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361 Cards in this Set
- Front
- Back
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Biomedical “Medical” Model
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Assessment factors (signs & symptoms of disease)
Focus is the diagnosis & treatment of disease |
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Holistic Models (e.g., Nursing)
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Expanded focus: views the body, mind & spirit as interdependent & functioning as a
whole within the environment Individuals are considered active participants in their health care Assessment factors (expanded to include culture & values, family & social roles, self- care behaviors, environmental stress, developmental tasks, etc.) |
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Primary Prevention
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(promote optimum health prior to the onset of problems) – healthy diet,
exercise, immunization, etc. |
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Secondary Prevention
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(early identification & treatment of existing health problems) – PAP smear, mammogram, PPD, etc.
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Tertiary Prevention
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(rehabilitation & restoration of health) - cardiac rehab, etc.
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Assessment (collection of subjective and objective data)
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Starts with the first patient contact
Forms the data base (the foundation for making a diagnosis) |
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Subjective (statements)
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Symptoms
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Objective (observations)
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Signs-->
Inspection Palpation Percussion Auscultation Patient’s medical records |
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Medical Diagnosis
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Assessment data (used to diagnose disease)
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Nursing Diagnosis
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Assessment data (used to diagnose a patient’s response to actual or potential health problems) - pain, altered skin integrity, ineffective coping, etc.
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Complete data
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health history and physical examination (ex. 1rst appointment in primary care, hospital admission)
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Episodic data
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mini data base concerning one problem (ex. acute illness-- common cold)
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Folllow-up data
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to asses progress
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Emergency data
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rapid and focused data collection
ex. chest paint-- you would ask "do you have a history of heart problems, MI, etc)" |
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6 benefits of the Interview process
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subjective data collection, identify areas of concern and perceptions of health status, identifies person's problems and stregnths, establishes rapport and trust, provides a comfortable bride to physical examination, and an opportunity for edu.
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Interview "Purpose"
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clarify why the patient is there
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Interview "Time"
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set time limits in the beginning
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Interview "Presence of others"
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could be other care givers, family, friends, interpreter etc. can have a positive or negative effect
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Interview "Confidentiality"
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avoid convos in public areas, don't discuss patients with friends or family, don't use their name, build pt trust!
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Verbal Communication
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Verbal (tone, words, speed, vocalizations, what you don't say)
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Nonverbal Communication
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(posture, gestures, facial expression, eye contact, body position, location in the room) - sometimes conveys more than verbal communication (SMILE)
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3 things to keep in mind while communicating with a patient
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The emotional impact of illness can affect interpretation of messages, May not be able to process information, Patient teaching may have minimal impact in hospital setting (best to give written instructions)
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Internal factors which affect the interview
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Acceptance of others (Tolerance for weaknesses, Convey warmth, caring & acceptance, Respect for other's health care decisions (may be different from yours),Empathy (to convey understanding for how the patient feels), Active listening (give the patient full attention)
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External factors which affect the interview
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Environment [Attempt to achieve a comfortable setting (temperature, lighting, noise reduction, etc.), Control interruptions, Sit 4-5 ft from patient & slightly to the side (allows patient to avoid eye contact if desired by looking straight ahead), Avoid standing (implies haste & superiority) , Professional Dress (e.g., good hygiene, keeping clothes & shoes neat & clean, & wearing a name tag), Ensure physical or psychological privacy (private room or pull curtain)
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5 challenges of note taking
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Impedes eye contact, Attention shifting, Interrupts patient’s narrative flow, Impedes observation of nonverbal behavior, Can be threatening
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Beginning the Interview- 2 steps
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1. Introduction (Always introduce yourself & your title) – explain your role 2. Address patient by surname (Mr./Mrs./Ms.) - unless permission given to use 1st name
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Open ended questions
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Requires narrative responses, Used to begin interview, Allows for description, leads to more info (e.g., "Tell me about your pain")
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Closed ended questions
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Requires 1-2 word answers or yes/no responses, Used to fill in omitted info or to get specific facts, Ask only one question at a time
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Facilitation
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(encourages patient to say more) - "uh huh" or "go on"
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Silence
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gives the patient time to think, helps him/her focus)
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Reflection
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echoes the response; helps patient elaborate) - …you're telling me that it hurts when
you cough |
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Empathy
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(shows understanding & acceptance) - "I can understand why your test results would upset you"
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Clarification
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(describe what you mean by "upset stomach")
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Confrontation
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(use this technique if the history is inconsistent, Inconsistency may occur in one visit or over time
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Interpretation
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(links events & associations; your impression of what patient has said) – "It seems as though every time you have a deadline to meet at work, you develop stomach pain"
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Explanation
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providing objective info
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Summary
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(final review of what the patient has said; surveys what we perceive the health problems/concerns to be)
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Traps to avoid
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providing false assurance, giving advise for pt decision making, using authority, avoiding difficult topics, engaging in distancing, using professional jargon, using leading or biased questions, talking too much, interruptin, asking why questions
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Close the interview with what?
