NURS 190 Midterm for Physical Assessment 2 Questions/Answers (Complete Guide)

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 los