mod 3 ha

• Factors contributing to a patient's body habitus include socioeconomic status, nutrition, genetic makeup, degree of fitness, mood state, early illnesses, gender, geographic location, and age cohort
• Observations to make during a general survey:

  • Does the patient hear and respond when greeted?
  • How does the patient move - with ease or stiffness?
  • What is the patient doing if hospitalized - sitting up watching TV or lying in bed?
  • What is on the bedside table?
• Assessment of the apparent state of health:

  • Make a general judgment based on observations
  • Consider if the patient is acutely or chronically ill, frail, or fit and robust
• Signs of distress to look for:

  • Cardiac or respiratory distress signs like clutching the chest, pallor, labored breathing
  • Signs of pain like wincing, sweating, protectiveness of painful area
  • Signs of anxiety and depression
• Height and build assessment:

  • Measure height and note if the patient is unusually short or tall
  • Describe the build - slender, lanky, muscular, or stocky
  • Check for body symmetry and deformities
• Weight assessment:

  • Note if the patient is emaciated, slender, plump, obese, or in between
  • Consider fat distribution in obesity and different conditions like Cushing's syndrome
• Skin color and lesions:

  • Check for pallor, cyanosis, jaundice
  • Look for rashes, bruises
• Dress and grooming assessment:

  • Evaluate clothing appropriateness, cleanliness, and condition
  • Note any unusual jewelry, body piercings
  • Consider personal hygiene and grooming in relation to age, lifestyle, and occupation
• Behavior and mental status assessment:

  • Behavioral health includes mental health, counseling, and addictions treatment
  • Mental health defined by well-being, coping with stress, productivity, and community contribution
• Components of mental health assessment:

  • Appearance & behavior
  • Speech & language
  • Mood
  • Thoughts & perception
  • Cognitive functions
• Skin, hair, and nails health assessment:

  • Collect information on symptoms, history, and lifestyle
  • Ask about rashes, lesions, moisture, bruising, edema, color changes, freckles, pain, hair, and nails
• Personal health history questions:

  • Sunburns, hospitalizations, allergies, recent illnesses, pregnancy, self-injury
• Family history questions:

  • Family members with skin problems, skin cancer, keloids
• Lifestyle and health practices questions:

  • Sun exposure, sunblock use, chemical exposure, body piercings, tattoos, skincare routine, smoking, alcohol consumption
• Cultural considerations:

  • Consider skin tones and melanin levels based on ethnicity
• Cultural Considerations:

  • Small amounts of melanin are common in pale or light skins
  • Large amounts of melanin are common in olive and darker skin
  • Carotene accounts for a yellow cast
• • Slight or no odor of perspiration depending on the activity
  • Skin is intact, no reddened areas
  • Skin is smooth and even; no lesions palpated
  • Skin is normally a warm temperature
  • Skin rebounds and does not remain indented when pressure is released
• Older Adult Considerations:

  • The older client's skin becomes pale due to increased melanin production and decreased dermal vascularity
  • Skin is smooth, without lesions
  • Skin lesions associated with aging: Seborrheic Keratosis
  • Skin may feel dryer because sebum production decreases with age
  • Skin is mobile, with elasticity and returns to original shape quickly; Recoil is usually immediate
  • Skin loses its turgor because of a decrease in elasticity and collagen fibers
  • Sagging or wrinkled skin appears in the facial, breast, and scrotal areas
• • Thinner hair because of a decrease in hair follicles
  • Pubic, axillary, and body hair also decrease with aging
  • Alopecia is seen, especially in men
  • Hair loss occurs from the periphery of the scalp and moves to the center
  • Older women may have terminal hair growth on the chin owing to hormonal changes
• Physical Assessment: Normal Findings of Scalp and Hair:

  • Natural hair color varies among clients from pale blond to black to gray or white, determined by the amount of melanin present
  • Individuals of black African descent often have very dry scalps and dry, fragile hair, which is of genetic origin
  • As people age, hair feels coarser and drier, thinner with slower growth
  • Varying amounts of coarser terminal hair cover the scalp, axilla, body, and pubic areas according to normal gender distribution
  • Fine vellus hair covers the entire body except for the soles, palms, lips, and nipples
• Physical Assessment: Normal Findings of Nails:

  • Nails are clean and manicured
  • Pink tones should be seen. Some longitudinal ridging is normal. Dark-skinned clients may have freckles or pigmented streaks in their nails
  • There is normally a 160-degree angle between the nail base and the skin
  • Nails are hard and basically immobile
  • Dark-skinned clients may have thicker nails
  • Nails appeared thickened, yellow, and brittle because of decreased circulation in the extremities
  • Pink tone returns immediately to blanched nail beds when pressure is released
• • Rashes: a change of the human skin which affects its color, appearance, or texture
  • Erythema (or erythematous): a skin condition that results in skin redness or rash
  • Edema: the abnormal accumulation of fluid in certain tissues within the body; may be under the skin (peripheral edema, or ankle edema), or it may accumulate in the lungs (pulmonary edema)
• Abnormal Findings of Skin:

  • Pallor (loss of color) seen in arterial insufficiency, decreased blood supply, and anemia
  • Cyanosis may cause white skin to appear blue-tinged, especially in peri-oral, nail bed, and conjunctival areas. Dark skin may appear blue, dull, and lifeless in the same area
  • Jaundice: yellowing of the skin or whites of the eyes, arising from excess of the pigment bilirubin and typically caused by obstruction of the bile duct, liver disease, or excessive breakdown of red blood cells
  • Bruise: a common skin injury that results in discoloration of the skin
• Description of Rashes:

