NSE103 Introduction to Health Assessment PDF

NSE103 - Introduction to Health Assessment Week 1: Vital Signs - Pulse & Blood Pressure Describe the assessment phase of the nursing process -​ The assessment phase involves collecting, organizing and analyzing data about the client’s health status to identify their needs, concerns and pr...

NSE103 - Introduction to Health Assessment Week 1: Vital Signs - Pulse & Blood Pressure Describe the assessment phase of the nursing process -​ The assessment phase involves collecting, organizing and analyzing data about the client’s health status to identify their needs, concerns and problems -​ Subjective data: information reported by the client, ie., feelings, symptoms, pain level, history -​ Objective data: observable and measurable data collected through physical examinations, diagnostic tests, lab results and vital signs -​ Physical assessment: conducting a head-to-toe examination to evaluate various systems, to find the area of concern -​ Once the assessment has been completed and you have a comprehensive understanding of the patient’s health, you can continue the process: diagnosis, planning, implementation, evaluation Describe related legislation specific to health assessment Scope of Practice -​ The tasks that nurses are legally allowed to perform based on their education and licensure -​ Nurses must conduct health assessments within their scope of practice; gather info about health status, conduct physical assessments and interpret the results -​ Nurses are NOT permitted to communicate a diagnosis Controlled Acts -​ Controlled acts are specific interventions/procedures that have the potential to cause harm if performed by unqualified individuals -​ Nurses must be aware of which acts are restricted and ensure any acts fall within their scope of practice, such as, performing a physical examination, administering certain injections CNO Standards -​ The CNO is the regulatory body for nurses which establish standards for nursing practice to ensure health assessment practices are safe, effective and within scope of practice -​ Nurses are held accountable for their practice, including documenting data, maintaining confidentiality, using evidence-based practices to provide culturally safe care Describe clinical judgment and priorities of care in relation to health assessment -​ Clinical judgement uses nursing knowledge to observe and assess situations, to identify and prioritize client concerns and generate evidence-based solutions -​ Use clinical judgment to determine: -​ Health & illness status -​ Health concern & needs, ability to engage in their care (consider client concerns first) -​ Decision to act/intervene or not, AND if action is required, what action First-level priority -​ Life threatening, requires urgent action - ie., impacted airway, breathing, circulation Second-level priority -​ May lead to clinical deterioration, require prompt action - ie., acute pain, infection risk Third-level priority -​ Non urgent, but needs addressing, ie., changes in coping, anxiety, depression Describe the guiding approaches to health assessment Health assessment frequency -​ Primary care: likely a focused assessment of client concerns, occur when client has a specific concern/reason for seeking care -​ Long-term care: head-to-toe assessment to determine deterioration in various systems, usually occur at admission or when changes in status to provide a baseline -​ Acute care: combination of assessments to address life-threatening conditions, determine what area is of immediate concern for intervention Health assessment types -​ Primary survey -​ An initial assessment used to identify life-threatening conditions, focusing on airway, breathing, circulation, disability, exposure -​ Focused assessment -​ Addressing a specific concern such as pain or trauma, it’s performed when the patient is presenting with a concern -​ Head-to-toe -​ Comprehensive physical examination where the nurses assesses each body system starting from the head and moving down the feet providing a detailed overview -​ Complete health assessment -​ Comprehensive assessment that includes history, physical examination and diagnostic tests, performed on new patients or routine, overall health assessments Describe the concepts of health promotion and its use as a guide to nursing assessment -​ Social and environmental interventions enable people and communities to increase control over their health - very important to consider social determinants of health and how they impact someone’s health and resources available to them -​ Consider the client’s health literacy and commitment to change, ensuring clients understand the information to make informed decisions on their health Describe health promotion interventions, education and counseling Approaches to health promotion -​ Behavioural: lifestyle changes unique to the client’s concerns, resources, skills -​ Relational: social changes between individuals, relationships and their environment -​ Structural: broadest level, the policies and laws in place, emphasis on advocacy -​ Integrative: