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Health Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the 5 steps of the nursing process?

A
  • Assessment: collecting subjective and objective data
  • Diagnosis: analyzing data to make a collaborative nursing judgment
  • Planning: determining outcome criteria and developing a plan
  • Implementation: carrying out the plan
  • Evaluation: assessing whether outcome criteria have been met & revising the plan as necessary
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2
Q

What does AIDET stand for?

A
  1. acknowledge
  2. Introduce
  3. Duration
  4. Explanation
  5. Thank you
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3
Q

Holistic nursing assessment vs physical medical assessment?

A
  • Holistic nursing assessment: collects holistic subjective & objective data to determine a client’s overall level of functioning in order to make a professional clinical judgment
  • Physical medical assessment: focuses primarily on the client’s physiological status
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4
Q

What are the 4 basic types of assessment?

A
  • initial comprehensive (complete): subjective and objective data
  • ongoing (partial): mini-overview as a follow up
  • focused (problem-oriented): specific concern
  • emergency (rapid): immediate & prompt
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5
Q

What are 4 major steps of assessment?

A
  1. collection of subjective data
  2. collection of objective data
  3. validation of assessment data
  4. documentation of data
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6
Q

What are the 4 phases of the interview when collecting subjective data?

A
  1. pre introductory
  2. introductory
  3. working
  4. summary & closing
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7
Q

What 5 things should you do when preparing for the health assessment?

A
  • review clients record
  • review clients status w/ other health care team members if indicated
  • educate yourself about the clients diagnosis and tests performed
  • reflect on your own feelings regarding the clients information
  • obtain and organize needed materials
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8
Q

Objective vs subjective data?

A

subjective: what client tells you
objective: what clinician directly observes

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9
Q

What are some examples of collection of subjective data?

A
  • biographical
  • history of present health concern
  • personal health history
  • family history
  • health and lifestyle practices
  • review of systems
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10
Q

What are some examples of collection of objective data?

A
  • physical characteristics
  • body functions
  • appearance
  • behavior
  • measurements
  • results of lab testing
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11
Q

What are 6 nonverbal techniques?

A
  • appearance (professional)
  • demeanor (professional)
  • facial expression (neutral)
  • attitude (nonjudgmental)
  • silence (allow time for reflection)
  • listening (open mind & body position)
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12
Q

What is the chief complaint?

A

the reason for seeking care and should be in the client’s own words

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13
Q

How to evaluate history of present illness?

A

use COLDSPA

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14
Q

What does COLDSPA stand for?

A
  • character: describe the character of the symptom
  • onset: when did this start
  • location: where is the symptom occurring
  • duration: how long has this been going on
  • severity: how bad is it, how is it impacting health
  • pattern: what makes it better/worse; how it occurs
  • associated factors: any related symptoms & feelings
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15
Q

What 4 things do you check for during orientation evaluation?

A
  • person
  • place
  • time
  • situation
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16
Q

What are the 4 abnormal levels of consciousness?

A
  • lethargic: opens eyes, answers questions, falls back asleep
  • obtunded: opens eyes to loud voice, responds slowly w/ confusion, unaware of environment
  • stuporous: awakens to vigorous shaking or painful stimuli but returns to unresponsive sleep
  • comatose: remains unresponsive to all stimuli; eyes closed
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17
Q

What is the AUDIT test used for? CAGE?

A

both for alcoholism

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18
Q

What are the 4 basic assessment techniques?

A
  • inspection
  • palpitation
  • percussion
  • auscultation
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19
Q

When does inspection begin?

A

the moment you first see the client

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20
Q

How do you perform an inspection?

A

-Have room at a comfortable temperature
- obtain adequate lighting
- looking and observing the patient
- only expose part of body examined
- note characteristics
- compare appearance of body parts

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21
Q

Light vs moderate vs deep vs bimanual palpatation?

A

light: depress <1cm
moderate: depress 1 to 2 cm (dominant hand)
deep: depress 2.5 to 5 cm (both hands)
bimanual: “sandwhich” the body part

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22
Q

When do you use your dorsal hand? ulnar/palmar surface? fingerpads for palpation?