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an open ended question
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4 to 12 feet
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social distance-- interview range
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1.5 to 4 feet
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personal distance-- distance for most physical assessment
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0 to 1.5 feet
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some physical assessment
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Inspection
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a general observation of the patients body and then at specified body systems, assess symmetry and using senses
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Palpation
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touching the patient to feel for skin texture, swelling, pulses, or lumps. assess the MCP for vibration, light (1cm) followed by deeper palpation
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bimanual palpation
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using both hands to assess an organ
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MCP
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metacarpo-phalangeal joints or ulnar surface of hands
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What part of the skin is best for assessing the temperature of a pt
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the back of the hand!
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percussion
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yielding a palpable vibration in assessment
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changes in percussion to note include
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location and size of organ, density (air fluid or solid mass) and superficial masses less than 5cm
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if percussion induces pain it indicates
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inflammation is present
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direct percussion
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striking the body directly (ex. tapping sinuses in an adult)
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indirect percussion
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2 handed technique
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upon indirect percussion of the DIP joint you hear a resonant sound
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normal lungs
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upon indirect percussion of the DIP joint you hear a hyperresonant sound
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indication of hyperinflated alveoli could be COPD
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upon indirect percussion findings tympany
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an air filled organ such as a tummy or intestine
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upon indirect percussion you find it to be dull
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a dense organ
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upon indirect percussion: flat
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muscle, bone, or tumor
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CVAT
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costovertebral angle tenderness
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DTR
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use a reflex hammer for this. Deep Tendon Reflexes
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Auscultation
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listening with a sthethoscope
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For low pitch sounds we use the _____ of the stethoscope
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bell
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for high pitch sounds we use the ______ of the stethoscope
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diaphragm
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well profused
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normal color of the skin indicating good circulation
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cachectic
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thin wasted appearance
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atrophy
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shrunken muscle
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hypertrophy
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increased muscle size
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edema
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swelling (fluid in the tissues)
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gait
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the patients walk
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ROM
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range of motion is full or limted
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serial weights
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weights taken daily or evvery week on a timely manner
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how much weight would one have to gain each week for it to be a sign of heart failure
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2-3 pounds
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hypothyroidism
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slows metabolism - is almost never the reason people gain weight but it is a possibility
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malignancy
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a rapid growing tumor can caused increased metabolism leading to weight loss
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febrile
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high temperature
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afebrile
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normal temp
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diurnal cycle
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the cycle our body temperature goes through everyday
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the change in temp seen because of the diurnal cycle
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1-1.5 degrees farhenheit
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when does the peak of our diurnal cycle occur?
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4pm
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when does the trough or low of our diurnal cycle occur
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4am
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how much can one's menstrual cycle change one's temperature
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may drop by .5-1 degree F
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when does the change in temp caused by the menstrual cycle start and end. why does this happen?
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it starts midcycle at ovulation and ends at the end of menses. happens because of progesterone secretion
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under what age do children have a very high temperature (103-105) with common colds
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8 years old
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why might an older adult have a normal temperature even when they are sick?
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they are prone to hypothermia
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typical temperature and range for oral temperature in F and C
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F- 98.6 (96.4-99.1)
C- 37 (35.8-37.3) |
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RECTAL temperature should be how much higher than the normal range of ORAL
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1 F and .5 C higher
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TYMPANIC temperature should be how much higher than the normal range of ORAL
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1 F and .5 C higher
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ALILLARY temperature should be how much LOWER than the normal range of ORAL
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1 F and .5 C lower
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at what age do we begin taking children's temp orally
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5-6 yo
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Fever is GENERALLY defined as a temperature above
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101-101.5 F and 38-38.5 C
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Where does one place the blue tip probe of an oral thermometer?
