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Exam 2 (for health assessment) Flashcards

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1
Q

what is the epidermis

A

-the top most layer of the skin
-Basal cell layer (Bottom)
- Horny cell layer (Shed)
- Derivation of skin color: melanin in basal cell layer

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2
Q

what is the dermis of the skin what does it have

A

the second layer
– Connective tissue: collagen
- Elastic tissue
- Nerves, receptors, blood vessels, lymphatics; hair, sweat, sebaceous glands

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3
Q

what is the subcutaneous layer

A

the most bottom layer
it has adipose tissue

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4
Q

what iare the functions of the skin

A
  1. Protection: physical, chemical, thermal and light
  2. Prevents penetration & loss of fluids
  3. Perception: touch, pain, temperature, pressure
  4. Fluid balance–> keeps anything from penetrating
    5 Temperature regulation via sweat & adipose layer
  5. Identification
  6. Communication
  7. Wound repair
  8. Absorption and excretion (toxins)
  9. Production of Vitamin D
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5
Q

what is verniz caesosa

A

thick, cheesy substance make of sebum and shed epithelial cells)
-this is present at birth

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6
Q

what is terminal hair

A

-on the scalp; soft and patchy loss

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7
Q

what happens with the hair after the first few months of birth

A

replaced by fine veluus hair

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8
Q

what happens with hair at midgestation

A

most skin covered with lanugo (fine downy hair of newborn

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9
Q

when do fair follicles develop

A

develop in fetus at 3 mos’ gestation

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10
Q

how does you skin change when you get pregnant

A

-Increased pigment: areolae, nipples, vulva, midline of abdomen (Linea nigra), face (Chloasma)
-Hyperestrogenemia- vasuclar spiders & palmar erythema (this means too much estrogen on the blood flow)
-Connective tissue develops increased fragility

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11
Q

what is stria gravidarum

A

stretch marks

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12
Q

what happens to you metabolism when you are pregnant

A

peripheral vasculature dilates & seat and sebaceous glands increase secretion.
Fat deposits laid down as maternal reserves for nursing baby

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13
Q

what happens to skin in the aging adult

A

-everything atrophies!
Loses elasticity and Lost of collagen (increase risk of shearing, tearing injuries), and SQ fat occurs & reduction of muscle tone
-wrinkling
-Decreased number and function of sweat and sebaceous glands (greater risk for heat stroke)
- dry skin xerosis
-Decreased thermoregulation
-Skin vascularity diminishes while vascular fragility increases
-Life style factors increase risk for skin disease & breakdown too

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14
Q

what happens to the nails and hair as you age

A

Hair- graying, feels thin and fine. Hair distribution changes-decreases and loss; and the female may have some bristly facial hairs
-Nails grow more slowly, surface is lusterless. characterized by longitudinal ridges

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15
Q

what would be the subjective data of the skin

A

-history of skin disease (allergies, hives, psoriasis, eczema)
-Change in pigmentation hypo/hyperpigmentation
-Change in mole (size or color)
-Excessive dryness or moisture
-Pruritus (inching)
-Excessive bruising
-Rash or lesion (N,O,P)
- Medications
Hair loss alopecia
-Change in nails
-Environmental or occupational hazards
-Health Promotion and Disease Prevention
-Ask about tattoos, body piecing & scars
if an adolescent ask about any acne or blackheads

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16
Q

what subjective skin data do you collect from infants and children

A

-birthmarks?
-Jaundice? Cyanosis? Pallor? Erythema?
-rash (diaper) or sores?
-burns or bruises and how did they happen?
-has the child been exposed to scabies, impetigo, lice?
-have they been exposed to measles, chicken pox, scarlet fever?
-does the child bite their nails or twirl their hair
-does the child use sunscreen

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17
Q

what subjective data do you collect about the skin in aging adults

A

-What changes have you noticed in your skin in last few years?
-Any delay in wound healing?
-Skin pain or pruritis?
-Any change in feet: toenails; bunions, wearing shoes?
-Any falls?: bruises, trauma?
-History of diabetes or peripheral vascular disease?
-What do you do to care for your skin?

