Chapter 4 Vital Signs and Anthropomorphic Data - PowerPoint PPT Presentation

Loading...

PPT – Chapter 4 Vital Signs and Anthropomorphic Data PowerPoint presentation | free to download - id: 7512ee-NzIwM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Chapter 4 Vital Signs and Anthropomorphic Data

Description:

Chapter 4 Vital Signs and Anthropomorphic Data Feng Xin * SKIN ERUPTION Macules entirely flat Maculopapules macules with slightly elevated portions of the lesion. – PowerPoint PPT presentation

Number of Views:72
Avg rating:3.0/5.0
Slides: 119
Provided by: Ftp90
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Chapter 4 Vital Signs and Anthropomorphic Data


1
Chapter 4 Vital Signs and Anthropomorphic Data
  • ?? Feng Xin

2
Main contents
  • Vital signs
  • temperature
  • pulse
  • breathing
  • blood pressure
  • Anthropomorphic data
  • height
  • weight
  • Mental status
  • Gait
  • Skin
  • Lymphatic system

3
VITAL SIGNS
4
VTAL SIGNS
Vital signs are measurements of the body's most
basic functions.
  • body temperature
  • pulse
  • breathing
  • blood pressure

5
BODY TEMPERATURE
6
BODY TEMPERATURE
  • The importance of body temperature
  • Internal body temperature is tightly regulated to
    maintain normal cellular function of vital
    organs.
  • Deviation of temperature by more than 4? above or
    below normal can produce life-threatening
    cellular dysfunction.

7
BODY TEMPERATURE
  • Regulation of internal temperature is
    controlled by the hypothalamus which maintains a
    set point for temperature.

8
BODY TEMPERATURE
  • How is the temperature taken

thermometer
Mercury-filled glass thermometer
electronic thermometer
9
BODY TEMPERATURE
  • Mercury-filled glass thermometers have been
    largely replaced by electronic thermometers that
    give rapid, accurate readings when they are well
    calibrated.

10
BODY TEMPERATURE
  • The temperature may be measured in the
  • mouth, axilla, rectum
  • placing the thermometer under the patients
    tongue for 3 minutes.

11
BODY TEMPERATURE
  • Simultaneous Temperatures in Various Regions
  • The rectal temperature is about 0.3? higher than
    that of the oral reading
  • The axillary temperature is about 0.5 ? less
    than the oral value.

12
BODY TEMPERATURE
  • Scales on clinical thermometers
  • Fahrenheit ( F )
  • Celsius ( ? )
  • In our country the Celsius scale is usually
    used ,but in the united states often uses the
    Fahrenheit scale.

13
normal temperature
BODY TEMPERATURE
  • The population range of this set point varies
    from 36.0-37.5 ?.
  • minimum temperature
  • 300 to 400 a.m.
  • maximum temperature
  • between 800 and 1000 p.m

14
BODY TEMPERATURE
  • The normal body temperature of a person varies
    depending on gender, recent activity, food and
    fluid consumption, time of day.
  • Record the patients temperature at each visit.
    Doing so establishes an individualized baseline
    for future reference and detects deviations from
    this baseline, either fever or hypothermia
  • It is impossible to know an individuals normal
    temperature without a prior established baseline.

15
abnormal temperature
BODY TEMPERATURE
  • Body temperature may be abnormal due to
  • fever (high temperature)
  • a maximum oral temperature above 37.5 ?
  • a axillary temperature exceeding 37.3 ?.
  • a rectal temperature exceeding 38.0 ?.
  • hypothermia (low temperature).
  • usually is defined as 35.0 C

16
BODY TEMPERATURE
  • Falsely low levels
  • incomplete closure of the mouth , breathing
    through the mouth ,leaving the thermometer in
    place for too short a time , or the recent
    ingestion of cold substances.
  • Falsely elevated levels
  • inadequate shaking down of the thermometer ,
    previous ingestion of warm substances , smoking ,
    recent strenuous activity , or even a very warm
    bath.

17
THE PULSE
18
pulse
PULSE
The pulse is the physical expansion of the
artery. As the heart pushes blood through the
arteries, the arteries expand and contract with
the flow of the blood. The pulse rate is a
measurement of the heart rate, or the number of
times the heart beats per minute.
19
PULSE
  • Palpation of the Arterial Pulse
  • Using the first and second fingertips, press
    firmly but gently on the arteries until you feel
    a pulse.
  • Count your pulse for 60 seconds (or for 15
    seconds and then multiply by four to calculate
    beats per minute).