A

dorsal: temperature
ulnar/palmar: vibrations
fingerpads: pulses, texture, size, shape, crepitus (fine discriminations)

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23
Q

What are 9 thing you can palpitate for?

A
  • texture
  • temperature
  • moisture
  • mobility
  • consistency
  • strength of pulses
  • size
  • shape
  • degree of tenderness
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24
Q

What are 5 reasons we do percussion?

A
  • eliciting pain
  • determining location, size, and shape
  • determining density
  • detecting abnormal masses
  • eliciting reflexes
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25
Q

What are 3 types of percussion?

A
  • direct: tapping w/ one to two fingertips
  • blunt: flat hand and use the fist of the other to strike the flat hand
  • indirect: tap middle finger of nondominant hand w/ pad of finger of dominant hand
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26
Q

What is auscultation?

A

the correct use of the stethoscope

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27
Q

What are 5 sounds elicited by percussion?

A
  • resonance: normal lung - hollow sound
  • hyperresonance: lung w/ COPD - booming sound
  • tympany: puffed cheel, gastric bubble - drum like sound
  • dullness: diaphragm, effusion, liver - thud like sound
  • flatness: muscle, bone - flat sound
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28
Q

How do you perform a correct auscultation?

A
  • eliminate distracting noise
  • expose body part being auscultated
  • war diaphragm and bell before use
  • explain what is being listened to
  • angle earpieces of binaural down and forward
  • do not apply too much pressure when using bell
  • avoid listening through clothes
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29
Q

What do we use the diaphragm for? bell?

A
  • diaphragm: high pitched sounds like normal heart, breath, and bowel sounds
  • bell: low pitched sounds like abnormal heart sound and bruits
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30
Q

What are bruits?

A

loud, blowing sounds over other major arteries

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31
Q

How can you tell b/w the diaphragm and bell?

A

bell is the smaller side

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32
Q

Why do we document?

A

to provide a chronologic, progressive record to outline the client’s course of care

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33
Q

What should you avoid when documenting data?

A
  • words good/bad/seems
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34
Q

What does SBAR stand for?

A
  • situation
  • background
  • assessment
  • recommendation
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35
Q

What order of intrusiveness should you always go in?

A

least intrusive to most intrusive

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35
Q

When do we use the glasgow coma scale?

A

used for client w/ traumatic brain injury; common in ICU comatose patients

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35
Q

What do the different scores mean for the glasgow coma scale?

A

score of 15 = optimal LOC
score <15 = some impairment in LOC
score of 7 or less = coma

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35
Q

What should you look at when assessing mental status?

A
  • LOC and mental status
  • posture, gait, movements, dress, and grooming
  • behavior and affect
  • speech, facial expressions, and eye contact
  • mood, expressions, and thought process
  • cognitive abilities (concentration and memory)
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36
Q

What are the 7 steps of the diagnostic reasoning process?

A
  1. identify strengths and abnormal data
  2. cluster data
  3. draw inferences
  4. propose possible nursing diagnoses
  5. check for defining characteristics
  6. confirm or rule out diagnoses
  7. document conclusions
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37
Q

What position should the client be in during chest exam?

A

sitting - allows for full expansion of lungs

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38
Q

What is the first and most critical phase of nursing?

A

assessment

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39
Q

What are some special considerations to be aware of with patients?

A
  • gerontologic variations
  • cultural variations
  • emotional variations
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40
Q

What should you do when interacting w/ anxious clinets?

A
  • provide simple, organized questions
  • ask simple, concise questions
  • do not hurry
  • decrease external stimuli
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41
Q

What should you do when interacting w/ angry clients?

A
  • keep a calm, reassuring, in control manner
  • allow the client to vent feelings
  • avoid arguing with or touching client
  • never allow client to position him/herself b/w you and the door
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42
Q

What is a genogram?

A

used to identify genetic patterns

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43
Q

What is standard precuations?

