Week 3 - Ch.9 & Ch.13 Flashcards
(110 cards)
1
Q
what is subjective data vs objective data ?
A
Subjective is the patients own experiences
objective data is gathered through technical measurements and observations by healthcare providers
2
Q
what is inspection vs palpation ?
A
Inspection is concentrated watching while palpation is used the sense of touch to confirm what you have seen during inspection
3
Q
what is percussion ?
A
it is the tapping of the persons skin with short, sharp strokes to asses underlying structures
4
Q
why use percussion when x-rays are available ?
A
your hands are easily available, immediate feedback
5
Q
What are the two forms of percussions ?
A
1) Direct : striking hand contacts the patients body wall
2) indirect: in which the your non dominant striking is placed on the patient - your middle finger of that hand stays on the surface while the other fingers need to be lifted - with dominant hand use the middle finger to percuss the stationary middle finger on patients body - movement is all in the wrist
6
Q
what characteristics in sound do you look for in the percussion process ?
A
amplitude (intensity - loudness - softness), pitch ( frequency - vibrations per second), quality (timbre) , overtone ( length of time the note lingers)
7
Q
what are the basic differences in sounds that one should look for ?
A
structures with more air (lungs) produce louder, deeper, and longer sounds b/c it vibrates freely
denser structures (bones or organs) give softer, higher, shorter, sounds
8
Q
what is auscultation ?
A
listening to parts of the body such as the heart and the blood vessels - this requires a stethoscope
9
Q
What is a diaphragm and bell in a stethoscope ?
A
Diaphragm ( flat edge) that is used for hearing high pitched sounds such breathe, bowel, and normal high pitched sounds
Bell is best for soft low pitched sounds
do not listen through gown
10
Q
what should be done prior to starting any assessment ?
A
An ENVIRONMENTAL SCAN needs to be done to assess any risks, both sides of patients body are open, no noises, lighting
11
Q
What is a Otoscope ?
A
it funnels light into the ear canal and onto the tympanic membrane
12
Q
what is a Ophthalmoscope ?
A
it illuminates the internal eye structure
13
Q
What is important to do after the use of equipment
A
it is important to clean the equipment - make sure to have a designated clean and dirty area
14
Q
Define health care associated infections ?
A
they are infections that are acquired in a health care setting - hospitals are reservoirs for virulent microorganisms some of which are antibiotic resistant
15
Q
what are the steps needed to prevent HAI’s ?
A
1) before initial patient or patient environment contact 2) before sceptic procedures 3) after contact with blood, bodily fluids, secretions, excretions 4) after contact with any equipment contaminated with body fluids 5) after removing gloves
16
Q
what are the tiers of precautions ?
A
1) Routine practices - which are intended to be used for all patients at all times - regardless of their risk of infection - these practices are designed to reduce the risk of transmission of microorganisms - they apply to all excretions except sweat
2) Additional precautions - which are intended to be used when routine practices cannot fully manage the transmission of organisms
17
Q
how do you handle assessment with a infant ?
A
make sure that the parent is present - place supine on padded examination table - perform examination 1 to 2 hours after child has been fed - make sure environment is warm - most infants like eye contact -
18
Q
how do you handle assessment with a toddler ?
A
have the child sit up - greet the child - have mother or parent undress child - start with non threatening areas - head, nose, ears, or throat last
19
Q
how do you handle assessment with preschool age children ?
A
verbal communication is good - offer choice if possible - allow them to pay with equipment if it helps - examine thorax, abdomen, extremities, and genitalia - head, eye, nose, ear, throat last
20
Q
how do you handle assessment with school age children ?
A
they can sit on examination table - small talk is good to break the ice - children should undress on their own (leave pants on, gown , or cover with towel) - head to toe approach
21
Q
how do you handle assessment with adolescents ?
A
adolescent should be alone without parent or sibling -do not treat them like an adult or a child - examine genatalia last - head to toe approach
22
Q
How do you perform assessment on older adults ?
A
place on examining table - use sense of touch b/c other senses may be diminishing - head to toe approach
23
Q
how do you perform assessment when individuals have acute challenges ?
A
Collecting a mini database of the problem and continuing examination when distress is alleviated
24
Q
What are the layers of the skin ? In order, from outermost to innermost layer ?
A
epidermis - dermis- subcutaneous layer
25
how many layers does the epidermis have ?
The epidermis has two layers: Basal cell layer (inner) and horny cell layer (outer)
26
which cell layer produces new skin cells ?