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at the base of the tongue the sublingual pocket
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How long do you have to wait to take temp orally after pt has had hot or cold liquids?
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15 min
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How long do you have to wait to take temp orally after pt has smoked?
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2 min
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what type of probe do you use for axillary and rectal temp
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red tip
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how far do you insert a rectal thermometer?
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1 inch
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when is tympanic temperature unreliable?
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if pt has an ear infection or another local infection such as a tooth ache
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if pulse is regular how long should you count it for?
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30s and multiply by 2
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if pulse is irregular how long should you count for?
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60 seconds
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sinus arrhythmia
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pulse increases with inspiration and decreases with expiration (common in children and young adults)
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at what age can we being to take children's pulse radially rather than apically
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2 yo
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normal rate bpm
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60-100bpm
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bradycardia
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<60bpm
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tachycardia
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>100 bpm
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pulse deficit
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difference between apical and radial pulse . should be 0
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cardiac arrhythmia
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irregular heartbeat
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a 4+ in pulse strength
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bounding
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a 3+ in pulse strength
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full (normal in exercise)
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a 2+ in pulse strength
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normal
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a 1+ in pulse strength
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weak, thready
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a 0 in pulse strength
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absent
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normal adult respiration rate
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10-20/min
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bradypnea
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<10 breaths per minute
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tachypnea
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>20 breaths per minute
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breath is easily seen in what area for women
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thoracic or chest
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breath is easily seen in what area for children and men
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abdominal
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systolic BP
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maximum pressure exerted on arterial walls during ventricular conraction
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diastolic BP
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resting pressure between contractions
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pulse pressure
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difference between systolic and diastolic BP
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blood viscosity
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increased pressure with thicker blood
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peripheral vascular resistance (PVR)
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increased pressure is generated to pump against constricted blood vessels
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sympathetic nervous system stimulation (4 steps)
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stress-->stimulates SNS --> vasoconstriction --> increases BP
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elasticity of vessel walls affects BP how?
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with stiffer vessels such as in arteriosclerosis BP goes up
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normal BP range
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systolic <120
diastolic <80 |
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prehypertension
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S 120-139
D 80-89 |
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hypertension
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S >140
D >90 |
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before hypertension is Dx how many times must it be documented?
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2x
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once hypertension is Dx does it ever go away?
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no, it is controlled
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goal BP for diabetics
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<130/80
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at what point in life does a women's BP become equated with a male's tendency to have high BP
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after menopause
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which race is at the highest risk for hypertension
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african americans
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because of our diurnal rhythm when is BP lowest and highest
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highest in late afternoon
lowest in the morning |
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after someone smokes how long should you wait to take their BP?
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30 min
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what meds affect BP
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NSAIDS and decongestants
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if BP differs in arms which reading do you use?
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the highest one
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how long should you wait before repeating taking BP
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15seconds
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auscultatory gap-- how can it be prevented
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if present there can be a long silence between 1rst and 2nd heart sound. by pumping the cuff up high enough(+30)
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paradoxical pulse
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the difference in Systolic BP between inspiration is greater then 10mm Hg indicating serious conditions
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normal difference between SBP between inspiration and expiration
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5 mm Hg
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orthostatic (postural) hypotension
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a significant drop in BP that occurs when changing positions
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name 3 things that cause orthostatic (postural) hypotension
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meds, bed rest, and dehydration
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hypovolemia
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dehydration
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Health history is completely
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subjective
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3 purposes for Health history
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establish subjective data base, help develop problem list, help establish a diagnosis
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Biographical data- source of info.
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who provided info?
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Biographical data- reliability of info.
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was the pt or provider consistent?
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T or F : reason for seeking care or CC may focus on illness
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T
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2 aspects of "reason for seeking care" statement
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problem and duration
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Present health status- for a well pt requires...
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very short statement f general health
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Present health status- for an ill patient requires...
+name 2 systems of doing so |
a symptom analysis and description of the characteristics is needed
1. PQRSTU 2. OLD CART |
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Present health status includes what that is personal to the patient?
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their understanding of their present state of health
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4 Qs to ask when asses the past history of a present health issue in symptom analysis
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1. have you had the symptoms before?