A

assume all are infected

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44
Q

What does IWIPE?

A
  • Introduce yourself to client
  • wash your hands
  • identify the client
  • provide for privacy
  • explain the assessment and/or procedure
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45
Q

What are the 3 types of assessment forms for documentation?

A
  • initial assessment form: completed during the nursing admission
  • frequent or ongoing assessment form: flow charts that help staff record and retrieve data for frequent reassessments
  • focused or specialty area assessment form: focuses on one major area of body for clients who have particular problem
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46
Q

What are four risk factors for substance abuse?

A
  • history of early aggressive behavior
  • lack of parenteral supervision
  • poverty
  • drug availability
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47
Q

What are four risk factors affecting mental health?

A
  • economic/social factors
  • exposure to violence
  • unhealthy lifestyle choices
  • impairment in neurologic system
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48
Q

What is the 1st part of the physical exam?

A

general survey

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49
Q

What two things do you do during a general survey?

A
  • perform systemic examination and record general characteristics and impressions of client
  • observe any significant abnormalities
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50
Q

What is jaundice?

A

yellow coloration of skin due to an excess of bilirubin

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51
Q

What is cyanosis?

A

blue coloration of skin due to low o2 level

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52
Q

What do abused children look like when talking about age?

A

they look younger

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53
Q

What are 11 things to consider when doing your general survey?

A
  • physical development
  • gender and sexual development
  • apparent age compared to reported age
  • skin condition and color
  • dress and hygiene
  • posture and gait
  • level of consciousness
  • behaviors, body movements, and affect
  • facial expression
  • speech
  • vital signs
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54
Q

What is the order of anthropometric measurements and vital signs?

A

anthropometric measurements
- height
- weight
- BMI
- waist/hip ratio, waist circumference
vital signs
- temperature
- pulse
- respirations
- blood pressure

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55
Q

What should the clients position be when taking their height?

A

client stands shoeless w/ heels together and back straight while looking ahead

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56
Q

When do we reach our final adult height and when does it begin to wane?

A
  • final height reached ages 18-20
  • wanes in 5th life decade as intervertebral discs thin
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57
Q

What are two types of abnormal heights?

A
  • giantism = excessive secretion of GH
  • achondroplasia dwarfism = limbs are shorter
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58
Q

What should you do when taking weight?

A
  • zero scale
  • remove shoes/heavy clothing before standing on scale
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59
Q

What is the conversion between kg and lbs?

A

1 kg = 2.2 lbs

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60
Q

What are 9 health risks related to obesity?

A
  • hypertension
  • dyslipidemia
  • type 2 diabetes
  • coronary heart disease
  • stroke
  • gallbladder disease
  • osteoarthritis
  • sleep apnea and respiratory problems
  • some cancers
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61
Q

What are common indicators of weight status and there values?

A
  • BMI: normal (18.5-24.9), underweight (<18.5), overweight (25.0-29.9), and obese (>30)
  • waist circumference: women (<35in), men (<40 in)
  • waist-to-hip ratio: women (<0.8), men (<0.9)
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62
Q

What is the normal range for oral temps and the average?

A

normal range: 96.6-99.5 F (35.9-37.5 C)
average: 98.6 F (37.0 C)

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63
Q

How will tympanic, axillary, and rectal deviate from the normal oral range?

A

tympanic: 1.4 F higher
axillary: 1 F lower
rectal: higher

64
Q

What are some things to consider w/each of the different temperature routes?

A
  • oral: under the tongue beside the frenulum, wait 15 min. after food/drink
  • axillary & temporal: questionable accuracy
  • rectal: sheath & lubricate, insert 1 in or less, RED PROBE
  • tympanic: quick, safe in ear canal
65
Q

What are some things that can cause changes in temp?

A
  • strenuous exercise (rises)
  • stress (rises)
  • ovulation (rises)
  • viral/bacterial infections, maignancies, trauma, blood/immune/endocrine disorders (rises)
  • geriatric (lowers)
  • time of day (variation up to 1.5 F)
66
Q

What are some signs of fever?

