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Integumentary System > Physical Assessment > Flashcards

Flashcards in Physical Assessment Deck (41)
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1

What is a normal assessment of the skin?

1.Evenly pigmented
2. No petechiae, purpura, lesions or excoriation
3. Warm, dry, intact, elastic turgor

2

What is a normal assessment of the nails?

1. Pink, oval, and adhere to the nail bed

3

What is a normal assessment of the hair?

1. Shiny and full
2. Amount of distribution appropriate for age and gender
3. No flaking of scalp or forehead

4

What is the subjective data for a general assessment during the interview process?

1. PMH
2. Medications
3. Allergies
4. Surgery

5

What is the subjective data for assessment of health practice?

1. Hygiene
2. Diet history
3. Elimination
4. Exercise/Activity
5. Sleep/rest
6. Self-concept
7. Values/belief system

6

What subjective data is assessed for medications used and drug reactions?

1. OTC, prescribed or homeopathic
2. Past reactions to meds
3. Photosensitive drugs
4. Side effects of steroids

7

What are some photosensitive drugs?

1. Sulfa
2. Diuretics
3. Tetracycline
4. Doxycycline

8

What are some side effects of steroids relating to the integumentary system?

1. Acne
2. Thinning of skin

9

What subjective data is important for assessment of allergies?

1. Allergy - something that consistently happens when using the same antigen
2. Irritation - unpredictable
3. Fruits - pesticides

10

What is the main question to determine scabies outbreak?

Is the itching so uncomfortable it wakes you out of your sleep?

11

What is the most important factor of assessing skin?

Change is the most important factor

12

What does normal skin look like?

It depends on the melanin

13

What does pale skin look like?

Decreased amounts of Hgb

14

What does blue mean for skin assessment?

Inadequate tissue perfusion with oxygenated blood

15

Deep red

Over abundance of RBCs meaning polycythemia Vera, sunburn, fever, allergic reaction, emotions

16

When inspecting lesions what needs to be documented?

Size
Location
Color
Distribution
Shape

17

When inspecting for odors of the skin what assessment needs to be documented?

Unusual smells
Yeast/ bacteria
Intertriginous areas

18

What does intertriginous mean?

In between skin folds

19

Where are common intertriginous areas located?

Axilla, perineal area/groin, under breast, abdominal folds, between digits

20

How many inches at a time to we assess the hair?

1inch blocks

21

What could felt cold skin indicate?

Shock, organ failure, septic

22

How do we assess the temperature of a patients skin?

Using the back of the hand

23

What is assessed about turgor?

Is it elastic, sluggish, inelastic, tenting

24

What does skin turgor indicate?

Hydration status

25

What do we assess relating to moisture of a patients skin?

Are they moist or dry. Keep dry.

26

What do we assess for texture of the skin?

Is the skin smooth, firm, even, calluses (palms/soles) normal

27

What areas do we use to assess dark skin?

Lips
MM
Nail beds
Buttocks
Palms
Soles

28

How can we determine a dark skin patient is cyanotic?

They are usually ashen or gray in the eyes, lips, MM, nail beds

29

How can we determine a dark skin patient has eccchymosis/bruising?

It's hard to tell unless they have lightly pigmented skin

30

How can we tell a dark skin patient has erythema?

They will have a deeper brown or purple color and increased skin temp