health assessment scc/ucf test 2

flexion

extension

abduction

adduction

pronation

supination

circumduction

inversion

eversion

rotation

protraction

retraction

elevation

depression

synovial joints

bursa

skeletal muscle

epiphyses

20

lordosis

osteoporosis

shortening of the vertebral column. caused by loss of water content and thining of the intervetebral disks, which occurs more in the middle years, and a decrease in height of individual vertebrae, which occurs in later yrs. from osteoporosis

1. joints
pain, stiffniess, swelling, heat, redness, limitation
2. muscles
pain (cramps), weakness
3. Bones
pain, deformity, trauma (fractures, sprains, dislocations)
4. Functional assessment (ADL)
5. Self-care behaviors

joint pain and loss of function

any problems w/ jts. pain?
loc. which jts. 1 side, both side,
quality, severity, onset, timing, how often, is the pain aggravated by movement, rest, position, weather? pain relieved by rest, med., application of heat or ice, is thepain assoc. w/ chills, fever, recent sore throat, trauma, repititive activity, any stiffness, swelling, heat, redness, limitaion, which activities give you problems

morning

Later on the day

morning, improves during the day

trauma, repetitive motion

morning and after rest periods

cramping or aching

any problems in the muscles, such as pain, cramping?, if in calf is the pain when walking, does it go away w/ rest?, are your muscle aches assoc. w/ fever, chills, the "flu", any weakness in muscles., location where is the weakness, how long have you noticed weakness, do the muscles look smaller there?

any bone pain, affected by movmt., any deformity of any bone or jt. due to injury trauma, does it affect the ROM, any accidents or trauma,:fractures, jt. strain, sprain, dislocation, which ones?when did this occur? at treatment was given? any problems or limitations now? any back pain, in which part, is it felt anywhere else like shooting down leg?, any numbness, tingling, limping

Do your jt. problems create any limits on your usual activities of daily living? which one? if the person answers yes ask specifically about each activity, bathing, toileting, dressing, grooming, eating, mbility, communicating

Funcional assessment is important to screen the safety of independent living, the need for home health care services, and quality of life. Assess any self care deficit

any occupational hazards that could affect eh muscles and jts.? does your work invlove heavy lifting or any repetitive motion or chronic stres to jts. any efforts to alleviate these? thell me about your exercise program, any pain, how do you treat it, have you had any recent wt. gain, please describe your daily diet. taking any med. for musc system: aspirin,..., ifperson has chronic disability or crippling illness: how was your illness affected (interfered w/ family, friends, the way you view yourself)

were you told about any trauma to inant during labor and delivery? did the baby come head first? was there a need for forceps
did the baby needd resuscitation
were the baby's motor milestones achieved at about the same time as siblings or age mates
has your child ever broken any bones,
have you ever noticed any bone deformity? spinal curvature?

involved in any sports how frequently,
do you use any special equip, what is the nature of your daily warm up,
what do you do if you get hurt,
how does your sport fit in w/ other shool demands and other activities

use the functional assessment history quest. to elicit any loss of function, self care deficit, or safety risk that may occur as a process of aging or musculoskeletal,
any change in weakness over the past mo. or yr.
any increase in falls or stumbling over the past. mo or yr
do you use any mobility aids to help you get around

when the person has articular disease, a history of musculoskeletal symptoms, or any problems w/ ADL

inspection and palpation of jt. integrated w/ each body region
observation of ROM as person proceeds through motions, age specific screening measures, such as ortolani's sign for infants, or scoliosis screening for adolescents

inspect, palpate, ROM, Muscle testing

the size and contour of the jt. inspect the skin and tissues over the jts. for color, swelling, and any masses or deformity. presence of swelling is significant and signals jt. irritation.

palpate each jt., for skin temp., muscles, bony articulations, and are of jt. capsule,
notice any heat, tenderness, swelling, or masses.

passive rom

geniometer

abnormal, because fluid is contained in an enclosed sac, if you push on one side of the sac, the fluid will shift and cause a visible bulging on another side.

