Different types of Assessment techniques • Inspection- ALWAYS initial technique regardless of which organ or tissue being seen • Asculation- use stethoscope • Percussion- dominant tip of hand & use finger tips & middle finger/ percussion of liver & kidney= blunt percussion—> indirect—> putting non dominant hand, make a fist, and your thumb/ pose two strikes • Palpation- finger pads & metacarnigeal finger joints of the hand for moderate to deep palpation, finger pad circular motion palpation Most common type of clinical equipment • Doppler- used when pulses cannot be palpated • Goniometer- used to assess the degree of joint flexion and extension • Woodland-used to assess fungal infection on the skin • Skin-fold caliper- used to assess subcutaneous thickness • Transilluminator- detects blood, fluid, or mass in body cavities • Stadiometer- measures height of pt Different types of primary lesions • Macual • Palpal • Vesicle • Burley • Reel Different types of secondary lesions • Scalliod • Fissure • Liftenification- usually results in hardening of the epidermis due to constant rubbing of the skin • Atrophy- a lesion that is transparent, dry, paper like, resulting from thinning or wasting of the skin due to loss of collagen and elastin/ usually common in elderly patient Review types of vascular lesions • Venous like- usually find in neck and lips, dark blue in color and compressible • Hemojoma • Poor twined stained- flat lesion that’s purple red, irregular in shape, & when pt becomes emotional or cries, it deepens in color Different types of malignant lesions • Basal carcinoma • Malignant melanoma • Carposis sarcoma- common in pt’s with HIV Lesions classified in configuration • Group lesions- lesions that appear in clusters or are together • Confluid lesions- lesions that run together • Discreet lesions- lesions that are separated • Target lesions- lesions with constrictive circles of colors • Anular- lesion that has only one circle Pulses location • Popliteal- behind the knees • Brachial- anticubetal part of the arms • Radial- medial part of the wrist • Ulnar- lateral part of the wrist • Femoral- inguenol area Parts of hands used for assessment • Dorsal part of the hand- used to assess skin temperature • Pads of the fingers- used to assess pulses, edema, lymph nodes, & light palpation • Tip of fingers- used to assess skin turgor, direct & indirect percussion—> Direct- use index finger for sinus infection, percuss temporal area as well as mastoid area, Indirect- lung tissues or bladder that is full • Metacarpal Phaylengeal Joints- ulnar part of the hand used to palpate moderate to deep palpation *Safest palpation is LIGHT PALPATION* *Palpation used in CAUTION is DEEP PALPATION* *Obese pt palpation use MODERATE-DEEP PALPATION b/c fatty tissue in abdomen* Grading of Edema • 0= no edema • 1+ = 2mm • 2+ = 4mm • 3+ = 6mm • 4+ = 8mm Grading of Pulses • 0 = NO pulse • 1+ = weak & thready • 2+ = Normal • 3+ = brisk • 4+ = bounding Types of abdominal palpitations & depth of palpitations • Light palpation- 0.5cm-1cm/ finger, one hand circular motion to assess for pulse, lymph nodes, pain or tenderness *safest type palpation* • Moderate palpation- 1cm-2cm/ pads of finger circular motion • Deep palpation- 2cm-4cm/ dominant finger pads over non dominant and can be up to metacarpal phylengeal joints/ contraindicated when there is abdominal rigidity caused by inflammation, dissecting aneurism, peritonitis, topic pregnancy * Criteria to rule out skin malignancy—> ABCDE= if pt is positive to this criteria it is likely pt has skin malignancy or skin cancer. * If you suspect a pt to have lyme disease, which is caused by a bite of a tick, next question to ask pt is—> have you been hiking or camping lately?? * When assessing pt & pt refuses exam YOU have to—> DOCUMENT what was refused & WHAT was done * Skin is composed of epidermal, dermal, & subcutaneous layers. Also, muscles and bones. * Nerve endings, blood vessels, hair roots= Dermis * Stage 1= epidermis, one layer, reddened skin Stage 2= two layers involved, epidermis and dermis Stage 3= three layers involved, epi, dermis, and subcutaneous Stage 4= four layers involved, epi, dermis, subcutaneous, muscles and bones Two types of Sweat Glands • Eccrine- distributed all over the body made of water and salt • Apocrine- mainly on groin and axillary region made of water, salt, and protein. If mixed with bacteria, musty old odor Two Types of Hair • Vellus- distributed all over body/ pale, fine, short hair/ found all over body except for lips, nipples, palms of feet , and parts of external genitalaie • Terminal- long hair/ found in scalp, axillary region, eyebrow, pubic hair, leg, chest, face * palpate lymph nodes in gentle circular motion, for adults—>nonpalpable, cannot palpate, no swelling on the lymph nodes, For children—> maybe have swelling of some lymph nodes and it is normal to see, we still refer to doctor for further evaluation How to Assess for Lymph Nodes • Gentle circular motions Normal findings in Newborn • Malia- tiny white poppies in nose of the baby that usually go away in 3 weeks • Vernus- white cheeks substance on face/ back of the baby usually made up of sebum and epidermal cells and goes away in several baths of the baby • Mongolian spots- purpilish/black/ blue spots in the buttocks of dark babies, usually goes away at the age of 3 • Vetilligo- patchy and deep pigmented areas or whitest areas over the face, neck, hands, feet and skin fold. Harmless and stays with pt up to adulthood • Lanego- fine hair found in newborn prominent in upper chest, shoulder, and back Four types of headaches • Classic Migraine- aura, spots and flashes of light, nausea/ vomitting, tingling sensation of face and extremities • Cluster headache- onset sudden, many headaches that can happen in less than a few minutes. episodes can be weeks, days, or months • Tension headache- aka muscle contraction. onset is gradual pain is steady and maybe unilateral or bilateral, starts in cervical area to the upper part of the head • Sinus Migraine- pt has sinus infection How to test for clubbing of the fingers • mirror the dorsal part of the finger together and there should be a DIAMOND shape between the fingers and the normal angle is 160 degrees= pt has no clubbing of the fingers * Best technique to assess skin tumor or tenting would be pinching below the clavicle or the median aspect of the wrist* Different types of pediatric abnormalities • Cranial synostosis • Pedial alcohol syndrome • Acronamoli • Hydrosypphilus * Proper way to assess a dark pt—> inspect lips, oral mucosa, sclera, palm and soles of the feet Types of Sounds • Percussion of bones—> flat and short sound • Liver/heart—> dullness • Lungs—> indirect percussion—>resonance • Abdomen- tympani • Air is trapped in the lungs—>hyper-resonance * when assessing an infant & see that the skin of the infant is white and the hair is black and the iris is pink= absence of color is what the baby will have* * High pitched sounds= Diaphragm* * Low pitch= Bell*
