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Health Assessment: Skin, Hair, Nails, and Lymphatic System

Health Assessment Lecture Notes

Week 5 Lecture Overview

  • Focus on assessment of Skin, Hair, Nails, and the Lymphatic System.

Skin, Hair, Nails

Findings Indicative of Systemic Disorders

  • A review of how various body system disorders can affect skin, hair, and nails, including:

    • Cardiovascular

    • Gastrointestinal

    • Genitourinary

    • Endocrine

    • Neurologic

    • Hematology

    • Psychiatric

Health Promotion and Education

  • Emphasized the importance of:

    • Proper sunscreen use

    • Skin self-assessment strategies

    • Awareness and management of photosensitivity

    • Medication implications such as:

    • Antibiotics (ABX): Tetracyclines, doxycycline, ciprofloxacin, etc.

    • Diuretics: Thiazides (HCTZ)

    • Disease reference: Lupus

Skin Self-Assessment

  • Utilizing the ABCDE method for melanoma detection (see Table 11.1 in Jensen textbook):

    • A - Asymmetry: One half does not mirror the other half.

    • B - Border Irregularity: Is the border ragged or notched?

    • C - Color: Variability in color.

    • D - Diameter: Lesion greater than 6mm (about the size of a pencil eraser).

    • E - Evolution: Changes in shape, size, or color over time.

  • Normal Characteristics of Moles:

    • Consistent color, size < 6mm, well-defined edges, round/oval form, emergence before age 30.

  • Abnormal Characteristics of Moles:

    • Asymmetry, irregular borders, multiple colors, diameter > 6mm, and changes over time.

Risk Assessment for Skin Cancer

  • Identification of clients at increased risk for developing skin cancer includes:

    • A) A 68-year-old male groundskeeper

    • B) A 34-year-old female in Denver

    • C) A 54-year-old female with a family history of malignant melanoma

    • E) A 48-year-old male who had a kidney transplant

    • F) A 19-year-old female with fair skin who uses tanning beds

  • Answer Key: Selections include A, B, C, E, F.

Abnormal Findings

  • Classifications of abnormal findings include:

    • Skin

    • Pruritis

    • Rashes

    • Lesions/Wounds

    • Nail Changes: Clubbing, Koilonychia (spoon nails), longitudinal ridging, Beau's lines, onycholysis

    • Hair: Infestations, dandruff

Types of Lesions

  • Primary Lesions: Arise from previously normal skin.

  • Secondary Lesions: Develop following primary lesions.

Categories of Skin Lesions

  • Macules: Flat, colored spots on the skin.

  • Papules: Small, raised bumps on the skin.

  • Wheals: Swollen, raised areas often associated with allergic reactions.

  • Bulla: Large blisters containing clear fluid.

  • Pustules: Pus-filled lesions.

  • Vesicles: Small blisters containing serous fluid.

Changes of the Nails

  • Table 11.18 discusses:

    • Clubbing

    • Spoon Nails (Koilonychia)

    • Longitudinal Ridging

    • Beau Lines: Horizontal lines indicating temporary cessation of growth.

    • Onycholysis: Separation of the nail from the nail bed.

Pressure Injuries

  • Risk factors for pressure injuries include:

    • Mobility

    • Sensation

    • Moisture

    • Perfusion

    • Nutrition/Hydration

    • Friction/Shear

Lymphatic System Assessment

Introduction to Head, Face, Neck, and Lymphatics

  • Assessment focuses on regions such as:

    • Scalp

    • Cranium

    • Lymphatic system

    • Parathyroid

    • Thyroid

    • Salivary glands

  • Muscle anatomy includes:

    • Sternocleidomastoid

    • Trapezius

  • Blood supply considerations:

    • Carotid and temporal arteries, jugular veins

  • Nerves:

    • Cranial nerve (CN) V: Trigeminal nerve

Skull Structure and Function

  • The skull serves as a protective enclosure for the brain, consisting of:

    • Cranial bones: Frontal, parietal, occipital, temporal

    • Sutures: Points of union between cranial bones (coronal, sagittal, lambdoid)

Facial Structure and Function

  • Facial Bones: 14 bones articulate at sutures impacting facial expressions

  • Salivary Glands: Palpation of parotid (largest and can’t be felt under normal conditions) and submandibular glands.

  • Temporal artery assessment is notable for pulsation palpation.

Lifespan Considerations for Older Adults

  • Changes in older adults include:

    • More pronounced bony structures due to decreased subcutaneous fat.

    • Increased likelihood of skin lesions; skin cancer risk.

    • Commonly encountered conditions: hypothyroidism, hyperthyroidism (hypothyroidism more prevalent).

    • Cultural considerations influencing health assessments.

Thyroid Function and Assessment

  • The thyroid gland, an endocrine organ, straddles the trachea, producing:

    • Thyroxine (T4) and Triiodothyronine (T3) which regulate cellular metabolism.

  • Physical characteristics:

    • Structures include isthmus (connecting lobe) and palpable landmarks (cricoid cartilage and Adam’s apple).

Location of Lymph Nodes

  • An overview of lymph node locations:

    • Preauricular: In front of the ear.

    • Postauricular: Superficial to the mastoid process.

    • Occipital: At base of the skull.

    • Submental: Midline behind mandible.

    • Submandibular: Halfway between angle and tip of the mandible.

    • Jugulodigastric (Tonsillar): Under the angle of the mandible.