dislocation, subluxation, contracture, ankylosis

dislocation

contracture

ankylosis

abnormal, because fluid is contained in an enclosed sac, if you push on one side of the sac, the fluid will shift and cause a visible bulging on another side

goniometer

crepitation

are raised, firm, and nontender, and overlying skin moves freely. common sites are in the olecranon bursa and along extensor surface of the ulna, occur w/ RA

ask the person to hold both hands back to back while flexing the wrist 90 deg. acute flexion of the wrist for 60 sec. produces no symptoms in the normal hand

reproduces numbness and burning in a person w/ carpal tunnel syndrome

direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand

firmly stroke up on the medial aspect of the knee 2-3 times to displace any fluid watch the medial side in the hollow for a distinct bulge from a fluid wave. normally none is present

occurs w/ very small amts of effusion, 4-8mm from fluid flowing across the jt

is reliable when larger amts. of fluid are present.

use your left hand to compress the suprapatellar pouch to move any fluid into the knee jt. w/ you rt. hand, push the patella sharply against the femur, if no fluid is present the patella is already snug against the femur

degenerative diseases of the knee

mcmurray's test

perform this test when the person has reported a history of trauma followed by locking, giving way, or local pain in the knee. position the person supine as you stand on the affected side. hold the heel and flex the knee and hip. place your other hand on the knee w/ fingers on the medial side. rotate the leg in and out to loosen the jt. externally rotate the leg and push a valgus (inward) stress on the knee . normally the leg extends smoothly w/ no pain

if you hear or feel a click mcmurray's test is positive for torn meniscus

start w/ feet and work your way up the extremeties

tibial torsion
place both feet flat on the table and push to flex up the knees. w/ the patella and the tibial tubercle in a straight line, place your fingers on the malleoli. in an infant, note that a line connecting the four malleoli is parallel to the table

metartarsus adductus. it is usually present at birth and usually resolves spontaneously by age 3

metatarsus varus

ortolani's maneuver,

at every professinal visit until the infant is 1.

also used to check for hip dislocation by comparing leg lengths

one knee significantly lower than the other is a positive indication of allis' sign and suggest dislocation

place the baby's feet flat on the table and flex the knees up. scan the tops fo the knees; normally they are at the same elevation

spina bifida

polydactyly

syndactyl

simian cease

dermoid sinus

a weakness of the shoulder muscles

genu varum

genu varum (knees apart)

genu valgum (knees together)

genu valgum

pes planus

is common during adolescence because of chronic poor posture. screen w/ the forward bend test starting at age 10-12,

trauma or infection

include progressive lordosis and toward the third trimester, anterior cervical flexion, kyphosis, and slumped shoulder

include a decrease in ht., more apparent in the 8th and 9th decades also slight flexion of hips and knees, kyphosis is also common

include a decrease of fat in the body periphery and fat deposition over the abdomen and hips. the bony prominences become more marked.

walk (w/ shoes on), climb up stairs, walk down stairs, pick up object from floor, rise up from sitting in chair, rise up from lying in bed

joint effusion

ankylosis

swan neck often resembles curve of swan's neck

boutonniere deformity the knuckle looks as if it is being pushed through a buttonhole.

osteoarthritis

Heberden's nodes

bouchard's nodes

acute rheumatoid arthritis

achilles tenosynovitis

scoliosis

is flexible; it is apparent w/ standing and disappears w/ forward bending. it may be compensatory for other abnormalities such as leg length discrepency

is fixed; the curvature shows both on standing and on bending forward.

talipes equinovarus (clubfoot)

forward to open on the buccal mucosa opposite the second molar

up and forward to the floor of the mouth and opens at either side of the frenulum

32 permanent teeth 16 in each arch

20 deciduos, or temporary teeth, all should appear by 2 1/2 yr. of age

vascularity in the upper respiratory tract

after age 60, and it continues progresively w/ age

the oral cavity the soft tissues atrophy and the epi. thins, especially in the cheek and tongue. a decrease in salivary secretion and the presence of dentures that cover secondary taste sites. tooth surface is abraded, gums begin to recede and the teeth begin to erode at the gum line.

a gradual loss of subcutaneous fat starts during later middle adult years, making the nose appear more prominent in some people. the nose hairs grow coarser and stiffer and may not filter the air as well. the hairs protrude and may cuase itching and sneezing.also the sense of smell may diminish because of a decrease in the olfactory nerve fibers

bifid uvula

malocclusion

discharge, frequent colds, sinus pain, trauma, epistaxis, allergies, altered smell

sores or lesions, sore throat, bleeding gums, toothache, hoarseness dysphagia, altered taste, smoking, alcohol consumption, self care behaviors, dental pattern dentures or appliances

