HEALTH ASSESSMEN
ASSESSMENT
T SKILLS LECTURE
•
PURPOSE OF HEALTH A
ASSESSMENT
SSESSMENT
1. Screening of general well-being
a. Database creation – foundation of
basis for development of NCP
2. Validation of the complaints
a. Checking of problems – VS taking, ask
queries
3. Monitoring of the current health problem
4. Formulation of diagnosis and treatments
a. Development of NCP – patient
satisfaction (intervention, physical &
nursing intervention)
•
ASPECTS OF PHYSICAL ASSESSMENT
1. Instrumentation – use of instruments during
physical assessment (prepared after PA
assessment from head to toe), must near the
student
2. Client- age group, privacy, provide comfort
3. Examiner – professional looking
4. Environment – according to Nightingale’s
theory
HEALTH ASESSME
ASESSMENT
NT PROCESS
1. Data collection – interview, history taking,
physical assessment, medical records
2. Documentation – organized
a. FOCUS – main problem
b. DATA – supports main problem
c. ACTION – dependent, independent,
collaboration, health education
d. DIAGNOSTIC REASIONING – relevant
data collection, organized data, what
happens here is to have a good
conclusion on how to manage your
patient.
INSTRUMENTS – gloves, BP app, Suellen’s chart, reflex
hammer, etc.
BMI Computation
ht in kg/ wt in m2
lbs/in x 703
GUIDELINES IN HEALTH ASSESSMENT
1. Practice standard precautions
• with the use of gloves, mask, gowns,
eye protection and handwashing
• protection from bodily fluids
• environmental control
2. The general sequence of performing the
techniques of PA
Inspection, palpation, percussion,
auscultation
ABDOMINAL: inspection, auscultation,
percussion, palpation
ASSESSING the ABDOMEN (I,A,P,P)
Inspection is used to check for
physique
• Auscultation is 2nd for us not to alter
the result from the bowel movements
o Used to check for bowel
sounds
–
hyperactive,
normoactive, hypoactive
• Percussion is used in 4 quadrants
o Air filled – drum
o Lower left -dull
• Palpation is last to prevent pain
o Used to check for cysts and
tenderness
Begin the physical assessment by measuring
the height, weight, BP, temperature, pulse rate
and respiration (after general survey)
Explain each step in the examination and how
the patient can cooperate.
Organize steps of Physical Examination so that
client does not change position too often and
to avoid omissions.
Perform the procedure using head-to-toe
sequence.
•
3.
4.
5.
6.
7. Sequence of examining the quadrant of the
abdomen – we follow the normal sequence of
the body (physiology)
• RLQ
• RUQ
• LUQ
• LLQ
Regions of the abdomen
Spine – C, T, S, L, Coccyx
Hypochondriac – mental illness concerning
about your health
Hypokondriac – below the breastbone
(Greek)
Iliac – near pelvis (iliac crest)
8. Avoid abdominal palpation among patient w/
tumor of the liver and the kidney.
• It will burst most especially for those
with soft tumor (cancer cells will
spread)
• Abdominal
aortic
(affected
is
oxygenated blood) aneurysm
9. Do auscultation of the abdomen for 5 minute
before concluding absence of bowel sounds
– borborygmi (moving sounds)
• Rationale: the patient may be
constipated
• Fast: diarrhea
10. If female patient will be examined by a male
nurse or a male physician, a female nurse
must be in attendance
DOCUMENTATION/LEGAL ISSUES
1. Litigious society – we must be vigilant in
conducting H.A.
2. Establishing trusting and caring relationship
3. Inform patient of what to expect, where to
assess it and how it will feel.
4. Protest by patients’ needs to be addressed.
5. All procedures, injury caused during the
physical assessment must be documented
properly
TECHNIQUES IN PHYSICAL ASSESSMENT
INSPECTION – the systematic & deliberate
observation of a patient using sense of vision, smell
and hearing
• Direct – relies on sight & smell
• Indirect – use of equipment to expose
internal tissues or to enhance view of a
specific body area
Guidelines in Inspect
Inspection
ion
1. Focus on observation
2. Use of good lighting
3. Expose body parts
4. Make comparisons
PALPATION – use of handwash & gloves. Assess for:
• Texture (rough/smooth)
• Temperature (warm, hot, cold)
• Moisture (dry, wet, moist)
• Motion (still/vibrating)
• Consistency of structure (solid or fluid filled)
Handwash → explain procedure → ask for content
If anxious → their muscles can be rigid/inaccurate
If there’s pain in the site, stop.
