Lecture 10 - Integumentary and Face Flashcards
What is the largest organ in the body?
The skin
How does the skin aid in temperature regulation?
The skin can aid in heat loss through sweat glands and with heat storage through subcutaneous insulation.
What vitamin does the skin produce?
Vitamin D when exposed to sunlight.
What is eczema?
Inflammation of the skin - most often in folds of skin
What is Psoriasis?
Chronic and recurrent thickening of skin that is exacerbated by scratching
What is rosacea?
Flushing due to blushing, heat
What is cellulitis?
Infection of the skin
What are Xerosis and Seborrhea?
Dry skin; Oily skin
What is photosensitivity?
Being more sensitive to sunlight and susceptible to burns - side effect of many medications.
When assessing a rash on a patient, what important information should be collected?
How the rash started or where it began.
When doing a skin assessment, which order should information be collected in?
Least to most invasive - start with hands and nails, move to more invasive areas, finish with toes and feet.
What things should be notes when assessing the colour and temperature of skin?
- Pigmentation
–> Skin tone, freckles, moles, birthmarks - Color change
–> Pallar, erythema (rash), cyanosis, jaundice - Temperature
–> Should be even bilaterally
Where is moisture normal on the skin?
On the face, axilla, and hands.
How do the skin, hair, and nails change in older adults?
Skin
–> Thins, atrophy of subcutaneous fat
–> Loss of muscle tone
Hair
–> Grey/white, fine or thin
–> Male pattern baldness may present
–> Female facial hair may present due to decreased estrogen
Nails
–> Growth rate decreases, toenails thicken
What is skin mobility and turgor and how is it tested?
Mobility - Skin’s ease of rising
Turgor - Elasticity of skin
Gently lift pinch large fold of skin under clavicle
What is a good way to check for dehydration?
Testing skin turgor
What is the normal angle of the nailbed?
160°
(any more is considered curve, 180° could be considered early clubbing)
Which six things should be notes when describing lesions?
Color, elevation, pattern or shape, size, location, distribution
When describing the shape of lesion, what do the following words mean?
Annular
Target
Linear
Gyrate
Annular - circular
Target - Also called iris (eye shaped)
Linear - straight line
Gyrate - curved/twisted line(s)
See slide 13, lecture 10
When describing the pattern/distribution of lesions, what do the following words mean?
Polycyclic
Grouped
Discrete
Zosteriform
Confluent
Polycyclic - Annular lesions that grow together
Grouped - Clusters of lesions
Discrete - Distinct, individual lesions that remain separate
Zosteriform - Linear arrangement along nerve route
Confluent - Lesions that merge together
See slide 14, Lecture 10
What are the ABCDEs of self screening moles of cancer?
A - Asymmetry
B - Borders (uneven)
C - Colour (two or more shades)
D - Diameter (0.6 cm/0.25’’ +)
E - Evolution (always suspicious)
What causes a pressure (decubutis) ulcer?
Prolonged pressure on the skin distorts capillaries and occludes blood flow and O2 delivery.
What are some risk factors for pressure ulcers?
Impaired mobility or LoC, decreased sensory perception.
Poor nutrition
Shearing injury
Old age - skin thinning, moisture from incontinence.
What are the stages of a pressure ulcer?
- Skin appears red but unbroken. Blanches in response to pressure.
- Partial thickness loss of epidermis/dermis, red woundbed.
- Full thickness crater, subcutaneous fat might be visible.
- Full thickness pressure injury involving all skin layers and extending into supporting tissue. Muscle, tendon and bone might be visible.
What is the range of the Braden scale? What do different scores indicate?
6-23.
15-18 - At risk
13-14 - Moderate risk
10-12 - High risk
9> - Very high risk
What is the Braden Scale?
A scale used to predict the risk of a patient developing pressure sores.
How long does it take a stage 1 pressure ulcer to develop?
2 hours
What should you palpate for when assessing the face?
Any deformities, lumps, or tenderness.
Also palpate temporal artery and TMJ.
The ability to make facial expressions is the role of which Cranial Nerve?
CN VII
What kinds of things should be inspected on the head?
General size and shape of skull, note any deformities or lumps
What kinds of things should be inspected when assessing the face?
Facial structure symmetry, eyes should not sink or protrude.
Also note of twitching/tics and the ability to make facial expressions (CN VII)
What should be inspected/palpated when assessing the neck?
Symmetry of all structures, note obvious pulsations.
Also observe ROM and test CN XI by resisting movement of neck.
What kind of headache has the shortest duration?
Cluster
What kind of headache is chronic and genetic in nature?
Migraine
Secondary headaches can be associated with which conditions?
Head trauma
Vascular disorders
Substance use or withdrawal
Systemic infection
Metabolic problems (hypoglycemia)
Problems with skull, neck, eyes, ears, nose, teeth, moth
Neuralgia or Occipital neuralgia headaches
What is Scotoma?
Blind spots in vision
What is decreased acuity?
Decreased peripheral vision
What is diplopia?
Double vision
What is conjunctivitis?
Inflammation of the conjunctiva - pinkeye
What is photophobia?
Sun sensitivity in eyes - symptom of some medication
What is the rule of 20’s for eye care?
For every 20 minutes spent looking at a screen, spend 20 seconds staring at something 20 feet away.
How should a Snellen chart be used?
Have the patient stand 20 feet away from the chart, cover one eye, and read each line.
If patient has prescription glasses, allow them to remain on.
How are visual fields assessed in an examination?
Test peripheral vision by having patient 60cm across from you.
With one eye covered, move you finger across the peripheral visual fields and have the patient tell you when they can no longer see it.
What is the corneal light reflex?
Assess eyes react symmetrically to light shone from 30 cm away.
