Aging and Skin Changes: An Overview, Exams of Physical Activity and Sport Sciences

Download Aging and Skin Changes: An Overview and more Exams Physical Activity and Sport Sciences in PDF only on Docsity! Physical Assessment Exam 1 Review 1. Setting of his symptoms Where was the person or what was the person doing when the symptom started? What brings it on? For example, “Did you notice chest pain after shoveling snow, or did the pain start by itself?” 2. Pain scale P: Provocative or Palliative. What brings it on? What were you doing when you first noticed it? What makes it better? Worse? Q: Quality or Quantity. How does it look, feel, sound? How intense/severe is it? R: Region or Radiation. Where is it? Does is spread anywhere? S: Severity Scale. How bad is it (on a scale of 0 to 10)? Is it getting better, worse, staying the same? T: Timing. Onset-Exactly when did it first occur? Duration-How long did it last? Frequency- How often does it occur? U: Understand Patient’s Perception of the Problem. What do you think it means? 3. Allergy Any drugs, foods, contact agents, and environmental to which the child is allergic and the reaction to the allergens. A true food allergy is an immune response caused by exposure to a food substance. Common pediatric food allergies include cow’s milk, eggs, peanuts, tree nuts, soybean and fish. A true food allergy can be life threatening but should be differentiated from a food intolerance, which causes distress and illness yet is a nonimmunologic response and not life threatening, Also note allergic reaction particularly common in childhood, such as allergic rhinitis, insect hypersensitivity, eczema and urticaria. 4. Changes to the older adult, skin changes The aging process carries a slow atrophy of skin structures. The aging skin loses its elasticity; it folds and sags. By the 70s to 80s, it looks parchment thin, lax, dry, and wrinkled. The outer layer of the skin thins and flattens. This allows chemicals easier access into the body. Wrinkling occurs because the underlying the underlying dermis thins and flattens. A loss of elastin, collagen, and subcutaneous fat and reduction in muscle tone occur. The loss of collagen increases the risk for shearing, tearing injuries. Sweat and sebaceous glands decrease in number and function, leaving dry skin. Decreased response of the sweat glands to thermoregulatory demand also puts the aging person at greater risk for heat stroke. The vascularity of the person skin diminishes while the vascular fragility increases; a minor trauma may produce dark red discolored areas, or senile purpura. Sun exposure and cigarette smoking further accentuate aging changes in the skin. Coarse wrinkling, decreased elasticity, atrophy, speckled and uneven coloring, more pigment changes, and a yellowed, leathery texture occur. Chronic sun damage is even more prominent in light- skinned persons. An accumulation of factors places the aging person at risk for skin disease and breakdown: the thinning of the skin, the decrease in vascularity and nutrients, the loss of protective cushioning of the subcutaneous layer, a lifetime of environmental trauma to skin, the social changes of aging (e.g., less nutrition limited financial resources), the increasingly sedentary lifestyle and the chance of immobility. When skin breakdown does occur, subsequent cell replacement is slower and wound healing is delayed. Because the aging changes in the skin and hair can be viewed directly, they carry a profound psychological impact. For many people self-esteem is linked toa youthful appearance. This view is compounded by media advertising in Western society. Although sagging and wrinkling skin and graying and thinning hair are normal processes of aging, they prompt a loss of self- esteem for many adults. 5. Report suspected abuse: DOCUMENTATION: Pallor in dark tones: by the absence of the luster of the underlying red tones. The brown skinnes shows yellowish brown and the black-skinned person appear gray or ashen. Observe generalized pallor in the mucous membranes, lips and nail beds. Look for the pallor of anemia in the palpebral conjunctiva and nail beds. When can pallor occur: • Anemia (spoon nails, fatigue, exertional dyspnea, rapid pulse, dizziness and impaired mental • functioning) • Shock ( rapid pulse, oliguria, apprehension and restlessness) 9. Define Jaundice -It’s a Yellowish skin color, which indicates rising amount of bilirubin in the blood. -Physiologic Jaundice: Is a normal variation in about half of all newborns. A yellowing of the skin, sclera, and mucous membranes develops after the 3rd or 4th day of life, because of the increased numbers of red blood cells that hemolyze after birth. The hemoglobin in the red blood cells is metabolized by the liver and spleen; its pigment is converted into bilirubin. - Abnormal Findings: Jaundice on the first on the 1st day of life may indicate hemolytic disease. Jaundice after 2 weeks of age may indicate biliary tract obstruction. 