health assessment

awareness of the objective world in relation to the self

awareness of objects through any of the five senses

difficulty/discomfort in talking, abnormal pitch/volume, but articulation and language are intact

distorted speech sounds, sound intelligible, basic language intact

abct appearance behavior cognition and thought processes

adolescents: Home environment, Education/employment, Eating, Activities, Drugs, Sexuality, Suicide, Safety

• valid detector of organic diseases. concentrates on cognitive functioning.
• max: 30,
• mild cognitive impairment: 18-23,
• 0-7 severe cognitive impairment

birth to 6 indentifys those who may be slow in development in behavioral language cognitive and psychosocial areas.

school age 7-11, for use beyond age wen developmental milestones are useful

• 1 alert: awake or readily aroused oriented fully aware of stimuli and responds appropriately
• 2 lethargic: not fully alert drifts off to sleep when not stimulated can be aroused to name when called in normal voice but looks drowsy. Responds appropriately to questions or commands but thinking seems slow/fuzzy. looses train of thought.
• 3 Obtunded: Sleeps most of time, difficult to arouse-needs loud shout or vigorous shake acs confused when is aroused, converses in monosyllables, mumbles, and requires constant stimulation for even marginal cooperation
• 4 Stupor/semi-coma: Spontaneously unconscious, responds only to persistent and vigorous shake or pain: has apropriate motor respnse, otherwise can only groan mumble or move restlessly
• 5 Coma: Completely uncounscious, no response to pain or to any external or internal stimuli

• true language disturbance, defect in word choice and grammar or defect in comprehension, defect is in higher integrative language processing
• Global:most common/severe: speech and comprehension are absent or reduced to a few stereotyped words/sounds and the persons name
• Brocas: Expressive/ the person can understand lanuage but cannot express him or herself
• Wernickes: receptive/ can hear sounds and words but cannot relate them to previos experiences. Speech is fluent effortless and articulated but can often be incomprehensible

raid shift of emotions

the existence of opposing emotions toward an idea object or person

due to brain disease of known specific organic cause delirium, dementia, intoxication, and withdrawal

In which organic etiology has not yet been established (anxiety disorder, schizophrenia)

protruberant abdomen

aging person "stoop"

• arm span = height
• body length form crown to pubis roughly equal to length from pubis to sole

• weight in kilograms/height in meters^2
• (weight in pounds/height in inches^2) *703
• <18.5 underweight
• 18.5-24.9 normal weight
• 25-29.9 overweight
• 30-39.9 obesity
• >40 extreme obesity

waist/hip 1> in men and .8> in women is indicative of android (upper body obesity)

• 37 C 35.8 to 37.3
• 98.6 F 96.4 to 99.1

• 60-100 bpm
• < 60 bradycardia
• >100 is tachycardia

• 3+ full boundind
• 2+ normal
• 1+ weak thready
• 0 absent

• 10-20
• babies 20 to 40
• kids ~20-30

• I tapping
• II swooshing soft murmur follows tapping
• III knocking crisp high itched sound
• IV abrubt muffling sound mutes to a low pitched cushioned murmur blowing quality
• V silence

97-98

deficiency in growth hormone in childhood. <3rd percentile delayed puberty hypothyroidism and adrenal insufficiency

excessive secretion of growth hormone by the anterior pituitary resulting in overgrowth of entire body. >height weight and delayed sexual development

excessive secretion of growth hormone in adulthood after normal completion of body growth . overgrowth of bone in face head hands and feet. no change in height. internal organs also enlarge.

congenitl skeletal malformation caused by a genetic disorder in converting cartilage to bone. large head with frontal bossing, midplace hypoplasia, short stature, and short limbs. often thoracic kyphosis, lumbar lordosis, abdominal protrusion.

connective tissue disorder. tall this stature, hyperextensible joints. arm span> height. pubis to sole >crown to pubis. cardiovascular complications cause mortality

• cushings
• administration of adrenocorticotropin (acth or excessive productio by pituitary will stimulate the adrenal cortex to secrete excess cortisol. characterized by weight gain and edema with central trunk and cervical obesity. fragile skin muscle wasting

<95/60

• prehypertension 120-139 or 80-89
• stage 1 hypertension 140-159 or 90-99
• stage 2 hypertension <160 or >100

• epidermis: stratum germinativum basal cell layer forms new skin cells (keratin protein, melanocytes), stratum corneum outer horny cell layer dead keratinized cells constantly being shed and replaced from below
• Dermis: connective tissue/collagen elastic tissue, hair follicles nerves vessels glands
• subcutaneious layer: adipose tissue fat cells energy insulation protection

• vellus: covers body except palms soles fingers umbilicus penis and labia
• terminal: scalp eyebrows axillae pubic area (men: face chest)
• lanugo: birth

