Health Assessment Exam #2

Skills requisite for physical examination are:

inspection

palpatation

percussion

auscultation

inspection

concentrated watching

always comes first

palpation

an examination technique in which the examiner's hands are used to feel the texture, size, consistency, and location of certain body parts

What are your fingertips best for?

best for fine tactile discrimination, such as skin texture, swelling, pulsation, and determining the presence of lumps

What is grasping best for?

detect the position, shape, and consistency of an organ mass

What is your palm best for?

best for feeling vibrations

percussion

Tapping the person's skin with short, sharp strokes

depicts the location, size, and density of the underlying organ

ausculation

listening to sounds produced by the body, such as the heart, blood vessels, lungs, and abdomen

standard percautions

Precautions taken when there is contact with any body fluid or non-intact skin/mucous membrane

What should we observe when a person first walks in?

physical appearance

body structure

motility

behavior

General survey expected findings:

age- appear to match the age they state

sex - sexual development is appropriete

LOC- alert and oriented

skin color - even tone and intact

facial features -symetrical

overall appearance - no signs of acute distress

general survery body structure:

stature

nutrition

symmetry

posture

position

Motility includes:

gait

ROM

State: no involuntary movement if none was observed

Behavior includes:

facial expression

mood and affect

speech

speech pattern

dress

personal hygiene

More abdominal fat means someone is at risk for what?

diabetes and heart disease

nociceptive pain

pain from a normal process that results in noxious stimuli being perceived as painful WARNING

neuropathic pain

Pain caused by lesions or other damage to the nervous system.

visceral pain

a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera

somatic pain

Pain that originates from skeletal muscles, ligaments, or joints. May be accompanied by nausea, sweating, tachycardia, and hypertension

reffered pain

pain that is felt at a particular site but originates from another location

acute pain

pain that is felt suddenly from injury, disease, trauma, or surgery

chronic pain

episode of pain that lasts for 6 months or longer; may be intermittent or continuous

breakthrough pain

pain restarts or escalates before next scheduled analgesic dose

FLAAC for nonverbal infant

face

legs

activity

cry

consolability

overweight percntile

85th %

obsese percentile

95th %

obesity BMI

over 30 kg/m2

How would you start an effective nutritional assessment?

current weight and weight Hx

What is the purpose of the skin?

Protect against bacterial invasion

help regulate body temperature

act as a sensory organ

lanugo

fine downy hair of a newborn infant

vernix caseosa

cheesy substance covering the skin of the fetus

sebum

oily substance secreted by sebaceous glands that moisturizes, holding water in the skin, producing milia

linea nigra

a dark line appearing on the abdomen and extending from the pubis toward the umbilicus

chloasma gravidarum

brownish pigmentation of the face (mask of pregnancy)

senile purpura

discoloration due to increasing capillary fragility

complete physical assessment

Skin assessment integrated throughout the examination

Scrutinize the outer skin surface first

Regional physical exam

-Individuals may seek health care for skin problems, and the assessment focused on skin alone.

-Assess skin as one entity; getting an overall impression helps reveal distribution patterns.

inspection and palpation of the skin

color

temp

moisture

texture

thickness

edema

mobility and turgor

vascularity or bruising

diaphoresis

profuse sweating

inspection of hair

texture

color

distribution

lesions

inspection of nails

shape and contour

consistency

color

capillary refiil

profile sign

viewing the finger from the side to detect early clubbing

clubbing

bulbous enlargement of the distal phalanges of the fingers and toes that occurs with chronic cyanotic heart and lung conditions

What do nails reveal?

oxygen status

capillary refill

liver issues

ABCDEF

A: asymmetry

B: border

C: color

D: diameter

E: elevation or evolution

F: funny-looking

acrocyanosis

Temporary cyanotic condition, usually in newborns, resulting in a bluish color around the lips, hands and fingernails, and feet and toenails. May last for a few hours and disappear with warming.

phsiologic jaundice

When the infant liver can't rid bilirubin fast enough

cutis marmorata

transient bluish red marbling pattern when exposed to cold temps

carotenemia

yellow-orange color in light-skinned persons from large amounts of foods containing carotene

How can we tell if a baby is dehydrated

Look at the fontinals

pallor

paleness

Variations in skin color

pallor

cyanosis

erythema

jaundice

brown-tan

What are secondary skin lesions?

crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, keloid

cranial bones

frontal, parietal, occipital, temporal

Sutures

coronal

sagittal

lambdoid

How many facial bones are there?

14 bones also articulate at sutures

madible

lower jaw that does not attach to a suture

inside the skull, the brain is held by what?

membranous meninges

neck

conduit of many structures

sternocleidomastoid and trapezius are innervated by cranial nerve _____

XI

MEMORIZE STRUCTURES OF THE NECK

Where is the greatest supply of lymph nodes?

head and neck

preauricular nodes

in front of the ear

posterior articular lymph node

directly behind the ear over the mastoid

occipital lymph node

base of the skull

submental lymph nodes

lymph nodes beneath the chin

submandibular lymph

halfway between the angle and the tip of the mandible

When you are pregnant what happens to your thyroid?

enlarges

caput succedaneum

Diffuse edema of the fetal scalp that crosses the suture lines. Reabsorbs within 1 to 3 days

Cephalhematoma

collection of blood between the periosteum and the skull bone that it covers

does not cross the suture line

results from trauma during birth

Tension headache symptoms READ ABOUT HEADACHES

pain is like a band squeezing the head

migraine

specific type of headache characterized by severe head pain, sensitivity to light, dizziness, and nausea

cluster headache

pain is in and around one eye

normocephalic

round and symmetric

cranial VII

facial nerve

raise eyebrow

smile

frown

Inspection and palpation of the neck

Symmetry

Range of motion

Lymph nodes

Trachea

Thyroid gland

Posterior approach

Anterior approach

Auscultate the thyroid for bruit if enlarged

Summary checklist of head, face, neck

canthus

The corner of the eye, the angle where the lids meet.

caruncle

found in the medial canthus, it is a small fleshy mass containing sebacceous glands

III, IV, VI cranial nerves

moves the eyes in different directions

Sclera

white of the eye

Cornea

The transparent layer forming the front of the eye.

corneal reflex

contact with a wisp of cotton stimulates a blink in both eyes

iris

a ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening

pupil

opening in the center of the iris (round and regular)

How is the size of the pupil determined?

Size is determined by balance between parasympathetic and sympathetic chains of autonomic nervous system

lens

the transparent structure behind the pupil that changes shape to help focus images on the retina

PERRLA

pupils equal, round, reactive to light and accommodation

consensual light reflex

simultaneous constriction of the other pupil

pupillary light reflex

normal constriction of pupils when bright light shines on retina

fixation

feflex of the eye toward and object attracting our attention

accomadation

adaptation of the eye for near vision

convergence of eyes

Medial rotation of both eyeballs towards the object being viewed

presbyopia

impaired vision as a result of aging

vitreous humor

soft, jelly-like material behind the lens in the vitreous chamber; helps maintain the shape of the eyeball

When the vitreous humor is not renewed continuously, what happens?

floaters appear from debris that accumulates

cataract formation

a clouding of the crystalline lens from a clumping of proteins

diabetic retinopathy

damage to the retina as a complication of uncontrolled diabetes

Glacuoma

eye disorder characterized by increase of intraocular pressure (IOP). If left untreated may progress to optic nerve damage and visual impairment or loss.

Age-related macular degeneration (AMD)

loss of central vision characterized by yellow deposits