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50 Cards in this Set
- Front
- Back
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When is a comprehensive assessment of the patient necessary?
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- new patients
- provides fundamental and personalized knowledge about the patient - strengthens the clinician-patient relationship - helps to identify and rule our physical causes related to patients concerns - provides baseline - provides platform for patient education - develops proficiency in the skills of physical examination |
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When is a focused assessment appropriate?
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- for established patients, especially during routine or urgent care visits
- addresses focused concerns or symptoms - assesses symptoms restricted to a certain body system - applies specific body system exam methods |
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What are the most important physical exam techniques?
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BP, assessment of central venous pressure from the jugular venous pulse, listening to the heart for valvular disease, breast exam, detection of hepatic or spleen enlargement, Pap smear
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What is subjective data?
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- what the patient tells you
- the history, from chief complaint through review of symptoms |
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What is objective data?
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What you detect during the examination
- all physical findings |
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What are the 7 components of Comprehensive Adult Health History
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- Identifying data and Source of the History
-Chief Complaint - Present Illness - Past History - Family History - Personal and Social History - Review of systems |
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What is identifying data?
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age, gender, occupation
Source of history -- usually the patient but can be a friend, family, or medical referral |
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Present Illness
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- amplifies chief complaint- explains how each symptom developed
- includes patients thoughts and feelings about the illness - pulls in relevant portions of ROS - may include meds, allergies, smoking/alchol |
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Review of Symptoms
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documents presence or absence of common symptoms related to each body system
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When describing the symptoms what is important to note?
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1) location
2) quality 3) quantity or severity 4) timing, including onset, duration, and frequency 5)setting in which it occurs 6) factors that aggravated or relieved the symptoms 7) associated manifestations |
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What are the functions of skin?
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1. Protection
2. Prevents penetration 3. Perception 4. Temperature regulation 5. Identification 6. Wound repair 7. Absorption and excretion 8. Synthesizes vitamin D |
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What are the layers of the skin?
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there are three layers of the skin
- epidermis, dermis, and subcutaneous tissue |
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Epidermis
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Avascular thin outermost layer
- it is nourished by blood vessels in the dermis Composed of two important strata: 1) The stratum corneum- dead keratinized cells that normally separate (Keratin) 2) The stratum Germinativum- basal cell layer is made up of rapidly proliferating living cells that slowly migrate upward, keratinize and are shed from the stratum corneum (4 week process) |
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Keratin
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Keratin- insoluble protein that provides the skin with its protective properties
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What are the two major cell types in the basal cell layer?
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Keratin-
Melanocytes |
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Melanocytes
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produce melanin- the number of melanocytes are roughly the same in all people -- what differs is the amount of melanin in the melanocytes
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What affects skin color?
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Skin is derived from 3 sources:
- the mainly brown pigment is melanin - the yellow orange pigment is carotene - the red purple tones come from the underlying vascular bed |
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Dermis
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makes up the bulk of the skin
- dense connective tissue - chiefly collagen and elastin - the nerves, lymphatics, blood vessels, and sensory receptors lay in the dermis - hair follicles- invaginations intot he dermis |
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Collagen
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tough fibrous protein that enables the skin to resist tearing
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Elastin
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a resilient tissue that allows the skin to stretch with movement
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What are appendages of the skin?
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Hair, nails, sweat and sebaceous glands
- the hair and nails are made of dead keratinized cells |
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Subcutaneous layer
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the 3rd layer mostly made of adipose tissue
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Adipose layer
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thermal regulator as well as a protection over bony prominences
- stores fat for energy |
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Sebaceous glands
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produces sebum- protective lipid substances -- oil and lubricates teh skin and hair and forms an emulsion with water that slows water loss from the skin
- they are everywhere except the palms and soles |
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Sweat glands
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Two kinds
Eccrine- open directly onto the skin surface and produce a dilute saline solution that we called sweat- widely distributed and mature by the time we are two months old Apocrine- found in close association with hair follices-- occur mostly in the axillae, areolae, the navel, the pubis, and the perineum and secrete a mily stick secretion into the hair follicles |
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What sweat gland is involved in BO?
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Apocrine- become active during puberty and sexual stimulation
- bacterial flora residing on teh skin reacts with apocrine sweat toe create BO |
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Subjective data- SKIN
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- previous history of skin disease
- change in pigmentation - change in mole - excessive dryness or moisture - pruritus - excessive bruising - rash or lesion - medications - hair loss - change in nails - environmental or occupational hazards - self care behaviors |
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What is the difference between skin of very young, older adult, and healthy adult skin?