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18
Q

what preparation do you have to do when you are going to conduct a skin exam

A

-External variables that influence skin color: Emotions, Environment, Physical (position)

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19
Q

what equipment is needed when you are going to conduct a skin exam

A

-Strong direct lighting
-Small centimeter ruler
-Penlight
-Gloves!
-For special procedures:
-Wood’s light, Magnifying glass
-Materials for laboratory tests: KOH, glass slide

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20
Q

descrbie inspection and palpation when it comes to conducting a skin exam

A

-color (general pigmentation and tone)
-is pallor, erythema, cyanosis, jaundice, ashen present
-make note of any moles, freckles and birthmarks
-dark skinned people have areas of lighter pigmentation on the palms, nail beds, and lips
-Healthy dark brown 4 (fair white 2) tone with even pigmentation and consistent with genetic background. No concerning moles or lesions
-are there any needle marks, tattoos, scars etc

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21
Q

what is type 1 on the Fitzpatrick skin type scale

A

light
-pale white skin
-always burns and never tans

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22
Q

what is type 2 on the Fitzpatrick skin type scale

A

white and fair
-usually burns and it tans with difficulty

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23
Q

what is type 3 on the Fitzpatrick skin type scale

A

-medium, white to olive
-burns mildly and tans gradually

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24
Q

what is type 4 on the Fitzpatrick skin type scale

A

-olive, moderate brown
-rarely burns and tans with ease

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25
what is the type 5 on the Fitzpatrick skin type scale
-brown and dark brown -very rarely burns and it tans very easily
26
what is type 6 on the Fitzpatrick skin type scale
-black, very dark brown to black -never burns and it tans very easily
27
what do calluses do
they increase pressure
28
what is edema
swelling caused by too much fluid in the body tissues -you can see how severe it is based on how deep the indentation is -this is apart of palpating the skin and inspecting it
29
what does mobility and turgor
-reflects elasticity --this is apart of palpating the skin and inspecting it
30
what is ecchymosis
bruising
31
how do you assess lesions
-Color -Elevation -Pattern or shape -Size in cm -Location and distribution on body -Exudate? describe (color, consistency, amount, odor) -Palpate lesions -Wear gloves -Note surrounding skin-temp, scales come off, bleed? -Blanching? -if there is fluorescence that means that there is fungal or yeast infection --this is apart of palpating the skin and inspecting it
32
how do you inspect or palpate hair give an example of how you would chart your findings
-Color -Texture -Distribution (Head and body) -Lesions e.g Hair is brown, fine, straight, and shiny with even distribution in relation to age, sex and race. Scalp and hair clean, free or lesions or pest
33
how do you inspect and palpate nails give an example of how you would chart your findings
-Shape and Contour -Profile Sign-clubbing? -Consistency -Color (linear pigmentation, leukonychia striata, melanoma) -Capillary Refill Time (CRT) e.g Nails are clean and slightly curved. Nail folds and edges are smooth and rounded. Surface is smooth and regular without splitting or markings. Nail bed is even, pale pink, base firm, with convex angle < 160. No clubbing, capillary refill less than 3 seconds
34
what is clubbing
the angle of the nail and bed and the nail bed itself
35
what is a cafe au lati spot
light brown spot -present in infants
36
what is Cutis marmorata
-rare deep purple net like birth mark on babies this is temporarty cyanotic conditon
37
Acrocyanosis
-hand and feet of the infant being blue
38
what is Erythema toxicum
-found in infants -they look like little pimples but dont pop them
39
what is Carotenemia
yellow pigmentation of the skin
40
what is milia
-benign and transient subepidermal keratin cysts that present as small firm white papules in various numbers most commonly distributed on the face,