Techniques in Palpat
Palpation
ion
1. Light (ballottement)
▪ 1-2cm (use of dominant hand)
▪ Only on abdomen
▪ Light, rapid pressure from quadrant to
quadrant
2. Deep (bimanual palpation)
▪ abrupt, deep pressure, then release the
pressure but maintain skin contact with
fingers
Guidelines in Palpation
1. Warm your hands
2. Minimize discomfort
3. Use correct part of the body
4. Start light then proceed to deep
PERCUSSION – tapping the fingers quickly & sharply
against body surfaces to produce sounds, to detect
tenderness, or to assess reflexes. Percussing for sound
helps locate organ boarders, identify shape and
position determine if organ is solid or filled w/ fluid or
gas
Types of Percussion
1. Direct – skin to skin
a. Sinus patients → tenderness/elicit
sounds in child’s thorax
2. Indirect – chest/abdomen
a. Plextor (hammer) – dominant hand
b. Pleximeter – middle finger
3. Blunt – back (kidney)
Normal Percussion Sounds
1. Resonance – gas filled, long hollow sounds
(chest, abdomen) mostly LUNGS
2. Tympany – loud, high pitched, drum like
sound heard over gastric air bubbles
(intestines)
3. Dullness – soft, high pitched thudding (liver,
heart)
Sound
Intensity
Pitch
Duration
Quality
Source
Resonance
Moderate to loud
Low
Long
Hollow
Normal lung
Tympany
Loud
High
Moderate
Drum like
Dullness
Soft to moderate
High
Moderate
Thud like
Hyper resonance
Very loud
Very low
Longer
resonance
Flatness
Soft
High
Short
Gastric
air,
bubble,
intestinal air
Liver,
full
bladder,
pregnant
uterus
(emphysema)
hyperinflated
lung tissue
muscle
Percussion Guideline
Guideliness
1. Have patient void
2. Room is quiet and distraction free
3. Remove jewelry
4. Compare sounds on one sound of the body to
the other side percuss
• In assessing the intestines, RLQ → LLQ i n
zigzag
AUSCULTATION
• includes listening to various breath, heart and
bowel sounds
• Used diaphragm of stethoscope to hear high
pitched sound
• Use of bell of stethoscope to listen to low
pitched sound (heart – s3&s4)
i. Use of diaphragm or bell
ii. X hole – diaphragm
iii. With hole – bell (very quiet
environment)
Parts of stethoscope
Auscultate without dress
than
booming
Flat
Guidelines in Auscultati
Auscultation
on
1. Room is quiet and distraction free
2. Gown and bed can cause interference
3. Exposed area to be auscultated
4. Instruct client to be quiet and remain still
5. Warm the stethoscope
6. Close your eyes to focus
Different Position
Positionss
1. Fowler’s position
a. High – 80-90°
b. Semi-fowler’s - 45°
c. Low – 30-35°
d. This position is often used for patients
who have cardiac issues, trouble
breathing, or a nasogastric tube in
place.
e. Skin, head, neck, ENT, eyes, mouth,
throat, thorax and lungs, neurological,
vasculature, musculoskeletal
Sitting
2.
- skin, head, neck, ENT, eyes, mouth,
back, posterior and anterior thorax and lungs,
heart,
peripheral
vasculature,
musculoskeletal, neurological
3. Supine - more on trunk, abdomen, head, neck,
anterior thorax and lungs, breast, axillae,
heart, abdomen, extremities, pulses
4. Prone – skin, posterior thorax, lungs, hips,
musculoskeletal
5. Sim
Sims’
s’ – rectum and female genetalia
6. Dorsal re
recumbent
cumbent – female genetalia, anterior
thorax, lungs, breast, axillae, heart and
peripheral
vasculature,
abdomen,
musculoskeletal
7. Lithotomy – female genetalia and rectum
8. Knee – chest – rectum and prostate
9. Erect position – (standing) height, weight,
body posture
EXAMINATION TOOL
TOOLS
S
1. Chemical dot thermometer
2. Ear digital thermometer
3. Electric digital thermometer
4. Tympanic thermometer
5. Temporal artery thermometer
6. Otoscope – eyes
7. Tuning fork
a. w/ knobs (lower vibrations 265 hz)
b. w/ tines (high vibrations 512 hz)
8. Goniometer – range of motion
9. Mercury thermometer
10. BP Apparatus
11.
12.
13.
14.
15.
16.
17.