10. Inspection: Inspection ALWAYS comes first. It is concentrated in watching. It is close, careful scrutiny, first of the individual as a whole and then of each body system. Always compare the right and left side of the body. Inspection requires good lighting, adequate exposure, and occasional use of certain instruments such as (otoscope, ophthalmoscope, penlight, nasal and vaginal specula to enlarge your view.) -Palpation: Often confirms what you noted during inspection. Use your sense of touch to assess: texture, temperature, moisture, organ location and size; any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses and presence of tenderness or pain. a) Fingertips: Best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps. b) A grasping action of the fingers and thumb. To detect the position, shape, and consistency of an organ or mass. c) The dorsa (backs) of hands and fingers. Best for determining temperature, because the skin is thinner than the palms d) Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand. Best for vibration. Palpation technique should be systematic, calm and gentle. Identify any tender areas and palpate them last. -Percussion: It’s the act of tapping the person’s skin with short, sharp strokes to assess underlying structures. The stroke yields an audible vibration and a characteristic sound that depicts the location, size and density of the underlying organ. Percus 2 times in each location using even, “staccato blows”. Production of Sound during Percussion 1) Amplitude (or intensity), a loud or soft sound 2) Pitch (or frequency), the number of vibration per second 3) Quality (timbre), subjective difference caused by the distinctive overtones of a sound 4) Duration, the length of time the note lingers - Auscultation: It’s the listening to sounds produced by the body, such as the heart, blood vessels, and abdomen. You use the Diaphragm, most often because its flat edge is best for high-pitched sounds (breath, bowel, and normal heart sounds. The Bell endpiece has a deep, hollow, cuplike shape. It is best for soft, low-pitched sounds such as extra heart sounds murmurs. Never listen through a gown. Therefore reach under a gown to listen, and take care that no clothing rubs on the stethoscope. Finally avoid your “own” artifact. 11. Reflection: -Echoes client’s words by repeating part of what a person has just said - Can help express feelings behind words - Mirroring client’s words can help a person elaborate on a problem Facilitation: - Encourage client to say more -Shows person you are interested MAP = 2x Diastolic + Systolic/ 3 OR MAP= Diastolic + 1/3 Pulse Pressure resting pressure that the blood exerts constantly between each contraction. The pulse pressure is the difference between the systolic and diastolic pressures and reflects the stroke volume. The mean arterial pressure (MAP) is the pressure forcing blood into the tissues averaged over the cardiac cycle. Diurnal rhythm. It’s a daily cycle of a peak and trough occurs: the BP climbs to a high in late afternoon or early evening and then declines to an early-morning low. BP is measured with a stethoscope and an aneroid sphygmomanometer, and it must be recalibrated at least once a year. The width of the rubber bladder should equal 40 % of the circumference of the person’s arm. The length of the bladder should equal 80% of the circumference. Allow at least a 5 minutes rest before measuring the BP. Then take two or more BP measurements separated by 1 to 2 minutes. A normal BP reading is < 120/<80 mmHg in adults. The Procedure: The person may be sitting or lying, with the bare arm supported at heart level. When seating, the person feet should be flat on the floor, because BP has a false-high measurement when the legs are crossed vs uncrossed. 1) Palpate the brachial artery, which is located just above the antecubital fossa, medial to the biceps tendon. With the cuff deflated, center it about 2.5 cm(1 in.) above the brachial artery and wrap the cuff evenly 2) Now palpate the brachial artery or radial pulse. Inflate the cuff until the artery pulsation is obliterated. Note that number. When you inflate the cuff to auscultate the BP, you will add 20-30 mmHg to the number you noted, to identify the maximum inflation level. This maximum inflation pressure helps you to avoid missing an auscultatory gap, which is a period when the Korotkoff sounds disappear during auscultation. 