Health Assessment Jarvis Exam 2

Front 1

There are two layers to our skin. The Epidermis (on top) and the Dermis.

Back 1

The Epidermis also has several layers the most important being the stratum germinativum or basal layer. This layer of the epidermis forms new skin cells who's major ingredient is keratine. This layer also contains melanocytes which gives us our skin color.

Front 2

The stratum corneum layer of the epidermis is the outermost dead layer. Skin cells migrate up to this layer from the basal layer.

Back 2

The dermis contains the hair folicles, sebacious gland (oil), eccrine glands, and apocrine glands (both sweat).Apocrine glands open into a hair folicle and produce a more milky substance. the are normaly in the axila, pubic area, and nipples.

Front 3

The subcutaneous layer is the layer of fat at the bottom of the dermis.

Back 3

As we age all the layers of our skin thin and flatten making them less stretchy and more prone to tearing. Skin turger is often much longer than 2 seconds in the elderly and they may exibit "tenting"

Front 4

A junctional nevus (mole) is only a macule and is often seen in kids. A junctional nevus can turn into a compound nevus which is a macule or papule normally seen in adults.

Back 4

Annular or circular lesions begin in the center and spread to the periphery.

Front 5

Confluent lesions run together (urticaria AKA hives).

Back 5

Discrete lesions remain seperate from one another.

Front 6

Grouped lesions are clustered together.

Back 6

Gyrate lesions twist, coil, and are sometimes snake-like.

Front 7

Target or iris lesions resemble the iris of the eye with a distinct center.

Back 7

Linear lesions are "lines" such as scratches.

Front 8

Polycyclic is a configuration where annular lesions grow together.

Back 8

Zosteriform configuration is when lesions grow along the path of a nerve such as seen with shingles.

Front 9

A macule is a flat area of skin color change less than 1 cm. (freckles)

Back 9

A papule is a macule you can feel basically such as a mole.

Front 10

A patch is a macule larger than 1 cm. (mongolian spot).

Back 10

A plaque is a papule larger than 1 cm possibly drier and harder.

Front 11

A nodule is larger than a papule, solid and elevated, hard or soft, may extend deeper into dermis.

Back 11

A wheal is superficial, raised and erythmatious. (mosquito bite).

Front 12

A tumor is larger than a few centimeters, hard or soft, deeper into dermis, and may be benign or malignant.

Back 12

A vesicle is an elevated cavity containing clear fluid up to 1 cm in size.

Front 13

Urticaria is larger than wheals, normally more than one is seen, they are extremely pruritic.

Back 13

A pustule is a vesicle filled with puss.

Front 14

An ulcer is a deeper abrasion spreading into dermis, may bleed, and leaves a scar when it heals.

Back 14

Pallor is a pailing of the skin caused by vaso constriction such as may happen in high stress situations.

Front 15

Erythema is redness caused by vasodilation (of capillaries mainly) such as may happen in emotional distress. In light skinned persons erythema will be visible, in dark skinned persons you can palpate for the temperature change that occurs from vasodilation.

Back 15

Cyanosis is a blue tint to skin caused by lack of oxygenated blood getting to the tissues. Breathing disorders can cause this as can poor circulation. In light skinned persons this may be seen readily, in dark skinned persons you would look O2 sat levels to determine an oxygenation problem.

Front 16

Jaundice is a yellowing of the skin caused by rising levels of bilirubin in the blood. Jaundice can be caused by hepatitis. Look for the begining sign of jaundice in the light skinned person in the sclera. the same is true for dark skinned persons but do not confuse their fatty deposits for jaundice.

Back 16

Skin turgor and adema are assessed to determine the patient's current hydration state. Turger is tested by pinching a small section of skin and noting how long it takes to return to normal. Edema is tested by inspections and palpation, if edema is noted it needs to be determined if it is pitting edema.

Front 17

Pitting edema is measured on a scale: 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

Back 17

ABCDE rule is used to assess pigmented lesions: Asymmetry, (not regularly round or oval, two halves of lesion do not look the same)

Border irregularity (notching, scalloping, ragged edges or poorly defined margins)

Color variation (areas of brown, tan, black, blue, red, white, or combination)

Diameter greater than 6 mm (i.e., the size of a pencil eraser), although early melanomas may be diagnosed at a smaller size (Oliviero, 2002).

Elevation and Enlargement

Front 18

Nails should be neat, well groomed, no chipping or pitting, profile sign should be less than 160*. Cappilary refill should be less than two seconds when nail bed is blanched.

Back 18

Skin should be smooth, free of lesions or bruises, warm to touch bilaterally (when applicable). Color should be consistent with genetic background without extreme color changes.

Front 19

Skin protects our bodies, adjusts our temperature and hydration.

Back 19

Most lymph nodes are normally non-palpable, to assess lymph nodes gently palpate the area where the node should be and not any tenderness, pain, and swelling.

Front 20

Trachia should be midline, thyroid may or may not be palpable, if palpable should not have nodules or and swelling, carotid pulses should be equal bilaterally, regular, and around +2 without bruits or murmurs.

Back 20

The head should be normocephalic, no lesions, lumps, bumps. bruises. Note any hair loss or growth, color of hair and consitancy. Neck should be staight and centered no pain or tenderness on palpation. Full active ROM and strength 3-4 out of 5 are normal.

Front 21

PERRLA:
Pupils Equal, Round, React to Light, and Accommodation.

Back 21

The three visual reflexes are tested by the pupillary light reflex and the accomidation test. (look near then far......)

Front 22

CN 1
Test for smell using two different scents, one at a time while the patient closes one nostril.

Back 22

CN 2
Test for confrontation by covering one eye with the patient and drawing hand in from periphery until patient states can see your hand.

Front 23

CN 3
Test the EOM using H or star pattern. CN 3 includes all directions except toward nose and corners of eyes.

Back 23

CN 4
Test EOM, this is the patient looking at their nose.

Front 24

CN 5
Have patient clench teeth while you try to force jaw down or move jaw from side to side. Also cotton ball on cheek to test sensation.

Back 24

CN 6
Test EOM, this is patient lookin laterally at corners of eyes.

Front 25

CN 7
Have patient make facial expressions, smile, frown, puff out cheeks and examiner pushes cheeks in to see if air escapes equally from each side.

Back 25

CN 8
Whisper a different word like "pizza" into each ear while pushing in the tragus. if patient repeats word CN 8 is intact.

Front 26

CN 9
Have patient say AHH uvula should rise midline,

Back 26

CN 10
Test gag reflex by touching back of throat with tongue depressor.

Front 27

CN 11
Shrug shoulders against resistance, also neck movements against resistance.

Back 27

CN 12
stick out tongue, should protrude midline, no shaking or deviation to one side.