41
what are comedones
-balck heads or white heads
42
what is the Linea nigra
the black line you get from your belly button to the pubic bone
43
what is Chloasma
dark skin patches on the face and sunexposed areas that you get during pregnancy
44
what are vascualr spiders
-looks like a spider web -dilation of end vasculature under the skin
45
what are Variscosities
-these are varicose veins -veins become enlarged, dilated, and overfilled with blood
46
what would see during a skin exam of and aging adult
-senile lentigines (live spots) -benign proliferation of immature keratinocytes - waxy or scaly and slightly raised
47
what is Xerosis and what does it cause
dry skin -common as you age -sweat and sebaceous glands, puritus and the skin is flaky and loose -common when you age
48
what are Acrochordons
-skin tags
49
what is sebaceous hyperplasia
acne for old people
50
what happens to the texture of the skin when you age
-Looks thin, SQ fat diminishes, may feel thicker over chest and stomach -tugor and mobility decrease
51
what happens to hair and nails when you you age
Hair: decreased growth, facial hair in women, alopecia, graying Nails: decreased growth, hard, toenails thickened-evaluate for onychomycosis.
52
what is the ABCDEF rue
-use this when conducting a skin assessment A—asymmetry B—border irregularity (melanomas have uneven or blurred borders) C—color variation (melanomas usually are not one color, they can have traced of red, blue or white) D—diameter (>6mm) (greater than and use the pencil eraser as a ball part) E—elevation and evolution (enlargement) F-funny looking
53
when should you see a dermatologist
If you notice a mole different from others, or which changes, itches, or bleeds even if it is smaller than 6 millimeters, you should see a dermatologist
54
what abnormal findings could be present in a skin exam
-Confluent (spreading) -Discrete (only one) -Grouped -Zosteriform--> when you have shignles)
55
what are the primary skin lesions
-Papule and Plaque -Macule and Patch -Nodule and Tumor -Wheal and Urticaria
56
why do we need the skeletal system
1.support to stand erect 2.movement 3.protects the inner vital organs (brain, spinal cord, and the heart) 4. produce red blood cells, white blood cells ad platelets in the bone marrow (hematopoiesis) 5.reservioir for storage of essential minerals like calcium and phosphorus in the bones
57
what is flexion
bending a limb at a joint
58
what is extension
Straightening the limb at a joint
59
what is abduction
moving a limb away from the midline of the body
60
what is adduction
moving a limb toward the midline of the body
61
what is pronation
turning the forearm so the palm is down
62
what is supination
turning the forearm so the palm is up
63
what is circumduction
moving the arm in a circle around the shoulder
64
what is inversion
moving the sole of the foot inward at the ankle
65
what is eversion
moving the sole of the foot outward at the ankle
66
what is rotation
moving the head around a central axis
67
what is protraction
moving the body part forwards and parallel to the ground
68
what is retraction
moving the body part forwards and parallel to the ground
69
what is elevation
raising the body part
70
what is depression
lowering a body part
71
what are synovial joints
-freely moveable joint
72
what does the tendon connect
muscle to bone
73
what do ligaments connect
bone to bone
74
what it the bursa
sack of support fluid for the joint
75
what is the Temporomandibular Joint and what kind of joint is it
-(hinge and glide) Articulation of the mandible and temporal bones
76
what are the landmarks of the spine for C7 and T1
Spinous processes of c7 and T1 are prominent at the base of the neck
77
what are the landmarks of the spine for T7 and T8
Inferior angle of the scapula normally is at the level of the interspace between T7 and T8
78
what is the landmark for L4
* An imaginary line connecting the highest point on each iliac crest crosses L4
79
what is the landmark for
Imaginary line joining the two symmetric dimples that overlie the posterior superior iliac spines crosses the sacrum
80
how many bones in the spine is there
7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 4 Coccygeal -there are plexuses (interlacing nerves)
81
