Health Assesment Exam 2

Describe the ABCDEF mnemonic of melanoma

A: assmetry
B: Border
C: color
D: diameter
E: evolving
F: feeling

define hypopigmentation and provide an example

happens when the melonosytes are destroyed somehow
like in vitiligo

define hyperpigmentation and provide an example

melasma is an example ( mostly in women)
assosiated with hormonal changes
caued by increase in melanin

pigmented nevi

moles; local accumulation of melanin

freckles

flat, melanized patches

striae

a flat, discolored area on the skin larger than 1 cm
( stretch marks)

melanoma

most serious
malignant proliferation of melanocytes
irreugulary shaped with color variations

vitiligo

white patches on the skin caused by the destruction of melanocytes associated with autoimmune disorders

explain the clincial significance of cool skin

could be : hypothermia
or they could have clammy, cool skin from shock

localized cold feet and hands could be a sign of peripheral arterial disease

explain the clincial significance of hot skin

increased metabolic rates : fever , hyperthyroidism
heat stroke
possibel signs of inflammation or infection

explain the clinical significance of diaphoresis,

Excess moisture, or diaphoresis, is abnormal in the absence of strenuous activity.

what disease conditons can be assosiated with diaphoresis

Hyperthermia, extreme anxiety, pain, or shock(cool and diaphoretic), hyperthyroidism,hypoglycemia.

describe the process of assesing skin turgor , what locations are most appropriate ?

Technique: Pick up and slightly pinch skin on forearm or under clavicle.

normal and abnormal findings of skin turgor

Skin should be elastic (move easily when lifted).Should return immediately when released="No tenting

what is the cause of 'tenting'?

dehydration or excess weight loss

Reduced mobility- edema, excess scarring, or scleroderma (a rare connective tissue disorder)

what chronic disease can result in skin thickening?

Diabetes mellitus/insulin resistance can cause abnormal collagen resulting from hyperglycemia

Acanthosis nigricans is a condition that causes areas of dark, thick velvety skin in body folds and creases and typically affects the armpits, groin, and neck.
NOT BECAUSE OF POOR HYGIENE

excessively thin skin or shiny skin is the result of what

Decreased thickness of the skin can be seen , arterial insufficiency and aging
The skin may also be shiny and hairless on legs with advanced age and arterial insufficiency

how do thyroid abnormalities impact changes in hair distribution ?

Hypothyroidism can lead to thinning hair, dryness, and brittle hair. Hair may become sparse, particularly on the scalp's outer edges
Hair growth cycles may be disrupted, leading to slower growth and a decrease in overall hair volume.


Hyperthyroidism can also cause changes in hair distribution, though the effects may differ from those of hypothyroidism.
Hair loss or thinning may occur, but it might be more diffuse rather than localized to specific areas.

Although not directly caused by thyroid abnormalities, alopecia areata, an autoimmune condition that leads to hair loss in patches, can sometimes be associated with thyroid disorders.
Thyroid dysfunction can influence the immune system, potentially triggering or exacerbating conditions like alopecia areata..

what is the significance of hair loss on the lower legs

If there is no hair on loweer legs and the person has not shaved the it could mean they have PAD, Alopicia areta, a Vascular Insufficiency, trauma or an injury.

What is kolionychia and what are possible causes?

Koil=hollow.
Onychia = nails.
Also known as "spoon nails".May be congenital.May be caused by anemia or other medical conditions.

what is leukonchia and what is the possible cause.

Leuk=white
Onychia=nail
Caused by trauma to the nail

what is clubbing. What does it represent?

Clubbing is associated with chronic hypoxia, e.g.emphysema or congenital heart problems in children.

what are beau's lines?