2. did you find out what was wrong? 3. what diagnostic tests were done? results? 4. how were you treated? was it effective? |
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OLD CART
O |
Onset: date/time, sudden/gradual, predisposing factors (ex. exposure to sick ppl)
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OLD CART
L |
Location: point with 1 finger, where does pain radiate if it does?
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OLD CART
D |
Duration: how long does it last? frequency? constant/intermittent? if intermittent does it subside completely in between on periods?
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OLD CART
C |
Character: quality (ex. sharp, dull, throbbing, black, tar-like stools), quantity/severity - quantify whenever possible (ex. blood: saturated 2 pads/hr or pain: scale 0-10)-- ask regarding ability to ADLs, and patient description: (ex. "this is the worst headache i've ever had")
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OLD CART
A |
Aggravating Factors/Associated Factors:
Aggrav. F - what makes pain worse? Assoc. F- what other symptoms arise when the main problem occurs, secondary symptoms |
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OLD CART
R |
Relieving Factors: what makes the symptom (s) better?
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OLD CART
T |
Treatment: what has the Pt tried, what was the effect?
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What percent of all illnesses are treated first with self care before seeing a health care provider?
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70-90%
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Past History- Childhood illnesses
What do we "list"? Examples |
List" the illness & date [or age] of occurrence; additional details should be identified in the Review of Systems
Examples:measles (rubeola), mumps, rubella (German measles), diptheria, pertussis (whooping cough), polio, rheumatic fever, scarlet fever, varicella (chicken pox) |
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Past History- Serious or Chronic illness
What do we "list"? |
"List" the illness & date [or age] of occurrence; additional details should be identified in the Review of Systems)
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Past Health History: Hospitalizations.. Identify: (5)
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Identify the cause, date, name of hospital, treatment & length of hospitalization)
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Past Health History:
Accidents/Injuries ... Identify (3) Examples. |
identify: Dates, nature of event & resulting disability
examples: burns, fractures, lacerations, loss of consciousness, penetrating wounds |
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Past Health History: Operations
list: |
List procedure, indication for procedure (if unclear), date [or age], sequela
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Gravida
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number of pregnancies
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Para
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carrying a pregnancy to a 500 g weight or 20 weeks gestations, regardless of survival
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Still birth
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loss of baby after 20 wks gestation
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SAB
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spontaneous abortion- miscarriage
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TAB
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therapeutic AB, induced
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Multiple births (twins, triplets) are counted as how many paras
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1
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Deliveries
list : (6) |
date, type of delivery, sex, birth weight, condition of infant, and complications
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Past Health History: Immunizations
List: |
List all dates (if known) or year of last immunization & adverse reactions.
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Immunization Info resource
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CDC National Immunizations Program Web Site
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Ask adults about these immunizations (6)
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Tetanus(once q10yr), Tdap (given once to adults <65), MMR(measels, mumps, rubella), Hep B (if at risk), Flu shot (good for everyone), and Zostayax (single does for herpes zoster prophylaxis fpr >60 yo)
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Health care worker immunizations
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Hep B, Flu, MMR< varicella (if not immune)
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Hep B series
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today, in 1 month, in 6 months
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Hep A series
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2 injections given 6 months apart
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What is recommended for children?
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Hep A 12-23 months
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Twinrix
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combo of Hep A and Hep B vaccines
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Gardisil
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available to young men and women, protects against viral strains of HPV that lead to genital warts and cervical cancer
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Meningococcal
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for college freshmen in dorm ors military recruits
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pneumococcal polysaccharide vaccine
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age 65+ or other high risk individuals
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for screening tests identify 2 things:
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date given and result
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Immunity blood tests (5)
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measles, mumps, rubella, varicella, Hepatitis
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Infection blood tests (3)
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HCV , RPR, HIV
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Until what year was lead found in paint?
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1978
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From what countries was lead most commonly used in ceramics?
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Mexico, China, Hong Kong, India, Italy
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Lead poisons what cells? and what does it cause in children
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poisons RBCs, interfering with iron uptake leading to anemia and sometimes mental retardation
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TB surveillance- Skin test
PPD |
purified protein derivative
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A positive PPD indicates...