1.excessive bone resorption w/ further tooth loss occurs; 2. muscle imbalance results form a mandible and maxilla now out of alignment,which produces muscle spasms, tenderness of muscles of mastification and chronic headaches; and 3. the temporomandibular jt. is stressed, leading to osteoarthritis, pain and inablility fully open mouth.

epistaxis

sit up w/ head tilted forward, pinch nose between thumb and forefinger for 5 to 15 min.

dysphagia

does the child have any mouth inf. or sores, such as thrush or canker sores, does the child have frequent sore throat, did the child's teeth erupt about on time?, are the teeth straight to you, using a bottle etc.,

any dryness in the mouth, are you taking any med., have you had any loss of teeth, can you chew all types of food, are you able ot care for your own teeth, noticed a change in your sense of taste or smell

rhinitis, discharge is common w/ this, varying from watery and copious to thick, purulent, and green yellow

swollen, boggy, pale, and gray

inspect and palpate the nose external nose, nasal cavity,
palpate the sinus areas (transillumination),

hump or shelf in the nasal cavity

perforation

chronic allergies and acute infection (sinusitis)

transillumination

lips-color, moisture, cracking or lesions
teeth and gums-note any diseased, absent, loose, or abnormally positioned teeth, compare the number of teeth to what is expected; gums look pink o rcoral w/ a stippled (dotted) surface;
tongue- check fo rcolor, surface characteristics, and moisture
buccal mucosa- for color, nodules, or lesions,
palate-the more anterior hard palate is white w/ irregular transverse rugae. the soft palate is pinker smooth, and upwardly movable

cheilitis (perleche)

the opening of the parotid salivary gland.

red w/ mumps

koplik's spots

leudoedema

fordyce's granules

yellow w/ jaundice. in blacks w jaundice, it may llk yellow, muddy yellow, or green brown

oral kaposi's sarcoma

observe the oval, rough surfaced tonsils behind the anterior tonsillar pillar. the color is the same pink as the oral mucosa and their surfae is peppered w/ indentations, or crypts. in some crypts collect small plugs of whitish cellular debris.

1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching the uvula
4+ touching each other

bright red, swollen and may have exudate or large white spots

respiratory distress

chronic allergy from wiping the nose upward w/ palm.

1. inspect and external nose for symmetry, and deformity, or lesions 2. palpation-test patency of each nostril 3. inspect using nasal speculum: color and integrity of nasal mucosa, septum-note any deviation, perforation or bleeding turbinates-note color, any exudate, swelling, or polyps
4. palpate teh sinus areas-note any tenderness

1. inspect using penlight: lips, teeth and gums, tongue, buccal mucosa-note color; if structures are intact, any lesions
palate and uvula-note integrity and mobility as person phonates
grade tonsils,
pharyngeal wall-note colro, any exudate, or lesions
2. palpation: when indicated in adults, bimanual palpation of mouth
w/ the neonate, palpate for integrity of palate and to assess sucking reflex

furuncle

herpes simplex 1

leukoplakia

candidiasis or monilial, termed "thrush"

smooth, glossy tongue (atrophic glossitis)

geographic tongue (migratory glossitis)

ankloglossia

black hairy tongue

macroglossia

carcinoma

caries

red scaling, shallow, painful fissures at corners of mouth

choanal atresia

epistaxis

aphthous ulcers

typmanic memebrane or eardrum

1. it conducts sound vibration form the outer ear to the central hearing apparatus in the inner ear
2. it protects the inner ear by reducing the amplitude of loud sounds
3. its eustachian tube allows equalization of air proessure on each side of the tympanic membrane so that the membrane does not rupture

peripheral, brainstem, and cerebral cortex.

ottitis media, or OM

1. earaches, 2. infections, 3. discharge 4. hearing loss
5. environmental noise 6. tinnitus 7. vertigo 8. selfcare behaviors

ottitis externa

Hx frequent ear infection (OM, OE)
Discharge? (ottorhea, rhinorrhea)
Hearing deficits
Speech or language problems
Immunization history

otorrhea and suggests infection; it may come from canal or may indicate a perforated eardurm

*chilhood illnesses- history of frequent URI's, history of frequent ear infections, external and middle
*history of accidents, illnesses, no serious or chronic illnesses, no ear or other surgery
*immunizations-of significance is pertussis, HIB, phneumoccal (PCV-7)
*Developmental history speech and language
*adaptive device, hearing aids
*environmental noise, use of ear jacks
*newborn hearing screen last exam date, hearing test results
*allergies
*current medications

Family social history
*history of ear infection
*smoking
*child care
*self care-bottle feeding, pacifier use, ear canal cleansing
*swimming-ottitis externa?