20
PULSE
  • the pulse may be palpated in any of the
    accessible arteries.
  • Wrist (Radial artery)
  • Neck (Carotid artery)
  • Inside of the elbow (Brachial artery)
  • Behind the knee (Popliteal artery)
  • Ankle joint (Posterior tibial artery)
  • The examiner ascertains the contour of the pulse
    wave and its volume, rate, and rhythm.

21
PULSE
  • Pulse Rate
  • normal between 55 and 100 beats per
  • minute(BPM).
  • Infants and children have higher normal heart
    rates. an infant would have a normal pulse rate
    ranging between 100-160 bpm.
  • For a well-trained athlete, a normal resting
    heart rate may be closer to 40 beats a minute.

22
PULSE
  • bradycardias lower than 55 BPM
  • tachycardias above 100 BPM

23
RESPIRATIONS
24
RESPIRATIONS
  • Normal Respirations
  • Respirations are when you breathe in and out.
  • Your respiratory, or breathing rate is the
    number of times you breathe in and out in 1
    minute.

25
RESPIRATIONS
  • Normal Respirations
  • At rest, the normal respiratory rate in adults is
    between 14 - 18 cycles per minute, in the
    newborn, the rate is about 44, gradually the rate
    diminishes until maturity. Women have slightly
    higher rates than men.

26
RESPIRATIONS
  • How to count a person's respirations?
  • Ask the person to sit upright.
  • Try to count the other person's respirations
    without him knowing
  • Use a watch with a second hand and count his
    breaths for 60 seconds.
  • Use any of the following methods to count
  • Look at his chest rise and fall. One rise and one
    fall are counted as 1 breath.
  • Listen to his breaths.
  • Place your hand on the person's chest to feel the
    rise and fall

27
BLOOD PRESSURE AND PULSE PRESSURE
28
BLOOD PRESSURE AND PULSE PRESSURE
  • Arterial Blood Pressure
  • Blood pressure (BP) is the pressure exerted by
    circulating blood upon the walls of blood
    vessels, and is one of the principal vital signs.

29
BLOOD PRESSURE AND PULSE PRESSURE
  • Measurement of Arterial Blood Pressure
  • sphygmomanometer

30
BLOOD PRESSURE AND PULSE PRESSURE
  • Measurement of Arterial Blood Pressure
  • The patient may be either sitting or lying in the
    supine position. In some cases, the pressure may
    be quite different with changes in posture.
  • The patient should have been resting for some
    time.

31
BLOOD PRESSURE AND PULSE PRESSURE
  • Bare the arm and affix the collapsed cuff snugly
    and smoothly, so the distal margin of the cuff is
    at least 3cm proximal to the antecubital fossa.
    Rest the arm on the table or bed with the
    antecubital fossa approximately at the level of
    the heart.

32
BLOOD PRESSURE AND PULSE PRESSURE
  • Palpate for the exact location of the brachial
    arterial pulse
  • Place the end of the stethoscope on the elbow

33
BLOOD PRESSURE AND PULSE PRESSURE
  • Inflate the cuff using the inflation bulb until
    the flow of blood is cut off.
  • Open the valve slightly so the pressure drops
    gradually while making observations by
    auscultation.

34
BLOOD PRESSURE AND PULSE PRESSURE
  • The pressure where the first sound was heard is
    the systolic pressure and the last sound heard is
    the diastolic pressure.

35
BLOOD PRESSURE AND PULSE PRESSURE
  • normal blood pressure
  • Less than 140 mm Hg systolic pressure and
  • Less than 90 mm Hg diastolic pressure
  • Hypertession (high blood pressure)
  • 140 mm Hg or greater systolic pressure or
  • 90 mm Hg or greater diastolic pressure
  • hypotenssion (low blood pressure)
  • Systolic pressure less than 90 mm Hg or
  • diastolic pressure less than 60 mm Hg

36
ANTHROPOMORPHIC DATA
37
HEIGHT
38
HEIGHT
  • Height development
  • Linear growth infancy, childhood and
    adolescence
  • Linear grow requires
  • the presence of growth homone
  • adequate nutrition
  • a skeleton able to respond to these signals

38
39
HEIGHT
  • Height development
  • mature height After achieving mature height,
    height should not change throughout the years of
    maturity into old age.
  • Mature height is determined by
  • genetic
  • environmental factors, especially nutrition

39
40
HEIGHT
  • Height development
  • loss of height with aging there is a
    hormone-independent loss of bone mineral density,
    leading to a slow and gradual loss of height.
    Addition of pathologic states such as
    osteoporosis and spinal compression fractures
    produce sometimes dramatic loss of height.

