B244 Exam 2, come back to edit

signs of abuse/neglect

bruises, burns, lacerations, scars, bony deformities, alopecia, retinal hemorrhages, dental trauma, and head and abdominal injuries

(skin and hair abnormalities may be the most visible clues in detecting this problem)

contact burn

a burn caused by intentionally placing a hot object such as as cigarette, light bulb, light or hot iron on the skin

trichotillomania (hair pulling)

loss of scalp hair can be cause by physical manipulation

impetigo

contagious, superficial skin infection characterized by isolated pustules that become crusted and rupture

exanthem

a widespread rash, usually in children accompanied by systemic symptoms due to viral infection

keratoses

thickened areas of epidermis

seborrheic keratoses

pigmented, raised, warty-appearing lesions that may be seen on the face or trunk

solar keratosis (actinic keratosis)

squamous cell carcinoma confined to the epidermis

petechiae

lesions appear as small, reddish-purple pinpoints

(difficult to see)

petechiae causes

tiny hemorrhages within the dermal or submucosa - caused by intravascular defects and infection

ecchymosis

bruising on a bony prominence

light skin ecchymosis

dark red, purple, yellow, or green color, depending on age of bruise

dark skin ecchymosis

deeper bluish or black tone; difficult to see unless it occurs in an area of light pigmentation

ecchymosis cause

trauma to the blood vessel resulting in bleeding under the tissue

bruise (ecchymosis)

a discoloration of the skin or mucous membrane caused by blood seeping into the tissues as a result of a trauma to the area

telangiectasia

permanent dilation of preexisting small blood vessels (capillaries, arterioles, or venules) resulting in superficial, fine, irregular red lines within the skin

telangiectasia causes

rosacea, collagen vascular disease; actinic damage, increased estrogen levels

telangiectasia examples

essential telangiectasia, hereditary hemorrhagic telangiectasia, spider telangiectasia

spider veins

dilated blood vessels, typically found in the legs, that radiate from a central point

assessment of skin temperature

- use the dorsal aspect of your hands

- skin should be warm

- temperature should be consistent throughout

impact of age on skin

changes in skin texture may be expected: skin thinning, fragile, and excessive dryness

impact of age on hair

a decrease in hair growth

impact of age on nails

- nail growth slows

- toenails: become thicker, harder, brittle, and yellowish

impact of age

- sebaceous and sweat gland activity decreases and results in drier skin and less perspiration

- epidermis things and flattens

- dermis becomes less elastic; loss of collagen and elastic fibers = wrinkles

gray hair is due to

decrease in the number of functioning melanocytes

axillary and pubic hair production

this declines due to reduced hormonal functioning

impact of aging on older adults

- increased sensation to touch and the environment

- generalized chronic itching

- susceptible to skin infections

- healing response is delayed

meaning of skin turgor

this is when you note moisture

testing of skin turgor

- pinch skin, skin springs back to previous state designates normal elastic skin turgor

- stays pinched or tented poor or abnormal skin turgor seen in dehydration

ABCDE

use this scale to help you remember early signs of melanoma

A

asymmetry (not round or oval)

B

border (poorly defined or irregular border)

C

color (uneven, variegated)

D

diameter (usually greater than 6 mm)

E

evolving (a skin lesion that looks different from others or is changing in size, shape, or color)

skin cancer risks

- family history

- excessive exposure to sun and uv light

- personal history

- older age

- fair skin; blond or red hair

- blue or green eyes

- moles

macule

flat, circumscribed area that is a change in the color of the skin; less than 1 cm diameter

macule examples

freckles, flat moles, petechiae, measles, scarlet fever

papule

elevated, firm, circumscribed area less than 1 cm in diameter

papule examples

wart, elevated moles, lichen planus, cherry angioma, neurofibroma, skin tag

vesicle

elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1 cm in diameter

vesicle examples

varicella (chickenpox), herpes zoster (shingles), impetigo, acute

pustule

elevated, superficial lesion; similar to a vesicle but filled with purulent fluid

pustule examples

impetigo, acne, folliculitis, herpes simplex

sebaceous glands

secrete sebum, a lipid-rich substance that keeps the skin and hair from drying out

sebaceous glands: secretory activity

stimulated by sex hormones (primarily testosterone), varies according to hormonal levels throughout the life span

normal hormone-related changes of adolescence

- apocrine glands enlarge and become active with hormone simulation

- increased sebum production (oily appearance and predisposing the individual to acne)

- coarse terminal hair appears in the axillae and pubic areas of both female and male

jaundice

yellowish color of skin, sclera of eyes, fingernails, palms of hands, and oral mucosa

cyanosis

grayish-blue tone, especially in nail beds, earlobes, lips, mucous membranes, palms, and soles of feet

erythema

reddish tone with evidence of increased skin temperature secondary to inflammation

pallor

pale skin color that may appear white

psoriasis

- a common chronic skin disorder that can occur at any age but usually develops by age 20

- an inflammatory process causes lesions, and the disease can range from mild to severe

psoriasis clinical findings

- lesions appear as well-circumscribed, slightly raised, erythematous plaques with silvery scales on the surface

- appear on elbows, knees, buttocks, lower back, and scall

- small bleeding may occur is lesion is scratched

- other symptoms: pruritus, burning, and bleeding of the lesions and pitting of the fingernails

herpes simplex

a chronic, incurable condition transmitted by contact during an outbreak when the infected person is shedding by a number of factors including sun exposure, stress and fever

herpes simplex clinical findings

- many patients report a sensation of slight stinging and increased sensitivity

- lesions are very painful and highly contagious after direct contact with skin

herpes simplex: type 1

associated with oral infection

herpes simplex: type 2

associated with genital infection

herpes outbreaks are triggered by:

sun exposure, stress, and fevers

varicella (chickenpox)

