Patient Assessment General Examination (2) PDF

Patient assessment By Faculty of Dr. Shayma Abouldahab Applied Health Science Technology General Examination (2) Dr shayma aboul Dahab  Regional examination 1. head 2. neck 3. lymph node 4. upper and lower limb  The Hea...

Patient assessment By Faculty of Dr. Shayma Abouldahab Applied Health Science Technology General Examination (2) Dr shayma aboul Dahab  Regional examination 1. head 2. neck 3. lymph node 4. upper and lower limb  The Head 1. Skull 2. Face 3. Eye 4. Nose 5. ears 6. Mouth 7. Parotid gland  1. Skull 1. Metastasis 2. Alopecia  Radiotherapy  Collagen diseases  2. Face A. Facial expression 2. Thyrotoxicosis 3. acromegally 4. Myxoedema 5. Toxic look B. Assymetry as facial palsy C. Facial O edema as superior vena cava obstruction D. Color:pallor – cyanosis -jaundice  3. Eyes 1. Eye lids:oedema (puffiness), ptosis,retraction 2. Eyeball:exophthalmos 3. Conjuctiva:colors (pallor), subconjuctival hemorraghe 4. Sclera:jaundice 5. Lens:cataract  4. N ose 1. Nasal bleeding:hypertension,local condition 2. W orking ala nasi:pneumonia,asthma 3. Saddle nose:depressed nasal bridge due to repeated truma 5. Ears:deafness due to streptomycin (anti TB)  6. M O U TH Lips : 1. pursed lip (emphysema) 2. Colors (pallor-cyanosis) Tongue: 1. Bitten tongue:epilepsy 2. Colors:blue (cyanosis)-pallor(bleeding)- brown(smoking) 3. U lcer:TB 4. D ry tongue:dehydration 5. Macroglossia:obstructive sleep apnea syndrome  7. Parotid gland Enlargment ofparotid gland:filling space between mastoid process and mandibule, with elevation ofear lobule Causes 1. Tumour 2. Mumps  Regional examination 1. head 2. neck 3. lymph node 4. upper and lower limb  2. N eck (in sitting position) 1. Thyroid 2. Trachea (chest examination) 3. Lymph node 4. Neck vein  1. Thyroid gland Inspection (anteriorly):swelling on the front ofthe neck moving with swallowing Palpation (from behind):comment on size,surface, mobility,consistency. Percussion:(direct)on the manubrium to detect retrosternal extension Auscultation:murmur (a continuous sound that is heard over the thyroid mass) 2. Trachea  3. Lymph node Lymph node enlargement in the neck and others Comment on: 1. Site 2. Size 3. Consistency (soft-hard) 4. Tenderness 5. Mobility (fixed-mobile)  Palpable lymph node Site ofpalpable lymph node 1. Cervical lymph node 2. Supraclaviculer 3. Axillary lymph node 4. Inguinal lymph node 5. Epitrochlear Causes oflymph node enlargement Localized 1. Acute lymphadinitis 2. Tuberculosis 3. Metastasis 4. H odgkin Generalized 5. Leukemia-lymphoma 6. Infection:TB  Inspection (size-color) Large nodes are visible on inspection,Ifnodes are infected,the overlying skin may be red and inflamed. Palpation (size-consistency-mobility- tenderness) Lymph nodes should be palpated using the most sensitive part ofyour hands (the fingertips).  Head and neck (cervical-supraclavicular):the nodes should be palpated with the patient in an upright position and the examiner standing behind (similar to the examination ofthe thyroid gland)  Axillae:To examine the nodes at the right axilla: 1. The patient should be sitting comfortably,and you should stand at their right-hand side. 2. Support their right arm abducted to 90 with your right hand. 3. Examine the axilla with your left hand. To examine the nodes at the left axilla,perform the opposite maneuver to the above.  Inguinal:with the patient lying supine,palpate inguinal region along the inguinal ligament.  Epitrochlear nodes: flex right elbow and feel with your fingers in the groove above and posterior to the medial epicondyle ofthe humerus.  4. Neck veins (venous pressure) The jugular veins are a major part ofcirculatory system. They run from head,down through neck and into upper chest. There are two main pairs of jugular veins,the internal and external jugular veins, Internal jugular vein not seen as it lies behind sternomastoid muscle  Jugular veins join up with other veins to form the superior vena cava that is the largest vein in the body,and it delivers blood directly into the right atrium ofheart.  Normally by inspection is not seen Ifthe vein is visible that is means:Jugular vein distention. W hen it happens,it’s often a sign ofheart and circulatory problems most common causes ofJV distension: 1. Cardiac tamponade. 2. Collapsed lung (tension pneumothorax). 3. Pulmonary embolism. 4. H eart failure. 5. Pulmonary hypertension. 6. Superior vena cava syndrome  Regional examination 1. head 2. neck 3. lymph node 4. upper and lower limb  4. U pper limb H ands (skin-nails) Skin 1. Tempreture 2. Sweating 3. Color 4. Palmar erythema (liver cell failure) 5. Cutaneous hemorrhage (pitichiea- hematoma) N ails Clubbing:painless enlargement ofthe end of the finger due to Proliferation ofconnective tissue result in loss ofthe normal angle between the skin and nail plate Causes ofclubbing 1. Suppurative lung diseases 2. Lung cancer 3. Tuberculosis 4. Chronic hypoxemia 5. Congenital heart diseases 6. O ccupational D iagnosis ofclubbing by inspection tangentially obliteration ofthe angle between the nail and nail bed  Lower limb Inspect the legs from the groin to the feet noting any asymmetry, skin changes, varicosities, O edema. vascular insufficiency include pallor,coolness, cyanosis. clubbing 3. G astrointestinal:Abdominal pain,dysphagia, heartburn,vomiting,haematemesis, diarrohea,constipation,rectal bleeding 4. G enitourinary:D ysuria,discharge. 5. Neurological:Numbness,weakness,tingling, blackouts,visual change 6. Psychiatric:D epression,anxiety 7. G eneral review:W eight loss,appetite change,lumps or bumps (nodes),rashes, joint pain