Assess that pupils are parallel.
Asymmetrical corneal reflex might indicate what?
Deviation as a result of muscle weakness or paralysis.
What is a Cover-Uncover eye test? What finding is nor normal?
Cover one eye watch opposite eye. If it darts, deviates, or appears unfocused it indicates that the eyes might be out of alignment
How are extraocular muscles assessed?
Ask patient to follow your finger as you trace the six cardinal positions.
What is PERRLA? What cranial nerves does it assess?
Pupils Equally Round, React to Light and Accommodation.
Assess CN III, IV, VI
How do the supportive eye structures change with age?
The skin loses elasticity and suborbital adipose tissue may herniate, appearing droopy.
Because Lacrimal glands are secreting less, pts may complain of dry eyes.
Impaired visual acuity associated with aging impacts quality of life in which ways?
Decreased participation if social and leisure activities and increased risk for injuries, accidents, and falls.
What is otorrhea?
Discharge from ear
What nerve dysfunction does vertigo indicate?
CN VIII - Vestibulocochlear
Should patients be encouraged to use cotton swabs to clear ears?
No, it can lead to ear wax impaction or ear infection.
Which areas should be palpated to elicit tenderness on the ear?
The pinna, tragus, and mastoid process
What is an otoscope?
A tool that allows for inspection of the ear canal
Where should the cone of light be when inspecting the tympanic membrane?
4:00 - Right ear
7:00 - Left ear
How should you perform a whispered voice test?
Stand arms length behind the individual and whisper a set of three random numbers and letters.
Test only one ear at time.
Repeat twice if not heard - after third attempt chart as a by-pass.
When should you not perform the whispered voice test?
When a pt has hearing aids
Why does hearing acuity decline with age?
The cilia lining the ear canal become coarse and stiff, impeding sound waves from travelling toward eardrum
Frequent ear infections may result in scaring of the eardrum
What kind of sounds are lost first in hearing loss?
High pitched sounds are lost first, followed gradually by middle and lower ranges.
What is Rhinorrhea?
Discharge from the nose
Can epistaxis be a medical emergency?
Yes. Excessive nosebleeds may require urgent intervention
What might cause someone to have an altered sense of smell?
Post Covid-19 infection
Smoking
Aging
Damage to CN I
What is Bruxism?
Grinding of teeth
How is tonsil size graded?
On a scale of 1-4.
If they are touching uvula - 3+
If they are pushing on uvula - 4+
How is oral health, taste and smell affected by aging?
Decreased sense of smell due to decreased olfactory nerve fibers, and decreased salivary gland secretions lead to loss of taste.
Periodontal disease may lead to tooth damage or loss.
Difficulty eating and loss of taste lead to decreased appetite and predisposes older adults to malnoutrition.
Aging might cause senile pruritis or predispose older adults to dermatitis. What additional questions should you ask if a pt presents with these?
Any ointment or creams that they have been using to self-treat it - perfumes might cause additional itching/irritation
What are senile lentigines?
Macules of hyperpigmentation that occur on the skin in irregular shapes
What are acrochordons and where are they common?
Skins tags
–> Common eyelids, cheeks, neck, axillae, trunk
How does the texture of skin change with age?
It tends to get dryer, flakier, and loose.
Turgor decreases - skin will tent
How does the thickness of the skin change with age?
It becomes thinner of the dorsa of hands and feet, forearms, lower legs, and bony prominences.
It becomes thicker over the abdomen and chest
What is senile tremor?
A tremor that appears in older age that is benign - might causes head nodding or tongue protrusion
What is glaucoma? What is a concern for an older adult with glaucoma?
Optic nerve damage and loss of visual field. Older adults might not adhere to eyedrops.
Older adults might present with pingueculae. What is this?
A yellowish-plaque like benign growth on the cornea.
Older adults might present with xanthelasma. What is xanthelasma?
Yellow-ish growths around or on of the eyelids due to lipid deposits.
How does the appearance of the tympanic membrane change with age?
It becomes more opaque and white. It might appear duller or thickened.
What is a major concern for an older adults who is losing teeth?
Malnutrition and preference to avoid meat and vegetables for easier to chew foods.
What are ADLs?
Activities of Daily Living
–> All things recorded at work + stairs
What are IADLs?
Instrumental Acts of Daily Living
–> Necessary activities for community living
–> Shopping, meal prep, housekeeping, laundry, managing finances, taking medications, using transportation
What is the Katz index? (description)
A list of ADLs listed in descending order of most complex to simple activities. Typically people lose the more complex skills first, and regain them last.
1 point is awarded if the person can do something independently, and 0 is awarded is the person is dependent on assistance.
What order are the ADLs on the Katz index listed, from top to bottom?
From most to least complicated
–>Showering, dressing, toileting, transferring, continence, feeding.
Which three cognitive/psychiatric issues are most common in older adults?
Delirium, Dementia, and Depression
What is considered diagnostic for depression?
A depressed mood and loss of pleasure/interest in activities that is present for at least 2 weeks.
What is the most common mental health problem for older adults? Why?
Depression is the most common mental health problem for older adults due to loneliness.
What is the most common kind of dementia?
Alzeimer’s
Quality of life for older adults (and most individuals) is linked closely to….
Social function
What are the different kinds of social support that can benefit older adults?
Informal
–> Family and friends
Semiformal
–> Neighborhood groups
–> Senior canters
–> Religious groups
Formal
–> Social welfare
–> Home-care programs
How does hyperthyroidism affect the skin?
Skin feels smoother, softer, and velvety
How does hypothyroidism affect the skin?
Skin feels rough, dry, and flaky.
On the Braden scale, what does a high score indicate?
Low pressure score risk
