motion, pain with motion, flexion flattens the lumbar spine. Limited internal rotation is an early and reliable sign of hip disease. Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease.
Gout
Metabolic disorder of disturbed purine metabolism associated with elevated serum uric acid. It occurs primarily in men older than 40.
Usually involves first metatarsophalangeal joint.
Clinically-redness, swelling, heat, extreme tenderness
Ballottement of the Patella
Reliable test when larger amts of fluid are present.
Use left hand to compress the suprapatellar pouch to move any fluid into the knee joint. Use right hand to push the patella sharply against the femur.
If no fluid is present, patella is already snug against the femur.
If fluid is present, your tap on the patella moves it thru the fluid and you will hear a tap as the patella bumps up on the femoral condyles.
Bulge Sign
Tests for swelling in the suprapatellar pouch-confirms presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other. Firmly stroke up on the medial aspect of the knee 2 or 3 times to diplace any fluid. Tap the lateral aspect. Watch the medial side in the hollow for a distinct bulde from a fluid wave. Normally-none present.
Bulge sign occurs with very small amts of effusion (4-8 mL) from fluid flowing across the joint.
Kyphosis
an outward curvature of the thoracic spine
person compensates by holding the head extended and tilted back
CKD
(Chronic Kidney Disease)
decreased kidney function or kidney damage lasting 3+ months. Can lead progressively and irreversibly to end-stage renal disease (ESRD)-when person survives only by dialysis or kidney transplant.
Much higher among African Americans-likely due to underutilization of antihypertensives and RAAS inhibitors.
Kidney Function
pH 4.5-8.0
Sp. Gravity 1.003 to 1.030
little/no protein
no glucose
fewer than 5 RBCs/WBCs
Blood Tests:
creatnine (end product of muscle metabolism) normal = 0.7-1.5 mg/dL (measuer of GFR)
BUN (measures urea, an end-product of protein metabolism) normal = 10-20 mg/dL (rises with decreased fluid volume or increase in protein intake)
Renal Calculi
renal stones-crystals of calcium oxalate or uric acid-form in kidney tubules then migrate and become urgent when pass into ureter, become lodged and obstruct urine flow. cause severe flank pain with radiation to the groin or abdomen, N/V, restlessness, gross or microscopic hematuria.
Aging Adult Male Genitourinary System
- sperm production decreases after 40 (increased connective tissue present in tubules)
- testosterone declines very gradually after 55-60-phys changes not evident until later in life
- pubic hair decreases
- penis size and testes decrease in size, testes less firm
- slower, less intense sexual respnse, refractory period lasts longer (12-24 hours)
- side effects of meds: antihypertensives, psychotropics, antidepressants, antispasmodics, sedatives, tranquilizers, narcotics, estrogens, heavy alcohol
BPH
benign prostatic hyperplasia
gradual enlargement of the prostate-considered to be a normal part of aging
s/s of BPH and prostate cancer are simlar=hesitant, interrupted, or weak urinary stream, urinary urgency, leaking or drbbling, increased frequency of urination, especially at night.
Prostate Cancer
S/S=frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination, continous pain in lower back, pelvis, thighs
malignant neoplasm often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone-hard and fixed. The medican sulcus is obliterated.
PSA=prostate specific antigen-made by prostate gland; increases as prostate cancer develolps; BPH, age and prostatitis can also cause PSA to increase; ejaculation causes temporary rise
DRE=digital rectal exam-prostate located just in front of the rectum
Increased risk=African Americans, men with first degree relatives
DRE offered yearly after 40
PSA yearly beginning at 50
Stone-hard, irregular, fixed nodule indicates carcinoma
diet-high in red meat, processed meat, saturated fat, dairy products may increase risk
decreased risk-diet high in fiber, fruits, vegetables
Prostate
2.5-4 cm wide
should not protrude more than 1 cm into the rectum
heart shaped with palpable center groove
smooth
elastic, rubbery
slightly movable
non-tender to palpation
TSE
(Testicular Self-Exam)
Timing=once a month
S=slow, warm water relaxes scrotal sac
E=examine, check for changes, report changes immediately
Hold scrotum in palm of hand, gently feel each testicle using thumb and first 2 fingers. Testicle is egg shaped and movable, feels rubbery with a smooth surface (like peeled hardboiled egg). Abnormal lumps are rare and usually not worrisome. Watch for firm, painless lump, hard area, enlarged overall testicle–call physician.
Testicular Cancer
Rare. Rare before 15, peaks during 20-39, then declines. Most-age 18 to 35. Associated with hx of cryptorchidism.
No early symptoms
When detected early and tx bf metastasis, cure rate is almost 100%
palpation-painless firm nodule or harder than normal section of testicle
or enlarging testis (most common symptom)-non-tender swelling of testis
firm palpation doesn’t cause usual sickening discomfort as with normal testis.
Colorectal Cancer
(CRC)
20% higher rate for African-American women and men than whites
prevented by removal of adenomatous polyps
colonoscopy every 10 years beginning at age 50
guaiac-based fecal occult blood test or fecal immunochemical test yearly (occult bleeding=cancer)
2nd leading cancer killer
often asymptomatic-symptoms include-blood in stool, pain, aches, abd cramping, change in bowel habits, iron deficiency anemia, unexplained weight loss
hereditary nonpolyposis colon cancer-related to endometrial, ovarian and gastrc cancer.
Ovarian Cancer
- may experience abdominal pain, pelvic pain, increased abdominal size, bloating, non-specific GI symptoms
- may be asymptomatic
- biopsy necessary
- high risk-annual transvaginal ultrasonography
Postmenopause
- age 48-51 (range from 35-60)
- preceded by 1-2 yr decline in ovary function-irreg menses, farther apart, lighter flow
- ovaries stop producing progesterone/estrogen
- cells in reproductive tract are estrogen dependent-dramatic physical changes
- uterus shinks
- ovaries atrophy, not palpable
- ovulation may occur sporadically after menopause
- cervix shrinks, paler, thick glistening epithelium
- vagina-shorter, narrower, lest elastic bc of increased connective tissue
- increased risk for vaginitis
- decreased vaginal secretions
- vasomotor instability (hot flashes)
HRT
Side Effects of HRT
fluid retention
breast pain
vaginal bleeding
breast cancer risk
Breast Cancer
- Tail of Spence=site of most breast tumors
- BRCA1 and 2-genes mutations
- white women have higher incidence
- western diet, high fat
- obesity
- age > 50
- first degree relative
- high breast tissue density
- early menarche, late menopause
- nulliparity or 1st child after age 30
- oral contraceptive use
- estrogen and progestin use
- alcohol > 1 per day
- solitary, unilateral, non-tender mass
- solid, hard, dense
- fixed to underlying tissue
- women age 30-80
- advanced cancer-firm or hard irregular axillary nodes, skin dimpling, nipple retraction, elevation and discharge
Cervical Cancer
cervical cancer screenings should begin within 3 years after first intercourse or by age 21, continue annually (after age 30-screen every 2-3 years after 3 consecutive normals)
PapSmear
HPV vaccine
Incontinence-female
urgency, dysuria, nocturia, hematuria
urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder (contracts-causing urgent need to void)
stress incontinence-involuntary urine loss with physical strain (sneezing/coughing)
