ODCT skin, hair and nails F20 PDF

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Health Assessment...

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F20

Moving forward each system will be assessed using an IPPA approach (Inspection, palpation, percussion, auscultation). Explain what these are and provide an example for how these techniques are applied during a physical examination Physical Assessment Techniques (IPPA) Inspection

Palpation Percussion

Auscultation

For each technique provide an overview of how you would assess them. Provide an example of when you would use each of these techniques Using our senses such as vision, smelling, and hearing, I would inspect for any moisture, skin colour, size, and symmetry of the body with proper lighting and instrument. I would use this technique for skin, hair, nail, and ear assessment. For any change in its normal colour, size, and shape Using my warm hands I would assess the parts of the body that is accessible. I would use this technique to gently check for skin temperature, turgor, tenderness, and thickness. By gently tapping the surface of the body to produce a vibration or sound. The heard will determine if that areas is filled with air or fluid by the quality of sound heard. This technique is used to know the size and shape of the internal organs underneath to establish a baseline data. Differentiate direct vs indirect Direct  Using 2, 3, or 4 fingers or with the middle finger directly tap the area to be assessed. The movement is fast and using the wrist to tap the surface area, usually the sinuses. Indirect  Using the middle finger of the non-dominant placed it in the area to be assessed, and us the 1 or 2 finger and tap it on top of the middle finger of the non-dominant hand. Listen for the resonance of the sound. What are you assessing with the diaphragm and the bell? Diaphragm  Use to listen for high pitch sound such as bowel sounds and lung sounds Bell  Used for assessing low pitch sound such as vascular sound and heart sounds This technique is done using the stethoscope to assess for the pitch, quality, and intensity of the sound produced by the specific organ such as the heart, GI tract, and lungs.

Adapted from: Jarvis Physical Examination and Health Assessment 2019

F20 Skin, Hair & Nails ALL assessments are done bilaterally, this system will be integrated into other body systems Provide an overview of the assessment technique you Outline any patient direction you would provide to enhance your physical would use & how you would properly landmark the area assessment findings & identify all normal findings for each section to be assessed Inspect Colour I will assess the area that is not exposed to the sun first such as the palms of I will assess using the natural light if possible to assess if the hands. Checking if there is something that is different from the normal. the skin has the same colour as the rest of the body. I The same assessment is done on both sides of the body. Document all the would also consider the genetic and background of the findings. patient while performing the assessment. Also, ask the Normal: patient  For lighter skin colour: from light pink to ruddy pink  For darker skin: light to deep brown to olive Abnormal:  If there is a vitiligo, a condition in which some areas of the skin will be white or light skin compared to the rest of the body due to absence of melanin in some areas.  Presence of cyanosis (bluish discoloration due to decrease supply of oxygen in the area), pallor or paleness, erythema (red discolouration due to trauma, fever, sunburns), and jaundice (yellow discoloration). Freckles/mole/nevus Lesion assessment mnemonic: ABCDEE (explain what and how you would assess this) I will examine and note if they are the same in size and A-symmetry-I will examine the pigmented lesions and if I draw a line in colour, if they have even edges, and ¼ smaller or 6mm. the middle it should look the same. Border Irregularity- I will inspect the border and it should have well defined lines on the sides. Colour Variation- I will check to see that it has a uniform and 1 in colour all over the pigmented lesions. Diameter- I will examine the area and note that the size of it should not be more done 6mm or ¼ inch smaller Elevation and Evolution: I will check and see that it is flat and there is absence of evolution. The shape, size, and colour remain the same. There is no itchiness or an elevated area. Hair: colour & texture I would ask the patient to sit down. Then I will inform and ask for consent. I will examine the texture by taking a few strands of When I examine the hair I should find, the colour to range from pale blond hair and roll it between my thumb and finger to assess it. to black to grey. I would keep in mind about the genetic factors and their Adapted from: Jarvis Physical Examination and Health Assessment 2019

F20 While doing that I will assess the hair colour.

