HA

• INTEGUMENTARY SYSTEM

  • THE MOST IMPORTANT FUNCTION OF THE INTEGUMENTARY SYSTEM IS PROTECTION
• MACULE - A flat circumscribed area of altered skin

  color, generally less than 3/8”. EX: = freckle, flat nevus
• PAPULE - Is a small solid, elevated skin lesion

  • acne, fungal infections
• VESICLE - Circumscribed, elevated lesion, contains some serous fluid.

  • Less than 3/8th inch
  • EX = early chicken pox
• JAUNDICE - is a yellow discoloration of the sclera and skin, as a result of raised serum bilirubin, and is usually detectable clinically when the bilirubin is greater than 3mg/dL
• PERRLA - Pupils Equal Round Reaction to Light and Accommodation
• OTOSCOPE - potentially gives a view of the ear canal and tympanic membrane or eardrum
• WEBER

  • Technique: Tuning For placed at midline forehead
  • Normal: sound radiates to both ears equally
  • Abnormal: sound lateralizes to one ear
  • Ipsilateral conductive hearing loss or Contralateral sensorineural hearing loss
• RINNE TEST

  • Bone conduction will allow the sound to be transmitted
  • Then place the tines of the still vibrating right next to, but not touching the external canal. They should again be able to hear the sound.
• ORO-PHARNYX EXAMINATION

  • The uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up
• CRANIAL NERVE 9 DYSFUNCTION: Patient has suffered stroke, causing loss of Mfunction of left CN 9.

  As a result, uvula is pulled towards the normally functioning (ie right) side.
• LEFT PERITONSILLAR ABSCESS - Note deviation of uvula towards right.
• TORTICOLLIS

  • Derived from the LAtin: tortus (twisted) + collis (neck or collar)
  • Torticollis is a symptom related to turning or bending of thge neck
• Torticollis is a symptom related to turning or bending of thee neck
• CRANIAL NERVE

  • are pairs of nerves that connect to the brain to different parts of your head, neck, and trunk. There are 12 of them, each named for their function or structure.
• Sensory nerves are involved with your senses, such as smell, hearing, and touch.
• Motor nerves -  control the movement and function of muscles or glands.
• 1. OLFACTORY NERVE

  Function: Sensory

  • not tested routinely, it is tested when the client report loss or sense of smell due to head trauma
• • Anosmialoss of sense of smell bilaterally with tobacco, smoking, allergic

  rhinitis and cocaine use
• Unilateral loss of sense of smell in the absence of nasal disease is neurogenic anosmia
• 1. OPTIC NERVE

  Function- Sensory

  test visual acuity and visual fields

  • test peripheral vision
• ophthalmoscope examine the ocular fundus to determine the color size, and shape of the optic disc
• Use of Snellen chart

  • distance of client and Snellen chart 6 meter or 20 ft
  • ask the client to remove glass or contact lens
• 20/20- client can read in 20 meter with a normal eyesight of 20.
• 1. OCULOMOTOR

  Function- both (sensory and motor)

  • eyelid and eyeball movement

  Move eye up and down and peripheral vision- PERRLA,
• 1. TROCHLEAR

  Function- Both

  Serve the superior oblique eye muscle

  Innervate superior oblique eye muscle Inferior lateral

  movement of the eye
• 1. TRIGENEMAL

  Function- Both(Sensory and Motor)

  • The largest of the cranial nerves. Its primary function is to provide sensory innervation to the face, and mastication(chewing)
  • More specifically, the sensory information conducted by this nerve includes touch, pain, and temperature.
• 1. ABDUCENS

  Function- both

  • Serve as a lateral rectus eye muscle
  • How to test Turn eye laterally
  • Proprioception (sensory awareness of part of the body)
• PERRLA - Pupils Equal Round Reaction to Light and Accommodation
• Check the pupil for size regularity, equality, direct and consensual light reaction and accommodation.

  Normal- size 3- 5 mm
• 1. FACIAL

  Motor function - Observe for movement and facial symmetry as the patient follows these direction: smile, frown, lift eyebrow, show teeth, puff cheeks.

  • Press the patient puff cheek in and note that the air escape equally from both sides.
  • SensoryNote: do not test routinely
• 1. AUDITORY/ACOUSTIC (VESTIBULOCOCHLEAR)

  Function: sensory

  • test hearing acuity by the ability to hear normal conversation.
• Weber Test- it is valuable if a patient reports that hearing is better

  with one hear than the other.
• 1. Weber test- place a vibrating tuning fork in the middle of the patient head. As if the tone lateralizes equally in both ears or better in one.
• RINNE TEST

  It compares bone conduction and air conduction sound (AC and BC)
• 1. GLOSSOPHARYNGEAL

  Function : Both

  Motor Function

  1. Depress the tongue with a depressor. Note pharyngeal movement as the patient say “ahh or yawn. The uvula and soft palate should rise in the midline and the tonsillar pillar should move medially.
• 1. VAGUS

  Function: Both

  MOTOR

  Stimulate gag reflex

  SENSORY

  1. sense of taste, sensation of the one third of tongue and throat
• 1. SPINAL ACCESSORY

  Function: Both

  Motor: assess the sternocleidomastoid and trapezius muscle (neck shoulder) for equal size.

  Check equal strength of these muscle by asking the patient to rotate the head forcibly against the resistance applied to the side of the chin.
• 1. HYPOGLOSSAL

  Function: Both

  Motor

  1. inspect tongue. No wasting or tremor should be present.

  2. ask the client to thrust forward the tongue

  3. ask the patient to say “light”, “tight”, “dynamite
• BRONCHIAL SOUNDS -  heard over the trachea are

  high – pitched, harsh sounds with expiration

  longer than inspiration .