• subaceous: sebum(protective lipid substance) secreted through the hair follicles lubricates skin and hair and forms emulsion not on palms or soles most abundant in scalp forehead face chin
• sweat: eccrine colied tubules dilute saline reduces body temperature, apocrine thick milky secretion located in axillae anogenital area nipples navel secretion due to emotional and sexual stimulation bacteria on skin react with it to create musky skin odor

protection: physical thermal and light wave sources, prevents penetration: microorganisms, perception: touch pain temp pressure, temp regulation: sweat, identification, communication, wound repair, absorption and excretion, production of vit D

• 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

160 or less

baldness hair loss

elevated cavity containing free fluid larger than 1 cm diameter

dusky blue color to skin or mucous membranes due to increase amount of unoxygenated hemoglobin

intense redness of the skin due to excess blood in dilated superficial capillaries as in fever or inflammation

self inflicted abrasion on skin due to scratching

(boil) suppurative inflammatory skin lesion due to infected hair follicle

skin lesion due to benign proliferation of blood vessels in the dermis

skin lesion shaped like a target

yellow color to skin palate and sclera due to excess bilirubin in the blood

tightly packed set of paules that thickens skin from prolonged intense scratching

benign fatty tumor

softening of tissue by soaking

flat skin lesion with only a color change: freckles

(mole) circumscribed skin lesion due to excess melanocytes papule

elevated skin lesion >1cm diameter deeper than papule

palpable skin lesion of <1 cm mole

skin lesion in which papules coalesce or come together.. plateu like

itching

red-purple skin lesion due to blood in tissues form breaks in blood vessels

elevated cavity containing thick turbid fluid

skin lesion due to permanently enlarged and dilated blood vessels that are visible

sloughing of necrotic inflammatory tissue that causes a deep depression in skin, extending in dermis

elevated cavity containing free fluid up to 1cm diameter blister

raised red skin lesion due to interstitial fluid ... mosquito bite allergic reaction

linear shape of skin lesion along a nerve route

white hairline linear markings from trauma or picking normal

common rash in first 3-4 days of life.. tiny punctate red macules and papules on the cheeks trunk chest back and buttocks

newobrn bluish color around the lips hands fingernails feet and toenails should go away with warming and time

transient mottling in the trunk and extremities in response to cool temp red or blue pattern

infant tiny white papules on cheeks forehead nose chin, resolve in weeks

liver spots small flat brown macules elderly

raised thickened areas of pigmentation that look crusted scaly and warty (dark greasy stuck on) (elderly)

dry skin ... (elderl)

skin tags eyelids cheeks neck axillae trunk overgrowths of normal skin... elderly

raised yellow papules with central deppresion forhead and cheeks... look pebbly... elderly men normal

twisted coiled spiral

annular lesions grow together (psoriasis)

larger than a few centimeters in diameter firm or soft, deep into dermis

hives wheals coalesce to form extensive reaction pruritic

encapsulated fluid filled cavity in dermis or subcutaneous layer tensely elevating skin

scooped out but shallow depression no scarring

canker sores small painful round ulcers in the oral mucosa of unknown cause

white cheesy curdlike patch on buccal mucosa due to superficial fungal infection

decay in the teeth

indentations on surface of tonsils

red scaling shallow painful fissures at corners of mouth

closure of nasal cavity due to congenital septum between nasal cavity and pharynx

nosebleed usually from anterior septum

nontender fibrous nodule of the gum

small isolated white yellow papules on oral mucosa

small blue white spots with red halo over oral mucosa (early sign measels)

chalky white thick raised patcho n sides of tongue precancerous

upper or lower dental arches out of alignment

pair of salivary glands in the cheeks in front of the ears duct opens by 2nd molar

swelling of the throat

smooth pale gray nodules in the nasal cavity due to chronic allergic rhinitis

red swollen inflammation of nasal mucosa

oral candidiasis in newborn

one of 3 bony projections into nasal cavity

• frontal maxillary ethmoid sphenoid
• lighten weight of skul and provide mucous

walnut size beneath mandible at angle of jaw, duct opens at frenulum

almond shaped floor of mouth under tongue, many small openings along sublingual fold under tongue

• deviated a hump or shelf in one nasal cavity
• perferated (hole) spot of light from one side of nares to other with penlight

nodular ridge on hard palate

• 1 visible
• 2 1/2 between tonsillar pillars and uvula
• 3 touching uvula
• 4 touching eachother

• sucking tubercle small pad in middle of upper lip
• epsteins pearls small white papules on hard palate and gums
• bednars aphthae traumatic areas or ulcers on posterior hard palate

a diffuse red glow is normal

connects tongue to floor of mouth midline

frontal and maxillary

nasal discharge

difficulty swallowing