NR 302: Health Assessment 1 Exam 2 (Ch. 12, 13, 14, 15, 16, & 18) Flashcards
Ch. 12 Define: Jaundice
yellow-color of skin, palate & sclera due to excess bilirubin in the blood
Ch. 12 Define: Cyanosis
bluish color of skin or mucous membranes as a result of increased amount of non-oxygenated hemoglobin (ex: lips, nail beds, palpebral conjunctivae & palms)
Ch. 12 Define: Carotenemia
orangish skin tone due to increased serum carotene from ingestion of large amounts of carotene-rich foods (ex: carrots)
Ch. 12 Define: Uremia
renal failure causes retained urochrome (normal color urine = yellow pigmented) in the blood
Ch. 12 Define: Vesicles
elevated cavity containing free clear fluid, up to 1 cm (ex: herpes simplex, early varicella, herpes zoster, contact dermatitis)
Ch. 12 Define: Macule
flat skin lesion with only a color change
Ch.12 Define: Papule
solid, elevated palpable skin lesion
Ch. 12 Define: Tumor
lesions larger than a few cm in diameter, firm or soft, deeper into dermis; may be benign or malignant (ex: lipoma & hemangioma)
Ch. 12 Define: Purpura
red-purple skin lesion due to blood in tissues from breaks in blood vessels
Ch. 12 Define: Ecchymosis
non-raised skin discoloration caused by the escape of blood into the tissue from ruptured blood vessels (occur in mucous membranes) aka “BRUISING”
Ch. 12 Define: Petechia
small red or purple spot caused by bleeding into the skin. Indicates serious blood clotting disorders, drug reactions, or liver disease
Ch. 12 Define: Milia
tiny white bumps or small cysts on the skin (seen in newborns)
Ch. 12 Define: Stork Bites
common type of birthmark seen in a newborn “temporary” (medical term = nevus simplex)
Ch. 12 Define: Mongolian Spots
common variation of hyperpigmentation due to deep dermal melanocytes ( seen in Black, Asian, American, Indian & Hispanic newborns)
Ch. 12 Define: Striae
jagged linear “stretch marks” of silver to pink color (2nd trimester on breasts, abdomen, & thighs)
Ch. 12 Define: Linea Nigra
brownish black line down the midline (abdomen)
Ch. 12 Define: Chloasma
irregular brown patch of hyperpigmentation (face)
Ch. 12 Define: Vascular Spider
tiny red center lesions with radiating branches seen in White > Black women during pregnancy (face, neck, upper chest, & arms)
Ch. 12 Define: Senile Lentigines
“liver spots” that are small, flat, brown macules due to sun exposure (forearms & dorsa hands)
Ch. 12 Define: Acrochordons
“skin tags” are overgrowths of normal skin (eyelids, cheeks, neck, axillae, & trunk)
Ch. 12 Define: Alopecia
balding
Ch. 12 Define: Pallor
paleness of the face
Ch. 12 Define: Erythema
abnormal redness of the skin due to capillary congestion
Ch. 12 Define: Wheal
superficial, raised, transient, & erythematous lesion; has slightly irregular shape caused by edema (fluid-filled tissues); (ex: mosquito bite & allergic reaction)
Ch. 12 Define: Bulla
> 1 cm usually single chambered; superficial in epidermis; thin-walled easy to burst (friction blister, burns, contact dermatitis)
Ch. 12 Define: Cyst
encapsulated, fluid-filled cavity in dermis or SQ layer that tensely elevates skin (ex: wen)
Ch. 12 Define: Pustule
turbid fluid (pus) in cavity; circumscribed & elevated (ex: acne & impetigo)
Ch. 12 Define: Patch
macule > 1 cm (ex: mongolian spot, vitiligo, cafe-au-lait spot, chloasma, measles rash)
Ch. 12 Define: Cafe-au-lait
due to increased melanin pigment in basal cell layer
Ch. 12 Define: Albinism
total absence of melanin pigmentation
Ch. 12 Define: Fissure
linear crack with abrupt edges, extending into dermis; dry or moist (callus or corners of mouth)
Ch. 12 Define: Lichenification
prolonged, intense scratching that thickens the skin & produces tightly packed set of papules
Ch. 12 Define: Pruritis
itching
Ch. 12 Define: Xerosis
dry skin
Ch. 12 Define: Hirsutism
excessive body hair
Ch. 12 How to examine the skin lesions?
ABCDE (Asymmetry, Border irregularity, Color variation, Diameter, & Elevation)
Ch. 12 What are normal findings during a skin assessment?
