Physical Assessment Quiz 2

Apocrine vs Eccrine Glands

Apocrine = produces milky secretion & opens into hair follicles

• they become active during puberty

• secretion occurs with emotional & sexual stimulation

• in adolescents secretions from apocrine sweat glands increase

Eccrine = produces sweat, evaporation reduces body temp

• coiled tubes that open onto the skin surface & produce sweat

• widely distributed in body & mature into hair follicle

• mature in 2 month old infant

Dermal vs Epidermal Structures

• Epidermis: outer highly differentiated layer

  • basal cell layer forms new skin cells

  • Outer horny cell layer of dead keratinized cells

• Dermis: inner supportive layer

  • connective tissue or collagen

  • elastic tissue

Annular (circular)

• begins in center and spreads to periphery

• Annual ring = ringworm

Confluent

• lesions run together

• confluent = flowing together

• Uticaria (hives)

Discrete

• distinct & separate

• acne & skin tags

Gyrate

• twisted, coiled, spiral like & snake like

Grouped

• clusters of lesions

• contact dermatitis

Linear

• scratched, streak like or stripe

Target (Iris or the eye)

• concentric rings

• erythema multiforme

• bullseye of a target

Zosteriform

• linear arrangement along unilateral nerve route

• Zoster = shingles = rash that follows the nerve line

Polycyclic

• annular lesions grow together

• lichen, planus, psoriasis

  • poly = many circles/cycles overlapping eachother

Macule

• small, spot discolored area of skin

  • “mini macule” = less than 1 cm

Papule

• felt & causes by superficial thickening of epidermis

Patch

• macule’s that are larger than 1 cm

  • covers an area larger than a macule

Plaque

• small bumps on the skin merging together to form a large, raised flat patch

Nodule

• circular, elevated, solid lesion greater than 1 cm

Wheal

• superficial, raised, transient & erythematous, irregular in shape due to edema

  • wheal = welt

Tumor

• larger in diameter, firm or soft, deeper into dermis, may be benign or malignant

  • Tumor = tremendous nodule (deep/largest

Uticaria

• hives

• wheal coalesce to form extensive pruritic reaction

  • multiple wheals

Vesicle

• elevated cavity containing fluid

  • blister

Cyst

• encapsulated cavity containing fluid

Bulla

• usually single chamber, superficial in dermis & ruptures easily

  • Bulla = big bubble

Pustule

• pus in cavity that is circumscribed & elevated

Crust

• thickened dried out exudate

Scale

• compact flakes of desiccated skin from shedding of dead excess keratin cells

Fissure

• crack or split

Erosion

• scooped out but shallow depression

Ulcer

• deeper depression extending into dermis with irregular shape, may bleed, leave scars

Excoriation

self inflicted abrasion

• superficial

Scar

• permanent fibrotic change after healing

Atrophic scar

• skin level is depressed with loss of tissue & thinning

Lichenification

• prolonged intense scratching leads to thickened skin (set of papules)

Keloid

• benign excess of scar tissue

  • beyond original injury

Pressure injuries

• Stage 1: non-blancheable skin loss

• Stage 2: partial thickness skin loss

• Stage 3: full thickness skin loss

  • Stage 4: full thickness skin/tissue loss

Tinea corporis

• ringworm of the body

Tinea pedis

ringworm of the foot (atheletes foot)

Primary contact dermatitis

• rash caused by irritant or allergy

Labial herpes simplex

• cold sores

Tinea veriscolor

• noncontagious fungal infection caused by overgrowth of yeast

Herpes zoster

• shingles

Erythema migrans of lyme disease

• rash caused by early localized lyme disease

Psoriasis

• overactive immune system causes an increase of cell growth casuing plaque

Cranial nerves

1. Olfactory: nerve responsible for smell

• advise pt to close eyes and have them smell alcohol wipe

2. Optic: never responsible for vision

• shine light in the middle of pt eye to see if there is equal length between the two (cross eyes, ages 3-5) (headlights). Snellen or jager chart. periphery test: pt closes eyes, you cover your eye and move hands in three cardinal points

3. Oculomotor: responsible for eye movement

• check too see if pupils contrict to light & finger to nose

• PEERLA (pupils are equal round and reactive to light)

4. Trochlear: innervated superior oblique muscles

• move finger in 6 cardinal points, pt head doesnt move

5. Abducens: control lateral rectus muscle

• move finger in 6 cardinal points, pt head doesnt move

6. Trigeminal: provides sensation to the face

• touch cheek, chin w/ eyes closed & clench jaw & open mouth

7. Facial: controls facial expressions

• smile, frown, grimace, puff cheeks, raise eyebrows, close eye tightly & BMP

8. Vestibulocochlear (acoustic): hearing & balance

• rub fingers in each ear

9. Glossopharyngeal: contributes to taste from posterior third of tongue

• “gag reflex” open mouth, place tongue depressor

10. Vagus: parasympathetic innervation to thoracic & abdominal organs

• say ah “ see if uvula is moving”

