NR 302 exam 2
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| major functions of skin | Protection
Prevents penetration
Perception-touch, pain, temp, pressure
Temp regulation
Self image
Communication-emotions
Wound repair-surface
Absorption/secreation
Production of vit d from cholesterol
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| Vellus versus terminal hair | Vellus-fine hair on most of body
Terminal-dark, thick scalp and eyebrows
After puberty- axilla, pubic, chest, face
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| Pediatric skin changes | -free of terminal hair only have lanugo(soft fine downy hair), no temp regulation,
vernix(thick cheesy covering)-helps with temp reg-milka- pimples from mom estrogen
-stork bites-head beating on opening in delivery-mongolian spots-bottom go away 1-2 yrs
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| pregnant skin changes | -Skin pigment increases--chloasma-raccoon face
-linea nigra-medial line down belly
-striae gravidarum-stretch marks
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| geriatric skin changes | tenting
-sebum decreases-dryness
-Sweat decreases-over heat easy
-Melanin decreases- grey hair
-sensitivity to light from subcu loss
-senile legtigines-liver spots
-cherry angiomas-small red moles
-seborrhes keratosis- looks like warts
skin tags-n
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| subjective data for past skin diseases | Allergies, hives, psoriasis-over production of skin cells triggered by stress, emotions, poor health,Eczema, birth marks, tattoos, piercings
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| generalized pigmentation | Pallor-pale
Jaundice-yellow
Cyanosis-blue
Erythema-red,
Change in nails
Sun exposure
Skin self-exam
ruddy/blue-(low O2, from bone marrow)
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| Moles need to know | size, shape, color change, sores not healing
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| Seborrhea is | a lot of moisture
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| xerosis | dryness
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| Pruritus | itching—mild-prickling, tingling or intolerable
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| OBJECTIVE SKIN DATA inspect/ palpate | color, eye, dark mucous membranes-liver problems, temp-warm, thickness uniform, edema, mobility, turgor, vascularity,
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| edema skin scale | 1+mild pitting 2mm
2+ moderate pitting 4mm
3+ deep pitting 6mm
4+ very deep pitting 8mm
Non-pitting-measuring tape
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| vascularity of skin | cherry angiomas-trunk after 30 yrs age
bruising- contusion, hemotoma
tattoos- educate for hep c
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| abnormal skin ABCDE criteria | A-asymmetry
B-border irregularity
C-color change
D-diameter greater then 6mm
E-evolving changes(size, shape, itching, tender, surface bleeding, shades of color
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| Primary lesions of macule | non palpable, smaller the 1cm, circular border
Ex.) ephilides(freckles), senile lentigines(liver spots)
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| Primary lesions of patch | larger than 1 cm, irregular border
Ex,) Mongolian spots, vitiligo, port-wine stain
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| Primary lesions of papule | raised, solid palpable masses, smaller than 0.5 cm, circular border
Ex.) mole, warts
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| Primary lesions of plague | larger than 0.5 cm, groups of papules that form lessions
Ex.) psoriasis, actinic keratosis
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| Primary lesions of Vesicle | smaller the 0.5 cm, fluid filled, round oval
Ex.)rash
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| Primary lesions of Bulla | larger than 0.5 cm, full of water no pus, round, oval
blister
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| Primary lesions of pustules | small, inflamed, pus-filled, blister-like lesions
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| Primary lesions of purpura | mucous membranes due to haemorrhage from small blood vessels
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| Primary lesions of cyst | fluid filld, semi-soild
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| Primary lesions of impetigo | crusty common skin infection caused by streptococcus (strep) or staphylococcus (staph)
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| Vascular lesions Venous lake | benign vascular lesions that result from dilated venules
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| Vascular lesions Spider angioma | collection of blood vessels near the surface of the skin
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| Vascular lesions Petechiae | small, purpuric lesions up to 2 mm across
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| Vascular lesions Ecchymosis | a large type of hematoma (>1 cm)
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| Malignant lesions basal cell carcinoma | looks like mole
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| Malignant lesions squamous cell carcinoma | dark irregular
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| Malignant lesions melanoma | dark
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| Malignant lesions Kaposi’s sarcoma | j shaped
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| (hair)Seborrhea | dandruff, cradle cap
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| (hair)tinea capitis | scalp ringworm
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| (hair)alopecia areta | a condition in which hair is lost from some or all areas of the body, usually from the scalp
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| (hair)folliculitis | infection in the hair follicles
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| (hair)Furuncles | or boils are caused by an accumulation of pus and dead tissue around the root of the hair
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| (nails)normal profile | 160 degrees
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| (nails)clubbing | 180 degrees
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| (nails)Schamroth technique | nails and fingers back to back diamond shape
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| (nails)capillary refill | blanching for dehydration, blood flow
