health ass.

• The general survey


  Systematic, comprehensive, continuous collection, validation, and communication of client's data using a variety of methods
• Assessing appearance and mental status

  1. Explain procedure to the patient

  2. Do handwashing

  3. Provide privacy
• Physical assessment


  • Observe body built, height, and weight
  • In relation to patient's age, lifestyle, and health
  • Height should be proportionate to the arm span
  • If not, consider Marfan's syndrome
• Marfan syndrome


  • Disorder of connective tissues manifested by changes in the skeleton, eyes, and cardiovascular system
  • Inherited gene defects in fibrillin results in formation of abnormal elastic fibers
• Gigantism


  Enlarged soft tissue and late closure of the growth plates
• Dwarfism


  • Essentially a person with short stature
  • May be caused by: Gonadal dysgenesis (XO → Turner syndrome), Bone and metabolic diseases, No known cause (constitutional delayed growth), Chronic abuse and neglect (independent of nutrition), Genetic mutations (achondroplasia)
• Achondroplasia


  • Most common form of dwarfism
  • Happens when growth plate chondrocytes are inhibited from functioning and proliferating (leads to suppression of epiphyseal plates)
  • This stunts growth (but may have average-size portions of their bodies → torso)
• Proportionate dwarfism


  Are the same size all over (e.g. hypothyroidism)
• Disproportionate dwarfism


  May have some average-size parts of the body
• Sthenic body type


  • Average height, well-developed musculature, wide shoulders, flat abdomen, and oval face
  • Muscular, thick-set individual, with broad chest and high diaphragm
  • Stomach tends to lie transversely
  • Gallbladder is high in the abdomen (away from midline)
  • Transverse colon is also high
• Hypersthenic body type


  • Short, stocky, may be obese, broader chest, thicker abdominal wall, rectangular-shaped face
  • Very muscular, thick-set individual
  • Broad chest
  • High diaphragm
  • Stomach tends to lie transversely
  • Gallbladder is horizontal high in the abdomen (away from the midline)
  • Transverse colon also high
• Asthenic body type

  • Long, thin-chested lean individual
  • Lower positioned organs (diaphragm, stomach, gallbladder, and transverse colon)
  • Stomach and transverse colon descend into pelvis (during erect position)
  • Exaggeration of the hyposthenic type
• Hyposthenic body type


  • Tall, willowy, poorly developed musculature, long, flat chest, abdomen may sag, long neck, triangular face
  • Similar to asthenic but features mentioned are not as marked
• Cachetic (Cachexia)


  • Profound and marked malnutrition
  • Wasting
  • Ill health
• Debilitated


  Weak, feeble, lack of strength (with weakness and loss of energy)
• Failure to Thrive


  • Physical and developmental delay or retardation in infants and children
  • Seen in children with illness but more in those with psychosocial or maternal deprivation
• Endomorph body type


  • Stocky build, with prominent abdomen
• Ectomorph body type


  • Physiological type that is tall with long and lean limbs
• Mesomorph body type


  • Husky and muscular body
• Body Mass Index (BMI)

  • Ratio of your weight and height
  • There are two (2) formulas
  • Weight in kilograms divided by height in squared
  • Weight in pounds multiplied to 700, divide by height in inches, and divide again by height in.
• Waist circumference


  • Male: ≤ 102 cm (40 inches)
  • Female: ≤ 88 cm (35 inches)
  • AbN: anything beyond the measurements
• Gynoid Obesity


  • Fats are located on the hips and thighs
  • Peripheral type of obesity
• Android Obesity


  • Fats are located mainly on the waist
  • Central type of obesity
  • Increases risk for certain diseases (diabetes mellitus II, high cholesterol and triglycerides, hypertension, and heart disease)
• Causes of obesity


  • Poor diet (high in fat and calories)
  • Sedentary lifestyle
  • Not enough sleep (hormonal changes lead to increased hunger and craving of high-calorie food)
  • Genetics (rate of metabolism)
  • Increasing age (decreases muscle mass, slows metabolic rate → easier to gain weight)
  • Pregnancy (post-pregnancy weight may be difficult to lose)
• Cushing syndrome


  • Due to excess cortisol in the body (from medications or pituitary gland tumor)
  • Truncal fat
  • Thin limbs (relatively)
• Causes of unexplained weight loss

  • Cancer
  • Diabetes mellitus
  • Hyper hypothyroidism
  • Depression
  • Diuresis
• Assessing posture and gait

  • Standing position: Let patient stand against the wall (with shoulders lying flat), Let patient sit on a chair with backrest, Let him/her walk towards you
  • Normal: Evenly distributed weight, Able to stand on heels and toes, Toes pointed straight ahead (equal on both sides), Posture erect, movements coordinated and rhythmic, arms swing in opposition, stride length is appropriate
  • Abnormalities: Limping/discomfort, Shuffling, Wide/Broad base gait, Fear of falling, Loss of balance, Movement disorder
• Scoliosis


  "S" formation, Lateral curvature in the normally straight vertical line of the spine
• Lordosis


  Excessive inward curve of the spine, Exaggerated lumbar concavity
• Kyphosis


  Increased forward curvature of the spine, Causes hunching of the back
• Posture tendencies in COPD

  Tend to lean forward, Brace selves with arms
• Posture tendencies in tension/anxiety

  Shoulders elevated, Stiff
• Alcohol breath


  Breath odor
• Halitosis


  Bad breath (caused by food particles, and bacteria, etc.)
• Acetone breath


  Sweet and fruity breath indicates diabetic ketoacidosis
• Bromhidrosis


  Presence or absence of body odor
• Asians and Native Americans

  Have fewer sweat glands, Less obvious body odor (than Caucasians and Black Africans)
• Signs of distress in posture or facial expression

  • Observe at rest (or during conversation): Note degree of eye contact (natural, sustained, and unblinking/averted), Smiles and frowns appropriately, Immobile face/expressionless, Flat/sad with poor eye contact (depression), Decreased eye contact (anxiety/fear), Drooping or gross asymmetry in neurologic disorders/injuries: Bell's palsy, Cerebrovascular accident, Stare of hyperthyroidism: Eyelid retraction

  
• Poor nutritional status


  Listlessness/Apathy, Poor muscle tone, Hair: thin/sparse, Cheilosis (fissures at mouth angles), Glossitis (inflammation of the tongue), Acute/Chronically ill, Frail/Feeble
• Client's attitude


  Cooperative/Willing, Unresponsive/Unwilling, Anxious