Health Assessment Exam 2

Abdomen, GI, GU, Cardiovascular, Eyes, Neuro, Skin, Hair, Nails, Musculoskeletal, Peripheral Vascular

Solid Viscera

Don’t change the shape of the abdomen (spleen, pancreas, liver)

Hollow Viscera

Change the shape of the abdomen (stomach, gallbladder, bladder)

Aorta location

Behind the peritoneum; palpable

Organ found in all four quadrants

Small intestine

Kidneys location

Retroperitoneal; CVA, R is lower than L due to the liver

Abdomen, GI: infants/children

• Umbilical cord

• Liver = majority of abdomen

• Bladder is higher

• Slim abdominal shape

Abdomen, GI: pregnancy

• Enlarged uterus => organs push upwards

• Increased venous pressure => constipation => hemrrhoids

• Morning sickness (hCG)

• Pyrosis, reflux

• Linea nigra, striae

Abdomen, GI: aging adults

• Decreased: salivation, taste, liver size, peristalsis, stomach acid

• Relaxed abdominal muscles

• Gallstones

• Constipation

• Increased fat deposits

Lactose Inolerance

Lack of lactase needed to absorb lactose => abdominal pain, bloating, gas

Celiac Disease

Autoimmune disorder; intolerant of gluten => diarrhea, abdominal pain, distention

Abdomen distention causes

Obesity, pregnancy, cysts, tumors, air/gas, ascites, feces

Intestinal obstruction s/s

Dehydration, restlessness, vomiting, fever, tenderness to palpation

Early bowel: hyperactive sounds

Late bowel: absent sounds

Hernia

Organ protruding through weak intestinal lining (caused by intra abdominal pressure_

Ascites

Fluid accomodation in the abdomen (due to liver disease, heart failure, pancreatitis, cancer)

Cullen’s Sign

Purple discoloration around umbilicus (due to pancreatitis)

Appendicitis s/s

RLQ pain/tenderness and fever

Vulval vestible components

• Urethral meatus

• Skene’s glands (lubricate urethral/vaginal openings)

• Vaginal orifice

• Hymen

• Bartholin’s glands (lubricate vaginal opening)

Internal male genitourinary anatomy

• Testis

• Epididymis

• Vas deferens

• Ureters

• Bladder

Glandular male genitourinary anatomy

• Prostate

• Seminal vesicles

• Bulbourethral glands (urethral lubrication, pre-ejcatulation fluid)

GU: Infants

Female - engorged labia due to maternal estrogen

Male - testes developed in abdominal cavity (1.5-2 cm long, 1 cm wide)

GU: Children

Female - signs of puberty

Male - testis increase in size, signs of puberty

GU: Adolescents

Female - breast development, pubic hair, menses

Male - pubic hair

GU: Pregnancy

• Uterus enlarges and grows into abdomen

• pH => more acidic

• Increased cervical/vaginal secretions + glycogen (risk for yeast infection)

GU: Aging adults

Female - menopause, uterus/cervix shrink, secretions dry

Male - decreased sperm/testosterone/genital size, enlarged prostate

Testicular self examination (TSE)

13 yo+ (timing: 1x/month, warm shower, examination report)

Benign Prostatic Hyperplasia (BPH)

Normal enlarging of the prostate, can impede urine flow

Occult blood

Blood in stool (false positive: red meat, beets)

Lanugo

Fine downy hair; infants

Vernix caseosa

Thick, cheesy substance to protect the skin in utero; infants

Neurovascular: Children

• Thickened/darkened epidermis

• Hair growth

• Lymph nodes felt up to 6yo

• Long bones => epiphyses (growth occurs until 20yo)

• Lordosis is common

• Bowlegged normal for 1 year after starting to walk

• Knock knees normal 2-3yo

Neurovascular: Adolescents

• Apocrine sweat glands

• Increased fat deposits

• Secondary s3x characteristics

Neurovascular: Pregnancy

• Increased metabolism

• Progressive lordosis

• Dependent edema, varicose veins, hemorrhoids

• Pressure on radial/ulnar nerves => numbness/weakness in upper extremities

• Linea nigra, striae, chloasma

Neurovascular: Older adults

• Decreased elasticity/wound healing

• Xerosis (dry skin)

• Senile purpura (discoloration due to capillary fragility)