New skin cells are produced in the Epidermins (basal cell layer)
27
What role does Keratin play in the basal cell layer ?
When the basal cell layer produces the new skin - Keratin is dispersed throughout the layer - which makes it tough and fibrous
28
What other is dispersed within the basal cell layer ?
Melanocytes are interspresed in the basal cell layer which produces melanin - everyone has the same amount of melanocytes - the amount of melanin produced varies depending on genetics, hormonal, and environment
29
where do the new cells from the basal cell layer go ?
The new skin cells migrate up and flatten on the outer HORNY CELL LAYER
30
what does the horny cell layer consist of ?
The horny cell layer consists of dead keratonized cells that are interwoven and closely packed - these cells are constantly being shed and (desquatmated) and replaced with new cells from below
31
Is the epidermins avasculaer?
Yes, it recieve nourishment by the blood vessels in the dermis below
32
where is skin colour derived from ?
1) brown pigment melanin mainly 2) yellow- orange tones from carotene 3) red - purple tones in the underlying vascular bed
all people have different portions of these shades in combination with thickness of the skin and presence of edema
33
what is the dermis ?
The dermis is the inner supportive layer consisting mainly of connective tissue or collagen - it also contains resillent elastic tissue that allows the skin to stretch with body movements
34
what is collagen ?
It is a tough fibreous protein that enables the skin to resist tearing
35
what is located within the dermis ?
nerves, sensory receptors, blood vessels, lymphatic vessels, appendages from epidermis ( hair follicles, sweat glands, and sebaceousglands)
36
what does teh subcutaneous layer consist of ?
The subcutaneous layer consists of adipose tissue ( lobules of fat cells) - stores fat for energy - insulation - protection through soft cushioning effect - this loose subcutenous layer also gives increased mobility for the structures beeath
37
what is hair ?
Hair are threads of keratin, the hair SHAFT is the visible projecting portion, the ROOT is below the surface embedded in the follicle - the BULB MATRIX is the expanded area where new cells are produced
38
how do the hair follicles function ?
Each hair follicle functions independtly - so one hair follicle is growing the other may be resting
39
what are Arrector Pili ?
They are musculatire that are located around the hair follicle - which contract which causes the effect of goose bumps when exposed to cold hair or emotional states
40
what are the two types of hair people have ?
fine, faint (VELLUS HAIR) which coveres most of the body - TERMINAL HAIR is the darker thicker hair (scalp, eyebrows, puberty, males face and chest)
41
what are sebaceous glands ?
Sebacious glands produce sebum through the hair follcile - they are not found on the palms and soles - most abundant in scalp, forehead, face & chin
42
what is sebum ?
it is a protective liquid substance - it is an oil that forms an emulsion with water to prevent water loss from the skin - dryness of skin is caused from the loss of water not oil
43
what are the two types of sweat glands ?
ECCRINE GLANDS AND APOCRINE GLANDS
44
what are eccrine glands ?
they are coiled tubules that open directly onto the skin surface and produce a dilute saline solution called SWEAT - they are widely distributed throughout the body and are mature in 2 month old infants
45
what are apocrine glands ?
they are glands that produce thick, milky secretion and open into the hair follicle - located mainly in the axillae, anogenital area, nipples, navel
46
when do aprocrine glands become active ?
They become active during puberty and secretion occurs during sexual ad emotional stimulation -aprocrine glands decrease in dolder adults
47
Decsribe the strructre of nails ?
the nails are hard plates of keratin on the dorsal edges of the fingers and toes - the nail plate is clear with longitudal ridges that become evident as yoy get older - the pink colour of nails is derived from the underlying nail bed of the high vascular epithelial cells
48
what is the Lunula ?
it is the white semilunar area at the proximal end of the nail - it lies over the nail matrix
49
what is the nail matrix ?
Where new Keratinized cells are fomed
50
what are the nail folds ?
the nail folds overlap the lateral and posterior border - the cuticle covers and protects the nail matrix
51
define the functions of the skin ?
1. protection
2. prevention of penetration
3. perception - sensory surface
4. temperature regulation - sweat gland and subcutaneous insulation
5. idnetification - fingerprints
6. communication - emotions in the sign language of the face
7. wound repair
8. absorption and excretion
9. production of vitamin D
52
what hair follicles develop in infants ? what characteristics are present at birth ?
hair follicles developes three months into gestation - in midgesttaion the skin is covered with LANUGO ( fine downly hair of a newborn infact) - the first few months after birth this hair is replaced with by fine vellus hair
if termial hair is present at birth it will go through a period of patchy loss
VERNIX CASEOSA is the thick, cheesy substance made up on sebum and shed epithelial cells
53
what insuffiences does a infant pocess that makes them more sensitive than adults ?