-symmetry
-
Ch. 12 Normal findings in adolescent assessment
increased body odor & increased in fat deposition
Ch. 12 Define: Nodule
solid, elevated, hard or soft > 1 cm; may extend deeper into dermis > papule
Ch. 12 Define: Braden Scale
Pressure Ulcer Risk Assessment Scale (Sensory perception, moisture, physical activity, mobility, nutrition, friction & shear)
Ch. 12 Pressure Ulcer Stage 1
erythema of the skin
Ch. 12 Pressure Ulcer Stage 2
partial thickness skin loss including epidermis
Ch. 12 Pressure Ulcer Stage 3
full thickness skin loss involving SQ tissue
Ch. 12 Pressure Ulcer Stage 4
full thickness skin loss involving SQ tissue, muscle, & bone
Ch. 12 List some Primary Skin Lesions- immediate results of a causative factor
macule, papule, patch, nodule, wheal, vesicle, bulla, cyst, tumor & pustule
Ch. 12 List some Secondary Skin Lesions- results from a change in primary lesions, evolutional changes
crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, & keloid
Ch. 12 Define: Crust
thickened, dried out exudate lest when vesicles/pustule burst or dry out (impetigo, scab after abrasion, eczematous dermatitis)
Ch. 12 Define: Scale
compact, desiccated slakes of skin, dry, or greasy, silvery or white from shedding of dead excess keratin cells (scarlet fever, psoriasis-silver micalike, eczema, dry skin, seborrheic dermatitis-yellow, greasy)
Ch. 12 Define: Erosion
scooped-out but shallow depression; superficial lesion, epidermis is lost, & the lesion is moist but there is no bleeding; heals without scaring
Ch. 12 Define: Ulcer
deeper depression, extending into dermis, irregularly shaped. may bleed & leave scar when healed (ex: stasis ulcer, pressure sore & chancre)
Ch. 12 Define: Excoriation
self-inflicted abrasion; superficial & sometimes crusted (scratches from intense itching- insect bites, scabies, dermatitis & varicella)
Ch. 12 Define: Scar
after a skin lesion is repaired, normal tissue is lost & replaced with Connective Tissue (collagen); permanent fibrotic change (ex: healed area after surgery or injury, acne)
Ch. 12 Define: Atrophic Scar
resulting skin level depressed with loss of tissue; thinning of the epidermis (ex: Striae)
Ch. 12 Define: Keloid
hypertrophic scar; elevated skin level due to excess scarring tissue because of acne, ear piercing, tattoos, infections, surgery- look smooth, rubbery, “clawlike” (seen in Blacks)
Ch. 12 Define: Hematome
bruises you can feel; skin elevation
Ch. 14: Equipment used when doing the Eye Assessment
Snellen Eye Chart, Penlight, Opthalamoscope, & Opaque CArd
Ch. 14 Define: Palpebral fissure
open space between the eyelids
Ch. 14 Define: Palpebral conjunctiva
lines the lids and is clear, with many small blood vessels; forms a deep recess & fold back over the eye
Ch. 14 Define: Cornea
covers & protects the iris & pupil
Ch. 14 Define: Sclera
normal is white in color and it the outer layer that covers the eyeball
Ch. 14 Define: Choroid
the middle vascular layer behind the sclera that covers the eyeball
Ch. 14 Define: Retina
visual receptive layer of the eye in which light waves are changed into nerve impulses
Ch. 14 Define: Ocular Fundus
area of the retina visible through the opthalmoscope
Ch. 14 Define: Optic disc
area in which fibers from the retina converge to form the optic nerve
Ch. 14 Define: Macula
area of the sharpest vision
Ch. 14 Define: Macular Degeneration
a gradual loss of the central part of the field of vision usually affecting both eyes; accumulation of yellow deposits in & thinning of the macula lutea
Ch. 14 Define: Diabetic retinopathy
complication of diabetes mellitus caused by retinal vessel damage & occurs more amongst Blacks & Hispanics > Whites
Ch. 14 Define: Confrontation Test
measures peripheral vision
Ch. 14 Define: Cranial Nerve Test
test corneal reflex
Ch. 14 Define: Hyperopia
Farsightness
Ch. 14 Define: Myopia
Nearsightness
Ch. 14 Define: Presbyopia
impaired near vision in middle-age adults; loss of elasticity of the Lens
Ch. 14 Define: Astigmatism
unequal curvature of the cornea
Ch. 14 Define: Glaucoma
increases pressure within the eyeball; gradual loss of sight-> blindness
Ch. 14 Define: Blepharitis
inflammation of the eyelids
Ch. 14 Define: Periorbital Edema
swollen & puffy eyelids
Ch. 14 Define: Anisocoria
unequal pupil size
Ch. 14 Define: Exophoria
tendency of the yes to deviate outward
Ch. 14 Define: Strabismus
cross-eyed or wall-eyed; person can’t align both eyes simultaneously under normal conditions
Ch. 14 Define: Esophoria
inward deviation of the eye, usually due to extra ocular muscle imbalance
Ch. 14 Define: Mydriasis
dilated & fixed pupils
Ch. 14 Define: Ectropion
lower lid is loose & rolling out, does not approximate to eyeball. Occurs in aging as a result of atrophy of elastic & fibrous tissue, also trauma
Ch. 14 Define: Entropion
lower lid rolls in because of spasm of lids or scar tissue contracting “foreign body” sensation
Ch. 14 Define: Stye “Hordeolum”
painful, red, & swollen resembles a pustule at the lid margin (localized staph infection of the hair follicles)
Ch. 14 Define: Chalazion
a beady nodule protruding on the lid, non-tender, firm, discrete swelling with free moveable skin overlying the nodule (infection or retention cyst of the meibomian gland)
Ch. 12 what type of hair is vellus hair?
Fine & faint
Ch. 12 what type of hair is terminal hair?
Darker & thicker