Ophthalmoscope
Reflex hammer
Nasal speculum
Vaginal speculum
Weighing scale
Movable bed
Snellen chart
a. 20/200 yung letter E 200 ft malayo
nababasa pero 20 ft lang kayang
basahin ng taong Malabo ang mata
General Survey
Normal findings vs. abnormal findings
Physical Appearance
1. Age
a. Appears his/her stated age
b. Appears older that stated age
i. Chromosomal differences
ii. Premature sterility
2. Gender
a. Sexual development is appropriate for
gender and age
b. Delayed or advanced puberty
3. LOC
a. Client is alert, oriented, attends to
queries and responds appropriately
b. Confused,
disoriented,
lethargic,
obtruded, stuporous, comatose
c. Lethargic – drowsy, open eyes & look
at you, respond to questions then falls
asleep
d. Obtruded – open eyes, look at you but
responds slowly and is somewhat
confused
e. Stupurous – aroused from sleep only
after a painful stimulus, verbal
responds low or absent.
f. Comatose – remains unarousable, no
evident response to stimuli
4. Skin color
a. Color tone is even, skin is intact with
no obvious lesions
b. Pallor – pale
c. Cyanosis – bluish skin
d. Jaundice – yellow
e. Erythema – redness, any lesions
f. Ecchymosis – bluish discoloration
5. Facial features
a. Symmetric with movement
b. Immobile, masklike, asymmetric,
drooping
c. Bell
Bell’’s palsy – half face (drooping eye)
6. Overall
a. No signs of acute distress
b. Respiratory signs: shortness of breath,
wheezing
7. Pain
a. Indicate by grimace, holding/guarding
body part, knees drawn up over the
abdomen
Body Structure
- It appears within normal range for age, genetic
heritage
- Excessively short or tall
- body structure
1.
2.
3.
4.
5.
o endomorph
-pear-shaped
body,
rounded head, wide hips, shoulders, a
lot of fat on the body, upper arms and
thighs wider, front to back than side to
side
mesomorph
o
– high forehead, receding
chin, narrow shoulders, chest and
abdomen thin arms and legs/slender
little muscle or fat
o ectomorph – normal, lean
Height – assess standing straight without
shoes
a. Note growth of children and
diminished height in older adults
b. Wheelchairs or scoliosis – use of
wingspan
c. Marfan syndrome
d. Gigantism – pituitary (growth
hormone)
e. Dwarfism – hypopituitarism
f. Male = 5”4
Female = 4”11
Nutrition
a. Weight appears within normal range
for height and body build, body fat
distribution is even
b. Emaciated, cachetic (tissue wasting)
obviously obese with even fat
c. Distribution: fat coordinated in face,
neck, trunk with thin arms and legs
BMI
a. A practical marker of optimal nutrition
for height and an indicator for obesity
or protein calorie malnutrition
i. Wt in kg/ ht in m2
ii. Wt in lbs/ ht in in2 X 704
iii. Underweight ≤ 18.6
iv. Normal 18.5-24.9
v. Overweight 25-29.9
vi. Obesity class 1 30-34.99
vii. Obesity class 2 35-35.9
viii. Obesity class 3 ≥ 40
Symmetry
a. Body parts look equally bilaterally and
are in relatively proportion to each
other
b. Unilateral atrophy (loss of muscle
volume) or hypertrophy (increase in
muscle volume)
Posture
a. body erect, sway back
b. lumbar lordosis
c. thoracic lordosis
d. kyphosis
e. forward toe
f. hollow back
6. Mobility – manner of walking – base is as wide
as shoulder with, front placement, accurate,
walks smooth, even and well balanced
a. exceptionally wide base, staggered.
Stumbling, shifting gait
b. gait cycle – stance, swing
c. abnormal – spastic gait (stroke),
scissors (lower extremities)
7. Position
a. Client sits comfortably in a chair or in
bed or examination table, arms relaxed
at the sides, head turned to the
examiner
b. Curled up with fetal position, leaning
forward
8. Body odor
9. ROM
a. Full mobility of each joint, movement
is deliberate, accurate, smooth and
coordinated, no involuntary, no unpurposeful movement
b. Paralysis (absence of movement),
movement
jerky,
uncoordinated
tremors, seizure
c. LSC paraplegia – lower extremities
d. Hemiplegia – left and right body
e. Quadriplegia – all body
10. Behavior
a. Facial expression – client eye to eye
contact, expression are appropriate to
the environment, flat, depressed,
angry, sad, anxious
b. Mood and affect – client is comfortable,
cooperative with the examiner,
pleasantly
hostile,
distrustful,
suspicious, crying
c. Speech – speaks clearly, stern of
talking fluent with an even pace, word
choice is appropriate, difficulty of
kicking, abnormal pitch or volume
11. Dress
a. Appropriate to climate, looks clean
and fits the body and is appropriate to
age group.
