NURS 190 Midterm for PA 2

1. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE ABCDE of Melanoma • Asymmetry • Border Irregularity • Color Variation • Diameter Greater than 6mm • Evolving Changes Risk Factors • Sun sensitivity, difficulty tanning, hx of prolonged sun exposure, use of tanning booths, occupational exposure to chemicals like tar and radiation QUIZ QUESTION: Nevi this big and has color variation should be alerted for? – Malignant Melanoma 2. How to assess for central cyanosis? Look at patient’s oral mucosa QUIZ QUESTION: How to assess central cyanosis? – check the oral mucosa 3. Contact dermatitis Inflammation of the skin due to an allergy to a substance that comes into contact with the skin Redness, hives, vesicles or scales accompanied by intense itching 4. 3 Tineas; signs and symptom Tinea Corporis – fungal infection of the body Tinea Capitis – fungal infection of the scalp • Need to further assess the cause of pruritus of the scalp because this can be due to lice Tinea Pedis – fungal infection of the feet (athlete’s foot) 5. COPD, configuration of chest Barrel chest; AP:T diameter is equal QUIZ QUESTION: Expected finding with patient with COPD? • Barrel chest • Kyphosis • Hollow Clavicle • Protruding Sternum  angle of Louie 6. Scoliosis, kyphosis, lordosis, torticollis Scoliosis – lateral curvature and rotation of the thoracic and lumbar spine (S back); most common in female Kyphosis – exaggerated posterior curvature of the thoracic spine (hunchback); associated with aging. Lordosis – exaggerated curvature of the lumbar spine (swayback); compensation for pregnancy, obesity, and skeletal changes. Torticollis – muscle spasm by spinal accessory nerve, causing lateral flexion contracture of neck muscle 7. Physiological changes in older adult for all the systems discussed Skin, Hair, and Nails • Decreased elasticity, sebum production, perspiration, and melanin • Increased sensitivity to light • Nails become thicker, and more brittle Head, Neck and Lymphatics • Loss of subcutaneous fat in the face • Decreased reproductive hormone • Hair change, tooth loss, limited ROM • Complaints of tired or weak feeling due to thyroid dysfunction Eye • Decreased vision acuity • Presbyopia – age-related near vision difficulty • Cataract – thickened yellow lens; decreased lens clarity • Macular Degeneration – loss of central vision Ears, Nose, Mouth and Throat • Loss of hearing frequency • Gradual hearing loss (presbycusis) • Chelitis (angular stomatitis) • Decreased sense of taste and smell, saliva production, • Receding gum, tooth loss Respiratory • Decreased respiratory efficiency, cough ability • Changes in breath depth • Increased RR, effect of infection Breast and Axillae • Limited ROM for examinations • Modification of BSE • Changes in breast tissue composition • Gynecomastia in males • Increased breast cancer risk with aging Cardiovascular • Loss of ventricular compliance and vascular rigidity • Conduction system loses automaticity Peripheral Vascular • Increased BP • Decreased pulse with irregularities • Enlarged calf vessel 8. Different types of color – jaundice, pallor etc; What requires immediate intervention Cyanosis – mottled blue color in skin (REQUIRES IMMEDIATE INTERVENTION) Pallor – loss of skin color due to the absence of oxygen Uremia – pale yellow tone due to urinary retention Erythema – redness of the skin due to increase visibility of the oxyhemoglobin Jaundice – yellow undertone due to increase bilirubin in the blood QUIZ QUESTION: CYANOSIS is a priority because it indicates hypoxemia 9. How to assess jaundice, central cyanosis? Look for discoloration with the patient’s oral mucosa, then conjunctiva next 10. How to assess temperature Use the dorsal surface of the hand and feel for the temp QUIZ QUESTION: If assessing for temperature, use the DORSAL surface of the hand 11. Sxs of infection; patient suspecting with infection Older patient with pneumonia will present CONFUSION QUIZ QUESTION: patient suspected of fungal infection? – have you taken antibiotics recently 12. Assessing for pain; expected findings with acute pain /chronic pain Self-reported pain from patient is the most accurate assessment of pain QUIZ QUESTION: Best way to assess for pain is SELF-REPORTED pain from patient ..............................................................continued