Nails: shape & contour I will inspect the shape and contour of the nail by assessing the side view of the nail. Colour I will assess the nail plate by looking at it checking for any presence of streaks or presence of colour that is not normal.

Palpation

Temperature & moisture By using the dorsal side of my hand, I would palpate check the temperature of the patient. Then check both sides of the body. For moisture assessment, I would inspect the places were normal perspiration is present such as the face, hands, axilla as result of warm weather. Texture By using my palm and fingers, I would palpate the skin to assess the texture. Thickness By using the palm and fingers I would palpate and assess how thick the skin is

Edema -Where would you assess this? I will assess this in the lower extremities such as the feet and ankles. Using my finger I would lightly apply pressure for about 5 seconds and the release it. If an indentation is visible after the pressure is release it is then graded on a scale of four Mobility & turgor I will examine this by gently pinching the skin Adapted from: Jarvis Physical Examination and Health Assessment 2019

age that may affect the colour of their hair. The texture should be fine or thick hair, and it could be curly, straight, or kinky but still appear shiny and healthy. No visible signs of coarseness or dullness in colour. The nail should be well rounded, convex, and the angle of the nail bed should be about 160 degrees. The nail plate should be transparent with a pink nail be colour beneath. For people who have dark complexion, an appearance of linear pigmentation would be normal. Presence of Leukonychia striata (straight white hairline) is normal for everyone. How would you asses a nail profile? I will view the nail by holding it up and look at the side view of the nails. The angle of the base of the nail should be about 160 degrees. What are abnormal colour assessment findings for the nails  Presence of bluish discolouration (cyanosis) or paleness (pallor)  Presence of brown linear streaks for light skin person I will ask the patient to sit down or lie down if possible. The skin should be warm to touch on both sides of the body. A different in the temperature of the hand and foot maybe due to the environment. The skin should be moist but not overly moist or dry.

Normal: The skin should be smooth, firm have even surface to touch.

Normal: The skin should be thin in the majority of the body except for the hand and sole of the feet. Sometimes the elbows and knees may have a bit of a thick skin as well. Callus formation on hands and soles of the feet are normal due to the constant exposure to friction Normal: The skin should return to its normal smoothness after the release of pressure

What does skin turgor reflect?

F20 underneath the clavicle.

It shows the ability of the skin to return to normal position when streteched. Normal: It would be easy to gently lift the skin to test the mobility and turgor should return to normal after stretching it. This is to test the elasticity of the skin

Vascularity/bruising (ecchymosis) I will assess the bruising by asking the patient if he/she may have bump somewhere to cause the presence of ecchymosis. Hair: Texture, Distribution Using my hands and visual senses. I will inspect the hair by separating the sections of the scalp hair. Lesions (scalp) To inspect the scalp, I would observe for any presence of secretions or parasite (lice) and if there is I would wear gloves. Then I would separate the hair into small sections to check for the hair behind the ears and the back of the head as well. Nails: consistency

Normal: Presence of ecchymosis is acceptable if the patient may have somehow fallen or hit somewhere hard that caused the bruising. There is absence of varicosities and venous dilatations. To further assess, I will ask my patient if he/she had any accident. I would ask my patient to sit comfortably while I assess their hair. Normal: when I do my assessment I should be able to expect an even distribution of hair on the head.

Capillary refill I will test this by using my thumb and index finger and press the tip of the nail of my patient. I will do this

Adapted from: Jarvis Physical Examination and Health Assessment 2019

Normal: When I do my assessment, the scalp are should be free of any parasite or pest in habitants and should also be clean. Presence of dandruff or seborrhea are normal

Normal: The surface of the nail should be smooth and regular. What does Cap refill assess? The Blanch test examines the peripheral circulation. Normal: After pressing the tip of the nails of my patient it should return back to its usual pink colour...