b. Trousers too large, held up by belt,
looks unclean, inappropriate to the
climate
12. Personal hygiene – clean, groomed
appropriate for age, occupation, socioeconomic group, hair groomed, brushed
INTEGUMENTARY SYSTEM
Skin, hair, nails
- Ask patient first, always ask for consent, and
explain procedure, privacy, therapeutically
communication
History Questions
- Skin care habits
- Scaling, course, dry – dehydrated
Anatomy of the Skin
SA = approx. 20 sq ft
Thickness = 0.2-1.5mm
3 layers = epidermis, dermis, hypodemris
Glands = sebaceous – oil & sweat
Equipment
1. Magnifying glass
2. Natural light/white penlight
3. Small cm ruler
4. Microscope slide
5. Clean gloves
Checklist
- Ensure room is well lit
- Use handheld magnifying glass to aid
inspection
- Explain, ensure privacy, comfort, warm hands,
ask client to undress
- Perform in cephalon-caudal fashion
SKIN
Inspection
- Color, internal or external bleeding,
ecchymosis, vascularity (dilated?), lesions,
moisture, temperature, texture
- Face the patient – check for symmetry
- Supine – axilla, breast
- Side lying – rectal and genital area
Color – uniformed whitish, pink, brown color
1.
2.
3.
4.
DEVIATION FROM NORM
NORMAL
AL
Cyanotic – blue (circumoral cyanosis – mouth)
Jaundice – yellowish
a. Liver → bilirubin to intestines →
yellowish stool → if not worked yields to
yellowish skin (also in stool)
Ecchymosis – (kid – butt spank) blueish color in
the skin — lack of circulating oxygen in the area
Uremia – urine in blood, yellowish of sera, black
people (check for oral mucosa)
5. Pallor – pale (snuck/anemia) decreased in RBCs,
caused by decreased visibility of the normal
oxyhemoglobin caused by shock or anemia
6. Carotenemia – due to elevated levels of serum
carotene due to excessive ingestion of carotene
rich foods such as carrots
7. Hyperemia – dilated superficial blood vessels,
increased blood flow, febrile states, loc.
Inflammatory (too much redness)
8. Erythema – redness
9. Flushing
10. Xanthoma striate – yellowish discoloration of
palmar and digital creases (hyperlipidemia)
11. Bronze-like skin
12. Acanthosis nigricans – skin becomes brownish
and thicker, almost leathery – obesity, DM, use of
steroids (kili-kili)
13. Albinism – generalized whiteness, blue eyes
(absence of melatonin
14. Vitiligo – complete absence of melanin in patchy
areas of white or light skin on face, neck, hands,
feet, body and folds and around orifices
15. Erythematos
Erythematosus
us – butterfly flush
16. Systemic lupu
lupuss erythematosus – butterfly rash
17. Chloasma – mask like area of dark coloration of the
skin around the eyes, nose, cheeks and forehead
18. Linea Nigra – pregnant women dark lines in the
abdomen
Bleeding, Ecchymosis and Vascularity
-
There are no areas of increased vascularity,
ecchymosis or bleeding.
Bleeding, petechiae (rashes on dengue,
purpura, ecchymosis, spider angiomas,
Cenous stars, cherry angiomas, strawberry,
nevus flammeus, hemangiomas, necrosis
DEVIATION FROM NORMAL
1. Petechiae - are red purple discolorations of <0.5
cm in diameter. It does not blanch. If you pressed
on it, it does become white.
2. Purpura - presence of confluent petechiae or
ecchymosis over any part of the body. Bigger than
petechiae and circular in shape.
Ecchymosis
3.
- is a violaceous discoloration of
varying size, also called black and blue mark due
to extravasation of blood into the skin.
4. Echymosis - areas of ecchymosis signs of trauma
that could be the result of physical abuse.
5. Spider angiomas - are bright red and star shaped,
often noted on face, neck, chest. Common in
pregnant women, liver disease and hormone
therapy.
6. Cherry angiomas - are bright red circumscribed
areas that may be darken with age, can be flat or
raised, often seen in trunk
7. Strawberry hemangiomas (Nevus vascularis) - or
strawberry marks are bright red, raised areas with
well-defined boarders and does not blanch with
pressure. (Nevus vascularis)
8. Necrosis - purple to black (light- skinned people)
or very dark to black (dark-skinned people) —
common in diabetic patients.