*tenderness or deformity:
tragus, pinna, mastoiditis

*alignment, size, shape, symmetry
*skin: eczema, seborrhea, SCC, decubiti
*masses, nodes, nodules, furuncles
*drainage (otorrhea)
*hygiene

The external canal,the tympanic membrane,

tilt the person's head slightly away from you toward the opposite shoulder. pull the pinna up and back on an adult or older child; this helps straighten the S-shape of the canal; pull the pinna down on an infant and a child under 3 yr. of age hold the pinna gently but firmly. hold the otoscope upside down. lastly perform the otoscopic examination before you test hearing; ear canals w/ impacted cerumen give the erroneous impression of pathologic hearing loss

basal skull fracture and warrents immediate referral. CSF fees oily and is positive for glucose on TesTape.

*canal-note any redness and swelling, lesions, foreign bodies, or discharge.
(color, lesions, masses, discharge/cerumen/, foreign bodies/irritation from hearing aid, otitis externa (OE)).

shiny and translucent, w/ a pearl-gray color. the coneshaped light reflex is prominent in the anteroinferior quadrant (5o'clock in the rt. ear drum, 7o'clock in the left drum)

the umbo, manubrium, and short process

coor and characteristics, position, integrity of membrane

is a dense white patch on the drum this is a sequele of repeated ear infections

as a dark oval area or as a larger opening on the drum

voice test, tuning fork tests which includes the weber test, and rinne test

by placing one finger on the tragus and rapidly pushing it in and out of the auditory meatus. shild your lips so the person cannot compensate for a hearing loss w/ your head 30-60cm from the person's ear exhale and whisper slowly some two syllable words, normally the person repeats each word correctly after you say it.

high frequency sound and is used to detect high tone loss

hearing by air conduction (AC) or by bone conduction (BC), in which the sound vibrates through the cranial bones to the inner ear.

hold it by the stem and strike the tines softly on the back of your hand. a hard strike makes the tone too loud, and it takes a long time to fade out.

when a person reports hearing better w/ one ear than the other.

place a vibrating tuning fork in the midline of the person's skull and ask if the tone sounds the same in both ears or better in one. the person should hear the tone by bone conduction through the skull, and it should sound equally loud in both ears

air conduction and bone conduction sound

place the stem of the vibrating tuning fork on the person's mastoid process and ask him or her to signal when the sound goes away
normally the sound is heard twice as long by air conduction (next to ear) as by bone conduciton (through the mastoid process)

AC>BC

the ability of the vestibular apparatus in the inner ear to help maintain standing balance. also asses intactness of the cerebellum and proprioception

because it is filled w/ amniotic fluid and vernix caseosa

the presence of a tympanostomy tube in the central part of the drum. this is inserted surgically to equalize pressure and drain secretions

-size and shape fo auricle
-position and alignment on head
-note skin condition-color, lumps, lesions
-ck mov't of auricle and targus for tenderness
-evaluate external auditory meatus-note size, swelling, redness, discharge, cerumen, lesions, froeign bodies

-external canal
-cerumen, discharge, foreign bodies, lesions
-redness or swelling of canal wall

-color and characteristics
-note position (flat, bulging, retracted)
-integrity fo membrane

-note behavioral response to conversational speech
-voice test
-tuning fork test-weber and rinne

the presence of a tympanostomy tube in the central part of the drum. this is inserted surgically to equalize pressure and drain secretions

-size and shape fo auricle
-position and alignment on head
-note skin condition-color, lumps, lesions
-ck mov't of auricle and targus for tenderness
-evaluate external auditory meatus-note size, swelling, redness, discharge, cerumen, lesions, froeign bodies

-external canal
-cerumen, discharge, foreign bodies, lesions
-redness or swelling of canal wall

