This document provides guidance on performing a physical assessment of the skin, head, neck, and regional lymphatics. It outlines the necessary equipment and describes how to examine various areas including the skin, head, mouth, nails, face, neck, and lymph nodes. Key points covered include examining skin color, texture, lesions; examining the scalp, skull, mouth, tongue, palate; and assessing lymph nodes by location, size, shape, and characteristics. Sample documentation of objective findings and assessments are also provided.
Assessment is the first step of nursing process.
Assessing is the systematic and continuous collection, organization, validation and documentation of data.
This includes data about person’s physical and psychological status or study of the patient as a whole to identify his strengths and weakness and his needs and problems
Nursing assessment does not focus upon disease as do medical assessment. It is based on a board scientific knowledge, keen observation and purposeful listening.
Assessment is the first step of nursing process.
Assessing is the systematic and continuous collection, organization, validation and documentation of data.
This includes data about person’s physical and psychological status or study of the patient as a whole to identify his strengths and weakness and his needs and problems
Nursing assessment does not focus upon disease as do medical assessment. It is based on a board scientific knowledge, keen observation and purposeful listening.
The relationship between leadership and management continue to prompt some debate, although the literature demonstrates the need for both (Trent, 2003).
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CODE OF ETHICS: The guiding principle in nursing
code are the direction of conduct , understanding of what is right and wrong while providing care in the hospital and community settings.The ICN code of ethics are the milestone to establish nursing as a profession.
Values are enduring beliefs or attitudes about the worth of a person, object, idea, or action. Values are important because they influence decisions and actions, including
Nurses ethical decision making.
Nurses who understand how patients’ values and their own values shape nurse-patient interactions, and who continually develop sensitivity to the ethical dimensions of nursing practices, are best able to provide quality care and advocate for their patients.
History and physical assessment of integumentary systemSiva Nanda Reddy
this topic describes the assessment of integumentary system, history and physical examination in relation to integumatary system was described in detail
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Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
The relationship between leadership and management continue to prompt some debate, although the literature demonstrates the need for both (Trent, 2003).
leadership is viewed by some as one of managements many functions; others maintain that leadership requires more complex skills than management and that management is only one role of leadership; still others delineate between the two.
CODE OF ETHICS: The guiding principle in nursing
code are the direction of conduct , understanding of what is right and wrong while providing care in the hospital and community settings.The ICN code of ethics are the milestone to establish nursing as a profession.
Values are enduring beliefs or attitudes about the worth of a person, object, idea, or action. Values are important because they influence decisions and actions, including
Nurses ethical decision making.
Nurses who understand how patients’ values and their own values shape nurse-patient interactions, and who continually develop sensitivity to the ethical dimensions of nursing practices, are best able to provide quality care and advocate for their patients.
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this topic describes the assessment of integumentary system, history and physical examination in relation to integumatary system was described in detail
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Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
General examination by Pandian M , Dept of Physiology, DYPMCKOP,MHPandian M
Introduction
General examination carried out in following headings.
General appearance
History
Mental state and intelligence
Consciousness and cooperation
Build
Muscle power, Tone.
Development
Height , weight and secondary sexual development .
State of nutrition.
Pallor ( anemia).
Jaundice.
Cyanosis.
Clubbing.
Edema.
Lymphadenopathy
Skin condition and
Vital signs
Temp, Pulse ,Resiration, Blood Pressure.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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1. Assessment of the Skin,
Head, and Neck, including
Regional Lymphatics.
SA RA H M E RA J BSN - RN
2. Equipment
Examination light
Penlight
Mirror for client's self-examination of skin
Magnifying glass
Centimeter ruler
Gloves
Wood's light
Examination gown or drape
3. Physical Assessment:
• When preparing to examine the skin remember these key points:
Examinationof Skin:
Color
Vascularity
Texture: RoughnessEczema,Dermatitis.
Mobility: Decreased in case of edema, Obesity.
Turgor:Decreased dueto dehydration.
Moisture:
• Moisture:Dryness (hypothyroidism).
• Sweating (hyperthyroidism).
• Oily(acne).
SkinLesions
4. A. COLOR:
1.Brown(depositionof
melanin):
• Genetical(it is generalized)
• Sunlight(exposed areas)
• Pregnancy(face, nipples ,areola)
• Addison disease(exposed areas ,
pressure points, genitalia)
2.Blue (cyanosis):
• Peripheral: anxiety and cold: observed
in extremities and Nail
• Central: lung and heart diseases (nails,
lips, mucus membrane).
5. CONT..
3.Redcolor:
Increased visibility of oxyhemoglobin because of dilation of superficial blood
vessels e.g. Fever, blushing and local inflammation.