11. Spinal accessory: controls sternomastoid & trapezius muscles

• shrug & turn face against resistance

12. Hypoglossal: controls tongue movements

• tongue up, down, left, right

• light tight dynamite

Lymph nodes & location

1. Preauricular: in front of ear

2. Posterior auricular (mastoid): superficial to mastoid process

3. Occipital: at base of skull

4. Submental: midline, behind tip of mandible

5. Submandibular: halfway between angle & tip of mandible

6. Jugulodiagatric (tonsillar): under angle of mandible

7. Superficial cervicle: overlying sternomastoid muscle

8. Deep cervicle: deep under sternomastoid muscle

9. Posterior cervicle: posterior triangle along edge of trapezius muscle

10. Supraclavicular: just above & behind clavicle (at sternomastoid muscle)

LOACTION:

• neck (cervicle)

• axillary (armpit)

• groin (inguinal)

• popiteal (behind the knee)

• Epithrochlear (inside elbows)

Types of headaches

• Red flag headaches: is a severe headache in an adult or child who has never had one before

  • tension headache (most common): daily stress related head pain. feels like a tight band wrapped around head

  • migraine (second most common): severe, throbbing head pain, one sided (often), usually with nausea & light sensitivity

  • Episodic : occurs occansionaly or in phases (fewer than 15 days per month

  • Chronic: persistent or reoccuring long term (15 or more days.month for over 3 months)

• when did it start? dizziness? pain when swallowing? lumps?

  • ask 8 characteristics of pain

  • if they state it is the worst headache they have ever had, it is a medical emergency

Clubbing of fingernails

• inner edge of the nail elevated, looks wide and shiny

• clubbing of the nails occurs with congential cyanotic heart disease, lung cancer & pulmonary disease, COPD, emphysema

  • grows slowly, if caught early you can reverse it

Vasocontriction vs Vasodialation

• Vasoconstriction: narrow vessels

  • pale, cyanotic, cool, high BP

• Vasodialation: dialated vessels

  • red/pink/flushed, warm, decreased BP

• vessels contrict to keep heat. vessels dialted to release heat

• when BP is high vessels dialte to decrease BP

• both of these are the body regulating itself

Melenoma

• cutaneous melanomas: arise in sun/artificial UV

• Nodular melanoma: most common, quickly growing black, blue, pink red nodules

• superficial spreading melanoma: begins as brown to black macule w/ irregular borders

ABCDEF

• Asymmetry: not regularly round or oval

• Border irregularity: notching, scalloping, ragged edges

• Color variation: areas of brown, tan, black, red blue white

• Diameter: greater than 6 mm

• Elevation & Evolution: sudden appearance or recent change in mole

• Funny looking (stand out, sus)

Why is papilledema a serious concern

swelling of the optic disc

• can result in vision loss

• brain bleeds or tumors

Strabismus, Nystagmus, Periorbital Edema

• Strabimus: true disparity of the eye axes

• Nystagmus: oscillating movement best seen around the iris. disease of semicircular canals in ears, MS, brain lesions or paretic eye muscle

• Periorbital edema: lids are swollen and puffy. connective tissues in the eyes are losley connected, fluid can easily get in. occurs with crying, truama, CHR, renal failure, allergy, hypopthryoidism

What findings of the epicanthal folds & eyes indicate down syndrome

• upward lateral slope with epicanthal folds & hypertolerism (large scaling between eyes) & bushfield spot (light colored areas in outer iris) occurs with down syndrome

  • Fetal alcohol spectrum disorders: narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia

Exotropia

inward tuning of the eye

Exophthalmos

• foward displacement of the eyeballs & widened palpebral fissures

  • associated with thryotoxicosis

Confrontation test

patient covers one eye so does RN, bring your hand from behind there head in three points, until they see each one. Equally place light in the middle to check for crossed eyes, there should be equal distance between eyes

Summary checklist: hair, skin & nails

• inspection: color, shape, texture, shape, contour

• Palpation of skin, hair & nails: temperature, edema, mobility, bruising

• Note prescence of lesions: color, shape, size, location, configuration

  • teach self examination: health promotion

Summary checklist: head, face and neck (including regional lymphatic examination)

• Inspect & palpate the skin: contour, deformities, palpate temporal artery & TJM

• Inspect & palpate the face: facial expression, symmetry, abnormal movements

• Inspect & palpate the neck: ROM, enlargement

• Asculate thryoid for bruit (if enlarged)

During infancy cervicle lymph nodes are?

• not palpable

• childs lymph nodes are palpable

  • kids get sick all the time, so they will most likely always be swollen

Pillar cyst (Wen)

Benign growth that presents smooth, fluctuant swelling on scalp

Hypothyroidism

• can be thyroid issues but also be cardiac issues

What are normal findings in a 1 month old when assessing the infant