Physical Assessment as a Screening Tool Flashcards
List several screening procedures
- Visual inspection
- skin and nail assessment
- Abdominal Screening procedures
- Fracture Screening
why is it important to screen the skin and nails for abnormal changes?
changes in skin and nails may be the 1st sign of inflammatory, infectious and immunologic disorders
T/F: new onset of skin lesions should be medically evaluated?
TRUE
especially in children
what is included in an integumentary visual inspection?
- inspect for:
- recent rashes, nodules, or other skin changes
- unusual hair loss or breakage
- increased hair growth (hirsutism)
- nail bed changes
- itching (pruritus)
skin should be assessed for what 6 things?
- texture
- color
- temp
- clubbing
- circulation
- edema
list changes in skin color to note
- pallor
- jaundice
- cyanosis
what can pallor indicate?
- anemia
- arterial insufficiency
- fainting
- shock
where should you inspect for jaundice? What can it indicate?
- where
- sclera
- conjunctiva
- lips
- hard palate
- tongue
- what can it indicate
- liver condition
- hematologic disorder
what can central cyanosis indicate?
- advanced lung disease
- CHF
- low hemoglobin
what can peripheral cyanosis indicate?
- CHF
- venous obstruction
- anxiety
- cold environment
- 1st observed in hands/feet, lips or nose
what is a change in skin temperature indicative of?
- indication of the vascular supply
Other signs of decreased vascularity?
- paresthesia
- muscle fatigue/discomfort
- cyanosis with numbness
- pain and loss of hair
things to keep in mind when assessing darker skin
- changes 1st noticed in:
- fingernails
- lips
- mucous membranes
- conjunctiva of eye and palms/soles in ppl with darker skin tones
List and describe the ABCDEs Critera
- Asymmetry → uneven edges, lopsided in shape, one-half unlike the other half
- Border → irregularity, irregular edges, scalloped or poorly defined edges
- Color → black, shades of brown, red, white, occasionally blue
- Diameter → larger than a pencil eraser (>6 mm)
- Evolving → mole or skin lesion that looks different from the rest or is changing in size, shape or color
follow-up questions if you suspect skin cancer after assessing a pt’s skin
- how long have you had this?
- has it changed in the last 6 weeks to 6 months?
- has you doctor seen it?
Name 3 specific rashes/skin lesions
- Dermatitis
- Herpes Zoster (Shingles)
- Rheumatologic diseases
describe dermatitis
referred to as eczema
skin is red, brown, or gray; sore; itchy and sometimes swollen
Types of dermatitis
- Contact dermatitis → skin reacts to something it has come into contact with
- Dyshidrotic dermatitis → affects the skin that gets wet frequently
- Atopic dermatitis → often accompanies asthma or hay fever
describe Herpes Zoster
- rash may last 1-14 days
- reports burning, shooting pain and tingling or itching
- lesion appear unilaterally along the path of a spinal nerve
T/F: a skin rash or lesion may be the first S/S of an underlying rheumatologic disease?
TRUE
list several rheumatologic diseases that have skin lesions associated with them
- SLE → butterfly on face
- Discoid lupus erythematosus
- Lyme disease
- psoriatic arthritis
- reactive arthritis
- scleroderma
what characteristics of lymp nodes increase the suspicion of cancer?
- hard
- immovable
- nontender
Inspection of the nail bed
- should be evaluated for
- color, shape, thickness, texture, and the presence of lesions
- capillary refill should occur in 3 seconds
Name 3 nail abnormalities
- Beau’s lines
- Splinter hemorrages
- Clubbing
what are Beau’s lines?
- Transverse grooves across the nail beds
- caused by decreased or interrupted production of the nail by the matrix
- usually caused by acute illness or systemic insult
- other associated conditions
- poor peripheral circulation
- eating disorders
- cirrhosis
- recent MI
- other trauma
what are splinter hemorrages?
- red-brown, linear streaks
- may be a sign of silent MI or pt may have hx of MI
- Systemic conditions assocaited with them:
- bacterial endocarditis
- vasculitis
- renal failure
what is clubbing?
- usually results from chronic O2 deprivation in tissue beds
- often observed in pts with:
- COPD
- congenital heart defects
- cor pulmonale
- can occur within 10 days in pt with acute systemic condition
- pulmonary abscess, malignancy or polycythemia
when would clubbing require a medical evaluation?
rapid development of clubbing over the course of 10-14 days
what is a method to determine if there is clubbing at the fingernails?
Schamroth’s sign
Tests involved in abdominal screening
- Kidney fist percussion
- Liver fist percussion
- Spleen fist percussion
- Murphy’s sign
- McBurney’s Point
- Rovsing Sign
- Palpation and Auscultation of AAA
what is considered an abnormal finding with all the organ percussion tests?
tenderness with percussion
what is Murphy’s sign for?
Acute cholecystitis (gall stones)
what is an abnormal finding with Murphy’s sign?
pt stops breathing/winces or reports tenderness
difference between McBurney’s Point and Rovsing Sign?
both for appendicitis
- Abnormal finding for:
- McBurney’s point → tenderness
- Rovsign sign → R lower quadrant tenderness with remote rebound testing at L lower quadrant
abnormal finding for palpation testing for AAA
- pulse width of >3 cm
- provocation of symptoms including exquisite tenderness or referred pain to back is also abnormal
abnormal findings for auscultation of AAA
- presence of bruit
- abnormal blowing or swishing sounds
T/F: combo of palpation and auscultation tests for AAA improves their clinical value
TRUE
but only for thin pts with aneurysms greater than 5 cm
when would you perform abdominal palpation and auscultation?
In pts:
- with a suspicion of abdominal pathology causing LBP
- who present with a non-mechanical pattern of LBP unchanging with postures, positions, activities, etc
- at high risk for AAA
- present with S/S of AAA
- who are not responding to therapy interventions
List several clinical decision rules used for fracture screening
- Canadian C-spine rules
- NEXUS criteria
- Pittsburg knee decision rule
- Ottawa knee decision rule
- Ottawa ankle decision rule
use of a tuning fork to detect fractures
- if you cannot get close with palpation then it is not beneficial to use a tuning fork
- sensitivity and specificity is not great
- positive findings suggest bony involvement
- but this is not diagnositc!
what types of bones does auscultation work for detecting fractures in?
works best for long bones of the body
abnormal finding would be a washed out or diffuse sound
tests that can be used for fracture detection
- Pubic-Patellar percussion test
- Fulcrum Test