A
  • onset: chills, pallor, increased pulse & respiration
  • flushed face
  • hot, dry skin
  • malaise
  • scant dark urine
  • anorexia
  • nausea/vomiting
  • hypo/hperthermia
67
Q

What are 4 characteristics you should pay attention to when taking pulse/HR?

A
  • rate: 60-100 bpm
  • rhythm: regular or irregular
  • amplitude: 0-3+
  • arterial elasticity: straight/springy vs rigid
68
Q

How do you check pulse/HR?

A
  1. palpate w/ index & middle fingers
  2. count for 30 second and multiply by 2 (regular)
  3. count for 1 min if irregular (or if using apical)
  4. don’t press too hard = occlusion
69
Q

What do the numbers mean for pulse amplitude?

A

0 = absent
1+ = weak, diminished
2+ = normal
3+ = bounding

70
Q

What pulse is the most utilized?

A

radial pulse (thumb side of wrist)

71
Q

Where are the locations of the radial, brachial, and carotid pulse?

A

radial: thumb side of wrist
brachial: medial aspect of arm (elbow region)
carotid: neck

72
Q

What does arrhythmia mean?

A

irregular rhythm

73
Q

what is bradycardia and its causes?

A

too slow (<60)
causes: heart block, sitting/standing long time

74
Q

what is tachycardia and its causes?

A

too fast (>100)
causes: fever, stress, anxiety, exercise, hemorrhage

75
Q

What arrhythmia is normal in kids?

A

sinus arrhythmia = pulse speeds and slows w/ respirations

76
Q

What 4 characteristics should you look for w/ respirations?

A
  • rate: 12-20 breaths a minute
  • rhythm: regular, even in and out
  • depth: equal, bilateral expansion 1-2 in
  • effort: should be unlabored and comfortable
77
Q

what is the respiration rate in newborns?

A

30-40 breaths/minute

78
Q

What is a normal o2 sat and what causes inaccuracies?

A

normal: 95-100%
inaccurate w/ cold extremities or nail polish

79
Q

What is dyspnea?

A

labored/difficult breathing

80
Q

what is apnea?

A

cessation of breathing

81
Q

bradypnea vs tachypnea?

A

bradypnea: slow breathing (<12)
tachypnea: fast breathing (>20)

82
Q

What is orthopnea and what should you do when this occurs?

A

orthopnea: breathing discomfort while lying flat
- sit patient up

83
Q

what is hypoxia?

A

low blood oxygen

84
Q

What is systolic, diastolic, and pulse pressure?

A
  • systolic: measurement of pressure of blood in arteries when ventricles are contracted
  • diastolic: measurement of pressure in blood when arteries of ventricles are relaxed
  • pulse pressure: systolic - diastolic (30-50mmHg)
85
Q

what are the different categories of blood pressure?

A
  • normal: <120/<80
  • prehypertension: 120-139/80-89
  • stage 1 hypertension: 140-159/90-99
  • stage 2 hypertension: >160/>100
86
Q

what should you check when sizing your BP cuff?

A
  • bladder width should be 40% circumference of arm
  • too large gives false low
  • too small gives false high
87
Q

What should you make sure when taking blood pressure?

A
  • avoid nicotine/caffeine 30 min prior
  • feet uncrossed and flat on floor
  • no talking
  • empty bladder
88
Q

What can influence BP?

A
  • age (increases as we get older)
  • race (black tend to be higher)
  • diurnal rhythm (lowest in AM)
  • weight (obesity causes it higher)
  • emotions (high when stressed)
  • pain (increases)
  • caffeine and tobacco (increases)
  • certain medications
89
Q

hypotension vs hypertension vs orthostatic hypotension?

A
  • hypotension: low BP
  • hypertension: high BP
  • orthostatic hypotension: measure lying, sitting & standing
90
Q

What should we consider w/ adults pertaining to fevers?

A

less likely to show fever

91
Q

What is pain?

A

the 5th vital sign and “it is whatever the patient says it is”

92
Q

Is pain subjective or objective?