consider the whole person; blend conventional & holistic healthcare -​ Individualized: customizing health plans based on the person’s status, goals & concerns -​ Adapted: involves adjusting the approach as needed based on feedback or status change Health education -​ Focuses on sharing knowledge and information to help people make informed decisions on their health and healing practices Health counselling -​ Individualized and provides personalized guidance, support and strategies for behavioural changes and health management Outline the components of a primary survey (airway, breathing, circulation, disability, exposure) and how to combine with a body systems approach Airway - ensure the airway is clear and unobstructed, check patency: airway is open, no blockages Breathing - ensure client is breathing properly, consider respiration rate, even breath sounds Circulation - assess blood circulation; blood pressure, heart rate (rhythm, rate, strength) Disability - assess neurological function, level of consciousness (alert & oriented), speech, pain Exposure - assess for wounds, fractures, burns, skin integrity, body temp., movement When considering various body systems: -​ Head & neck: assess head for signs of trauma, bleeding, decreased level of consciousness -​ Chest: examine for fractures, bruising, listen for breath sounds or chest injuries -​ Abdomen: palpate for tenderness or rigidity which may indicate internal injury -​ Pelvis: assess for signs of fractures or instability -​ Limbs: check for fractures, circulation, motor and sensory functions, assess distal pulses What are interventions based on and what are the intervention types? Based on IMMEDIATE ACTION -​ Effective: interventions that are a necessary course of action -​ Nonessential: interventions that are not needed/absolutely necessary -​ Unrelated: interventions that are not connected to the problem -​ Contraindicated: interventions that may cause more harm, should not be used Apply the components of a mental status examination Appearance -​ General presentation to other people -​ Age, sex, race, body build, position, eye contact, dress/grooming, manner, attentiveness Behaviour -​ Mood & affect; speech, voice, tone, ability to communicate feelings -​ Agitation, unusual movements, gait Cognition -​ Consciousness, attention level, engaging in abstract reasoning -​ Orientation (time, person, place), memory, capacity to read and write Thinking -​ Perception (5 senses), what they’re thinking, awareness and judgement of their situation Levels of Consciousness Alert & oriented: client is awake, engages & responds appropriately to interactions Confused & disoriented: client shows altered cognition, difficulty in memory retention Lethargic: client is slow and sluggish to arouse to stimuli Obtunded: significant impairment in level of consciousness and requires continuous stimuli (shaking) Unconsciousness: client does not respond to any stimuli, no purposeful motor responses Levels of Orientation Place, time, person, self Describe how to ensure the best setting and approach for assessment and practice with the proper use of equipment -​ Create a comfortable environment: choose a quiet, private, well-lit, safe space to minimize distractions and is comfortable for the client -​ Patient-centered approach: introduce yourself, why you’re there, ensuring they are informed and respected, be culturally sensitive and incorporate their beliefs in your work -​ Use equipment properly: ensure all equipment is clean, sterilized and functioning properly; use appropriate size of equipment and ensure readings are accurate Provide feedback to the client in an informative and respectful manner -​ Be clear and specific: use simple language and provide examples of what needs improvement -​ Show empathy: acknowledge challenges and avoid being judgemental -​ Focus on solution: highlight progress and offer advice for improvement -​ Encourage collaboration: involve the client in the discussion and achieving goals -​ Follow up: offer continued support and check-ins to monitor progress Understand Maslow’s Hierarchy of Needs in relation to health assessment -​ Consider priorities of care and what actions are important to take first and what actions follow -​ A primary survey will help determine priorities of care and recognize clinical deterioration to trigger a focused assessment of body types -​ Physiological needs are the most basic on the hierarchy, emphasizing those physiological needs such as breathing as most vital in order to move up the hierarchy -​ Nurses must assess these basic physiological needs to ensure that the patient’s survival needs are met, ie., vital signs, respiratory problems, nutrition, hydration Vital Signs Define components of vital signs, focus on pulse and blood pressure Pulse: a pressure wave that expands and recoils the artery when the heart contracts/beats -​ Radial pulse: located between your wrist bone and thumb - use the pads of 3 fingers -​ Carotid pulse: located on the side of your neck -​ Only use when radial is absent or difficult -​ PALPATE CAROTID ARTERY ONE