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- skin in very young is unable to effectively prevent fluid loss or function in temp regulation
- the stratum corneum of older skin thins and flattens allowing chemicals easier access into the body |
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Why does wrinkling occur?
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- loss of elastin, collagen, and subcutaneous fat, as well as reduced muscle tone
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Physical Exam for skin
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Perparation- reduce external variable
Equipment needed- direct lighting, penlight, centimeter ruler, gloves for open For special procedures- Wood's light, magnifying glass, materials for lab tests |
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Examples of color affected by variables?
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Temporary pallor- fear, exam room is too cold
Temporary erythema- embarrassment, exam room too hot |
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What are some examples of widespread color change?
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pallor, erythema, cyanosis, jaundice, increased pigmentation
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Pallor
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when red pink tones from oxygenated hemoglobin is lost, the skin takes the color of the connective tissue which is mostly white
- in tan people the person will look more yellowish brown color or ashen - can be observed in mucous membranes, lips, and nail beds - common in anxiety, great from vasoconstriction - can be seen in anemia- check in palpebral conjuctiva and nail beds - fainted, poor areterial flow in the feet |
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Raynaud’s phenomenon
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skin color changes in response to cold temperature- primary raynaud's is when you see it in their hands
- secondary raynaud's phenomenon can be because of a connective tissue disease |
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Erythema
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intense redness of skin due to excess blood in superficial capillaries, expected with fever, or localized infection, or emotional
- occurs in carbon monoxide poisoning and venous stasis |
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Jaundice
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exhibited by yellow color, indicated a rise in bilirubin in the blood
- first noted in junction of hard and soft palate or in sclera - seen in severe mononucleosis hepatitis, cirrhosis, sickle celled anemia, newborns |
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Cyanosis
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bluish mottled color that signifies decreased perfusion of tissues with oxygenated blood
- Anemic person will not look cyanotic because there is no Hgb present - polyythemia (increased RBC) will look ruddy blue all the time - occurs with heart failure, shock, chronic bronchitis |
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Vitiligo
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decreased pigmentation
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Increased pigmentation
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- when we see it around the neck it is called nigricans-- indicative of diabetes
- we see it around the lips too |
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Mongolian spot
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- common variation of hyperpigmentation in black, asian, native american, and hispanic newborns
- blue black to purple macular area at the sarum or buttocks - fades during the 1st year of life - 90% of black, 80% of asians and native americans, and 9% of whites |
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Comedonal Acne
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- increase activity in sebaceous glands increased oiliness
- mild may have white and blackheads - severe has papules, pustules, and nodules |
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What happens to older adults skin?
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- more wrinkling
- senile purpura- bruising in old people - dry skin (xerosis)- changes in keratin and reduction in sweat and sebum - senile lentigines- small flat brown macules that are a cluster of melanocytes that appear after sun exposure - aged skin repairs itself more slowly and wound healing can be as 4x as long-- this contributes to infections and ulcers Keratoses and skin tags |
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Keratoses-
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raised, thickness areas of pigmentation- looks crusted, scaly and warty- sebhorrheic lookds dark, greasy and stuck on
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Skin tags (acrochordons)
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overgrowth of normal skin forms a stalk and polyplike (occurs on eyelids, cheeks, neck axillae, and trunk)
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Temperature of skin
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- check bilaterally with dorsa of hands
- skin should be warm and the temperature should be equal and bilateral - hands and feet might be slightly cooler |
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Moisture of skin
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- perspiration is normal on face, hands, axilla, and skinfolds
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Edema
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fluid in intercellular spaces and should not be present
4 is the worst - congestive heart failure, kidney and liver failure |
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What to check for on skin?
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color, temperature, moisture, texture, thickness, edema, mobility and turgor, any lesions
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Primary skin lesions diagnosis
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- distrubtion, localized, primary or secondary, color, sharpness of edges, surface contour, geometric shape
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PRimary skin lesions
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1) Macule
2) Patch 3) Papule 4) Plaque 5) Nodule 6) Tumor 7) Wheal 8) Urticaria 9) Vessicle 10) Bulla 11) Pustule 12) Cyst |