-color and characteristics
-note position (flat, bulging, retracted)
-integrity fo membrane

-note behavioral response to conversational speech
-voice test
-tuning fork test-weber and rinne

swimmer's ear it is an infection of the outer ear, w/ severe painful mov't of the pinna and tragus, redness and swelling of pinna and canl, scanty purulent discharge, scaling, itching, fever, and enlarged tender regional lymph nodes.

darwin's tubercle

tophi

carcinoma

keloid

sebaceous cyst,

severe swelling of canal, inflammation, ternderness

single, stony hard, rounded nodule that obscures the drum, nontender; overlying skin appears normal.

exquisitely painful, reddened, infected hair follicle.

more comon than osteoma. small, bony hard, rounded nodules of hypertrophic bone, covered w/ normal epithelium

polyp

if an acute otitis media is not treated, the drum may rupture from increased pressure. perforation also occur from trauma. usually appears as a round or oval darkened area on the drum,

serous otitis media

blue drum (hemotympanum)

suggests a yeast or fungal infection
*fungal infection (otomycosis)

oculus sinister, or left eye

orulus dexter, or right eye

both eyes

*acuity change's
*blurring
*clouding? cataract
*floaters? myompia, retinal detachment
*blind spots (scotoma)? glaucoma, migraine, neuro
*night blindness? glaucoma, decreased Vit A
*halso? glaucoma

Pallative: provactive: tried
Quality: burn/itch/pressure/stabbing
Region/Radiation: uni/bilateral
Severity/scale: intensity
Timing: onset, duration
Understanding? what the pt. fears the most

tearing, photosensitivity/ phopia, vision changes, eye discharge (color,amt.,dry eyes (xeropthalmia), crusting/matting), redness or swelling, seasonal allergies, trauma or FB (foreign bodies)
Contact lens?

*strabismus (eso/exotropia)
*diplopia
*glaucoma
*corrective lens
*surgery
*medications
*self care behaviors (vision exams, occupational hazards)

snellen chart, handheld vision screener, opaque card/occluder, penlight, ophthalmoscope, ishihara's test, gloves, OD, OS, OU

1. cataract formation, or lens opacity
2. glaucoma, or increased ocular pressure
3. macular degeneration.

bright light shines on the retina

this is a reflex direction of the eye toward an object attracting a person's attention

accomodation

by 8

1. vision difficulty (decreased, acuity, blurring, blind spots), 2. pain, 3. strabismus, diplopia 4. redness, swelling, 5. watering, discharge 6. past history of ocular problems 7. glaucoma, 8. use of glasses or contact lenses, 9. self-care behaviors

floaters

acute narrow angle glaucoma

scotoma

optic atrophy, glaucoma, or vit. a deficiency

photophobia

strabismus

diplopia

lacrimation due to irritants or obstrucion in drainage of tears

epiphora due to irritants or obstruction in drainage of tears

glaucoma

snellen alphabet chart

top indicates the distance the person is standing from the chart while the denominator gives teh distance at which a normal eye could have read that particular line

a handheld vision screener

presbyopia

this is a gross measure of peripheral vision, it compare's the person's peripheral vision w/ your own, assuming yours is normal

position yourself at eye level w/ the person, about 2 ft. away. direct the person to cover one eye w/ an opaque card, and w/ the other eye to look straight at you. cover your own eye opposite to the person's covered one. hold a pencil or your flicking finger as a target midline and slowly advance it in from the periphery in several directions

50 deg. superiorly, 60 deg. nasally, 70 deg. inferiorly, 90 deg. temporally,

corneal light reflex (the hirschberg test), cover test, diagnostic position test

drooping of upper lid

protruding eyes

sunken eyes

anemia

scleral icterus

assess the parallel alignment of the eye axes by shining a light toward the person's eye. direct the person to stare straight ahead as you hold the light about 30cm (12 inch) note the reflection of the light on the corneas; it should be in exactly the same spot on each eye

small degrees fo deviated alignment by interrupting the fusion reflex that normally keeps the two eyes paralles.