A

the subjective patient report recorded or taken objectively

93
Q

What are 4 types of pain?

A
  • acute: associated w/ recent injury, short term
  • chronic: persistent, 6 months or more
  • cancer: may be causes by cancer, treatment, or metastasis
  • intractable: high resistance to pain relief
94
Q

What are 8 pain descriptors?

A
  • cutaneous = skin (burning)
  • visceral = internal organs (ache, cramp)
  • deep somatic = ligaments, tendons, bones, blood vessels (throb, ache)
  • radiating = felt at source and extending to other areas
  • referred = felt in body areas away from pain source
  • phantom = felt in nerves left by missing, amputated, or paralyzed body parts
  • neuropathic = abnormal processing of pain message from damage to nerves (burning, shooting, tingling)
  • inflammatory = anything ending in -itis
95
Q

What are two ways to gain objective data of pain?

A
  • numeric pain intensity scale (0-10)
  • wong-baker faces pain scale (0-5)
96
Q

what are 4 types of violence?

A
  • physical abuse
  • psychological abuse
  • economic abuse
  • sexual abuse
97
Q

What are 3 categories of violence?

A
  • intimate partner
  • child abuse
  • elder mistreatment
98
Q

What does it mean to be a mandatory reporter?

A

if we suspect something we are required to report it

99
Q

What are 3 interview techniques to use when working w/ an abused patient?

A
  • maintain a safe, confidential environment
  • discuss mandatory reporting prior to interview
  • ask direct questions in a calm manner
100
Q

What are 11 things you should look for when assessing abuse?

A
  • dress/hygiene: soiled clothing, clothing covering wounds and bruises
  • mental status: anxious, withdrawn, poor eye contact
  • vital signs: elevated pulse, bp
  • skin: scars, bruises, burns
  • head and neck: missing hair
  • eyes: bruising, black, swelling
  • ears: obvious injuries, hearing loss
  • abdomen: bruising in various stages of healing
  • genitalia and rectal area: bruising, bleeding
  • musculoskeletal system: dislocations, old and new fractures
  • neurologic system: tremors, loss of feeling
101
Q

culture vs ethnicity?

A
  • culture: totality of socially transmitted products of human work and thought characteristics of a population of people that guide their worldview and decision making
  • ethnicity: a socially, culturally, and politically constructed group that holds in common a set of characteristics not shared by other w/ whom members of group come into contact with
102
Q

What 6 things should you consider when dealing w/ other cultures?

A
  • time
  • space
  • eye contact
  • body language and hand gestures
  • silence
  • touch
103
Q

Religion vs spirituality?

A

religion: formal, organized, group-organized, objective
spirituality: informal, non-organized, self reflection, subjective

104
Q

What is tripod position?

A

when you have hands on knees - sign of labored breathing

105
Q

What is the body’s largest organ system?

A

the skin

106
Q

What are the external structures of the integumentary system?

A
  • skin
  • hair
  • nails
107
Q

What are the 3 layers of the skin?

A
  • epidermis: outermost layer
  • dermis: middle layer
  • subcutaneous tissue: deepest layer
108
Q

What makes up the epidermis?

A
  • cells bound tightly into sheets for protection
  • made up of stratified squamous epithelium
  • contains keratin and melanocytes
  • avascular
109
Q

What are the primary functions of the epidermis?

A

protection/regulation of water loss

110
Q

What are the two layers of the epidermis?

A
  • stratum germinatiuvum: innermost layer
  • stratum corneum: outermost layer
111
Q

What are the functions of the dermis?

A
  • blood vessels dilate and constrict to regulate temp/BP
  • nourishes the epidermis
  • expands and contacts w/ body movements
112
Q

What makes up the dermis?

A
  • made up of connective tissue and collagen
  • highly vascular
  • contains hair follicles, sebaceous glands, sweat glands, sensory fibers, and nerve endings
113
Q

What are the functions of the subcutaneous tissue/adipose tissue?