1. more permeable which puts them at risk for fluid loss - sebum is present at birth producing milia and cradle cap in some babies
2. ineffective temperature regaultion - eccrine glands do not secrete in the first few months
3. subcutaneous layer is ineffeccient - no protection against cold
4. pigement system is ineffiecent
54
what are the affects on womens skin when she becomes pregnant ?
1. change in hormone levels increases pigmentation in the areolae and nipples, vulva, and sometimes midline of the abdomen ( LINEA NIGRA) or in the face (CHLOASMA)
2. connective tissues becomes fragile which causes (STRIA GRAVIDARUM - stretch marks) which develops breasts, thigh, abdomen
3. metabolism increases during pregnancy - the peripheral vasculature dilates - sweat and sebacious glands increase secretion
4. fat deposits are laid down particularry in buttocks and hips as maternal reserves
55
why happens to skin as you age ?
1. skin loses its elasticity, it folds and sags - by the 70s & 80s in looks parchment thin, lax, dry, and wrinkled
2. epidermis outer layer (stratum corneum) thins and flattens - chemicals enter easier
3. wrinkling ocursb/c the underlying dermis thin and flattens
4. elastin.,collagen, subcutaneous fat, muscle tone are lost (loss of collagen icreases risk of tearing injuries)
5. sweat glands and sebaceous glands decrease in number and function - leaving the skin dry - decreased thermoregulation puts them at risk for heat stroke
6. vascularity of skin diminished while vascular fragility increases
56
what is SENILE PURPURA ?
dark red discoloured areas of the skin due to trauma common in older individuals
57
what are different factors that affect the skin ?
1. sun exposure
2. cigarettes
3. chrinic sun damage
58
what accumulated factors increase older adults risk to skin disease ?
1. thinning of the skin
2. loss of protective cushioning
3. decrease in vascularity and nutrients
4. environemnetal trauma
5. social changes of aging
6. sedentary lifestyle /immbolity
59
what happens to hair as you age ?
1. functioning melanocytes decrease - hair turns grey
2. male balding W shaped
3. pubic hair and axillary decreases
4. females may ghave bristly fcaial hair due to decrease in estrogen
5. nails grow slowly
60
which are some inetersting facts about skin ?
1. pale individuls are more at risk for melanoma
2. nipple, scrotum, genitals are darker than the rest of the body
61
what is alcohol flush syndrome ?
it is something that occurs in 90% of indigenous people and 50% of asian descent - it is a genetic disposition that causes redness, flushing of the face, heat sensation, splotchy, redness in neck, and accelerated intoxicatio
62
what are some common benign pigmented areas ?
1. Freckles (Ephelides): small, flat macules of brown melanin pigment that occur only in sun exposed skin
2. Mole (nevus): prolifertaion of melanocytes, tan to brown in colour - flat or raised - JUNCTIONAL NEVUS is macular only and occurs in chldren and adolescents it can progress to COMPOUND NEVUS which is macular & papular (raised)
3. Birthmarks may be tan to brown in colour
63
what are some abnormal signs when it comes to pigmented areas ?
A: Assymetry
B:Borders are uneven
C: Colour variation
D: Diameter greater than 6 mm
E: Elavation and Evolution
64
what is Pallor, ?
red pink tones from oxygenated haemoglobin in the blood are lost, the skin looks white b/c of the colour of collagen
can be caused by anxiety, fear
for fark skinned people it can be seen by the lack of lustre in their skin
ca be obsereved in nails beds and lips
65
what is erythema ?
intense redness of the skin from excess blood (hyperemia) in the dilated superficial capillaries
associated with fever, local inflammation or emotional reactions
darkers skinned people you need to palpate skin (warmth, tightness, and tautness)
66
What is Cyanosis ?
bluish, molted discolourtion that signifies decreased perfusion; tissue are not adequately perfused with oxygenated blood
changes in level of conciousess due to low O2 levels and respiratory distress
indiciates hypoxemia
occurs with shock, heart failure, chronic bronchitis, Congenital heart disease
67
what is jaundice ?
yellow discolouration, rising amounts of bilirubin in blood
yellow in the sclera of eye all the way to iris
occurs with hepatitis, cirrohsis, sickle cell. transfusion rxn and, hemolytic disease
68
what are somethings to look for when exmaining skin ?