what is the glenohumeral joint consist off and what makes up the rotator cuff
-humerus and scapula -Supraspinatus -Infraspinatus -Teres minor -Subscapularis
82
what makes up the elbow q
-Medial and lateral epicondyles -Olecranon process of ulna
83
what makes up the wrists an carpal
-Radiocarpal joint -Midcarpal joint -Metacarpophalangeal joints -Interphalangeal joints
84
what makes up the hip joint and what kind of joint is it
-ball and socket joint -Acetabulum and head of femur -Anterior superior iliac spine -Ischial tuberosity -Greater trochanter of femur
85
what makes up the knee joint and what kind of joint is it
-hinge joint Femur, tibia, and patella Medial and lateral menisci (cartilage) Cruciate ligaments (supports knee) Prepatellar bursa Quadriceps muscle (power house of the knee) Suprapatellar pouch (most synovial fluid)
86
what makes up the angle and the foot and what kind of joint is it
-hinge -Tibiotalar joint -Medial and lateral malleolus -Metatarsals -3 ligaments lateral, 1 ligament medial to stabilize joint (sprain or rupture with extreme inversion or eversion)
87
where does lengthening happen
in the epiphyses (these are the growth planes)
88
pregnancy and psoture
-can cause lordosis and waddling bc of the enlarging fetus -felt as low back pain -Anterior flexion of neck and slumping of shoulder girdle are other postural changes that compensate for lordosis -this can all put pressure on the ulnar and median nerves during the third trimester -this can cause aching numbness and weakness in upper extremities
89
what is bone remodeling and when does this happen
Bone remodeling is cyclic process of resorption and deposition; after age 40 resorption occurs more rapidly than deposition -this happens when you get old
90
what is osteoporosis
-women are more at risk for it - we lose a great deal of our bone density and loss of mineralized bone mass - increases the risk of fractures -Aging adults should engage in physical activity like balance training, strength training and fast walking, as well as consume the recommended amount of calcium and vitamin D.
91
what is the most noticeable as we age and what is it caused by
Postural changes and decreased heigh postural changes: caused by loss of water content and thinning of intervertebral disks height: Decreases height of individual vertebrae, in later years from osteoporosis
92
what is kyphosis
backward head tilt to compensate for kyphosis, and slight flexion of hips and knees -think about the hunch back or notradame
93
what happens to the bony prominences when you age
they become more marked
94
what is functional assessment of ADL's and what is it for, what questions do you ask
-To determine adequate and safe performance of functions essential for independent home life -Which activities give you problems? -Is the pain with walking? -Is the pain affected movement? -Does it affect range of motion? -Do your joint, muscle, bone problems create any limits on your usual ADLs? Which ones -Any change is strength over the past months or years
95
what is the get up and go test
this is for the older adults when you need to see if they are at an increased risk of falling -record the time it takes the person to rise from an armchair, walk 10 feet, turn, walk back, and sit down again -12 seconds or more identifies older adults at an increased risk of falls
96
what are abnormal findings ad abnormalities affecting multiple joints (inflammatory conditions)
-Rheumatoid arthritis--> produces swelling of tenderness around the whole joint -Limits all planes of range of motion in both active and passive motion -Ankylosing spondylitis--> fusion of vertebral bodies
97
lwhat is the difference between crepitation and crack
Crepitation: audible and palpable crunching or grating that comes with movement -Happens when articular surfaces in the joints are roughened rheumatoid arthritis Crack: when a tendon or ligament slips over bone during motion like when you bend the knee
98
what are degenerative conditions
-Osteoarthritis (degenerative joint disease)--> cartilage breaks down -Osteoporosis-more common in white women -this isnt always symmetrical
99
what is the order of Musculoskeletal examination
