Lab Test 1: Skin Assessment Techniques

Lab Test 1: Assessment

• Positions for Examination:

  • Dorsal Recumbent: lying on back, knees pulled in, hips externally rotated
  • Supine: lying on back, legs extended
  • Sitting
  • Lithotomy: lying on back, feet supported in stirrups
  • Sims: lying on side, lower arm behind body, upper arm and leg flexed
  • Prone: lying on stomach, head turned to side

• Skin Color Variations:

  • Cyanosis: blue coloration, poor circulation, insufficient oxygen
  • Jaundice: yellow-orange coloration, excessive bilirubin in blood
  • Pallor: pale coloration, reduced oxyhaemoglobin in blood
  • Erythema: reddening of skin, dilated capillaries

• Primary Skin Lesions:

  • Macule: flat, <1cm diameter, circular border (freckles, measles, petechiae)
  • Papule: raised, solid, palpable mass, <0.5 cm (warts, plaques)
  • Nodule: raised, solid, palpable mass, deeper than papule, irregular border (tumors)
  • Vesicle: raised, fluid-filled, round/oval, thin walls (herpes, early chicken pox, blisters)
  • Bulla: raised, fluid-filled, larger than vesicle (burns)
  • Wheal: raised, reddish area, irregular border (insect bites, hives)
  • Pustule: raised, pus-filled vesicle/bulla (acne, boils)
  • Cyst: raised, encapsulated, solid/fluid-filled mass (sebaceous cysts, epidermoid cysts)

Visual Examination

• Presbyopia: difficulty seeing close up (aging)
• Myopia: difficulty seeing far away
• Cataracts: cloudiness in lens, interfering with clear vision
• Strabismus: crossed eyes, poor neuromuscular control
• Nystagmus: involuntary eye movements (e.g., strokes)
• Visual fields: area of vision in each direction
• PERRLA: pupils equal, round, reactive to light and accommodation
• Red reflex: red-orange flash when light reflects off retina (infant test)

Lymph Nodes

• Normal Lymph Nodes: mobile, soft, moves with circular motion
• Inflamed Lymph Nodes: swollen, puffy, enlarged, painful, or tender
• Malignant Lymph Nodes: hard, immobile

Chest/Thorax Landmarks

• Suprasternal notch: notch at lower neck above collarbones
• Manubrium: upper part of sternum
• Sternal angle: angle where manubrium meets sternum body
• Ribs: include 2nd rib and 2nd intercostal space, midclavicular and midscapular lines, midaxillary, costal angle.

Cardiac Assessment

• PMI: point of maximal impulse (mitral area, apex of heart)
• Murmur: abnormal heart sound, often caused by turbulent blood flow (e.g., valve problems)
• Thrill: vibratory sensation felt on skin during a murmur (indicating loud murmur)
• Bruit: abnormal blowing or swishing sound (often heard with stethoscope)
• Blood flow pathway: Superior vena cava, right atrium, right ventricle, pulmonary valve, pulmonary artery, lungs, pulmonary veins, left atrium, left ventricle, aorta.

Self Breast and Self Testicular Exam

• Breast exam: perform monthly self-palpation, breasts should be smooth, firm and elastic
• Self testicular exams: check bulging, non-erect penis is soft and flaccid, no lesions, redness, sores, discharge

Musculoskeletal Assessment

• Postural abnormalities: lordosis (exaggerated lumbar curve), kyphosis (hunchback), scoliosis (crooked spine)
• Hypertonicity: muscle over-flexion
• Hypotonicity: less muscle tension, flaccid
• ROM positions: flexion, extension, dorsiflexion, plantarflexion, pronation, supination, abduction, adduction, internal rotation, and external rotation

Neurological Assessment

• Level of Consciousness: full consciousness, 4(walkie talkie), 3(stupors) ,2(drowsy/ disoriented) ,1(coma).
• Confusion, disorientation, obtundation, stupor, coma: different levels of consciousness.
• Neurological deficits: observed based on responses to stimuli

Other Assessments

• Aphasia/Deep Coma: difficulty speaking, unresponsive
• Cranial Nerves: symmetry during eye, shoulder shrugging, tongue in cheek and eyebrow test
• 5 Ps: pain, pallor, pulse, paresthesia (weird sensations), paralysis
• Glasgow Coma Scale: 3-15 (lowest score indicates greater neurological damage)
• Delirium: confused, disorientated (short-term, e.g., poor oxygenation, infections, medication)
• Dementia: irreversible cognitive decline (long-term)
• Memory assessment: immediate, recent, and remote memory
• Leukoplakia: white patches in mouth
• Bowel sounds: hypoactive, hyperactive, absent
• Breath sounds: vesicular, bronchovesicular, and bronchial.
• Pulse, edema scale, petechiae: indicators of circulation, swelling, and pinpoint skin marks.
• Quadrants: (upper left and right, lower left and right) for abdominal organ assessment (liver, kidneys, stomach, intestines).