• Kyphosis, marked bony prominences

• Fine, gray hair

• Solar lentigines (liver spots)

• Keratoses

• Acrochordons (skin tags)

Intermittent Claudication

Cramping of the leg caused by exercise (blockages; PAD)

Neurovascular objective data components

Inspect, palpate, ROM, muscle testing

Capillary refill

<3 seconds; no clubbing

Pale/blanched skin cause

Cold, arterial insufficiency

Ruddy/reddish skin cause

Venous insufficiency

Cyanotic skin cause

Central problems; hypoxemia

Bilateral edema/redness

System problem

Unilateral edema/redness

Localized problem

Hematoma

Blood filled, swollen bruise

Ecchymosis

Flat bruise

Pulse grades

0-3+

ROM grades

0-5+; Full ROM, against gravity, full resistance

• 3-5+ = active ROM

• 0-2+ = passive ROM

Phalen’s Test

Hands held back to back at 90 degrees for one minute (numbness/burning if carpal tunnel)

Tinel’s Sign

Percussion of median nerve at wrist (tingling/burning if carpal tunnel)

Kyphosis

Enhanced thoracic spine; older adults

Lordosis

Pronounced lumbar spine; pregnancy

Lasegue’s Test

Supine, leg straight at 90 degrees, foot dorsiflexed (sciatic pain if herniated disc)

ABCDEF skin self-examination

Asymmetry, border irregularity, color variation, diameter >6mm, elevation/evolution, funny looking

Mongolian Spots

Flat, blue-gray birthmark on lower back/buttocks

Stork Bites

Flat, pink birthmark caused by stretched blood vessels

Moro Test

Startle reflex when “dropped” (arms flay); shows clavicle fracture

Ortolani/Allis Test

Checks hip dislocation

Addison’s Disease

Bronze skin

Annular/circular lesion

Ringworm

Confluent lesion

Hives

Discrete lesion

Pimples, chickenpox

Grouped lesions

Dermatitis

Gyrate lesions

Twisted, snake-like

Zosteriform lesions

Follows nerve path; shingles

Primary lesions

Develop on unaltered skin

Macule

Flat, color change, <1cm; freckle

Papule

Thickened epidermis, <1cm; mole

Patch

Macule >1cm; Mongolian spot

Plaque

Papule >1cm; psoriasis

Nodule

Solid, elevate, >1cm; fibroma

Wheal

Raised, irregular shape; mosquito bite

Urticaria

Wheals => pruritic reaction; hives

Vesicle

Elevated cavity containing fluid (friction blister); chickenpox

Cyst

Encapsulated, fluid-filled cavity

Bulla

Ruptures easily, >1cm; blister

Pustule

Elevated cavity filled with pus; acne

Secondary skin lesions

Primary lesions undergone evolutionary change

Crust

Thickened/dried exudate; scab

Scale

Flakes of desiccated skin; eczema

Fissue

Linear crack with abrupt edges

Ulcer

Irregular shape, deep

Excoriation

Superficial abrasion (caused by scratching)

Scar

Fibrotic tissue

Keloid

Excess scar tissue

Candidiasis

Yeast infection

Impetigo

Reddish sores; bacterial infection

Atopic dermatitis

Eczema

Tinea corporis

Ringworm

Tinea pedis

Athlete’s foot

Labial herpes simplex

Cold sores

Petechiae

Tiny, red blood spots

Stage 1 pressure ulcer

Non-blanchable erythema, skin is unbroken

Stage 2 pressure ulcer

Partial thickness skin loss

Stage 3 pressure ulcer

Full thickness skin loss, red/vasculature

Stage 4 pressure ulcer

Full thickness skin/tissue loss, eschar/slough/tendon/bone

Deep tissue pressure injury (DTPI)

Begins in the tissue around a bony prominence, works its way to superficial skin

Peripheral artery disease s/s

Numbness, cold, shiny, pale/blue, round/red ulcers, in foot/toes

Peripheral venous disease s/s

Dull aches, edema, spider/varicose veins, irregular/discolored ulcers, in medial malleolus

Rheumatoid arthritis

Autoimmune swelling, bilaterally

Osteoarthritis

Wear and tear of joints

Bouchard nodes

On middle finger joints

Heberden nodes

On distal finger joints