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| facial land marks of eyes | -palpebral tissue- area where the lower and upper lids meet
-nasolabial fold-dimples symmetrical
-pinna- eye lids
-lateral canthus-opening of eye lids
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| lymph node locations | 1-preauricular-hair line by ear
2-postauricular-high behind the ear
3-occiptal- mid low behind ear
4-retropharngeal jaw lower lobe
5- Middle jaw line
6-submental-chin of jaw
7-superficial cervical chain-under ear middle neck
8-deep cervical chain--
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| pediatric bones head | -Posterior triangle frontal closed at 1-2 months
-Anterior diamond fontanel closed at 9-12 months
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| pregnant Head, Neck, and Lymph | -facial and extremities edema
-thyroid enlarges slightly
-headache 1st trimester from increased hormones
Late sign of preeclampsia
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| Geriatric Head, Neck, and Lymph | -low elasticity, sub cu fat, moisture, thyroid functions
-loss hair, teeth
-ROM limits
-cervical vertebra ridged
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| subjective headache migraine | -vascular, mainly women
-alcohol, stress, menstruation, eating choco/cheese
-family history
-nausea, vomiting, visual
-2x month 1-3 days
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| subjective headache cluster | vascular, mainly men
-eye, temporal, forehead, check
-Unilateral-same side
-1-2x day, ½ to 2 hrs
-remission
-alcohol, ingestion, daytime nap
-red eyes, tearing, rhinorrhea, naso congestion, eyelid drooping
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| subjective headache tension | -normal everyday
-frontal band-like tightness
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| subjective head injury | Light head, blackout (nero/cardiac), seizure verigo, dizzines
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| subjective vertigo | perception that person spins
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| objective vertigo | person feels like rom is spinning
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| objective head-inspection, palpation, auscultation head | -size-normocephalic
-round, symmetrical to body
-Temporal artery-light pressure
-2+ equal bilaterally
-temporomandibular joint-crepitation(move of fluid
-full ROM, not tenderness,
Tics, tremors, fasciculation’s (eye twitching)
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| objective head-inspection, palpation, auscultation neck ROM | flexion 45’, extension 55’, lateral bending 40’, rotation 70’
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| objective head-inspection, palpation, auscultation lymph nodes | – round circular pressure with fingerpads
If palpable-location, size. Movable, tenderness
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| objective head-inspection, palpation, auscultation arteries | Carotid arteries-bruits- bell ends low pitch while holding breath
Jugular veins –internal, external
-central venous pressure with ruler lie flat
JVD normal- 3 cm above sternal angle at 45’
meaning of abnormal reading
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| abnormal head Hydrocephalus- | big head
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| abnormal head Acromegaly | growth hormone, pituitary, gigantism
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| abnormal head Bell’s palsy | CN 7 facial, temporary unilateral facial paralysis from virus
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| abnormal head Cushing’s syndrome | excessive secretion from pituitary
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| abnormal head Down syndrome | flat nose, protruding tongue, short neck
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| abnormal head Parkinson’s disease | mask like expression
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| abnormal head CVA | no blood flow, hemorrhagic-burst
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| abnormal head Hypothyroidism | women- non-pitting edema, coarse facial features, dry skin, hair, eyebrows
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| abnormal head Hyperthyroidism | -graves
-goiter
-bulging eyes
-nervousness, fatigue, muscle cramps, heat intolerance, bounding pulse, short breath, tachycardia,silky hair/skin, blinking, staring
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| eyes pediatric | Iris is brown to dark, greyish blue by 3 months real color appears
4th week tears
Vision in both eyes by 6 weeks
Adult size by age 8
Peripheral vision by age 3
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| eyes pregnant | Dry eyes, visual problems by shifting fluids
Change in shape in last trimester
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| eyes geriatric | By age 45 lens losses elasticity, decrease tear, dryness, decrease pupillary size/response
Presbyopia-cant accommodate for near vision depth perception fails
Cataracts-cloudy clumping proteins
arcus senilis-lipids around limbus
Macular degeneration-ce
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| eyes subjective | Photophobia-inability to tolerate light
floaters- strings or dots that’s normal unless obstruct vision with myopia
lacrimation- tearing
epiphora- excessive tearing
strabismus- walleves were both eyes go outward differently
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| 3 types of strabismus of eye subjective | diploia-2 images of single object
esotropia- inward eyes
exotropia- outward eyes
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| eyes Objective-inspect, palpation, opthalmoscope. Snellen-visual acuity is | E chart for distance 20 ft, cover 1 eye, when miss letter use as fraction for 20/20 vision
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| eyes Objective-inspect, palpation, opthalmoscope. Jaegar or Rosenbaum | charts and what readings mean, how to assess visual acuity-
Near vision of 12 to 14 inches, without hesitancy, without moving card closer or further---PRESBYOPIA
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| eyes Objective-inspect, palpation, opthalmoscope. Fields of vision by confrontation | Stand eye level 2 ft away, both cover eye and move fingers 50 degrees upward, 70 degrees downward, 60 degrees nasally, saying now when see fingers