AT A TIME -​ Brachial pulse: located at the bicep tendon -​ Used only in young children & infants -​ Doppler machine amplifies the pulse rate Blood pressure: force of blood exerted against the arterial wall -​ Contracting when the heart is pushing blood out into arteries (coordinates with systolic bp) -​ Resting when the heart is filling with blood (coordinates with diastolic bp) Assessing pulse -​ Rate: count the pulse rate for 30s X 2 to report bpm (if at even tempo), 60s for children and when adult rate is irregular -​ Adult: normal (60-100 bpm) -​ Newborn: normal (100-175 bpm) -​ Rhythm: the frequency of pulsation felt by your fingers, ie., sinus arrhythmia = irregular heartbeat -​ Force: the strength of the pulsation when palpating the pulse -​ Equality: ALWAYS compare both sides for regularity/irregularity Assessing blood pressure Systole -​ The heart expands blood vessels, forcing blood from the ventricles out into the bloodstream -​ Left ventricle contraction pushes blood OUT into the arterial blood stream -​ Systole = maximum force on the arterial wall Diastole -​ Left ventricle is at rest and filling -​ Resting pressure that blood exerts between each contraction -​ Diastole lasts longer than systole Hypertension: a sustained increase in either systolic pressure (above 140 mm Hg) or diastolic pressure (above 90 mm Hg) Hypotension: low blood pressure (below 90/60 mm Hg) Define Stroke volume The amount of blood ejected from the ventricle with each cycle Pulse pressure Difference between systolic & diastolic, the force required for the heart to contract Orthostatic hypotension A drop in systolic bp of MORE than 20 mmHg (usually due to a change in positioning in older adults) Auscultatory gap Interval of absolute silence during deflation of the blood pressure cuff Korotkoff sounds Sounds when a blood pressure cuff changes the flow of blood through the artery, when vessels are constricted and now returning to normal -​ Korotkoff sound I = systolic sound -​ Korotkoff sound V = diastolic sound Bradycardia When resting heart rate drops below 60 bpm in adults → can mean the heart is not providing sufficient oxygenated blood to the tissues Tachycardia An elevated heart rate, above 100 bpm → due to stress, exercise, caffeine Identify common measurement errors -​ Age, sex, ethnicity, family history of hypertension, smoking, weight, sedentary lifestyle, diet/alcohol intake, emotions/stress, disease process Factors influencing blood pressure Cardiac output -​ The volume of blood flow from the heart through the ventricles -​ Increased cardiac output, increases blood pressure and blood flow Peripheral vascular resistance -​ Ability of an artery to expand and accommodate more blood and then recoil Volume of circulating blood: the amount of blood moving through the body Viscosity of blood: the bloods’ thickness Elasticity of vessel walls: the capacity to resume its normal shape after stretching/compressing Week 2: Measurements - Respirations, Oxygen Saturation, Temperature Apply knowledge to measurement components related to anthropometric body measurements of adults and children Anthropometric body measurements are non-invasive related to body size and adipose (fat) tissue -​ Weight, height, BMI, waist and hip circumference, waist-to-hip ratio, waist-to-height ratio -​ These measurements are NOT a diagnostic tool and should never be used alone - they can be used to generalize state of health and risk to disease/illness -​ Can provide information on a client’s health and nutrition status, developmental patterns, weight loss/gain, fluid loss/gain - BASELINE INFORMATION -​ Can help evaluate trends in primary care and calculate medication doses in acute care -​ Adopt an inclusive approach to body measurement assessments to ensure the client feels valued, consider their culture and how different cultures view different body sizes and lifestyles Body Mass Index ** consider guidelines based on different ethnicities Children: Weight, Height, BMI -​ Plotted on growth charts that identify percentiles expressed as a child’s BMI relative to other children of the same age and sex Define respirations, oxygen saturations, temperature, related terms and reasons measured Respiration: a person’s breathing and movement of air into and out of the lungs -​ Maintain position for counting pulse and count respirations: 30s X 2 regularity & 60s irregularity -​ Observe chest/abdomen movement: nasal flaring, eyes, intercostal tugging (respiratory distress) -​ Assess: -​ Rate -​ Rhythm: equal tempo between each inhale and exhale -​ Quality: relaxed and silent Pulse Oximetry/Oxygen Saturation: the ratio of hemoglobin molecules saturated with oxygen with unoxygenated hemoglobin -​ 97%-100% is normal -​ 92%-100% is acceptable, depending on health conditions, so it’s important to determine baseline -​ Hypoxia: insufficient oxygen in the blood Temperature: the degree of heat or cold in the body, controlled by the hypothalamus -​ 36.5-37.5 ℃ in adults (older adults have slightly lower temperatures) -​ 35.5-37.7 ℃ in infant/children -​ Hyperthermia: elevated body