1. tempertaure (use back of hand - dorsal) - hyperthermia or hypothermia
2. Moisture (diaphoresis - excessive sweating or Dehydration)
3. Texture
4. Thickness
5. Edema (fluid that accumulates in subcellular space) ( indent test)
6. Mobility and Tugor - grab skin from below clavicle and note the ease of grip and to retur to place
7. Vascularity of bruising ( CHERRY ANGIMAS are small smooth slight raised bright red dots that appear on the trunk in all adults older than 30)
69
what are some aspects and focus points for a lesions ?
1. colour
2. elevation
3. pattern or shape
4. size in cm
5. location or distrubution
6. any axudate: colour and odour
7. Primary lesion ( present on previously normal skin) or secondary lesion ( lesion changes over time from scratching or infection)
70
what are some aspects when inspecting and palpating hair ?
1. Colour
2. Texture
3. distribution (absence of genital hair may be an endocrine problem or HIRSUTISM is excess body hair may be endocrine abnormality)
4. Lesions
71
what are some fators and aspects when examining the nails ?
1. shape and contour ( profile sign of nail - 160 degrees of less)
2. consistency - smooth reg surface not brittle or splitting
3. colour ( CAPILLARY REFILL - depress nail to see refill time) - indicates status of peripheral circulation - refill should not take longer 1 to 2 seconds
72
what are the steps for skin self examination ?
advise adults to examine their skin once a month follow ABCDE rule
1. undress completely - forearms, palms, between fingers, back of hands
2. face mirror: bend arms - check elbows - study arms in mirror
3. face mirror: study entire front - start face - neck - torso- working down to lower legs
4. pivot to right side:
5. back to mirror: butt thigh lower legs
6. with handheld examine upper back
7. handheeld study scalp lifting hair
8. sit on chair - study inside of each leg - soles of feet
73
what is the Mongolian spot ?
is a varitaion of hyperpigmentation in newborns of idigenous, african, east indian, hispanic
located sacrum or buttocks that is blue black or purple in colour - sometimes it can be located in thighs, shoulders,abdomen, or arms
originates from deep dermal melanocytes
gradually fade furing teh first year
74
what is the cafe au lait spot ?
is a large round or oval patch of light brown pigmentattion
present at birth
75
what is neurofibromatosis ?
an inherited neurocutaneous disease - presence of 6 or more cafe au lait spots - each more than 1.5 cm in diameter
76
what are some variations that are common for infants ?
1) for the first 24 hours infants have a beefy-red flush for 24 hours b/c of vasometer instability then it fades to normal colour
2) HARLEQUINN COLOUR CHANGE occurs when the child is in the side lying psoition - lower half of the body turns red and the upper half oof the body blanches with a specific line of demarcation down the midline
3) ERYTHEMA TOXICUM is a common rash that appears in the first 3 to 4 days of life
77
what do clubbed nails indicate ?
congenital, chronic, cyanotic heart disease
emphysema
chronic bronchities
78
what are two temporary cyanotic conditions ?
1. ACROCYANOSIS is bluish colour around the lips, hands, amd fingernails, feet, toenails - lasts few hours amd dissappear w/o warming
2. CUTIS MARMORATA is a transient mottling in the trunk and extremeties in respose to cooler room temperatures - reticulated red or blue patterns over the skin
79
what is PHYSIOLOGICAL JAUNDICE ?
yellowing of the skin, sclera, and mucous membranes that develops **after the third of fourth day** of life
80
what is important to note about jaundice ?
jaundice on the first day of life indicates *hemolytic disease*
jaundice after two weeks of age may indicate *biliary tract obstruction*
81
what is CAROTENEMIA ?
produces a yellow orange colour in light skinned person but no yellowing in the sclera or mucous membranes
colour is best seen on palms, soles, forhead, tip of nose,nasolabial, and chin
82
other than skin colour change, what are some other factors to note ?
1. moisture
2. Texture - Milia are tiny white papules on the cheeks, forehead, across the nose, chin - causd by sebum occluding the opening of the follicles \*\* tell parents not to squeeze lesions , milia resolves itself\*\*
3. thickness (test mobility and turgor over the abdomen in an infant)- (Vascularity or Bruising)
4. hair
5. nails
83
what is a STROKE BITE ?
is a flat, ireegulayry shaped red or pink patch on the forehead, eyelid, upperlid but most commonly on the back of the neck - fades during the first year
84
During skin examination of an adolescent, what is common ?
an increase im sebaceous glands causes increased oiliness and ACNE (open comedoes - black heads & closed comedones - white heads)
85
What are some skin findings for pregnant women ?