a mild weakness noted only when fusion is blocked

is more severe than phoria it is a constant malalignment of the eyes

ask the person to hold the head steady and to follow the mov't of your finger, pen or penlight only w/ the eyes. hold the target back 12inc. so thte person can focus on it comfortable and move it to each of the six cardinal positions of gaze

weakness of an extraocular muscle or dysfunction of cranial nerve innervating it

media (anterior chamber, lens, vitreoous), and the ocular fundus(the internal surface of the retina)

match sides w/ the person. hold the ophthalmoscope in your rt. hand up to your rt. eye to view teh person's rt. eye. you must do this to avoid bumping noses. place your free hand on the person's shoulder or forehead. begin 10inc away from the person at an angle about 15 deg. lateral to the person's line of vision. note the red glow filling the person's pupil. this is the red reflex, and steadily move closer to the eye. if you lose the red reflex, the light has wandered off the pupil and onto the iris or sclera. adjust your angle to find it again, note any opacities in the media. these appear as dark shadwos or black dots interrupting the red reflex normally none are present.
moving in on the 15 deg. lateral line should bring your view just to the optic dis, systmatically inspect the structures in the ocular fundus, optic disc, retinal vessels, general background, and macula

color-creamy yellow oange to pink
shape-round or oval
margins-distinct and sharply demarcated, although the nasal edge may be slightly fuzzy
cup disc ratio-distinctness varies. when visible, physiologic cup is a brighter yellow white than rest of the disc. its width is not more than one half the disc diameter

it is a gray white new mon shape it occurs when pigment is absent in the choroid layer and you are looking directly at the sclera

is black due to accumulation of pigment in the choroid

number, color, a:v ratio, caliber, a-v (arteriovenous)crossing, tortuosity, pulsations

2:3 or 4:5

2DD temporal to the disc

last in the fundoscopic exam. a bright light on this area fo central vision causes some watering and discomfort and pupillary constriction

birth to 2 wk-refusal to reopen eyes after exposure to bright light; increasing alertness to object; infant may fixate on an object
by 2-4wk- infant can fixate on an object
by 1mo.- infant can fixate and follow a light or bright toy
by 3-4mo-infant can fixate, follow, and reach for the toy
by 6-10mo. infant can fixate and follow the toy in all directions

picture cards screens children from 2.5 yr-2yr.and11mo of age and is even reliable w/ cooperative toddlers as young as 2 yr.

use a picture chart or the snellen e chart

1. age 3-vision 20/50 or less in either eye
2. age 4 and over-20/40 or less in either eye
3. difference between two eyes is one line or more
4. child shows other signs of vision impairment, regardless of acuity

visual acuity, color vision, extraocular muscle function, external eye structures, eyelids and lashes, conjunctiva and sclera, iris and pupils, the occular fundus

using ishihara's test a series of polychromatic cards. each card has a pattern of dots printed against a background of many colors

strabismus, corneal light reflex, perform the cover test,

cover test

squint,crossed eye, causes disconjugate vision because one eye deviates off the fixation pt.

color vision *primary colors-red, yellow, green, blue,
male predominance x-linked recessive trait

present bilaterally,
move symmetrically

upper lids overlap superior past of iris,
meet (approximate)lower lids when closed
palpabral fissure horizontal in non-asian

aligned normally in socket w/out protrusion or sunken appearance

-ask pt. to look up as you pull down lower lids, conjunctiva is transparent
-color should show structure below white over sclera, pink over lower lids

-slide fingers along bony orbit to check for swelling of lacrimal duct
-press into the nasolacrimal duct

clarity- shine a light-scratches(going in sideways to see scratches on cornea)

-size (3-5mm)
-shape

direct light reflex,
consensual light reflex
perrla (pupils, equal, round, reactive to light, accomodation, confrontation)

increased pressure in teh anterior chamber

arcus senilis, ectropion, entropion

a puff of air measures the pressure of the eyeball and how much fluid is in the vitrous

commonly show on the sclera, these yellowish elevated nodules are due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust

arcus senilis

the infant's and the young child's external auditory canal is shorter and has a slope opposite to that of the adult's

Astigmatism

bruit

goiter

macrocephalic

microcephallic

normocephalic

toriticollis

PI (PQRSTU)
PHx
allergies
medications
FHx
SHX
ROS-general, eyes, cv, gu, neuro, endocrine, resp., gi, skin, breasts allergy immuno, eent, psych

