H+P General, Hair Skin and Nails ppt

rapid changes in weight over a few days suggests what

changes in body fluid

some reasons for weight gain

heart failure, liver failure, venous staisis, drugs like steroids or contraceptives

some reasons for weight loss

GI disease, chronic infections, HIV, malignancy, chronic cardiac pulmonary renal failure, depression and anorexia, drugs like antidepressants, thyroid meds

weakness

loss of muscle power

fatigue

general tiredness

fever vs chills

objective vs subjective

night sweats occur in

TB and malignancy

odors on body and breath

alcohol, acetone, uremia, liver failure

level of consciousness

awake, lethargic, obtundation, stupor, coma

facial expression

stare of hyperthyroidism, immobile facies of Parkinson's, flat or sad effect of depression

motor activity

anxious patients are agitated and restless, tremors, involuntary movement, paralysis, impaired gait

dressing, grooming, personal hygiene

baggy clothing-hypothyroidism, hiding needle marks, masking anorexia
holes in shoes- foot problems
copper bracelets- joint pain
bitten fingernails- stress

signs of distress

pain, anxiety, cardiac or respiratory distress

skin

pallor, cyanosis, jaundice, rashes, bruises, mottling of extremities

height

watch for turner syndrome, dwarfism, marfans syndrome, osteoporosis, vertebral compression fractures

what to look at for heart rate

rate and rhythm

if heart rhythm is irregular, where do you listen to heart

apex- 4-5th ICS, mid clavicular

what is core body temp

98.6 but fluctuates 1 degree throughout day

fever causes

infection, trauma, malignancy, drug reaction, immune disorders

what is BP

force of blood against artery walls

what can you heart when taking a BP

korotkoff sounds

if BP cuff is too small

BP will read high

if BP cuff is too large

will read low on small arm and high on large arm

reasons why BP could be elevated

white coat syndrome, caffeine, primary hypertension, tobacco

what is auscultatory gap

period which sounds indicating true systolic pressure fade away and reappear at lower pressure

what patients have auscultatory gap

arterial stiffness, atherosclerosis, Venus congestion in limb

hypotension

110/70

normal BP

120/80

elevated BP

120-129/ less than 80

stage 1 hypertension

130-139/ 80-89

stage 2 hypertension

over 140/90

orthostatic BP

Measurement BP as patient goes from standing to lying down and from lying down to standing

orthostatic BP readings

systolic BP decreases over 20 and diastolic decreases over 10

causes of orthostatic BP

drugs, moderate to severe blood loss, prolonged bed rest, diseases of autonomic nervous system

primary causes for high BP

age, genetics, race, obesity, inactivity

secondary causes for high BP

disease, stenosis, medications, thyroid disease

for hypertension, increase what foods and decrease what foods

potassium; sodium

acute vs chronic pain

Acute- less than 6 months
Chronic- more than 6 months

somatic pain

linked to tissue damage in skin, musculoskeletal system, or viscera

neuropathic pain

injury or lesion of the somatosensory system; burning or shock like

central sensitization pain

alter of CNS processing leading to amplification of pain signals, decreased pain tolerance

psychogenic pain

multifactorial- psychogenic, coping skills, cultural

idiopathic pain

unknown cause

underweight BMI

less than 18.5

normal BMI

18.5-24.9

overweight BMI

25-29.9

Obesity I BMI

30-34.9

Obesity II BMI

35-39.9

Extreme Obesity BMI

over 40

bradycardic

less than 60 bpm

normal bpm

60-100 bpm

tachycardic

over 100 bpm

bradypnea

less than 14 bpm

normal rr

14-20

tachypnea

over 20 bpm

hyperventilation

fast and deep

prolonged expiration

common in COPD

three layers of skin

epidermis, dermis, subcutaneous

functions of skin

keep body in homeostasis, protection, sensation, boundaries for body fluid

pallor

reduced blood flow or decreased RBC, less oxygen in skin; associated with anemia, shock, hypothermia, stress

cyanosis

blue discoloration in skin, mucous membranes, nails, sign of lack of oxygen; associated with respiratory and cardiac conditions

jaundice

bilirubin with is a breakdown of heme in RBCs; associated with liver and gallbladder

carotene

yellow pigment found in subq fat and places like palms and soles

vellus hair

short, fine, unpigmented, inconspicuous

terminal hair

course pigmented thick conspicuous

2 types of sweat glands

eccrine which is temperature control with direct opening to skin and approcrine which is pheromones

sebaceous glands

oil lubrication acne, seborrhea formed

most common cause of hair loss

male and female pattern baldness

what 3 things to look for when checking lesions

melanoma, BCC, SCC

what to include when describing a skin lesion

number, size, color, shape, texture, primary lesion, location, distribution, configuration

macule

circumscribed flat area of change in color less than 1cm in diameter, freckles, flat moles, rashes, measles, rubella

patch

circumscribed flat area of change in color of skin over 1 cm in diametes; vitiligo, tinea versicolor

papule

small solid elevation of skin less than 1 cm in diameter; nevi, wart, insect bite, acne, skin cancer, keratoses

plaque

small, circumscribed elevation of epidermis filled with purulent fluid; bacterial infections, folliculitis

nodule

solid elevation of the skin over 1 cm that usually expands into the deeper layers; cysts, lipoma, fibroma

pustule

small, circumscribed elevation of epidermis filled with purulent fluid, bacterial infections, folliculitis

vesicle

small circumscribed elevation of epidermis containing clear fluid less than 1cm in diameter; herpes infections, acute allergic contact dermatitis

bullae

circumscribed elevation of epidermis filled with purulent fluid over 1cm in diameter; herpes infections, acute allergic contact dermatitis

wheal

is circumscribed raised lesions of dermal edema, lasts under 24; hypersensitivity to drugs, insect bites, bee stings, physical stimuli

erosion

loss of epidermal or mucosal epithelium; after rupture of vesicle or bullae

ulcer

deeper loss epidermis and at least the upper dermis

petechiae

flat, Non blanchable punctate foci of hemorrhage

purpura

Non blanchable raised and palpable

ecchymosis

Non blanchable large area of purpura, AKA bruise

what two ways can you position patient for exam

seated to standing or supine to prone

areata hair

patchy and stress related

androgenic hair

male pattern/ aging male

traction hair

frontal temporal

totalis hair

loss of all head hair/ autoimmune

universalis hair

loss of all body and head hair/ autoimmune

hair pull test

pull from scalp to inspect breakage

hair tug test

pull with two hands to inspect fragility

onychomycosis

fungal infection of the nail

paronychia

inflammation around nail

onycholysis

separation of nail from nail bed

pitting nail

small depressions in nail plate

terrys nail

mainly white, ground glass appearance from obliteration of lunula

clubbing nail

may indicate a respiratory or cardiovascular disease

bedbound ulcer stage 1

intact skin with nonblanchable redness of localized area

bedbound ulcer stage 2

partial thickness loss with exposed dermis