* Stria* are jagged linear stretch marks coloured silver to pink that occur during the 2nd trimester on the abdomen, breasts, sometimes thighs
* Linea Nigra* brownish black line down the midline
* Chloasma* is an irregular brown patch of hyperpigmentation on the face - may occur with pregnancy or women taking oral contraceptive pills - dissappears after birth or when they stop taking pills
* vascular Spiders* lesions have tiny red centres with radiating branches and occur in face, neck, upper chest, arms
86
Whar are some skin findings in older adults ?
* senile lentigines* called liver spots - small, flat brown macules that are common variations of hyperpigmentation - clustered melanocytes that appear on the surafce of the skin after sun exposure - on forearms, dorsa of the hands
* Keratoses* these areas are rised thickened areas of pigmentation that look crusted, scaly, and warty ( *seborrhic & actinic are the two types)*
* Acrochordons (skin tags)*
* Sebacceous Hyperplasia* raised yellow papules
87
what is a MACULE ?
only a colour change - flat - \< 1 cm in diameter
88
what is PAPULE ?
Palpable - eleevated - \<1cm in diameter - caused by superficial thickening in epidermis (ex: mole)
89
what is PATCH ?
macules - \>1cm diameter -
90
what is a NODULE ?
solid - elevated - hard or soft - \>1cm diameter - may extend deeper into dermis than papule
91
what is a TUMOUR ?
larger than a few cm in diameter - firm or soft - deeper into dermis - may be benign or malignant
92
what is a VESICLE ?
also called a blister - elevated cavity - contains free fluid - up to 1 cm - serum flow id ruptured (example: herpes, chicken pox)
93
what is PLAQUE ?
papules that coalesce to form surface elevation wider than 1 cm - disc shaped lesio
94
what is a WHEAL ?
superficial - raised - trasient - erythematous - slightly irregular shape b/c of edema (mosquito bite, allergic rxn)
95
what is URTICARIA (Hives) ?
wheals that coalesce to form extensive rxn
96
what is a CYST ?
ecapsulated - fluid filled cavity in dermis or subcutaneous layer - tensely elevating skin
97
what is a BULLA ?
usually single chambered - superficial epidermis - \> 1cm diameter - thin walled - ruptures easily - (friction blister, burns)
98
what is PUSTULE ?
cavity filled with turbid fluid (pus) - circumscribed ad elevated (acne)
99
List the primary skin lesions ?
1. macule
2. papule
3. patch
4. nodule
5. tumour
6. vesicle
7. plaque
8. wheal
9. urticaria (hives)
10. cyst
11. bulla
12. pustule
100
List the secondary skin lesions ?
1. crust
2. scale
3. fissure
4. erosion
5. ulcer
6. excoriation
7. scar
8. atrophic scar
9. lichenification
10. keloid
101
What is a Crust ?
thickened - dried out exudate left when vesicle /pustules burst or dry up - colour can be like honey like, red - brown, yellow
102
What is SCALE ?
compact, dessicated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells (psoriasis, eczema)
103
what is Fissure ?
Linear crack with abrupt edges, extending into dermis, dry or moist
104
what is Erosion ?
scooped out but shallow depression - superficial - epidermis lost - moist but no bleeding - healing without scar b/c erosion does not extend into dermis
105
What is an Ulcer ?
deeper depression - extending into dermis - irregular shape - may bleed - leaves scars when heals
106
What is an Excoriation ?
self inflcited abrasion - superficial - sometimes crusted - scratches from intense itching
107
What is a scar ?
connective tissues (collagen) that replacs normal tissue after a skin lesion is repaired - a permananet fibrotic change
108
what is Lichenification ?
Thickening of the skin with production of tightly packed sets of papules - caused by prolonged intense sratching - looks like the surface of moss
109
What is Atrophic Scar ?
Depression of skin level as a result of loss of tissue - a thinning of the epidermis
110
What is a keloid ?
A hypertrophic scar - elevation of resulting skin level by excess scar tissue - which is invasive beyond the site of original injury - may increase long after healing occurs - looks smooth rubbery clawlike