Transverse groove across the nail. Caused by trauma.Starts at base of nail by cuticle and then grows out

distinguish between stage 1-iv pressure ulcer

stage 1: prolonged redness with unbroken skin

stage 2; partial -thickness skin loss appears as a shallow, opwn ucler with pink wound bed

stage 3: full thickness skin loss with damage to subcutaneous tissue

Stage 4: full thickness skin losswith exposed bone, muscle, or tendon , may have some eschar or slough

what is an unstageable ulcer?

eschar or slough may cover the entire wound bed, thus it is unstagable

clavus

small, painful area of thickened skin, usually on the toe; also called a corn

atopic dermatitis

superficial inflammation

seborrheic dermatitis

chronic inflammation
scaly, white, or yellowish skin on scalp, eyebrows, ears, axillae, chest or back

stasis dermatitis

inflammation seen mostly on lower legs of older adults
areas of scaling, petechiae and brown pigmentation

Psoriasis

usually develops by 20
slightly raised erthematous plaques with silvery scales

mostly on elbows, knees, buttocks, lower back, and scalp

Pityriasis Rosea

acute, self limiting disease of young adults in winter
thought to be viral

herpes simplex viral

outbreaks triggered by sun exposure, stress, fever
griuped vesicles with an erthematous base
very painful and highly contagious
eruption lasts about two weeks

herpes varciella ( chicken pox) viral

lesions erupt in crops
painful and highly contagious
infectivity lesions along sensory nerve line

herpes zoster ( shingles) viral

grouped lesions along sensory nerve line

tinea infections ( lesions from fungal infection)

a fungal infection of the skin or feet

like ringworm (tinea corporis)
jock itch ( tinea cruris )
scaling and balding ( tinea capitis)
athlesets foot ( tinea pedis)

candidiasis ( fungal infection )

affect superfical layers of skin and mucous memebranes

celluitis ( Lesions caused by baterial infection)

acute streptococcal or staphlocccal infection of skin and subcutaneous skin and tissue

impetigo ( bacterial)

highly contagious group a streptococcal infection
generally occurs on face, around mouth and nose

follicultis ( bacterial infection )

inflammation of hair follicles

furuncle/abscess ( bacterial)

staphylococcal infection

scabies ( caused by anthropods)

highly contagious mite sarcoptes scabei

lyme disease ( anthropods)

tick infected with borrelia burgdorferi

spider bites ( anthropods)

majority from black widow or brown recluse spiders

basal cell carcinoma

most common
locally invasisive; rarely metastasizes
nodular pigmented lesions with depressed center and rolled borders

squamos cell carcinoma

intially appears as a red, scaly patch

Kaposi's sarcoma

devlops in conective tissue of immunosupressed
dark bluepurple macules, papules, nodules, and plaques

Ecchymosis

bruise
dark red, purple, yellow

pediculosis ( hair)

lice on the body are called pediculosis corporis
pubic lice are called pediculosis pubis
Spread through person-to-person contact and shared clothing.

Alopecia areata ( hair)

chronic inflammatory disease of hair follicles resulting in hair loss on scalp
Unknown cause- believed to be autoimmune disorder, metabolic disease and stressful events.
Multiple round patches of hair loss

hirsutism ( hair)

increase in growth of facial, body, or pubic hair in women( PCOS)
Unwanted hair growth in women with an increase in hair on the face, body and pubic area.

onychomycosis ( nails)

Fungal infection of nail plate caused by Tinea unguium

paronychia ( nails)

Acute or chronic infection of cuticle.
Lay term: "infected hangnail".
Rapid onset of very painful inflammation at base of nail,abscess may form.
Inflammation develops slowly usually starting at nail base and works along side of nails.
Frequent exposure to moisture,nail biting are risk factors.

process for assesment of the jugular vein for pulsations

1.elevate patient 30-45 degrees ( can be as high as 90 degrees if venous pressure is elevated
elevate chin slightly and tilt head away from side being examined
use pen light to create tangential light
observe for pulsations ( should NOT be able to visualize vein itself)