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a TB infection but does not differentiate between active and inactive TB. CXR required
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Inactive TB
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latent TB infection (LTBI)
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Health care maintenance
(9 common exams to ask about) |
list dates and results of the following: eye exam, hearing test, dental exam, mammogram, CXR, ECG, lipid panel, physical exam, PAP, and others
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Allergies and reactions include: (6)
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meds, vaccines, foods, animals/insects, seasonal, and occupational
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NKA
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no known allergies
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NKDA
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no known drug allergies
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Current meds includes: (5)
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Prescription, OTC, herbal, vitamins, calcium
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Current meds list:
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Drug name, dose, route, route, frequency, rationale & duration of use
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at what age must one achieve peak bone mass by in order to decrease the risk of osteoporosis?
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25
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how many teen girls are getting enough Ca?
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1 in 10
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Ca needs for 4-8 yo
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800mg/day
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Ca needs for 11-24 yo
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1200-1500 mg/day
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Ca for >25yo
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1000mg.day
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Ca for postmenopausal women and men over 65
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1500mg/day
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how much vit D should one take to inc. Ca absorption
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400 IU
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Genogram
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used to map out family history
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Habits include : (5)
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tobacco, alcohol, drug abuse, sleep, exercise
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Pack year history
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ppd x number of years smoked
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Housing and Living Situation
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household members, relationships, marital history, children, quality of family relationships, domestic violence, support systems
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Occupational history
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list jobs had in past 5 years, current job satisfaction, job stress (physical and mental), number of hrs/wk
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how much Ca can be absorbed at a time
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500mg
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Economic status
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financial concerts, use of social services
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ROS
includes: |
overall health, skin, hair , anils, head and neck ,eyes, ears, nose, sinuses, mouth, throat, breast, lungs, thorax, breast, heart and peripheral vascular, gastrointestinal, urinary, musculoskeletal, neurologic, psychological, endocrine, hematologic, female, male, sexual health
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Problem list : (3 types of problems)
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past resolved
chronic unresolved acute problems (current and lasting less than 6 wks) |
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Risk Assessment : potential or high risk problems
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consider family history, risk factors, health beahaviors
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Child Health history differences from adult
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specified for age of cild, specified for developmental stage, mostly obtained from parent, parental concerns, prenatal data (mother's health), parent's coping ability, genetic predispositions, developmental tasks, developmental milestones, birthmarks, ability to see blackboard, immunizations on schedule?, congenital heart problems
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Social drinker
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get more details! this is not an accurate measure, how often are they "social drinking"?
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Between which two ages can we start using the adult health history format and the parent does not need to present?
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12-14yo
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Older adult health history differences
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may underestimate their symptoms, polypharmacy (usually on a lot of meds- do they have bad interactions?) , ROS include Qs about things related to age such as dentures, dry skin, or appetite changes, and Functional assessment
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Function assessment
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measure patient's self-care ability and ability to live independently
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Cultural considerations
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Some cultures think all you need is a good appetite and a feeling of being strong to be in good health and may be opposed to requesting meds
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mental status
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cognitive and emotional functioning
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mental health
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how well one functions in all situations, through out both good and bad days
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stressors
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may cause emotional-cognitive trauma and transient dysfunction
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mental status exam
• General Appearance |
(e.g., motor functioning such as tremors, twitching, excessive movement,
ability to sit still; degree of eye contact) |
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Obtunded
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• Sleeps continuously, difficult to arouse
• Arouses by shouting or vigorous shaking • Requires constant stimulation • Converses in monosyllables & mumbles |
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Stupor or Semi-coma
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Unconscious
• Responds only to vigorous shaking or pain • Withdraws from pain • Cannot converse; may groan or mumble |
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Coma
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Unconscious & unresponsive to pain
• Light coma (may have reflexes) • Deep coma (no motor response) |
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euthymic
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normal
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dysthymic
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chronic depressed mood
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Affect (objective)
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appropriate
• flat (no change in facial expression) • labile (extreme swings or over reaction) |
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delusion
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false belief that appears real
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paranoia
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persecutory associated with feelings of being treated wrongly
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oriented x3
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person place and time
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oreinted x4
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person place time preceding event
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psychotic disorder
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problems with thought processes
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cognitive disorder
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problems with cognition
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field of knowledge
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do they know who the president is? world events ?