temperature, ie., excessive heat, fever, viruses -​ Hypothermia: lowered body temperature, ie., prolonged extreme cold Temperature Routes Oral -​ Done under the tongue, usually with cooperative children -​ 35.8-37.3 ℃ Axillary -​ The underarm, commonly used unless a more accurate reading is required -​ 34.8-36.3 ℃ Tympanic -​ The ear, most commonly used in adult primary & acute settings -​ 36.1-37.9 ℃ Rectal -​ Used in pediatric and acute settings -​ 36.8-38.2 ℃ Identify the factors and common errors that influence vital sign measurements Factors -​ Age: vital signs vary with age, ie., older adults have much slower heart rate than children -​ Activity level: physical activity increases heart rate, blood pressure, respiratory rate -​ Medications: some medications alter vital signs, ie., lowering blood pressure -​ Emotions: anxiety/stress can elevate heart rate -​ Temperature: fever can elevate heart rate, extreme cold can lower blood pressure Common errors -​ Improper technique: incorrect use of equipment (ie., a cuff that’s too small for blood pressure) -​ Caffeine & nicotine use: can increase heart rate and blood pressure -​ Improper patient positioning: ensure client is sitting up straight, arm at heart level, feet flat Week 3: Physical Assessment & Pain Assessment Describe the use of and practice of the following techniques: inspection, palpation, percussion and auscultation Inspection: visual examination to identify any abnormalities - involves looking at skin colour, posture, movement, facial expressions and any signs that may indicate health issues -​ Assess bilaterally and begin assessing the entire body and narrow down to specific areas -​ Note any abnormal finding such as discolouration Palpation: involves using the hands to feel the body for any abnormal lumps, tenderness, temperature, pulsatility, swelling or changes in texture -​ Use a constant firm touch and refrain from using a staccato touch which can create anxiety -​ Always ask for permission to touch -​ Dorsal region: -​ When assessing temperature, use the back of your hand because that side is more sensitive to temperature -​ Fingertips: -​ Texture: smoothness or roughness of a surface -​ Thickness: how thin or thick an object is - turgor = the rigidity -​ Moisture: the amount of wetness on a surface -​ Swelling/masses: fingertips or a grasping motion to assess size and density of a mass -​ Bones and muscles: cup your fingers and thumbs for a gentle grasping motion to assess deformities, as well as the trachea and testicles -​ Pain/tenderness: always assess the painful area last -​ Glands: use your fingertips to assess organ location, size, density -​ Pulsatility: pulsations associated with the cardiovascular system, use the pads of your three fingers to locate ie., carotid, radial, brachial pulse -​ Crepitus/Crepitation: abnormal grating or crunching sounds felt/heard over joints where bones meet, ie., TMJ in the jaw - due to air becoming trapped in the tissues around the joint -​ Ulnar surface of hands (base of your palm) -​ Vibration: resembles a quivering or shaking motion that may be felt over the lungs -​ Pulsatility: abnormal pulsations felt over the hand Percussion: tapping the body to elicit sounds and determining if the sounds are appropriate for a region - least commonly used assessment tool -​ Sounds may not be accurate if client has a lot of adipose tissue or muscle, creating inaccuracy -​ Air filled: pneumothorax, air enters the lungs and disrupts normal breathing and sounds -​ Fluid filled: fluid in the abdominal cavity -​ Dense: abscess, a collection of pus can create a dullness Auscultation: listening to the body with the stethoscope, ie., heartbeats, lung sounds, bowel sounds -​ High-pitched sounds: use the diaphragm, ie., lung (breath sounds) and bowel sounds -​ Low-pitched sounds: use the bell, ie., heart sounds, vascular pulses for blood pressure When completing the objective assessment: -​ Trauma informed approach: ask for consent to touch, walk client through each step, give choices -​ Prepare the environment: clean, warm, proper positioning, involve care partners, assess using bare skin - clothing will lead to inaccuracy -​ Infection control: hand hygiene, clean equipment, proper PPE Define pain and classify pain Acute pain: short, limited in duration and often caused by something specific, ie., beesting, headache -​ Follows a predictable pattern and subsides when the cause is treated -​ Intensity can range from mild to severe - changes in vital signs is common Chronic pain: pain that continues and recurs for 3 months or more and persists beyond healing time -​ Primary chronic pain: based on a poorly understood condition, ie., back pain -​ Secondary chronic pain: manifests resulting from a disease or condition, ie., cancer Nociceptive pain: involves a noxious stimulus -​ Mechanical: stubbing your toe, being injected by a needle -​ Thermal: touching a hot surface -​ Chemical: exposure to a chemical -​ Somatic pain: originates in the skin, bone or muscles -​ Visceral pain: originates in the internal organs, ie., appendix, kidneys Neuropathic