Moisture
-
-
-
palpate all non-mucus membrane skin
surfaces using dorsal surface of hands and
fingers
skin is dry with minimum perspiration,
moisture vary from one area to another —
perspiration are normal on hands, axilla, face,
in between skin folds
Xeroxes (excessive dryness) — diarrhea and
laging nagsusuka
Diaphoresis (profuse sweating)
Lesions
Lesions configurations
1. Discrete - individual lesions are separate and
distinct
2. Group - clustered together
3. Confluent - merge so that discrete lesions are not
visible or palpable (purpura)
4. Dermatomal - form line or an arch and follow a
dermatome (follow a specific pattern)
ABCDEs of malignant (ca
(cancerous)
ncerous) melanoma
1. Asymmetrical lesions
2. Border is irregular
3. Color of lesion varies with shades of tan, brown or
black and possibly red, blue, or white
4. Diameter greater than 6mm
5. Elevated or enlarged lesion
Benign vs. malignant
Symmetrical — asymmetry
Even edges — uneven edges
One shade — two or more shades
Smaller than 1/4 inch — larger than 1/4 inch
Temperature
-
palpate all non-mucosal skin surfaces using
dorsal surface of hands
Should be warm and equal bilaterally; hands
and feet slightly cooler than rest of the body
Hypothermia
Hyperthermia
Shock - decreased blood circulation
(hypothermia)
Blood is warm
Skin turgor or skin p
pinch
inch
-
palpate skin turgor or elasticity which reflects
the skin’s state of hydration
Should return to its original contour rapidly
(less than or within 1-2 sec)
Poor skin turgor
Adult: pinch the forearm
Elderly: sternal area
Kids: abdomen
Edema
-
palpate skin for edema or accumulation of
fluid in the intercellular spaces
edema is not present (normal)
edema is present if skin feels fluffy and tight
(shiny)
Grading pitting edema
If pressed, it follows the pressure
1+, (2mm), 2+ (4mm), 3+ (6mm), 4+ (8mm)
Types of edema
1. Pitting - present when indentation remains on
skin after applying pressure
2. Non pitting - firm with discoloration or thickening
of skin
3. Angioedema - recurring episodes of mon
inflammatory swelling of skin, viscera and mucus
membrane
4. Dependent – by gravity, nahihila – lower
extremities are affected
5. Anasarca - generalized edema
6. Lymphedema - edema due to the obstruction of a
lymphatic vessel
Treatment for edema: diuretics
Texture
-
-
evaluate using finger pads, check abdomen
and medical surfaces of arms first
should feel smooth, even and firm, except
when there is significant hair growth, certain
amount of roughness can be normal
roughness on exposed areas (elbows, soles,
palms)
hyperkeratosis and silk-like (very soft)
-
NAILS
composed of keratinized or horny layers of
cells
Nail plate is approximately 0.5 to 0.75 mm
thick
Consists of nail roots, nail beds, periungual
tissues, lunula
Color of the nail
- inspect fingernails and toenails, noting color of
the nails
- check capillary refill (1-3 sec) by depressing
mail until blanching occurs
- Release the nail and evaluate the time
required for the nail to return to its previous
color
- Di agad narerelase: heart problems, blood
circulation problems
- Normal: Color pinkish
DEVIATION FROM NORM
NORMAL
AL
1. Leukonychia - white striations or dots in the
nailbed, results from trauma, infections, psoriasis,
arsenic poisoning
2. Leukonychia totali
totaliss - entire nail plate that is white
maybe due to hypercalcemia, leprosy, anemia,
cirrhosis, arsenic poisoning
3. Melanonychia - brown color of the nail plate,
which may result from the Addison’s disease and
malaria
4. Cyanotic - blush nail beds due to cyanosis, venous
stasis (not circulating ang blood sa specific area)
and sulfuric acid poisoning
5. Splinter hemorrhage - red of brown linear streaks
in the nail blood may be due to endocarditis, mitral
stenosis, cirrhosis
6. Lindsey’s nails - or half and half nails, proximal
end is white and distal portion is pink due to
chronic renal failure and hypoalbuminemia
7. Terry’s nail - whiteish with a distal band of reddish
brown seen in aging and some chronic diseases
Shape and configuration
-
asses the fingernails and toenails for shape,
configuration and consistency
view of the profile of the middle finger and
evaluate the angle of the nail base
Nail surface should be smooth and slightly
rounded or flat.
Thickness should be uniform throughout, with
no splintering or brittle edges, angle should be
160 degrees.