    • Superficial cervical: Overlying sternomastoid muscle.

    • Deep cervical: Deep under sternomastoid muscle.

    • Posterior cervical: Along trapezius muscle edge.

    • Supraclavicular: Just above and behind clavicle.

Assessment Findings for Lymph Nodes

  • Normal findings include lymph nodes that are:

    • 1-2 cm

    • Moveable

    • Nontender

  • Abnormal findings include:

    • Swelling/Enlargement

    • Tenderness

    • Hardness or rigidity

    • Lymphedema

Urgent Assessment Considerations

  • Attention is critical for:

    • Acute head injuries and neurological changes

    • Assessing neck pain

    • Monitoring for signs of potential malignancy and hyperthyroid crisis.

Subjective Data Collection

  • Multiple systems influencing structure and function include:

    • Personal and family history

    • Medications

    • Risk reduction and health promotion consideration.

Common Symptoms in the Head and Neck Region

  • Symptoms include:

    • Headache

    • Neck pain

    • Limited neck movement

    • Bumps or masses

    • Sleepiness associated with thyroid disorders

Objective Data Collection Techniques

  • Physical assessments involve:

    • Inspection and Palpation:

    • Head, hair, neck examination for abnormalities

    • Assessment of the temporal artery and pulse

    • Examination of lymph nodes

  • Auscultation for enlarged thyroid glands when indicated.

Critical Thinking and Assessment

  • Incorporating laboratory and diagnostic tests:

    • CT, MRI, lumbar puncture, thyroid labs: TSH, T3, T4

    • Reasoning strategic implementations for nursing diagnoses, outcomes, interventions, and collaboration with interprofessional healthcare teams.

Physical Examination Techniques

Inspect and Palpate the Skull

  • Assess for:

    • Size and Shape: Should be normocephalic (round and symmetric)

    • Texture and protrusions palpated through the scalp.

Inspect the Face

  • Facial structures should be symmetrical, observing behaviors and expressions for appropriateness.

  • Pay attention to involuntary movements and note abnormalities.

Inspect and Palpate the Neck

  • Head and neck symmetry plus assessing:

    • Range of motion

    • Any enlargement of glands or pulsations

    • Palpation of lymph nodes for size, shape, mobility, consistency, and tenderness.

Trachea and Thyroid Assessment

  • Ensure trachea is midline; palpate for any shifts and assess:

    • Thyroid for enlargement, consistency, and presence of nodules.

  • Auscultation of thyroid for bruit indicative of vascular abnormalities if enlarged.

Physical Changes in Aging Adults

  • Temporal arteries may become twisted and prominent with age.

  • Increased concave curve of the neck noticeable in older adults may point to kyphosis.

Thyroid Disorders: Clinical Manifestations

  • Graves Disease: Presentation involves goiter, eyelid retraction, exophthalmos.

  • Hypothyroidism: Symptoms include puffy facial features and coarse appearance.

Abnormal Facial Appearances Due to Chronic Illness

  • Acromegaly: Enlarged facial features indicative of hormone disorders.

  • Cushing Syndrome: Notable “moon-like” face appearance.

  • Bell’s Palsy: Resultant facial paralysis from lower motor neuron lesions.

  • Stroke: Leads to unexpected facial muscle paralysis from upper motor neuron lesions.

  • Parkinson Syndrome: Characterized by mask-like facial expression.

  • Cachectic Appearance: Presented through sunken eyes and hollow cheeks indicative of chronic wasting diseases.

Checklist for Head, Face, Neck, and Lymphatics Examination

  • Comprehensive assessment involving:

    • Skin inspection

    • Noting deformities

    • Facial movements

    • Neck position and gland assessment

    • Thyroid auscultation if enlarged.

Nose, Mouth, Throat Structure and Function

Nose

  • Functions include: air entry and sense of smell; composed of:

    • Bones, cartilage, and turbinates

    • Adenoids as lymphatic tissue.

Mouth

  • Primary roles involve:

    • Taste, mastication, and articulation of speech.

    • Structure encompasses hard and soft palates with vascular floor aiding sublingual absorption.

Salivary Glands

  • Positioned within the mouth to contribute to moisture, taste perception, and oral hygiene. Encompasses parotid, submandibular, and sublingual glands.

Throat (Oropharynx)

  • Critical for both respiratory and digestive systems and protective against infections through tonsils/adenoids.

Lifespan Considerations

  • Older Adults: Assessment needs to account for decreased salivary function, gustatory rhinitis, and oral health challenges often correlated with socioeconomic status.

  • Infants and Children: Developmental milestones for oral health are crucial; noting onset of salivation, tooth development, and dietary habits are necessary for efficient care.

Common Symptoms/Complaints in the Head, Neck, and Oral Regions

  • Include facial pain, headaches, sleep issues, dental pain, changes in taste, or nagging conditions like sore throats or nasal obstruction.

Subjective Data Collection Related to Nose, Mouth, and Throat

  • Detailed inquiries regarding discharge, trauma, allergies, and oral lesions. Assessment of risk factors and environmental exposures pertinent to health outcomes.

Objective Data Collection Techniques

  • Comprehensive physical examination applying:

    • Inspection techniques for external/internal nasal structures.

    • Throat evaluations for lesions or swelling indications.

Critical Thinking in Diagnostic Testing

  • Engagement with diagnostic resources to corroborate clinical findings; consider correlating lab results with clinical presentations to guide effective interventions and patient outcomes.