THIS GIVES YOU INFO ON PRESSURE IN RIGHT ATRIA ( so unexpected findings would be right sided heart failure

expected findings for rate, rythm, amplitude, and countour

rate- 68bpm ( pace)
rhythm- irregular or regular
amplitude - 2+
contour- bounding

assesment for orthostatic hypotension , and when should it be completed

a decrease in SBP of at least 20mm hg and or/ DBP of at least 10mm hg within 3 min of standing
Generally assosiated with fluid volume deficit, antihypertensive medications or prolonged bed rest

this happens during blood pressure assesment

s1

( lub)
closing of mitral and tricuspid valves
indicates beginning of systole

s2

( dub)
closing of aortic and pulmonic valves
indicating beginning of diastole

s3 ( what disease can it indicate and when are these normal/ abnormal)

often heard at apex
kentucky
rapid filling against the ventricle the ventricle wall
occurs during diastole
can be normal in children and pregnaant women

when heard in adult over age 30 it can be ( CHF) congestive heart failure

s4(what disease can it indicate and when are these normal/ abnormal)

tenessee
rush of blood heard with atrial contraction against the ventricles after atrial contraction

can be normal in athlletes and adults younger than 30
although usually its an abnormal sound

noncompliant or stiff ventricle , hypertrophy of ventricle, CAD, HTN, MI, aortic and pulmonic stenosis
occurs before s1

what is a heart murmur

abnormal heart sound is typically due to a leaky valve

difference between a systolic and diastolic heart murmur

systolic heart murmur is heard for symptoms of right and left heart failure as well as heart muscle contraction

Diastolic murmur - occurs during heart muscle relaxation between beats.

significance of unilateral assemetry vs bilateral edema

bilateral - heart failure, renal failure, or liver disease
unilateral-

valvular heart disease

disorders involving valves of the heart that impact the heart's ability to pump blood effectively to the lungs or tissues of the body and cause the heart to work harder

angina pectoris

chest pain that results when the heart does not get enough oxygen

unstable angina

chest pain that occurs while a person is at rest and not exerting himself

myocardinal infarction

heart attack

left ventricular failure

fatigue
SOB
orthopnea
dyspnea of exertion
displaced apical pulse and palpable thrill
S3 heart sound
systolic murmur
crackles in lungs

right ventricular failure

dependent peipheral edema
S3 heart sound
systolic murmumr
weight gain
ditended jugular vein

infective endocarditis

inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis

pericarditis

inflammation of the sac surrounding the heart ( perricardium )

venous thrombosis (thrombophlebitis)

Thrombus develops within a vein (inflammation of vein); caused by venous stasis, damage to inner layer of veins, and hypercoagulability; dilated superficial veins, edema, redness of extremity, warmth, tenderness, increased circumference of affected extremity

symptoms: low grade fever
fatigue
extremity may feel tense, full and heavy
nodules or lumps
pain ( 50% asymptomatic)
warm to hot or cool to cyanotic with severe edema

aneurysm

an excessive localized enlargement of an artery caused by a weakening of the artery wall.

peripheral vascular disease

diseases of blood vessels outside of the heart and brain
venous insiffucentcy
deep vein thrombosis

arterial insiffucenxy

most common causes is atherosclerosis or hardening of the arteries
blood flow may be comppletley stopped if a blood clot lodges in a narrowed area
leg cramping when you walk
chest pain or heart attack
pain after eating

arterial insufficency symtoms

absence of hair
shiny, thin, taut, pale
cooler skin temp
ulceration on tips of toes, foot or laterl malleous
diminshed or absent pulses
thickened nails

range of motion for the elbow joint

Hinge joint:
Flexion- bend elbow so lower arm moves toward should and hand is level with shoulder
Extension- straighten elbow
Hyperextension- bend arm back as far as possible (not everyone can hyperextend)

Internal rotation of the shoulders

External rotation of the shoulders

Describe the seven Fs of abdominal distension.

obesity ( fat)
Air or gas ( flatulence)
ascites ( intersitual fluid)
cyst or abcesses
pregnancy ( fetus)
feces ( constipation/fecal impaction)
tumor
hernia ( bowel pushing through abdominal wall musculature)