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significant positives
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These are the signs and symptoms that are present
• Record these first |
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significant negatives
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These are the signs and symptoms that are NOT present
• Record these after documenting the significant positives |
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Epidermis
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outer layer
avascular (a superficial epidermal cut won’t bleed) |
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Dermis
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inner layer
contains nerves, sensory receptors, blood vessels, lymphatics |
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Eccrine Glands
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Produces sweat/perspiration (saline)
• Matures at 2 months of age (infants start to perspire) |
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Apocrine Glands (open into hair follicles)
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Activated during puberty
• Secrete fluid in response to emotional stimuli & heat • Decomposition of apocrine sweat produces body odor (action of bacteria on fluid) • Located in axillae, nipples, areolae, anogenital area, eyelids & external ears • Secretion decreases with aging |
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Sebaceous Glands
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Secretes sebum (oil) that lubricates skin & nails
• oil secretion → leads to soft & supple skin • decreased oil secretion → leads to dry skin & wrinkles • Concentrated in scalp & face (absent on palms & soles)• Some conditions in adult & child are r/t overproduction of sebum (cradle cap,acne, seborrheic dermatitis) |
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Vellus hair
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Fine, soft, non pigmented
• Covers body (except palms & soles, umbilicus, glans penis, inside labia) |
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terminal hair
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Course, thick, pigmented (scalp, eyebrows, eyelashes, axillae, pubic [&
face/chest in males]) |
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skin vitamin D production
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compounds are converted into Vitamin D when ultraviolet light comes
into contact with skin surface; Vitamin D is necessary for the absorption of calcium • the use of sunscreen may interfere with the production of Vitamin D |
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• Xerosis
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(excessive dryness) – seen in the elderly
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• Seborrhea
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(AKA dandruff) - oily flakes of skin
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dysplastic mole
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a change which may indicate a precancer or cancerous condition)
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Pruritus
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(itching) - common with age (d/t xerosis) or kidney/liver disease (d/t
decreased metabolism & excretion of waste) |
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Excessive bruising
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(abuse, clotting disorder, falls [e.g., arrhythmia, neurologic disorders, ETOH)
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Alopecia
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(diffuse, patchy or total hair loss) - chemotherapy, familial, trauma/burns & stress
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Trichotillomania
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(pulling out hair)
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Hirsutism
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(excess terminal hair growth from increased androgen production by adrenal glands)
• most obvious on face in women but can affect entire body |
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intertriginous areas
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skin folds – e.g., under
breasts for fungus) & feet (particularly in diabetics) |
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Vitiligo:
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absence of melanin pigment in patchy areas (more common in dark skinned)
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ephelides
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freckles
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Pigmented nevi
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moles
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Pallor
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white or lighter coloration; ashen gray with brown/black skin )
• Anxiety/fear (vasoconstriction 2o to SNS stimulation) • Cold/cigarette smoking (peripheral vasoconstriction) • Shock (shunting blood from periphery to major organs) • Arterial insufficiency/anemia (decreased blood supply to PV system) |
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Erythema
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(red) “flushed appearance”
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Hyperemia
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excess blood) of superficial capillaries r/t:
• fever |
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cellulitis
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entry point of infection can not always be identified• cellulitis of an extremity (e.g., leg) – rest the extremity
because movement drives the infection deeper into the tissues. |
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Polycythemia
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increased RBCs
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Cyanosis
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(bluish, grayish): due to decreased perfusion of tissues (tissue hypoxia)
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Central cyanosis
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5 gm unoxygenated hgb 2o to cardio-pulmonary problems
(inspect lips, tongue, oral mucosa) |
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Peripheral cyanosis
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d/t vasoconstriction (e.g., exposure to cold) – inspect
nailbeds, extremities) |
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Jaundice (
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yellow, icteric
result of increase bilirubin the blood and skin |
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Bilirubin
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by product of RBC breakdown & is normally excreted through the
GI tract. |
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causes of jaundice
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biliary obstruction in GI tract, liver disease, immature liver
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sites of jaundice
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in junctions of hard and soft pallets, skin, and sclera
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Diaphoresis
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profuse sweating
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Corns vs. calluses
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calluses and corns are both thick areas of skin but corns have an inner core
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arterial insufficiency
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thin, colorless, hairless skin
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turgor
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pinch skin on anterior chest (below clavicle), test how quickly is snaps back
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Cherry angiomas
-appearance - location |
tiny blood blister
*genetic • bright red papular lesion, 1-5 mm • located on trunk, upper chest, extremities • normally increases with age |
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Telangiectases
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dilated superficial blood vessels
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spider angioma
-what is it? (from what color to what color) -location -associated with what disease? |
-central arteriole (fiery red) with capillary radiations; blanches (turns white) with pressure
-located on face, neck, arms, upper trunk; usually not below waist -associated with liver disease (d/t decrease metabolism of hormones resulting in estrogen excess) – a few may be normal |
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Venous star
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bluish spider angioma; non blanching with pressure
- associated with increased venous pressure (seen with varicose veins) - primarily located on legs |
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Petechiae
-size, color -resulting from -caused by |
-1 - 3 mm, deep red, rounded
- results from superficial capillary bleeding - caused by bacteremia, bleeding disorders (thrombocytopenia) – decreased platelets |
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Purpura
-what is it -color |
-extensive confluent patch of petechiae
-reddish purple, irregular (senile purpura r/t thinning skin) |
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Ecchymosis
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a typical bruise
-larger patch of capillary bleeding -r/t trauma, bleeding disorders or liver dysfunction -Purple/purplish-blue fading to green, yellow, brown over time |
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Hematoma
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subcutaneous nodule (raised bruise)
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Pattern Injuries
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suspect abuse (scalding, belt strap/buckle, cigarette burns, etc.)