40
41
HEIGHT
  • Expected stature
  • Expected stature can be estimated from
    standard scales or by adding 6.5cm(2.6 in )for
    boys and subtracting 6.5cm (2.6 in )for girls
    from the mid-parental height.

42
HEIGHT
  • standardized growth charts
  • Growth is plotted on standardized growth
    charts, which give a rapid, visual indication of
    current stature and growth trends over time.

42
43
HEIGHT
  • standardized growth charts
  • Height should be measured and recorded
    regularly as part of well child examinations
    throughout infancy and childhood. Once stable
    mature height is reached, it need not be measured
    more than once a year, or less, until the person
    reaches age 60. At this time, yearly measurement
    should be done.

43
44
Short Stature
HEIGHT
  • Short stature indicates a failure of growth
    hormone production, decreased tissue receptivity,
    or impaired nutrition.

45
Excessive Height
HEIGHT
  • Growth hormone accelerates linear bone growth at
    open epiphyses.
  • Linear growth in excess of that predicted by
    parental height, especially if a significant
    deviation from the previous record, suggests an
    overproduction of growth hormone from a pituitary
    tumor, gigantism.

46
HEIGHT
Loss of height long bone
length, Loss of cartirage in lower extremity
joints vertebral height
intervertebral disc spaces excessive spinal
curvatures.
46
47
HEIGHT
Loss of Height
  • A careful history and physical examination,
    combined with a minimum of radiographic
    investigation, can quikly identify the specific
    conditions affecting each individual patient.
  • Unfortunately, unless height is measured
    regularly, the slow progression of height loss
    may go undetected until changes are severe and
    significant disability brings the patient to the
    physicians attention.

48
WEIGHT
49
WEIGHT
  • Weight is recorded in pounds or kilograms,
    preferably without heavy clothing or shoes.
  • 1 pound0.454 kilogram

50
Body-Mass Index(BMI)
WEIGHT
  • Did you know you had a BMI?
  • Body mass index is a calculation that uses your
    height and weight to estimate how much body fat
    you have. Too much body fat is a problem because
    it can lead to illnesses and other health
    problems.
  • The formulae universally used in medicine produce
    a unit of measure of kg/m2
  • BMImass(kg)/height(m2)

51
Body-Mass Index(BMI)
WEIGHT
lt 18.5 underweight
18.5 to 24.9 healthy
25 to 29.9 overweight
 30 to 34.9 grade 1 obesity
35 to 39.9 grade 2 obesity
gt40 grade 3 (morbid obesity)
52
Body-Mass Index(BMI)
WEIGHT
  • Growth charts using the body-mass index have been
    developed and are being used increasingly in
    well-child care. Calculation of BMI and setting
    weight loss goals based on the BMI are clinically
    useful. It allows patients to compare themselves
    with other individuals and the population risks
    associated with their current and target BMI.

53
Weight Loss
WEIGHT
  • adrenal insufficiency, diabetes.
  • Idiopathic advanced age , any debilitating
    disease.
  • any systemic inflammatory disease.
  • Infectious
  • maldigestion dieting, decreased intake and
    starvation.
  • bowel obstruction, dental and chewing problems
  • cancers
  • Psychosocial dieting dementia, depression

54
Weight Gain
WEIGHT
  • Increased intake overeating, mild
    hyperthyroidism,
  • Decreased metabolic demands hypothyroidism,
    inactivity,
  • Salt and water retention congestive heart
    failure, kidney failure, nephrotic syndrome,
    hepatic insufficiency

55
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
56
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
  • Psychiatric and social disorders are common in
    medical settings. They are associated with an
    increased risk for nonpsychiatric illness and
    frequently confound the evaluation of patients
    presenting with nonspecific complaints .
  • It is imperative to recognize that the presence
    of a psychiatric diagnosis in no way decreases
    the probability of serious organic disease in a
    patient with appropriate signs or symptoms.

57
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Perceptions
  • Abnormal perceptions arising from primary injury
    to the sensory organs and their pathways are
    often negative or represent an exaggeration or
    distortion of the normal sensory signal.
  • Abnormal perceptions arising in the processing
    centers and cortex are more often complex.