A
  • support structure for dermis and epidermis
  • retains heat
  • protects body for cushioning
  • stores fat for energy
114
Q

What 3 things develop in infants pertaining to integumentary system?

A
  • lanugo: fine downy hair of newborn infant
  • vernix caseosa: thick, cheesy substance
  • sebum: holding water in the skin producing milia
115
Q

What 2 things occur in children pertaining to the integumentary system?

A
  • epidermis thickens, darkens, and becomes lubricated
  • hair growth accelerates
116
Q

What 3 things occur in adolescents pertaining to the integumentary system?

A
  • secretions from apocrine sweat glands increase
  • subcutaneous fat deposits increase
  • secondary sex characteristics
117
Q

What 5 things occur in elderly pertaining to the integumentary system?

A
  • lose elasticity
  • decrease in sweat and sebaceous glands
  • senile purpura: discoloration due to increasing capillary fragility
  • skin breakdown and wound healing slower
  • melanocytes decrease leading to fine gray hair
118
Q

What is another name for senile lentigienes?

A

liver spots

119
Q

How does culture and genetics affect risk for skin cancer?

A
  • dark-skinned individuals are less likely to get skin cancer due to melanin
  • increased risk for melanoma related to number of sunburns
120
Q

what is the biggest environmental risk factor for skin cancer?

A

UV radiation

121
Q

What should you ask when taking a patients health history when relating to integumentary system?

A
  • personal medical history/family history
  • chronic illnesses
  • allergic skin reactions
  • medications
  • hyperpigmentation
  • recent skin changes
  • ask about hair and nails
122
Q

What does pruritis mean?

A

itching

123
Q

What is an age appropriate question for adolescents?

A

skin problems such as oil, pimples, or blackheads

124
Q

What are some age appropriate questions to ask aging adults?

A
  • what changes have you noticed in your skin in the past few years?
  • any delay in wound healing?
  • any change in feet: toenails, bunions, wearing shoes?
  • falling: bruises, trauma?
  • history of diabetes or peripheral vascular disease?
125
Q

What would be some equipment needed for a skin physical exam?

A
  • strong, direct lighting
  • gloves
  • penlight
  • small centimeter ruler
  • sometimes a magnifying glass
126
Q

When would be a good time to do a skin assessment?

A

when patient is receiving a bed bath

127
Q

What is jaundice usually an indication of?

A

liver disease

128
Q

What are pigmented nevi?

A

moles

129
Q

What are striae and who are they typically seen in?

A

stretch marks - typically seen in pregnancy or overweight

130
Q

What is vitiligo?

A

hypopigmentation compared to the surrounding skin

131
Q

What is pallor?

A

paleness

132
Q

What is erythema?

A

redness

133
Q

What should you note when inspecting lesions?

A
  • anatomic location/distribution
  • color
  • elevation
  • pattern
  • shape/size
  • type
  • exudate
134
Q

What are 7 patterns of lesions?

A
  • singular/discrete: single lesion
  • grouped/clustered: lesions bunched together
  • polycyclic: annular lesions that come in contact w/ one another as they spread
  • confluent: lesions that merge and run together
  • linear: lesions that form a line
  • zosteriform: lesions following a nerve
  • generalized: lesions that are scattered all over body
135
Q

What are 4 shapes of lesions?

A
  • round/oval: solid appearance, no central clearing
  • annular: round w/ central clearing
  • iris: pink macule w/ purple concentric ring
  • gyrate: snakelike appearance
136
Q

What are 4 types of lesions?

A
  • primary: arise from healthy skin
  • secondary: arise from previously abnormal skin
  • vascular: involve blood vessels
  • lesions of aging: actinic keratoses, seborrheic keratoses
137
Q

What are two nonpalpable primary skin lesions?

A
  • macule: less than 1 cm in diameter
  • patch: greater than 1 cm in diameter
138
Q

What are 5 palpable primary skin lesions?