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| eyes Objective-inspect, palpation, opthalmoscope. EOMs Function - Corneal light reflex (Hirschberg test) | Person stares straight ahead light shines 12 inches away, note for same reflextion spot on both eyes
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| eyes Objective-inspect, palpation, opthalmoscope. cover test | stare straight ahead remove cover from 1 eye and find “steady, fixed gaze”, no jumping
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| eyes Objective-inspect, palpation, opthalmoscope. 6 cardial positions or fields of gaze | Head steady follow object with parallel eyes
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| eyes Nystagmus | Fine, oscillating movement, beating or jumping of eyes
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| eyes Ptosis | Lid lag, drooping upper lid
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| eyes Palpebral fissures | Horizontal, upward-Asian’s
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| Horizontal, upward-Asian’s | protrusion of eyeballs
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| eyes Ectropion | lower lids roll out
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| eyes Entropion | lower lids roll in
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| eyes Sclera should be | china white/grey-blue
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| eyes PERRLA | Pupils Equal Round, React to Light, and Accommodate (direct same side, consensual with other pupil)
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| eyes Mydriasis | dilatation of the pupil
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| eyes Miosis | constriction of the pupil
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| eyes Horner’s syndrome | Drooping eyelid (ptosis), Sinking of the eyeball into the face, Small (constricted) pupil (the black part in the center of the eye)
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| EYES Argyll Robertson | - where the pupils can respond to changes in distance (accommodation) but not to light
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| eyes abnormal Chalazion | blocked duct in one of the Meibomian glands
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| eye abnormal Stye | is an infection of the eyelid, resulting from a blocked oil gland
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| ear Helix | top curl of ear
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| ear Tragus | edge of ear t face where piercings
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| ear Lobus- | lower lobe
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| ear Cone of light | triangle that points to nose
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| ear Malleus | arm like bone
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| ear Eustachian tube | connects middle ear to nasopharynx
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| ear pediatric | -Eustachian tube straight
-pull pinna down for temp
-salivation in infants at 3 months
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| ear pregnant | -fullness, earaches
-Rhinitis-inflammation, epitaxies-nose bleed from more blood flow
-heightened smell
-edema of vocal cords
-gingivitis
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| ear geriatric | presbycusis-nerve degeneration, hearing loss
-cerumen-cilla stiff
-xrostomia-dry mouth
bleeding gums
Tinnitus-ringing, buzzing
Vertigo-objective-feel like spinning, subjective room is spinning
Rhinitis, epistaxis, gingivitis, auditory canal and Eust
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| ear Subjective-inspection, palpation, percussion, transilumination | equal size, shape, bilateral
-skin color same as face
-no tenderness pinna, tragus, mastoid process
-External-no swelling, redness, discharge of cerumen (color, texture)
-Tympanic-color(pearly grey), membrane intact, scarring,Otorrhea, tinnitus, vert
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| ear objective tympanic membrane | bluish tinge by blood in middle ear
-perforation and scarring
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| ear objective Darwins tubercle- | bump sm outside
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| ear abnormal Hemotympanum | blood in tympanic membrane
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| ear abnormal otitis externa | infection of outer ear
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| ear abnormal otitis media- | infection of inner ear
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| ear abnormal Tophi | small yellowish non-tender nodules, uric acid crystal, gout
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| Hearing acuity whispered test | 1 ear at time, 1-2 feet away 3 random words to test high frequency loss
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| Hearing acuity Rinne | tunning forks for conductive hearing loss, equal bilaterally
Air conduction 30 sec
Bone conduction 15 sec
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| Hearing acuity Weber | conductive or nerve damage, midline frontal forehead with no lateralization
Conductive loss from impact cerumen, infection, bad eardrum
Nerve loss- lateralization to better ear
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| Palpate frontal sinuses | eye corners by nose on eyebrow, percuss
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| Palpate Maxillary sinuses | above corners of mouth meet with nose holes
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| mouth buccal mucosa | pink, smooth, moist
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| throat tonsils and grading | 1+ visible
2+ halfway between pillars and uvula
3+ touching uvula
4+ touching each other
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| throat tongue | protrudes midline
-halitosis- bad breath
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| deviated septum | both side close in, long
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| perforated septum | Perforated-small circular hole
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| throat Ankyloglossia | tongue anchored to bottom born with
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| throat atrophic glossitis | smooth glossy vit deficiency
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| throat aphthous ulcers | canker sores
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| throat Leukoplakia | white patches from smoking/drinking, precancerous
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