DEVIATION FROM NORM
NORMAL
AL
1. Koilonychia - thin spoon nail with cupcake
depression and concave (papasok) due to iron
deficiency anemia or Raynaud’s disease
2. Clubbing - angle of >160 degrees, due to long
standing hypoxia and lung cancer
3. Beau’s line - a transverse furrow in the nail plate,
due to arrest of nail growth at the matrix,
associated with malnutrition and anemia
4. Onycholysis - separation of the nail from nailbed,
due to hypo and hyperthyroidism, repeated
trauma, Raynaud’s disease and eczema
5. Eggshell na
nails
ils - white, thin, and curved under free
edge, due to systemic diseases, medications,
nervous disorder, or sleeping with hand fisted
6. Onychatrophia - nails that atrophy, shrink and fall
off, due to injury to nail matrix and from systemic
diseases
7. Pterygium - abnormal for cuticle to overgrow the
nail and become attached to the nail, can occur in
Raynaud’s disease
Texture
-
-
-
palpate the nail base between you thumb and
index finger and note the consistency
The nail base should be firm on palpation, a
spongy nail base is an early indication of
clubbing, which is die to prolonged hypoxia
(chronic bronchitis, emphysema, heart
disease)
HAIR
Ask the client to remove hair bands and hair
pieces or to unbraid hair prior to inspection
process
If not possible, inspect the exposed areas as
completely as possible
Anatomy of Hair
Color of the Hair
- Inspect hair, eyebrows, eyelashes, and body
hair for color
- Hair varies from dark to pale blonde based on
the amount of melanin present
- Dark skinned — black hairs
- Blond — light hairs
- Patches of gray hair that are isolated or occur
in conjunction with a scar
- When melanin diminishes, the hair becomes
gray
Distribution
- Evaluate the distribution of hair on the body,
eyebrows, face and scalp
- The body is covered with vellus hair (arms).
Terminal hair is found in the eyebrows,
eyelashes, scalp and in axilla and pubic hair
areas.
- Absence of pubic hair, unless purposely
remove
DEVIATION FROM NORM
NORMAL
AL
1. Traction alopecia – hair loss in linear
formation in conjunction with hair styles, due
to curlers, and wearing hair in a tightly pulled
ponytail
Hirtuism
2.
– excess facial and body hair,
indicative of endocrine disorders such as
hypersecretion of andrecortical androgens. In
women, excess facial and chest hair. (side
effects of antibiotics)
Tine
capitis (ringw
3.
capitis
(ringworm)
orm) – broken off har with
scaliness and follicular inflammation, maybe
painful and purulent with boggy nodules
4. Seborrheic dermatitis - scalp is covered with
yellow brown scales, and crusts, scalp maybe
oily, edema maybe present. It is due to
increased production of sebum by the scalp.
DEVIATION FROM NORM
NORMAL
AL
1. Hydrocephalus - puno ng tubig and head
(Abnormal accumulation of CSF)
2. Acromegaly - growth hormones is affected
released by the pituitary gland (anterior)
Craniosynostosis
3.
- premature and closure ng
fissures ng skull (exophthalmus — bulging of the
eye is present)
4. Anencephaly - absence of the brain and skull
(neural tube defect - hindi nag iimprove habang
lumalaki yung bata (the CNS doesn’t develop and
it doesn’t create brain and skull))
5. Microcephaly - small head (developmental
problem) - isip bata sila kasi may problem sila sa
development ng brain
Lesions
- din gloves, lift scalp hair by segments, evaluate
scalp for lesions or signs of infestations.
- Scalp should be pale white to pink in lightskinned people and light brown kn darkskinned people, no sign of infestation,
dandruff (Seborrhea) maybe present
- Head lic
lice
e - Pediculus capitis. Maybe
distinguished from dandruff in that dandruff
can be easily remove from the scalp or hair,
whereas nits (lice larvae), are attached to hair
shaft and difficult to remove
Texture
- (parietal, frontal, occipital and temporal — use
of finger pads)
- Palpate hair between fingertips, note that the
condition of the hair from the scalp to the end
of the hair
- Hair may feel thin, straight, coarse, thick or
curly. It should be shiny, and resilient when
traction is applied and should not come out in
clumps on your hands
- Brittle hair – easily breaks off when pulled or
hair that is listless and dull, can be indicative
of malnutrition, hyperthyroidism, use of
chemicals and infection
HEAD AND FACE ASS
ASSESSMENT
ESSMENT
Inspection of the shap
shape
e of the head
• have the patient sit in a comfortable position
• Face the patient, with your head at the same
level with the patient’ head
• Inspect
the
shape
and
symmetry
(normocephalic, and symmetrical)
-
PALPATION OF THE HEA
HEAD
D
Place the finger pads on the scalp and palpate
of its surface, beginning from the frontal
continuing over the parietal, temporal and
occipital areas
Assess for contour, masses, depressions and
tenderness
Palpate the temporal artery, which is located
anterior to the tragus of the ear.