3.Reddishblue:
Combination of increased in level of hemoglobin & reduced in hemoglobin &
capillary stasis e.g. Polycythemia, observed on hands, feet, conjunctiva, mouth
face etc.
6. 4.Yellow:
• Jaundice: increased level of bilirubin; first in sclera then mucusmembrane &
skin
• Carotenemia: increased level of carotenoids due to myxedema,
hypopituitarism and diabetes observed on palm, sole and face does not
involve sclera and mucus membrane
DecreasedColor:
• Congenital (Albinism):Inability to form melanin it is generalized.
• Acquired (vitiligo):patchy symmetrical often involved exposed area.
• Anemia: decreased level of hemoglobin evident in conjunctiva.
7. B.VASCULARITY
(AN EVIDENCE OF BLEEDING AND BRUISING)
Petechia: pin point
hemorrhage beneath
the skin usually 1-
3mm round and flat
this suggest increased
bleeding tendency.
Ecchymosis: purple,
purplish blue and
sometime brown,
larger then Petechia
secondary to trauma
and bleeding disorder.
10. EXAMINATION OF MOUTH
Examination of mouth include Examination of:
Lips
Gums
Teeth
Tongue
Palate
Oropharynx
Mucus membrane
Breath/smell
11. Examination of
lips
• Color: Blue in Cyanosis pale
in anemia, normal lips are
smooth and pink.
• Any congenitalabnormality
i.e. Cleft lip
• Ulcers: Snail track ulcers are
is observedin syphilis.
12. CONT..
• Vesicles: In herpes simplex infection producedgrouped vesicles on lips with red base.
• Fissures: Mostly seen in hot season, dehydration, and pathological in anemia.
13. Examination of Gums
• Blue line running along the edges of gum in lead poisoning.
• Gums are swollen and spongy in case of scurvy(vitamin c deficiency).
• In gingivitis the edges of gums are red and bleed easily
• Periodontitis(Pyorrhea): pus between teeth and gums
14. Examination of Tongue
Color: Blue in Cyanosis, pale in anemia
• Red beefy tonguein deficiency of riboflavin(vitaminB2)
• Black tongue in patient taking iron mixture also in Addison diseases
15. Symmetry of tongue:
• Slightly deviated normally
from its mid line
• Grossly deviated towards
its side due to 12th cranial
nerve paralysis.
• Tremor: tremors of
tongue in Parkinson
diseases. And in severe
thyrotoxicosis.
16. Surfaceof tongue:
• Dry tongue in case of anxiety and dehydration.
• Bald tongue in anemia (iron deficiency & pernicious).
•Furring of tongue in excessive smoking.
Red strawberry tongue (In scarlet fever)
Ulcers:
• Malignant ulcers
• T.B ulcers on tip of tongue
• Patches on tongue in thrush and leukoplakia.
17. Examination of
under surface
• Ask the patient to touch the
hard palate with the tip of the
tongue
• In Ankyloglossia (tonguetie)
he is unable to touchthe
palate
18. • Sizeof Tongue:
Enlarged tonguein hypersecretion of growth hormone.
• Palate:
• Examine the palate , oropharynx, & mucus membrane for color pigments and deformity etc.
• A dirty gray colored membrane (pseudo membrane)is observed in diphtheria.
• Breaths/smell:
• Fishy: Uremia
• Mousy: Liver cirrhosis
• Fruity: Diabetes (DKA)
• Foul: In case of dirty teeth , mouth ulcers etc.
21. NAILS:
Normal: the angle between finger nail and nail bad is 160 degree.
Abnormal Nails:
• Bluish color: in Cyanosis
• Decreased capillary refill in anemia.
23. Clubbing:
• The Angle betweenNail and base of nail
is 180 degree or more e.g. cyanosis
24. Splinter
hemorrhage:
• Red or brown linear lines on
nails due to trauma.
• Tiny streaksof blood
underneath your nail plate.They
resemble thin wooden splinters.
Trauma is the most common
cause of splinter hemorrhages,
but underlying health conditions
can cause them too
25. Paronychia
• Inflammation of Skin around nails.
• Paronychia is nail inflammation that may
result from trauma, irritation or infection. It
can affect fingernails or toenails. Paronychia
can developwhen bacteria enter broken skin
near the cuticle and nail fold, causing an
infection. The cuticleis the skin at the base of
the nail.
29. Examination of
Thyroid:
• Examination of lymph node.
• Describe enlarge node under the
following terms.