*size/shape-normocephali/ atramatic (NC/AT)
*HC-hydro, macro, micro, anen-cephaly
*tenderness
*lesions
*temporal regions-temporal arteries,TMJ
*facial structures-symmetry (palsy), edema
*general
*periorbital-exophthalmos
*sinus problems

*trachea
*ROM
*strenth

*drain top to bottom
*enlarge w/ inflammation/infection-d/t collection WBC's
*location?pathognomonic to spc dz
*tenderness?
*mobility?
*size
-N1<cm.. nonpalpable most adults
-kids:larger=n1variant (less SQ)
-fibrous chronic enlargement

*goiter,
*thyromegaly
*multinodular
*single nodule
*vascular bruits

between 9mo. and 2 yrs.

1-2mo

hyperplasia of the tissue and increased vascularity

1. headache, 2. head injury
3. dizziness, 4. neck pain, limitation of motion 5. lumps or swelling 6. hisotry of head or neck surgery

anxiety or pain; a flat affect may indicate depression; excessive smiling may be inappropriate

their location, size, shape, delimitation (discrete or matted together), mobility, consistency and tenderness.

movable, discrete, soft, and nontender

visit up to age 2 then yearly up to age 6

about 32 to 38 cm.

1. inspect and palpate the skull-general size contour, note any deformities, lumps, tenderness, palpate temporal artery, tempormandibular jt.,
2. Inspect the face-facial expression, symmetry of mov't (cranial nerve VII), any involuntary mov
t edema, lesions.
3. inspect and palpate the neck-active ROM, enlargement of salivary glands, lymph nodes, thyroid gland, position of the trachea 4. auscultate the thyroid (if elarged)for bruit

this is an excessive secretion of growth hormone from the pituitary, after puberty, creates an enlarged skull and thickened carnial bones.

accompanies chronic wasting diseases such as cancer, dehydration, and starvation. features include sunken eyes; hollow cheeks; and exhausted, defeated expression

literally "hard skin" this collagen disease is characterized by chronic hardening and shrinking of connective tissue. can occur in any body organ

people w/ migraines lie down to feel better whereas people w/ cluster headaches they need to move even to pace the floor

hair texture becomes dry, brittle, and lusterless w/ inadequate nutrition

1. previous history of skin disease (allergies, hives, psoriasis, eczema) 2. change in pigmentation 3. change in mole (size or color) 4. excessive dryness or moisture 5. pruritus 6. excessive bruising 7. rash or lesion 8. medications 9. hair loss, 10. change in nails 11. environmental or occupational hazards 12. self care behaviors

(baldness) hair loss

circular shape to skin lesion

elevated cavity containing free fluid larger than 1 cm diameter

skin lesions that run together

thick, dried out exudate left on skin when vesicles/pustules burst or dry up

dusky blue color to skin or mucous membranes due to increased amt. of unoxygenated hemoglobin

scooped out, shallow depression in skin

intense redness of the skin due to ecess blood in dilated superficial capillaries, as in fever or inflammation

self inflicted abrasion on skin due to scratching

fissure

(boil) suppurative inflammatory skin lesion due to infected hair follicle

yellow color to skin, palate, and sclera due to excess bilirubin in the blood

hypertrophic scar, elevated beyond site of original inury

benign fatty tumor

flat skin lesion w/ only a color change <1cn

(mole) circumscribed skin lesion due to excess melanocytes

elevated skin lesions, > 1cm diameter

excessively pale, whitish-pink color to lightly pigmented skin

palpable skin lesion of <1cm diameter

itching

elevated cavity containing thick turbid fluid

compact desiccated flakes of skin from shedding of dead skin cells

sloughing of necrotic inflammatory tissue that causes a deep depression in skin, extending inot dermis

elevated cavity containing free fluid up to 1 cm diameter

raised red skin lesion due to interstitial fluid

linear shape of skin lesion along a nerve route

ABCDE:
asymmetry of a pigmented lesion (one that is not regularly round or oval)
Border irregularity (notching, scalloping ragged edges or poorly defined margins)
Color variation(areas of brown, tan, black, blue, red, white, or combination therof)
Diameter greater than 6mm (size of a pencil eraser) although early melanomas may be diagnosed at a smaller size
Elevation and enlargement

vitiligo

emotions (fear,anger, embarassement)
environment (hot room, chilly, cigarette smoking)
physical (prolonged elevation, dependent position, immobilization)

in sun exposed areas

feckles (ephelides)

mole (nevus)

junctional nevus

or profuse perspiration, accompanies an increased metabolic rate, such as occurs in heavy activity or fever

smooth and firm, w/ an even surface.