Normal findings
- skill is smooth, not tender, and without masses
or depressions
- The temporal artery is usually weaker
peripheral pulse than the other peripheral
pulses in the body
- The artery is not tender, smooth and readily
compressible.
Amplitude
0 - no pulse
+1 - weak/thready
+2 - normal
+3 - strong
+4 - bounding
DEVIATION FROM NORM
NORMAL
AL
1. Masses in the cranial bones that feel hard or soft
are abnormal
2. Palpation elicits localized edema over bony frontal
portion of the skull
3. Firm palpation reveals a softening of the outer
bone layer.
4. Temporal artery is hard in consistency and tender
Note: Inspection if the scalp is the same with
inspection of the head
Abnormal findings of the scalp
1. lacerations
2. Laceration with bleeding
3. Masses
-
INSPECTION OF FACE
Have patient sit in comfortable position facing
you
Observe patient’s face for expressions, shape,
and symmetry of the following structures:
eyebrows, eyes, nose, mouth and ears
Normal findings
- Symmetrical (facial features)
- Palpebral fissure equal
- Nasolabial fold present bilaterally
Abnormal findings of the fface
ace
- structures are absent or deformed
- Asymmetry of expression, nasolabial folds,
mouth, corners of mouth
Shape and features
- face the patient
- Observe the shape of patient’s face
- Note any swelling and such
Normal findings
- oval, round, slightly square
- There should be no edema, dis appropriate
structures or involuntary movements
ABNORMAL FINDINGS OF THE FACE
1. Hypertelorism - an abnormally wide distance
between the eyes (it could be down syndrome)
2. Slanted eyes with inner epicanthal folds, a short
flat nose and a thick protruding tongues (common
for Down syndrome people)
3. Facial skin is shiny, contracted and hard. The face
appears to have furrows around the mouth.
4. Exophthalmos - the face is thin with sharply
defined features and prominent eyes in Grave’s
disease (cases for hyperthyroidism or drug
addicts)
Periorbital
eedema
5.
dema - face is round and swollen with
characteristic and dry, dull skin
6. Eyes are sunken and the cheeks are hollow in
cachexia.
7. Parkinson’s disease - face is immobile and
expressionless with a starting gaze and raised
eyebrows
8. A transverse crease is noted across the nose
9. Rounded “moon face” along with red cheeks and
excess hair on the jaw and upper lip (Cushing
syndrome - hormones release a lot of ACTH)
Family of Coronavirus
Coronavirus
o SARS – Southern China (2002-2004)
o Snakes & bats
o 8,089 cases
o 774 deaths
o MERS-Cov – Middle East (Arabian Peninsula)
o Camel
o 2494 cases
o 858 deaths
o nCov – City of Wuhan, Hubei
o 14,564 cases
o 305 deaths
Transmission and Prevention
Prevention
• Hand washing
• Proper use of face mask
Virus
• Droplet — sneeze, cough (transmission) (no
use face mask - n95 with use)
• Airborne — stay in air
Lesions
- Inspect for lesions. Nothing for anatomic
location
- Note for groupings or arrangement of the
lesions
- Color
- Using ruler, measure lesions
- Inspect for elevation (raised or not)
- Note for exudate for color or odor
- Note the morphology of skin lesions
a. Primary - originating from perviously
normal skin
i. Pustule
b. Secondary – originating from primary
lesions
i. Scar
ii. Keloid formers
- Location distribution
a. Generalized
b. Regionalized
c. Localized
d. Scattered
e. Exposed area
f. Intertriginous – armpit area and singit
- Lesion shape
a. Discoid – round or oval
b. Annular – circular with central
clearing
-
c. Target (bull’s eye) – annular with
central internal activity
Lesion configuration
a. Discrete – individual lesions are
separate and distinct
Grouped
b.