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Flat Lesions
primary or secondary? MACULE |
flat, circumscribed, discolored, <1 cm (freckles, solar lentigens “liver spots”, flat nevi, petechia)
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Flat Lesions
primary or secondary? PATCH |
flat, irregular, >1 cm (vitiligo)
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Raised lesions
Papule |
solid, elevated, circumscribed, <1cm, raised nervus, wart verrucal
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Raised lesions
Plaques |
coalesced papules , >1cm psoriasis
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Raised lesions
Nodule |
solid, elevated, 1-2cm
lipoma= fatty growth |
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Raised lesions
Tumor |
larger than a few cm, firm or soft (lipoma)
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Raised lesions
Wheal |
superficial, raised, erthemoatous, irregular (alleric reaction, PPD, mosquito bit) cause interstital edema
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Raised lesions
Urticaria |
hives, wheals coalesce to form extensive reation, intensely pruitic
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Fluid Filled (raised)
Vesicle |
elevated cavity with clear fluid, <1 cm (herpes, simplex, chicken pox, shingles, contact dermatitis (poison ivy)
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Fluid Filled (raised)
Bulla |
elevated cavity with fluid, >1cm blister, burns
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Fluid Filled (raised)
Pustule |
contains pus; filled with leukocytes, not necessarily infected (acne)
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Fluid Filled (raised)
Cyst |
encapsulated fluid filled cavity in dermis or sub-q (sebaceous cyst) if deep, may be hard to differentiate from a nodule or a tumor (breast cyst vs tumor)
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Secondary lesion
Crust |
thickened dried exudate (dried serum/blood/pus) on top of 1o lesion (AKA scab)
• rupture of herpes vesicle results in crust with erythematous base • impetigo (staph & strep) |
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Secondary Lesion
Scale |
compact flakes of skin (psoriasis [white-silvery], seborrheic dermatitis [yellow-greasy],
seborrhea (dandruff) |
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Secondary Lesion
Fissure |
linear crack (cheilosis [corners of mouth], callused heels, tinea pedis [athletes foot] –
between toes,) |
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Secondary Lesion
Erosion |
shallow depression, moist, no bleeding (affects epidermis; e.g., varicella after rupture)
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Secondary Lesion
Ulcer |
deep depression into dermis; leaves scar
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Secondary Lesion
Excoriation |
superficial abrasion (dermatisis- red, open sores
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Secondary Lesion
Scar |
connective tissue replacing normal tissue
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Atrophic scar
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depressed scar-- stretch marks
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Hypertrophic scar
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excess scar tissue secondary to increased collagen formation (keloid)
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Lichenification
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thickening of skin (eczema [atopic dermatitis] chronic sun exposure
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Configurations
annular |
ring; clear center ,(tinea corporus [ring worm], pityriasis rosea)
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Configurations
semiannular |
1/2 ring
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Configurations
Discrete |
isolated
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Configurations
Confluent |
lesions run together (urticaria)
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Configurations
Grouped |
clusters of lesions
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Configurations
Gyrate |
coiled, spiral, snake lake
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Configurations
Iris or target |
solid center
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Configurations
linear |
scratch
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Configurations
Webb |
like/lace pattern mottled appearance
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Configurations
Zosteriform |
linear vesicles along a nerve route s/p Shingles (herpes zoster)
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Zostavax
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a vaccine for the prevention of shingles, recommended for persons > 60 yo
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When you shine a Wood's light on the skin and you see coral red color , it's what kind of infection
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bacterial
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When you shine a Wood's light on the skin and you see blue/green color , its what kind of infection
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fungal
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KOH
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potassium hydroxide- used to distinguish fungal infections
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tinea corporis
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ringworm
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tinea cruris
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jock itch - often spread from feet
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tinea pedis
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athletes foot
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tinea capitus
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fungal scalp infection
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Zostavax
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a vaccine for the prevention of shingles, recommended for persons > 60 yo
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Maligant Melanoma
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a highly metastatic cancer that grows deep, not wide. 1/2 of cases aris from pre-existing nevi. people with fair skin and lots of sun exposure are at risk. A- asymmetry, B- border irregular, C - color varies with lesion-- tan, brown black, red white and blue , D- diameter >6mm
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When you shine a Wood's light on the skin and you see coral red color , it's what kind of infection