- acute, highly communicable disease common in children and young adults

- herpes organism

- live vaccine given at 12 months and 4-5 years of age

- dormant organism with disease remains in body and can cause shingles

varicella clinical findings

- spread by droplets

- lesions first appear on the trunk and then spread to the extremities and the face

- start as macules and progress to papule and then vesicles

contact dermatitis (eczema)

- an inflammatory reaction of the skin that develops in response to irritants or allergens such as metals, plants, chemicals, or detergent

- this condition affects people of all ages and ethnic groups

contact dermatitis clinical findings

contact dermatitis develops in an area exposed to the causative irritant or allergen and appears as localized erythema that may also include edema, wheals, scales, or vesicles that may weep, ooze, and become crusted

stage I pressure ulcer

intact skin with non blanchable redness, usually over a bony prominence

stage II pressure ulcer

partial-thickness loss of dermis. presents as a shiny or dry swallow open ulcer with pink wound bed. may also appear as an intact or ruptured serum-filled blister

stage III pressure ulcer

full-thickness loss involving damage to or necrosis of subcutaneous tissue; subcutaneous fat may be visible

stage IV pressure ulcer

full-thickness tissue loss with exposed bone, tendon, or muscle

stages of edema 1+

2 mm indention with pressure applied

stages of edema 2+

4 mm indention with pressure applied

stages of edema +3

6 mm indention with pressure applied

stages of edema +4

8 mm indention with pressure applied

assessment of maxillary sinuses

- palpate for tenderness, pain, and swelling

- inspect for swelling

- transillumination of the sinus may be performed if sinus tenderness is present or infection is suspected

cluster headaches

onest sudden and associated with alcohol consumption, stress, or emotional distress

cluster headaches clinical findings

- the most painful of primary headaches

- intense episodes of excruciating unilateral pain

- repeat daily for weeks

migraine headaches

- second most common headache

- occur in childhood, adolescence or adult life; young women more susceptible

migraine headaches clinical findings

- starts with an aura caused by vasospasm of intracranial arteries and is described as a throbbing unilateral distribution of the pain

- other signs/symptoms: feelings of depression, restlessness, or irritability, photophobia, and nausea or vomiting

tension headache

- most common type of headache

- adults 20-40 years old

tension headache clinical findings

- usually bilateral and may be diffuse or confined. to the frontal, temporal, parietal, or occipital area

- pain usually steady, not throbbing

- feels like a tight band around their head

oral cancer risks

- tobacco use

- alcohol use

- age: increased after age 55

- gender: 2:1 male to female incidence

- HPV infection in mouth

- exposure to UV

visual acuity

decrease in central vision, distortion of central vision, use of dim or bright light to increase visual acuity, complaints of glare, difficulty in performing near work without lenses

when measuring visual acuity, note the following:

- near vision

- distant vision

- peripheral vision

visual acuity testing

- use Snellen chart

- test each eye individually

- test with and without corrective lenses

- is vision is less than 20/20, conduct pinhole test

pinhole test

- this maneuver permits light to enter only central portion of lens

- should result in an improvement in visual acuity by a least one line on the chart

visual acuity ratings

- normal: 20/20

- 20/30: can read 20 feet what normal vision can read at 30 feet

- 20/200: legally blind with this as best corrected visual acuity

nystagmus

involuntary movement of the eyeball in a horizontal, vertical, rotary, or mixed direction, it may be congenital or acquired from multiple causes

exophthalmos

bulging of eye anteriorly out of orbit

ptosis

drooping of eyelid due to nerve damage or systematic neuromuscular weakness

periorbital edema

swollen, puffy lids; occurs with crying, infection, trauma, and systematic problems including kidney failure, heart failure, and allergy

retinal hemorrhages in infancy

occurs in infant victims of shaken-baby syndrome

cardinal fields of gaze

- this test is done when the corneal light reflex is not symmetric

- check for nystagmus

- note lid lag

- note exposure os sclera above iris

cardinal fields of gaze purpose

test eye movements (tests cranial nerves III, IV, and VI)

peripheral vision

- estimate with confrontation test

- accurate measurement requires instrumentation

accommodation testing process

ask patient to fix his or her gaze on a distant object across the room. then ask the patient to shift his or her gaze to your finger, places about 5 inches from patient's nose

testing pupils for accommodation

- the pupils should constrict when the eyes focus on the near object

- the pupil should dilate when focusing on a distant object

impact of pregnancy on vision

- hypersensitivity and changes are seen in the refractory power of the eye. vision may change temporarily, probably don't want to change contact or glasses prescription

impact of pregnancy on vision: tears contain

an increased level of lysosome, resulting in a greasy sensation and perhaps blurred vision for contact lens wearers

impact of pregnancy on vision other

- corneal edema/thickening occurs

- diabetic retinopathy may worsen

- intraocular pressure falls

- subconjunctival hemorrhages may occur/resolve spontaneously

cranial nerves IX and X

elicit gag reflex

cranial nerve IX

glossopharngeal

cranial nerve X

vagus

cranial nerves V and VII

innervate facial muscle

- responsible for facial movement and symmetry

- both nerves innervated by pons area of brain