imprint your thumbs firmly against the ankle mallelus or the tibia

1+ mild pitting, slight indentation, no perceptible swelling of the leg
2+moderate pitting indentation subsides rapidly
3+deep pitting, indentation remains for a short time, leg looks swollen
4+ very deep pitting, indentation lasts a long time, leg is very swollen

cherry (senile) angiomas

bruising is should be consistent w/ the expected trauma of life. there are normally no venous dilations or varicosities

1. color, 2. elevation:flat, raised, or pedunculated 3. pattern or shape: the grouping or distinctness of each lesion, 4. sizein cm. use a ruler to measure 5. location and distribution on body: generalized or localized 6. any exudate. note its color and/ or odor

Color, texture, distribution, lesions

shape and contour, consistency, color

hirsutism

160 degrees

mongolain spot

teach skin self examination, using the abcde rule

cafe au lait spot

neurofibromatoi, an ingerited neurocutaneous disease

mili

(salmon patch) is a flat, irregularly shaped red or pink patch found on the forehead, eyelid, or upper lip, but most commonly at the back of the neck (nuchal are) present at birth usually fades during the first year

acne

striae

these are commonly called liver spots and are small, flat, brown, macules. they are not malignant and require no treatment

these lesions are raised, thickened areas of pigmentation that look crusted, scaly, and warty
different types inc:seborrgeic keratosis, actinic (senile or solar) keratosis

sebaceous hyperplasia

1.inspect the skin: color, general pigmentaion, areas of hypopigmentaion or hyperpigmentation, abnormal color changes
2. palpate the skin: temp, moisture, texture, thickness, edema, mobility and turgor, hygiene, vascularity or bruising
3. note any lesions-color, shape and configuration, size, location and distribution on body
4. inspect and palpate the hair: texture, distribution, any scalp lesion 5. inspect and palpate the nails: shape and contour, consistensy, color
6. teach skin self-examination

or circular, begins in center and spreads to perphery

lesions run together

distinct, individual lesions that remain separate

clusters of lesions e.g. vesicles of contact dermatitis

twisted, coiled spiral, snakelike

or iris, resembles iris of eye, concentric rings of color in the lesions e.g. erythema multiforme

a scratch, streak, line, or stripe

annular lesions grow together e.g. lichen planus, psoriasis

linear arrangement along a nerve route e.g. herpes zoster

anular, discrete, grouped, confluent, serpiginous, gyrate, target, iris, linear, polycylic, zosteriform

*nutrition
*comorbid Dz
*immobility
*inactivity
*moisture
*pressure
*shearing

(ringworm of the foot), "athletes foot" a fungal infection, first appears as small vesicles between toes, sides of feet, soles

psoriasis

head lice,

spoon nails-thin depressed nails w/ lateral edges tilted up, forming a concave profile. may be congenital or a hereditary trait; if all nails are involved may be due to iron deficiency anemia

transverse furrow or groove. a depression across the nail that extends down to the nail bed. occurs w/ any trauma that temporarily impairs nail formation, such as acute illness, toxic reactions, or local trauma

red-brown linear streaks, embolic lesions, occur w/ subacute bacterial endocarditis; also may occur w/ minor trauma

proximal edge of nail elevates; angle is greater than 180 deg. distal phalanx looks rounder and wider. seen w/ chronic obstructive pulmonary disease and congenital heart disease w/ cyanosis. occurs first in thumb and index finger

this ispersistent fungal infection of fingernails and more often, toenails, commonin older adults. fungus causes change in color texture, thickness, w/ nail crubling or breaking, and loosening of the nail plate, usually begining at the distal edge and progressing proximally

sharply defined pitting and crumbling of the nails w/ distal detachemtn often occurs w/ psoriasis

protection, prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vit. D

the fine downy hair of the newborn

the thinning of the skin, the decrease in vascularity and nutrients, the loss of protective cushioning fo the subcutaneous layer, a lifetime of environmental trauma to skin, the social changes of aging, the increasingly sedetary lifestyle, and the chance of immobility