Health Assessment Skin and MSK
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What are the functions of skin?
protection, temperature regulation, perception, absorption and secretion, production of vitamin D, adn indentification(fingerprints)
Identify nail shapes
early clubbing--flat across 180 degrees
curved--less than 160 degrees
What are some causes of clubbing in the fingernails?
Blood isn't getting to the fingers and toes
Causes: peripheral vascular disease, COPD
What are things to look for during skin history data collection? (subjective data)
trauma, excessive/spontaneous bruising, change in mole, change in pigmentation, excessive dryness or moisture, pruitus, rashes/lesions, hair changes or loss, wound healing changes, environmental/work hazards, tattoos and piercings, self-care/protective behaviors, medications
What are some alleviating factors for skin irritations? (ask patient what makes skin feel better?)
steroid creams, pills, benadryl, calamine, aloe, baths (cleansing skin, aveeno), ointments or lotions
What are some exacerbating factors? (Ask patient what makes skin feel worse?)
medications (antibiotics), topical substances, lotions, bathing, soaps, perfumes, foods, clothing, allergic history, stressors, illnesses
What are some important tips when assessing skin?
note age, gender, race, recreational/environmental hazards, exposure to illness, consider a medical problem with associated skin symptoms (butterfly mask =lupus/rosacea), ALWAYS ASK if TETANUS is up to date!
What equipment is needed for skin assessment?
direct light source/pen light, gloves, ruler, Wood's Lamp, magnifying lens,
What are some external variables that influence skin pigmentation?
emotional states, temperature, cigarette smoking, prolonged elevation/dependent position of extremeties, prolonged inactivity
What is the best place to look if central cyanosis is suspected?
Where is the best place to observe peripheral cyanosis?
fingers, toes, nails
What should you observe during a skin assessment?
vascularity (evidence of bruising), temperature, texture, mobility/turgor, lesions, nails, hair
What are the different degrees of pitting edema?
- +1 mild pitting
- +2 moderate pitting
- +3 deep pitting indentation remains for a short time
- +4 ver deep pitting indentation lasts for a long time
What is important to note when assessing skin lesions?
color, elevation, pattern/shape, size, location and distribution, exudate(wet/dry, color consistency), bleeding from lesion
What are some different primary skin lesions? Know what they Look like!
macule/patch, papule/plaque, nodule/tumor, wheal(mosquito bite, urticaria(hives), vesicle(liquid), cyst(hard), pustule (pus filled)
What are some secondary skin lesions?
crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, keloid(scar that is raised)
What are the ABCDEs of skin cancer?
- Border Irregularity
- Elevation and Enlargement
What are the different levels of burns?
First Degree- red, painful, blanches wih pressure, no blistering(epidermal layer only)
Second Degree- blisters, redness, ain, raw surfaces (partial thickness or to dermis layer)
Third Degree- skin white or charred, not painful (full thickness all skin elements destroyed)
What are some sources of pain?
- visceral pain--origniates from larger organs
- deep somatic pain--comes from blood vessels, joints, tendons, muscles, and bone
- Cutaneous Pain--skin surface and SubQ tissue
- Referred pain--felt at a different site from the origin of pain (same spinal nerve=brain can't differentiate
What is acute pain?
short term self-limiting, follows a predictable trajectory, dissipates after injury heals
What is chronic pain?
continues for 6 months or longer, types are malignant/nonmalignant, does not stop when injury heals
What are some acute pain behaviors?
guarding, grimacing, vocalization(moaning), agitation/restlessness, stillness, diaphoresis, change in vital signs
What are some chronic pain behaviors?
bracing, rubbing, diminished activity, sighing, change in appetite, movement, exercise, prayer, sleeping
What is the formula for BMI?
BMW= weight in kg divided by height in meters squared
What are some laboratory studies to observe in nutritional assessment?
hemoglobin, hematocrit, cholesterol, triglycerides, Total lymphocyte count, skin testing, serum proteins, nitrogen balance, creatinine(high index)
What are some classifications of malnutrition?
obesity, marasmus(protein-calorie malnutrition), kwashiorkor(protein malnutrition),
What is pellagra?
deficiency in vitamin B-3 and tryptophan
What is scorbutic gum?
Vitamin C deficiency
What causes foliicular hyperkeratosis and Bitot's Spots?
Vitamin A deficiency
Name the planes that the body can be divided into.
Median plane, coronal(frontal) plane, transverse(horizontal) plane
What are the types of joints?
immovable(bone to bone connection)--skull, pelvic
Slightly movable--neck(pivot) wrist(glide)
Freely movable (synovial)--knee, elbow(hinge), mandible (condyloid), ball and socket(hip shoulder)
Give some facts about muscles
comprises 40-50% of body weight
needs intact nerve supply, identified by tone(feeling resistance with passive stretch)
bulk of muscle is related to level of activity, function, and innervation
What is the only freely movable joint on head and most active joint in body?
What are the steps for starting a MSK assessment?
Onspect, palpate, ROM, strength--ALWAYS COMPARE SIDE TO SIDE SYMMETRY
What should you look for when assessing muscles and joints?
General appearance at rest and in motion, deformities, swelling, redness, skin/vascular status, condition of surrounding tissue, muscle size and symmetry
During palpation of joints what should you assess for?
temperature(heat/inflammation), swelling in soft tissues or fluid in joints, tenderness, nodules
What should you assess for when palpating joints with ROM?
palpate the joint and the nearby muscle during active range of motion, use active ROM for general screening healthy adult, to assess joint function, use passive ROM if unconscious, debilitated, protect joint if injured, assist in rehab
Are there any changes in ROM? Is there resistance of movement? DO you hear/feel crepitus with motion?
What should you evaluate when assessing muscle with reguard to its location and function?
active/inactive? paralysis? spasticity?
What is the order of the MSK assessment?
TMJ, neck(cervical spine), upper extremeties(shoulders, elbows, hands, wrists, fingers), lower extremeties(hips, knees, ankles, feet, toes), Spine
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