Health Assessment Exam 1 Chunk 3

Front 1

Skin color vs. skin pigmentation

Back 1

-skin color: consistent with genetic background
-pigmentation: color of the person's skin

Front 2

Equipment needed for exam

Back 2

strong direct lighting, small centimeter ruler, penlight, gloves

Front 3

Inspect the skin. Abnormal color changes.
-pallor
-erythemia
-cyanosis
-jaundice
-mottling

Back 3

-pallor: paleness (vasoconstriction)
-erythemia: bright, dark, red (vasodilation)
-cyanosis: bluish, mottled, usually around the mouth first, lower perfusion, sigh of heart failure/shock
-jaundice: yellowish, occurs in the hard/soft palate of mouth first
-mottling: patchwork of grey/blue on skin, occurs towards death, usually in the extremities first
-hypo-hyperpigmentation: hypo: white, less pigmentation
hyper: more pigmentation, freckles

Front 4

Palpate the skin. Grading for edema.
1+
2+
3+
4+

Back 4

1+ slight indentation, 2mm, normal contours, associated with interstitial fluid volume 30% above normal
2+ deeper pit after pressing, 4mm, lasts longer than 1+, fairly normal contour
3+ deep pit, 6mm, remains several seconds after pressing, skin swelling obvious by general inspection
4+ deep pit, 8mm, remains for a prolonged time after pressing, possible minutes, Frank swelling

Front 5

Brawny edema

Back 5

fluid can no longer be displaced secondary to excessive interstitial fluid-membrane, no pitting, tissue palpates as firm or hard, skin surface shiny, warm, moist

Front 6

Lesions
-confluent
-discrete
-annular
-grouped
-gyrated
-target
-linear
-polycylic
-zosteriform

Back 6

-confluent: lesions run together
-discrete: individual, remain separate
-annular: only 1, circular, develop at center and spread out
-grouped: clusters that don't run together
-gyrated: snake like
-target: target in the middle and spread out
-linear: straight line
-polycylic: annular lesions group together
-zosteriform: linear arrangement of lesions that run along a nerve path

Front 7

Primary lesions:

Back 7

primary lesions: from trauma, lesion that wasn't there before, on previously unaltered skin

Front 8

Primary lesions
-macule
-papule
-mongolian spot, freckle, cafe au lait spot
-nodule
-wheal
-vesicle
-cyst
-pustule

Back 8

-macule: <1cm, flat, hypopigmentation, freckle, small, patch=a lot of macules that run together
-papule: elevated, sharply circumscribed, <1 cm, pink/tan, mole, colored
-mongolian spot, freckly, cafe au lait spot
-nodule: solid, elevated, hard or soft, extends into dermis, benign or malignant
-wheal: superficial, raised, mosquito bit, red, slightly irregular shape, itchy
-vesicle: thin wall, bulging, <1cm, sharply defined, clear free fluid that comes out, seen in groups like Herpes (>1 cm=bulla)
-cyst: encapsulated, goes into dermis, shiny skin, dermal involvement
-pustule: puss-filled, doesn't go deep in dermis, elevated, pimple, circumscribed

Front 9

Secondary lesions:

Back 9

lesions that change over time due to an outlying factor (scar)

Front 10

Secondary lesions
-crust
-scale
-fissure
-erosion
-ulcer
-excoriation
-scar
-atrophic scar
-keloid
-lichenification

Back 10

-crust: thin or dried out exudates, scabs, color varies (depends on fluid)
-scale: compact, dry/greasy, cradle cap, flakes of skin
-fissure: break in surface of skin, linear, extends into dermis, crack in lips, dry
-erosion: scooped out shallow depression, heals without a scar
-ulcer: irregular in shape, could bleed, will leave a scar, bed sores, deep depression, extends into dermis
-excoriation: abrasion from friction, roadrash, no scarring
-scar: caused by repair of primary lesion, loss of normal tissue replaced by CT
-atrophic scar: depression of skin level with tissue loss, stretch marks (striae), loss of epidermis
-keloid: hypertrophic scar, elevated, excessive scar tissue, invasive, extends beyond injury site, smooth, claw-like
-lichenification: moss-like, skin thickens over, scaly

Front 11

Vascular lesions:

Back 11

no blood flow, will not blanch (due to no blood flow), refer to a blood source involvement to a lesion

Front 12

Vascular lesions
-petichia
-purpura
-telanglectasia
-strawyberry birth mark
-live spots

Back 12

-petichiae: small hemorrhage, bleeding from superficial capillaries
-purpura: group of petichiae
-telanglectasia: dilation of small vessels and capillaries cause flat, red marks to appear on the skin
-strawberry birthmark
-liver spots: normal due to aging, no treatment, sun exposure

Front 13

Stages of ecchymosis

1
2
3
4
5

Back 13

1. bright red
2. bluish purple
3. blue green
4. yellowish
5. starts to disappear( stage happens in 24 hours)

Front 14

Stages of ulcers

1
2
3
4

Back 14

1. skin isn't broken, red, no blanching, can intervene
2. broken skin, superficial skin loss, damage to epidermis, dermis involvement (aka erosion)
3. epidermis, dermis, subcutaneous tissue involved, skin scooped out, middle will be black and crater like
4. starting to see bone and CT, crater, other damage you can't see, tunneling-->damage under healthy skin (remember: black tissue (dead)=necrotic)

Front 15

Danger signs of lesions
ABCDE

Back 15

A-asymmetry
B-border irregularity
C-color variation
D-diameter, .6mm
E-elevation and enlargement

Front 16

Turgor:

Back 16

ability of skin to go back down after pinching (no tenting=good. tenting could indicate dehydration)

Front 17

Mobility:

Back 17

ability of skin to rise when pinched (pinch above clavicle)

Front 18

Braden scale

Back 18

Looks at skin integrity, higher number=more at risk for skin breakdown. skin assessment. looks at change of skin breakdown

Front 19

Inspect and palpate the hair and scalp
-hirutism
-vellus
-alopecia
-gray hair

Back 19

-hirsutism: increased body hair on females (indicates endocrine disorder)
-vellus: helps with body temp regulation (found in newborns, anorexia)
-alopecia: hair loss, baldness
-gray hair: caused by decrese in melanin production in follicles

Front 20

Inspect and palpate the nails of fingers and toes
-clubbing

Back 20

-clubbing significance: could indicate a respiratory disorder. clubbing angle=180' or greater. normal angle=160'