Location
Size
Shape
Surface characteristics
Consistency
Mobility/ Fixation
Sign of Inflammation
30. CONT..
• Structure and Function
• Subjective Data—Health History
Questions
• Objective Data—Physical Exam
• Abnormal Findings
34. Structure and Function (cont.)
• Lymphatics (cont.)
Jugulodigastric
Superficialcervical
Deep cervical
Posterior cervical
Supraclavicular
35. Structure and Function (cont.)
Developmentalcare
Infants and children
• Fontanels
• Head growth
• Lymphatic system
Pregnant female
Aging adult
36. Subjective Data— Health History Questions
• Headache
• Head injury
• Dizziness
• Neck pain or limitationof motion
• Lumps or swelling
• History of head or neck surgery
37. Subjective Data— Health History Questions
(cont.)
Additionalhistory for infants and children:
• Maternal alcohol or drug use
• Type of delivery
• Growth pattern
Additionalhistory for aging adult:
• Dizziness
• Neck pain
38. ObjectiveData— Physical Exam
• Head–Inspectand palpate the skull
Size and shape
Temporal area
• Head–Inspectthe face
Facial structures
44. Sample Charting:
• SUBJECTIVE:
- Denies any unusually frequent or severe headache, no history of
head injury, dizziness or syncope; no neck pain, limitation of
motion,lumps or swelling.
45. Sample Charting (cont.):
• OBJECTIVE:
- HEAD –Normocephalic, no lumps, no lesions, no tenderness.
-FACE –Symmetric, no weakness or drooping, no involuntary
movements.
-NECK – supplewith full ROM, no pain.Symmetric,no
lymphadenopathy or masses. Trachea midline,thyroid not palpable.
No bruits.
47. PRIMARY & SECONDARY SKIN LESIONS:
Lesions should be observed for;
• Anatomical location
• Arrangement and grouping
• Type of skin lesion
• Color of lesion
• Primaryskin lesionsare originallesions arisingfrompreviously normalskin.
• Secondarylesionscan originatefrom primarylesions.
48.
49. Primary Skin Lesions:
• There are three types of primary lesions
Non palpable Change in Skin Color.
Palpable elevated solid masse.
Palpable elevated serous fluid filled cavities.
50. 1.Non palpable Change in skin color
• Macule:<1cmcircumscribedboardere.g. Mole,petechia.
• Patch:>1cm may have irregular boardere.g. Vitiligo, Freckles, Ecchymosis
• Macule and patches are non-palpable skin changes. color may be brown, white, Purple red
etc.
52. • Plaque: >0.5 cm with circumscribed boarder e.g. Psoriasis, actinic
keratosis
53. • Nodule: 0.5-2cm with
circumscribed
boarders e.g.
Lipomas, Squamous
cell Carcinoma.
54. • Tumors: .1-2 cm (>2cm
extends deeper into the tissue)
e.g. Large lipomas Carcinomas.
55. • Wheal: Elevated mass with
transient boarders caused by
movement of serous Fluid in
dermis does not contain free
fluids in cavities like vesicles e.g.
insect bite, Urticaria.
56. • Cyst: Encapsulatedfluid filled or semi
solid masses in the subcutaneous
tissue or dermis e.g. Sebaceouscyst
57. C. Palpable elevated fluid filled cavities
• Vesicles: <0.5 cm with circumscribed boarder e.g. Chicken pox,
2nd degree burn blister.
58. • Bulla: >0.5cm Circumscribed boarder e.g. Large burn blister,
contact dermatitis, Bullous impetigo
59. • Pustules: pus filled
vesicles or bulla e.g.
Impetigo, furuncle
60. Secondary Lesions
• Erosions: loss of superficial epidermis, does not extend to dermis , with moist
area e.g. Scratch marks, ruptured vesicles.
• Ulcers: Skin extends to dermis e.g. Pressure ulcers
• Fissure: linear cracks in skin e.g. athletes foot
• Scales: Flakes secondary to dead epithelium e.g. psoriasis, dry skin, pityriasis
rosea.
• Crust: Dried residue of serum blood or pus e.g residual left following Vesicles,
impetigo, eczema
61. Cont..
• Scar: Skin mark after wound Healing
• Lichenification: Thickening & Roughening of the skin .Contact Dermatitis,
Eczema.
• Atrophic Skin: Thin , dry, transparent appearance of Epidermis e.g. Aged Skin
• Keloids: Hypertrophic scar tissue secondary to excessive collagen formation
during healing.
62. References
• Bicklay, L. S. (1999). Bates’ guide to physical examination and
history taking (7th ed). Philadelphia: J.B. Lippincott.
• Weber, J. & Kelley, J.(2007). Health assessment in nursing (3rd
ed). Williams & Wilkins: Lippincott.