– lesions are clustered
together
c. Confluent – lesions merge so that
discrete lesions are not visible or
palpable
Non-Palpable
- Macule – localized changes in skin color of less
than 1 cm in diameter (freckle)
- Patch – localized in changes in skin color of
greater than 1 cm in diameter (vitiligo, stage 1
of pressure ulcer)
Palpable (mostly differences are size)
- Papule – solid, elevated lesion less than 0.5 cm
in diameter (wats, elevated nevi, seborrheic
keratosis)
- Plaque – solid, elevated lesion greater than 0.5
in diameter (psoriasis, eczema, pityriasis
rosea)
- Nodules – solid and elevated; however, they
extend deeper than papules into the dermis or
subcutaneous tissues, 0.5 to 2.0 cm (lipoma,
erythema
nodosum,
cyst,
melanoma,
hemangioma)
- Tumor – the same as a nodule only greater
than 2 cm (carcinoma – such as advanced
breast carcinoma) not basal cell or squamous
cell of the skin (solid-filled)
- Wheal – localized edema in the epidermis
causing irregular elevation that may be red or
pale (insect bites, hive, angiodema)
Fluid-filled cavities
- Bullae – same as a vesicle only greater than
0.5cm (contact dermititis, large second-degree
burns, bollous impetigo, pemphigus)
- Pustule – vesicles or bullae that become filled
with pus, usually described as less than 0.5 cm
in diameter (acne, impetigo, furnaces,
carbuncles, folliculitis)
- Cyst – encapsulated fluid-filled or a semi-solid
mass in the subcutaneous tissue or dermis
(sebaceous cyst, epidermoid cyst)
- Vesicle – accumulation of fluid between the
upper layers of the skin (chicken pox)
Above skin surface
- Scales – flaking of the skin’s surface (dandruff,
psoriasis, xerosis)
-
-
-
Lichenefication – layers of the skin become
thickened and rough ad a result of rubbing
over a prolonged period of time (chronic
contact dermatitis)
Crust – dried serum, blood or pus on the
surface of the skin (impetigo, acute
eczematous inflammation)
Atrophy – thinning the skin surface and loss of
markings (striae, aged skin)
Below Skin Surface
- Erosion – loss of epidermis (ruptured chicken
pox vesicle)
- Fissure – linear crack in the epidermis that can
extend to the dermis (chapped hands or lips,
athlete’s foot
- Ulcer – a depressed lesion of the epidermis and
upper papillary layer of the dermis (stage 2
pressure ulcer)
a. Stages
i. Stage 1 – reddened but skin not
broken
ii. Stage 2 – epidermal and
dermal layers have sustained
injury
iii. Stage 3 – subcutaneous tissue
have sustained injury
iv. Stage 4 – muscle tissue and
perhaps bones have sustained
injury
- Scar – fibrous tissue that replaces dermal
tissue after injury (surgical incision)
- Keloids – excess collagen formation, rubbery,
enlarging of a scar past wound edges due to
excess collagen formation (more prevalent in
dark skinned persons) (burn scar)
- Excoriation – loss of epidermal layers
exposing the dermis (abrasion)
- Comedo – small black heads
- Giant comedo – black heads
- Nevus – birthmarks
- Benign vs Malignant L
Lesions
esions – ABCDE
- Burns
a. 1st degree – superficial thickness
(epidermis is injured or destroyed
skin is red and dry, painful, no blisters
b. 2nd degree – partial thickness
(superficial or deep) infected epidermis and dermis, most painful,
epidermis and upper layers are
destroyed, deeper dermis is injured,
hair follicles, sweat glands, nerve
endings are intact, painful, blisters are
present
c. 3rd degree – full thickness, no
sensation, epidermis and dermis are
destroyed, SC may be injured, sweat
glands, nerve endings are destroyed,
painless, skin is white, red, black, tan
or brown
d. 4th degree – full thickness, epidermis
and dermis are destroyed, muscles
and bones may be injured, sweat
glands, nerve endings are destroyed,
painless, skin is red, white, black, tan
or brown
Common skin order
orderss
- Psoriasis – is a chronic disease of marked
epidermal
thickening,
plaques
are
symmetrical and generally appear as red bases
topped with silvery scales. The lesions, which
may connect with one another, occur most
commonly on the scalp, elbows and knees.
- Contact dermatitis – is an inflammatory
disorder that results from contact with an
irritant,
- Urticaria (hives) – occurring as an allergic
reaction, it appears suddenly as pink,
edematous papule or wheals
- Freckles
- Diaper rash
- Cellulitis
- Rosacea Rhinopehy
Rhinopehym
ma
- Impetigo
- Sarcoma
- Malignant Melano
Melanoma
ma
- Tinea Barbae
- Tinea corporis (r
(ringworm)
ingworm)
- Herpes zoster
- Scabies