3) Deflate the cuff quickly and completely; then wait 15 to 30 seconds before reinflating so that the blood trapped in the veins can dissipate. Place the bell or diaphragm of the stethoscope over the site of the brachial artery. 4) Rapidly inflate the cuff to the maximal inflation level that you determined. Then deflate the cuff slowly and evenly, about 2 mmHg/ heartbeat. The point at which you hear the first appearance of sound, the muffling of sound, and the final disappearance of sound. These are phases I, IV and V of Korotkoff sounds. For all age-groups the “fifth” phase is used to define diastolic pressure. Also record the person’s position, the arm, used, and the cuff size, if different from the standard adult cuff. 13. Phase of the interview process 1.Introducing the Interview Keep the introduction short and formal. Address the person using his or her surname, and shake hands if appropriate. Unless the client directs you otherwise, avoid using the first name during the interview. Introduce yourself and state your role in the agency (if you are a student, say so). Give the reason for the interview: “Mrs. Sanchez, I would like to talk about what caused you to come to the hospital today and get an update on your overall health status.” “Mr. Craig, I want to ask you some questions about your previous medical history, family history, and any current complaints before we complete your physical examination.” 2. The Working Phase The working phase is the data-gathering phase. Verbal skills for this phase include your ability to form questions appropriately and your responses to the answers given by the client. You will likely use a combination of open-ended and closed questions during the interview * The open-ended question asks for narrative information. The open-ended question is unbiased; it leaves the person free to answer in any way* Inner edge of nail elevates; nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny. Chronic lung inflammation, lung cancers, heart defects with right-to- left shunts may cause release of growth factors (e.g., platelet-derived growth factor) and promote growth of vessels. Clubbing usually develops slowly over years; if the primary disease is treated, clubbing can reverse. 15. Cyanosis and swelling This is a blueish discoloration of the skin or mucous membranes. The tissues have high levels of deoxygenated blood. This is best seen in the lips, nose, cheeks, ears, and oral mucous membranes and in artificial fluorescent light. Do not confuse cyanosis with the common and normal bluish tone on the lips of dark-skinned persons of Mediterranean origin. is characterized by a blueish discoloration of the skin or mucous membranes. Cyanosis is frequently encountered in clinical practice, and the differential diagnosis of can be challenging as there are many conditions that can cause cyanosis. Is usually caused by problems of the heart, lungs, or blood • Impaired gas exchange secondary to pneumonia. • Embolism and ventilation perfusion mismatch. • Impaired gas diffusion via the alveoli. • High altitude. • Anatomic shunts. • Right to left shunt in congenital heart disease. • Arteriovenous malformation. Swelling is any abnormal enlargement of a body part. It is typically the result of inflammation or a buildup of fluid. Edema describes swelling in the tissue outside of the joint. Effusion describes swelling that is inside a joint, such as a swollen ankle or knee. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, pregnancy, infections, and many other medical problems can cause edema. Edema happens when your small blood vessels leak fluid into nearby tissues. 16. Assessing orientation There are four general elements to orientation: person; place; time; and situation. Orientation to person is simply the ability to identify one's name and is the last element of orientation to be lost, usually only in very severe dementia or in psychotic states. It's a good idea to preface your inquiry with a general comment about the fact you ask every patient these questions Orientation to place is the ability to name where they are, or at least what building, city, or state they are in. Time includes the date (allow a day or two error for inpatients who are frequently somewhat disoriented), day of week, year, and season. Situation is the ability to describe their global circumstances. (1) Who are you? -Psychiatric mental illnesses: Organic etiology has not yet been established (e.g., anxiety