pain: a lesion or disease, described as burning, stabbing, numbness -​ Can be related to nerve trauma, ie., spinal cord injury Nociplastic pain: no evidence of tissue damage and lack of biomarkers, ie., IBS Idiopathic pain: pain of an unknown origin, no obvious pathology -​ Assessment is most important here to determine a cause Referred pain: felt at a bodily location different from the site of origin -​ Cardiac ischemia, lack of oxygen to the heart, causing chest pain and pain down the arm ★ Understand that different cultures perceive pain differently and some cultures are taught to not complain when they are in pain, so it’s important to recognize and acknowledge how the client feels Nonverbal/behvioural and physiological indicators of pain -​ Subjective: a report of pain by the client, descriptors from them -​ Physiological: muscle tension, pupil dilation, changes in vital signs -​ Behavioural: facial and bodily responses -​ Cognition: ability to think, reason and remember knowledge -​ Psychological: irritability, anxiousness, withdrawal -​ Reactive: interference in daily functioning Time and frequency of pain assessments -​ Assess for baseline information during admission, when at primary care clinics and at a start of shift, before and after a procedure - to determine baseline status -​ Repeat pain assessment if there are any changes in client condition or client has a new concern, repeat about an hour after medication administration Reflect on the racial disparities associated with pain assessment and treatment -​ Racism and systemic inequities have led to undiagnosed pain in non-dominant, racialized groups - leading to reduced quality of life and premature death -​ If a client says they are in pain, believe them, unassisted pain can lead to inadequate treatment -​ Personal biases may make you think someone is seeking out pain killers because of their ethnicity, but you have a duty to assessing and treating the client regardless of your beliefs Understand the importance of self-report (subjective assessment) related to pain assessment ★ Chest pain is a priority of care -​ Approach with inclusivity and with cultural humility; recognize various cultures and practices when explaining pain and severity -​ Questions about the presence, location, severity, management and how it’s impacted daily living Unidimensional Pain Assessment Tools Only used to assess INTENSITY of pain Multidimensional Pain Assessment Tools How pain affects someone's daily living & quality of life, requires more time PQRSTU used with adolescents and adults - begin depending on concern, then proceed P Provocative: what makes your pain feel worse? Palliative: what makes your pain feel better? Q Quality: what does the pain feel like? (aching, stabbing, burning) Quantity: how bad is the pain? R Region: where do you feel the pain? Radiation: do you feel pain anywhere else? S Severity: evaluate pain to determine effective interventions? T Timing: when did the pain start, what were you doing, is the pain constant? Treatment: have you taken anything to relieve the pain? U Understanding: what do you think is causing the pain? Brief Pain Inventory -​ Assesses pain overtime, used commonly in primary care in clients with chronic conditions Cognitive Impairment -​ Abbey Pain scale used to assess clients with impaired cognition and communication, ie., dementia -​ PAIC-15 used to assess behavioural and physiological cues in clients with cognitive impairment FLACC Pain Tool -​ Assess pain in non-verbal, young children who cannot self report or are sedated Week 4: Integumentary Assessment Integument Pathophysiology Skin trauma Trauma can affect a single or multiple layers of the skin, ie., burns, scars Infections Bacterial, fungal, viral infections are caused by various pathogens ranging from mild to severe, ie., shingles Autoimmune/inflammatory Regional or generalized, may involve inflammation of the skin, ie., eczema, alopecia Nutritional disorders Poor nutrition can lead to vitamin deficiencies and cutaneous abnormalities, ie., white spots, hyperpigmentation Vascular disorders Usually involve arteries, veins or lymphatic vessels, ie., inadequate venous return Neurological disorders Involve interactions between the skin and the mind, ie., irresistible itching by anxiety or the urge, ie., shingles Systemic disorders Depends on the underlying disorder, ie., thyroid disease, diabetic ulcers Neoplastics Abnormal growths that are mostly benign (non-cancerous) and some malignant (cancerous), ie., basal cell carcinoma External agents Reactions to external agents such as the sun, new detergent or body washes, frostbite Pattern/distribution - is there a pattern to what you’re seeing Morphology - what is the structure of what you’re seeing Location - where is the variation located on the body Texture - what is the texture of the variation Symmetry - is the integumentary variation distributed symmetrically Colour - what is the colour of the variation Sensation - is the client feeling any loss of sensation or abnormal sensations (pruritus - itching) Skin Inspection steps: Inspect the skin for colour Pallor Lightening of the skin compared to the client’s typical complexion - due to a lack of oxygen-rich blood Cyanosis Bluish/whitish/greyish discolouration of the skin due to a lack of oxygen in the blood Erythema Reddening/darkening of the skin due to increased blood flow Brawny Brown-reddish discolouration associated with venous insufficiency Jaundice Yellowing discolouration Vitiligo The skin loses pigmentation in certain regions (patchy) Inspect the skin for nevi (moles) A - asymmetry Moles that are irregular/asymmetric in shape B - border irregularity Mole borders that are jagged in appearance C - colour Moles that have more than one colour within the mole D - diameter Diameter greater than 6 mm (pea-sized) E - evolution Moles that have changed; pain, size, colour, texture, shape, itching Inspect for skin integrity The Braden Scale - used to assess and screen for risk of developing pressure sores Stage 1 pressure injury Intact skin with localized area of blanchable erythema where prolonged pressure has occurred Stage 2 pressure injury Partial-thickness loss of skin that may appear as intact or ruptured blister Stage 3 pressure injury Full-thickness tissue loss in which tissue is visible but bone or muscle is not Stage 4 pressure injury Full-thickness tissue loss with visible cartilage and bone Unstageable Full-thickness tissue loss Inspect for other lesions Macule Flat spot (non-palpable) typically discoloured Papule Elevated, solid, palpable Wheal Swollen, inflamed skin patch that itches or burns Vesicle Small, fluid-filled sacs with thin walls Pustule Pus-filled, elevated, may have redness or swelling Fissure Crack or split of the outer layer of the skin Tumour Abnormal growth, palpable ie., lipoma Ulcer An open sore related to inadequate blood perfusion Erosions Breakdown of the top layer of skin Contusion Discolouration of the skin from damage to tissue below (bruise) ★ BILATERAL COMPARISON OF CLIENT’S BODY ★ Skin Palpation steps Palpate from shoulder to fingertips and from upper legs to toes Palpate the skin temperature -​ Use the dorsal regions of your hands -​ Note any asymmetry in skin temperature ie., inflammation is usually accompanied by warmth Palpate for skin texture, thickness, moisture -​ Use your fingertips -​ Diaphoresis: skin is excessively sweaty and clammy Palpate for skin turgor (elasticity) -​ Skin the returns immediately is considered normal turgor -​ Skin that takes some time to return to normal position is abnormal - associated with dehydration Palpate lesions and masses -​ Wear GLOVES for open lesions -​ Use your index finger and thumb to size the lesion Palpate for size and edema -​ Compare limb circumference of one arm to the other -​ Normally limb circumference is equal bilaterally at each site -​ Edema: indentation that remains after applying pressure over a location Nails Inspection and Palpation Inspect the nail condition and nail colour -​ Normally nails are smooth and clean -​ Abnormal findings are ridges, brittleness, indentation, discolouration Assess for clubbing -​ Related to hypoxia (reduced oxygen to the tissues) -​ The nail angle flattens, the nail bed softens and becomes spongy, nails curve and enlarge -​ First develops in the thumbs and then forefingers Palpate the nails for texture and consistency -​ Use a grasping motion to palpate the thickness of nails -​ Describe the appearance and location of thick, spongy or soft nails Palpate for capillary refill -​ Apply pressure to nail for 5 seconds, nail will blanch and release to observe colour return -​ Colour return taking longer than 3 seconds is considered abnormal Hair Inspection and Palpation Inspect and palpate for hair colour and texture -​ Note any variations in colour not attributable to hair dye -​ Note any patches or inconsistencies in texture or scalp integrity Inspect for hair distribution -​ Hair should be consistent without patches of hair or hair loss -​ Alopecia: patches of baldness or total absence of hair on the scalp Inspect and palpate for lesions -​ Start from the midline of the hairline on the forehead and make your way one side at a time to the base of the skull -​ Document and flakes, patches or lice Health Promotion and Disease Prevention Healthy eating -​ Determine clients diet, a well-balanced diet increases healthy hair, skin and nails -​ Vitamin deficiencies can lead to integumentary complications Skin, nail and hair care -​ Tools used on the skin, hair and nails should be cleaned regularly to reduce the risk of infection or infestation (lice) Environmental health -​ Exposure to irritants such as poison ivy, poison oak can lead to dermatitis (inflammation with burning or itching) -​ Changing body washes, laundry detergents, can lead to irritation -​ Overexposure to sun increases risk of skin cancer (melanoma) ★ Show your client unconditional positive regard, explain every process step by step, give them options to make sure they are comfortable and document descriptions from the client ALWAYS focus on how integumentary issues can look on various skin tones, not just white skin