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bacterial
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When you shine a Wood's light on the skin and you see blue/green color , its what kind of infection
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fungal
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Basal Cell CA (BCC)
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the most common type of skin CA and grows slowly, seldom metastasizes. usually appears on face (fair skin >40yo). usually starts as a skin colored papule, nodule with overlying telangiectasia, and may develop a depressed center
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KOH
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potassium hydroxide- used to distinguish fungal infections
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tinea corporis
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ringworm
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tinea cruris
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jock itch - often spread from feet
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tinea pedis
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athletes foot
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tinea capitus
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fungal scalp infection
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Maligant Melanoma
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a highly metastatic cancer that grows deep, not wide. 1/2 of cases aris from pre-existing nevi. people with fair skin and lots of sun exposure are at risk. A- asymmetry, B- border irregular, C - color varies with lesion-- tan, brown black, red white and blue , D- diameter >6mm
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Basal Cell CA (BCC)
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the most common type of skin CA and grows slowly, seldom metastasizes. usually appears on face (fair skin >40yo). usually starts as a skin colored papule, nodule with overlying telangiectasia, and may develop a depressed center
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Squamous Cell CA SCC
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a skin cancer that grows rapidly, usually appears on hands or head (sun exposed areas, usually >60 yo). erythematous scaly patch, 1 cm or more. develops central ulcer
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actinic keratosis
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pink, scaly papules, may be a precursor to SCC
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Vernix caseos
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thick cheesy substance consisting of sebum and shed epithelia cells , present at birth
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striae
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stretch marks
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solar lentigines
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flat, brown macules - liver spots
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seborrheic keratosis
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raised, crusty, irreg. lesion, "stuck on" appearance, sometimes waxy; non cancerous; located on trunk, face, hands (genetic)
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xerosis
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r/t to decreased sweat & sebacceous glands) - increased risk of heat stroke
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skin tags
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overgrowths of normal skin; not significant
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senile purpura
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superficial hemmorrhages with minor trauma (r/t increased vascular fragility )- increased incidence with sun damaged skin
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shearing/tearing injuries
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r/t loss of collagen in dermis
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sagging skin
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loss of elasticity
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leukonychia striata
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what hairline markings on nails from trauma or picking at cuticle
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normal nail angle
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<160 degrees
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clubbing
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nail angle straightens out to >180 degrees and nail bed becomes spongy
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melanoma appearance in nails
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brown linear streaks in whites
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splinter hemorrhages
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4-5 reddish brown streaks/nail (bacterial endocarditis , trauma)
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Koilonychia
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spoon nails/concave iron deficiency anemia
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Paronychia
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inflammation/infection of skin around nail bed
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Onycholysis
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loosening of nail plat (fungal infections)
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Pitting (nail)
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psoriasis
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subungual hematoma
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bleeding under nail plat, painful
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habit-tic deformity
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picking nail with index finger
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capillary refill
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< 2 sex (>2 sec= altered peripheral circulation)
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subungual hematoma
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bleeding under nail plat, painful
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habit-tic deformity
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picking nail with index finger
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capillary refill
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< 2 sex (>2 sec= altered peripheral circulation)
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