disorder or schizophrenia) Mental status assessment documents a dysfunction and determines how that dysfunction affects self-care in everyday life. *Age-related changes in sensory perception can affect mental status along with chronicity of disease process (presence of comorbidity). *Grief and despair surrounding these losses can affect mental status and can result in disability, disorientation, or depression. *Older adulthood contains more potential for losses. Full mental status examination is a systematic check of emotional and cognitive functioning. It is necessary to perform a full mental status examination when any abnormality in affect or behavior is discovered and in certain situations. Four main headings of mental status assessment: A-B-C-T -Appearance: This includes posture, body movements (voluntary, coordinated, etc.), Dress (appropriate for season, age, gender, and social group), Grooming and Hygiene. -Behavior: Level of consciousness (awake, alert, oriented, and responsive to stimuli), facial expression (comfortable eye contact unless precluded by cultural norm), Speech (pacing, articulation, and word choice), and mood (willing to cooperate.) -Cognition: Orientation (Time, place, person), attention span (Check person’s ability to concentrate by nothing whether he/she completes a thought without wandering), Recent memory (Ex. Ask the patients what they ate for breakfast), Remote memory (Past medical Hx, First job, birthdays, etc.) *Attention span commonly is impaired in people who are anxious, fatigued, or intoxicated. -Thought processes: the way a person thinks should be logical, goal directed, coherent, and relevant; should complete thoughts. *Anxiety and depression are the two most common mental health disorders seen in individuals seeking health care. *MMSE concentrates only on cognitive functioning and detect dementia and delirium. Status av. 27; scores between 24-30 indicate no cognitive impairment. Scores that occur with dementia and delirium are classified as follows: 18 to 23 = mild cognitive impairment; 0 to 7 = severe cognitive impairment. MoCA examines more cognitive domains, more sensitive to mild cognitive impairment. Score 30; score greater or equal than 26 considered normal. When a Full Mental Status Examination Is Necessary: -Initial screening: Suggests an anxiety disorder or depression - Behavioral changes: Memory loss, inappropriate social interaction - Brain lesions: Trauma, tumor, cerebrovascular accident, or stroke - Aphasia: Impairment of language ability secondary to brain damage. Test includes word comprehension(name objects in the room), reading (ask to read available print) and writing. - Symptoms of psychiatric mental illness: Especially with acute onset Factors That Could Affect Interpretation of Findings: -Known illnesses or health problems: Such as alcoholism or chronic renal disease -Medications: Side effects of confusion or depression -Educational and behavioral level: Note factor as normal baseline -Stress responses observed in social interactions, sleep habits, drug and alcohol use Screening tests: -Infants and children: Denver ll screening test (birth to 6 y/o) helps identify those who may be slow to develop in behavioral, language, cognitive, and psychosocial areas. Behavioral Checklist (7 to 11 y/o) is tool given to parent along with the history. Covers five major areas : mood, play, school, friends, and family relations. -Adolescents: Follow same ABCT guidelines as for adults. -Aging adults: Check sensory status, vision, and hearing before any aspect of mental status. Confusion is common and is easily misdiagnosed. Follow same ABCT guidelines with additional considerations. Behavior: Level of consciousness (Glasgow coma scale in testing consciousness in aging persons in whom confusion is common) 21. Visual accommodation Accommodation refers to your eyes' ability to see things that are both close up and far away. If your pupils are nonreactive to accommodation, it means they don't adjust when you try to shift your focus to an object in the distance or near your face. Step 3: While looking at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood). Step 4: • Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. • Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping circular motions of the finger pads to feel the breast tissue. • Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage. • Repeat the exam on your left breast, using the finger pads of the right hand. Step 5: Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it difficult to examine. 28. 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