  • Macule: small, flat area or spot in the skin; usually < 5 mm in diameter
  • Papule: small, raised area of skin < 5 mm; has a domed top or can be flat
  • Maculopapular: combination of macule and papule
  • Vesicles: a papule with a fluid-filled center
  • Pustule: vesicle containing yellow fluid
  • Nodule: larger swelling on the skin surface usually > 5 mm in diameter; extends deep into the skin and is usually firm to the touch
  • Petechiae: small, red-brown, flat macules; up to 2 mm in diameter; they do not blanch when pressure is applied with a finger
• • Purpura: little petechiae joined together; larger areas (> 2mm) of bleeding under the skin
  • Erythema: redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries
  • Rashes: an area of reddening of a person's skin, sometimes with raised spots, appearing especially as a result of allergy or illness
• Skin Lesions:

  • An abnormal lump, bump, ulcer, sore, or colored area on the skin
  • Types:
  • Nodule: a solid mass extending into the dermis
  • Tumor: a solid mass larger than a nodule
  • Cyst: an encapsulated fluid-filled mass in the dermis or subcutaneous layer
  • Wheal: a relatively reddened, flat, localized collection of fluid. An example is hives
  • Vesicle: circumscribed elevation containing serous fluid or blood. An example is chickenpox
  • Bulla: large fluid-filled vesicle. An example is a second-degree burn
  • Pustule: a vesicle or bulla filled with pus. An example is acne
• Abnormal Hair Findings:

  • Seborrhea
  • Tinea Capitis
• • The hyoid bone serves as a movable base for the tongue and an attachment for muscles of the neck
  • The thyroid gland is in the middle of the neck anterior to the trachea, helping in metabolism and regulating calcium and phosphorous
  • The nine sets of lymph nodes drain the head and neck, fighting infection
• Regional Examinations: The Head and Neck:

  • The skull is made up of the bones of the cranium and the face
  • The cranium includes frontal, parietal, temporal, and occipital bones
  • The muscles of the face play a role in expression of emotions and assist in neck movement
  • Movement of the facial muscles is controlled by cranial nerves V and VII
  • The carotid arteries provide the blood supply to the head
  • The temporal artery supplies blood to much of the face
  • The neck is supported and made mobile by vertebral processes and the sternocleidomastoid and trapezius muscles
• Health History:

  • Determine presence/absence of age- and gender-specific diseases of the head and neck
  • Common chief complaints: neck pain or stiff neck, hoarseness, neck mass, headache, head injury
• Evaluating Chief Complaint:

  • Determine the following characteristics:
  • Quality
  • Associated manifestations
  • Aggravating factors
  • Alleviating factors
  • Setting
  • Timing
• Past Health History:

  • Medical conditions
  • Surgeries
  • Medications
  • Injuries or accidents
  • Determine if family history of thyroid disease and headache
• • Normal findings: symmetrical movement with swallowing, Adam’s apple more pronounced in males, no masses, tenderness, or enlargement, absent bruit
  • Abnormal findings: mass, enlarged gland, goiter, asymmetrical enlargement, presence of a nodule or bruit
• • Shape maybe oval or rounded
  • Face is symmetrical
  • No involuntary muscle movements
  • Symmetrical facial movements
  • Neck:
  • Inspect and palpate for symmetry, masses or scars, enlargement
  • Check neck muscles for swelling and masses
  • Head Movement:
  • Move chin to chest, head flexes 45 degrees
  • Move head back and upward, hyperextends 60 degrees
  • Move to the side - towards the ear, laterally flexes 40 degrees
  • Move right and left, laterally rotates 70 degrees
  • Muscle Strength:
• Physical Assessment: Normal Findings and Common Abnormalities of the Head and Neck:

  • Skull:
  • Inspect size, shape symmetry
  • Palpate from front and down the midline then palpate each side of the head
  • Generally round with prominences in the frontal and occipital area (normocephalic)
  • Smooth, uniform consistency
  • No tenderness, lesions, nodules, mass, depressions
  • Face:
  • Inspect facial features for symmetry of structures, distribution of hair, eyes for edema
  • Facial movements: frown, raise/lower eyebrows, close eyes tightly, puff the cheeks, smile, and show teeth
• • Ask client to turn head to one side against the resistance of your hand. Repeat with the other side (STERNOCLEIDOMASTOID MUSCLE)
  • Shrug the shoulder against the resistance of your hands (TRAPEZIUS MUSCLE)
  • Normal findings: full ROM, equal muscle strength, pain-free, symmetrical muscles, no masses
  • Abnormal findings: limited ROM, pain, asymmetrical muscles, masses
  • Lymph Nodes:
  • Inspection and Palpation
  • Face the client, bend head forward slightly or toward side being examined
  • Palpate using finger pads (2nd and 3rd) rotating manner
• • Normal findings: unable to palpate or see nodes
  • Abnormal findings: enlarged nodes, able to palpate or see nodes, tenderness, firm, hard nodes
  • Trachea:
  • Inspect and palpate for lateral deviation, symmetry
  • Normal Findings: central placement in midline of neck; spaces are equal on both sides
  • Thyroid Gland:
  • Inspect lower half of neck overlying the thyroid gland for symmetry and visible masses
  • Ask client to drink, for client to swallow
  • Palpate for smooth areas of enlargement, masses, or nodules
  • Auscultate each lobe of the thyroid listening for a thyroid bruit
• Regional Examinations: The Eyes, Ears, Nose, and Throat:

  • Eye Structure - Lacrimal Apparatus
  • Functions of the Eye:
  • The eye transmits visual stimuli to the brain for interpretation, functions as the organ of vision
  • The eyeball is located in the eye orbit, a round, bony hollow formed by several different bones of the skull
  • In the orbit, a cushion of fat surrounds the eye
  • The bony orbit and fat cushion protect the eyeball
• In the orbit, a cushion of fat surrounds the eye
• The bony orbit and fat cushion protect the eyeball