Inspection: -Size and contour of joint -Skin color and characteristics Palpation of joint area: -Skin, muscles, bony articulations, and joint capsules ROM: -Active -Passive (if limitation noted in active ROM is present) -Measure with goniometer (if abnormality in ROM is present) -ROM with Palpation -Muscle testing
100
what happens to the muscles and the tendons when you age
-Contour of muscles becomes more prominent, and muscles and tendons feel more distinct
101
how does lifestyle affect musculoskeletal changes
-Sedentary lifestyle hastens MSK changes of aging -Physical exercise increases skeletal mass and helps prevent or delay osteoporosis -Physical activity delays or prevents bone loss in postmenopausal and older women -To reduce the risk of osteoporosis: -Engage in regular physical activity, including strength training, balance training, and fast walking -Maintain healthy body weight and recommended amount of calcium and vitamin D
102
what subjective data can be collected from the joints
-Pain -Stiffness -Swelling, heat, redness -Limitation of movement
103
what are the 5 grades of muscle testing
5: full range of motion against gravity and full resistance 4 : full range of motion against gravity some resistance (75%) 3: full range of motion with gracity (50%) 2: full range of motion with gravity eliminated (passive motion) (25%) 1: slight contraction (10%) 0: No contraction (0)
104
what subjective data can be collected from the muscles
-Pain (cramps) -Weakness
105
what is myalgia
-soreness to the muscles that has nothing to do with disease -soreness from working out -strains soreness from laying down or sitting down
106
what sub subjective data can be collected from the bones
-Pain -Deformity -Trauma- (fractures, sprains, dislocations)Mechanism of Injury
107
what additional subjective data can be collected from infants and children
-Birth trauma? Forceps during delivery? Breech birth? -Motor milestone achievements? -Any history of fractures or dislocations? -Any noticeable bone deformity or spine curvatures?
108
what do you have to assess for aging adults (muscles)
-any recent falls -scree women 65 yrs and older and postmenopausal for osteoporosis
109
what does fasculations mean
twitching
110
what deformities can the musculoskeletal system have
-Fracture -Dislocation -Subluxation -Contracture -Ankylosis
111
what is diastole
-Filling phase 2/3 of cycle Ventricles relax and fill with blood (early passive phase) -Atrial kick (Presystole, valves close, active phase)
112
what is systole
-Pumping phase 1/3 of cycle -Ventricular contraction, blood pumped out into arteries & lungs
113
what is arrhythmia/ dysrhythmia
irregular conduction through the heart
114
describe heart sound 1
-Closure of AV valves; loudest at Apex Mitral (M1) & Tricuspid (T1), beginning of systole, “Lub”
115
describe heart sound 2
-Closure of Semilunar valves, “Dub” Aortic (A1) & Pulmonic (P2); loudest a Base, end of systole
116
what are the effects of respiration on the heart sounds
Inspiration may cause Split S2 MoRe to the Right heart, Less to the Left
117
describe heart sound 3
-Ventricular filling sound, a vibration, indicating ↓ ventricular compliance -Occurs when ventricles resistant to filling during early rapid filling phase -early diastole -In adults, usually abnormal -it is best heard at the apex with the bell
118
what are conditions of volume overload
-heart failure MR AR TR
119
what are conditions of high cardiac output
anemia, PG, hyperthyroidism
120
Describe heart sound 4
-daLub - dup -vibration -noncompliant ventricle -Occurs when ventricles resistant to filling at end of diastole, at presystole -Atria contract and push blood into noncompliant ventricle In adults, usually abnormal -happens around S1 -Very soft and very low-pitched sound Best heard at Apex with Bell
121
what is a murmur
-after S2 before S1 and it always indictaes heart disease -wooshing -turbulance in blood flow
122
what is the order of examination for cardiovascular assessment
1. Pulse & Blood pressure 2. Extremities 3. Neck vessels 4. Precordium
123
what is a bruit
-blowing swishing sound -you auscultate for this in the carotid arteries -hold breath and use a bell
124
what is a thrill
you palpate the carotid artery vibration

Foundations (3 decks)

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