A
  • papule: elevated, less than 0.5 cm diameter
  • nodule: elevated, extend deeper into dermis by 0.5-2 cm
  • wheal: edema in epidermis causing irregular elevation and could be red or pale
  • plaque: elevated, greater then 0.5 cm in diameter
  • tumor: same as nodule but deeper than 2 cm
139
Q

What are 4 fluid filled cavities within the skin for primary lesions?

A
  • vesicle: elevated, contains serous fluid, less than 0.5 cm
  • pustule: vesicles or bullae that fill w/ pus, less than 0.5 cm in diameter
  • bullae: same as vesicle but greater than 0.5 cm
  • cyst: encapsulated fluid filled or semi solid mass in subcutaneous tissue or dermis
140
Q

What are 4 secondary lesions above the skin surface?

A
  • scales: flaking of skin surface
  • crust: dried serum, blood, or pus on surface of skin
  • atrophy: thinking of skin surface and loss of marking
  • lichenification: layers of skin become thickened and rough
141
Q

What are 6 secondary lesions below the skin surface?

A
  • erosion: loss of epidermis
  • ulcer: depressed lesions of epidermis and upper layer of dermis
  • keloid: enlarging of scar
  • fissure: linear crack in the epidermis that can extend into dermis
  • scar: fibrous tissue that replace dermal tissue after injury
  • excoriation: loss of epidermal layers exposing the dermis
142
Q

What are 6 vascular skin lesions?

A
  • petechiae: small red/purple spots from bleeding
  • purpura: rash of purple spots from internal bleeding
  • ecchymosis: bruising
  • angioma: skin growth, benign tumor
  • telangiectasia: dilated capillaries, appear small red spidery
  • vascular spider/venous star
143
Q

What are two skin color general pigmentations in infants?

A
  • mongolian spot: blue/gray birthmark that disappears in 3-5 yrs
  • cafe au lait spot: light bray birth mark that darkens with sun exposure
144
Q

What are 3 skin color changes in infants?

A
  • beefy red flush: red flush in cheeks
  • harlequin color change: color change through half the child
  • erythema toxicum: benign rash
145
Q

What are two temporary cyanotic conditions of infants?

A
  • acrocyanosis: blue discoloration of extremities
  • cutis marmorata: lacy blue/red vascular pattern
146
Q

What is carotenemia in infants?

A

yellow/orange skin pigmentation

147
Q

open vs closed comedones?

A

closed: whiteheads, contents not exposed
open: blackheads, contents exposed

148
Q

Seborrheic keratosis vs actinic keratoses?

A

seborrheic: dark, scaly appearance - greasy
actinic: red tan coloration, scaly plaque - precursor to squamous cell carcinoma

149
Q

Basal cell vs squamous cell carcinoma?

A

basal cell: papule to ulcer w/ raised borders; common, slow growing
squamous cell: patch to ulcer w/ erythematous base; faster growing

150
Q

What does ABCDE stand for and what do you use it for?

A
  • Asymmetry
  • border
  • color
  • diameter
  • evolving
  • use it for determining cancerous melanomas
151
Q

What are the 4 stages of a pressure ulcer?

A
  • stage 1: erythema and no break in skin
  • stage 2: partial thickness erosion
  • stage 3: full thickness into sub-q
  • stage 4: through all layers into muscle, tendons, or bone
152
Q

How do you assess turgor of the skin?

A
  • pull skin up and it should recoil w/in 2 seconds
153
Q

What is alopecia?

A

baldness

154
Q

nits vs lice?

A

nits: on hair strands
lice: on scalp

155
Q

How should you view the finger?

A

through profile sign

156
Q

What is clubbing?

A

when nail is past normal angle, <160

157
Q

How do you determine capillary refill?

A

push down on nail and should refill within 2 seconds

158
Q

What are 2 infections of the nails?

A
  • paronychia: fungal or bacterial
  • onycholysis: trauma from repitition
159
Q

What are 4 types of nail characteristics?

A
  • leukonychia: white spots
  • koilonychia: spoon nails
  • clubbing
  • beaus lines: run horizontal
160
Q
A

Health Assessment (3 decks)

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