58
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Affect Mood
  • Feelings are the way we react emotionally to the
    perceptions and events of our lives. Normally we
    have a range of feelings throughout the day and
    the intensity of our feelings may vary over time,
    from periods or relative intensity to periods of
    less intensity.
  • Abnormal extremes of feelings, either in degree
    or duration, may indicate psychiatric disorders.

59
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Thinking
  • Thinking is the process by which we connect and
    explain events to ourselves and others. It is a
    relational activity of great complexity.
  • disorders may be manifest by verbal symptoms
    expressed by the patient or by abnormal behaviors
    resulting from the disordered thoughts.

60
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Memory
  • AmnesiaAmnesia is a loss of memory. It can be
    retrograde for events of the past,or antegrade,
    the inability to form new memories.I t can be
    either global or selective for particular events
    or domains of memory.
  • It is indicative of brain injury or psychological
    disorder.

61
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Behaviors
  • How we behave, our actions in private and public,
    is the result of how we feel, how we think, and
    how we perceive the constraints and rewards of
    the social environment.
  • Behaviors which are consistently abnormal or
    unacceptable are indicative of personality or
    psychiatric disorders.

62
THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Thought Disorders
  • Schizophrenia and Other Psychoses As the
    prototypical psychosis, schizophrenia is now
    considered to comprise a group of diseases that
    are probably etiologically distinct
  • Primary psychotic disorders occur in adolescence
    or young adult life.
  • Onset of psychotic symptoms at older ages should
    raise concern about organic brain disease, drug
    intoxication or withdrawal.
  • Schizophrenia involves problems in thinking,
    affect, socializing, action, language, and
    perception.

63
GAIT
64
GAIT
  • Gait is a complex activity requiring normal
    sensory input from the feet, spinal cord, and
    vestibular system, and normal motor and
    cerebellar function.
  • Impairments in any of these systems leads to
    characteristic changes in the gait. Careful
    inspection of gait can greatly aid identification
    of the site of the lesion.

65
GAIT
  • The gait influenced by the rate, rhythm, and the
    character of the movements employed in walking.
    In assessing the neurologic contribution to gait,
    painful and restrictive conditions of the joints,
    muscles, and other structures must be excluded.

66
GAIT
  • Observe the patients usual gait in a
    well-lighted hallway.
  • Note the posture of the head, neck and trunk,
    swing of each arm, leg swing, width of stance,
    size of steps
  • Be sure to observe all three phases of gait
  • touch down, which should occur with the lateral
    heel,
  • stance which should be centered
  • push-off which should come off the great toe.

67
GAIT
  • observe the turn for loss of balance or multiple
    small steps to get turned around.
  • have the patient walk away from you on the toes,
    observing from behind, turn and walk toward you
    on the heels observing from the front. Note how
    far the heels and toes, respectively, are held
    off the ground.
  • Examine the wear on the patients shoes, abnormal
    wear pattern is a good clue to disorders of the
    foot and gait.

68
SKIN
69
SKIN
70
SKIN COLORATION
71
SKIN COLORATION
  • In human beings,the color of the normal skin
    results from a blend of four pigments
  • melanin (brown), brown hues that come from
    melanin pigment
  • Carotene (yellow), yellow hues that come from the
    nature color of nonvascularized collagen and from
    bile and carotene pigments
  • Oxyhemoglobin (red), erythematous hues that
    come from oxygenated hemoglobin contained in the
    cutaneous vasculature
  • reduced hemoglobin (bluish-red).

72
SKIN COLORATION
  • The amount of melanin is the determinant of the
    normal skin color.
  • Melanin pigment lesions ly deep in the dermis

73
Pallor
SKIN COLORATION
  • Pallor is the lack of the normal red color
    imparted to the skin and mucous membranes by the
    blood in the superficial vessels.
  • Inspection for generalized pallor is always
    supplemented by observing the color of the
    conjunctivae, the oral mucosa and palmar creases.
  • Pallor can be produced by
  • edema
  • anemia

74
Cyanosis
SKIN COLORATION
  • Cyanosis is the blue color seen through the skin
    and mucous membranes
  • when the reduced hemoglobin concentrations in
    capillary blood exceed 4.05.0g/dL,0.51.5g of
    methemoglobin, or 0.5g of sulfhemoglobin. The
    amount of oxyhemoglobin does not affect the color.

75
Cyanosis
SKIN COLORATION
  • Generalized cyanosis is seen in the lips, nail
    beds, ears, and malar regions.

76
Cyanosis
SKIN COLORATION
  • DDX(differential diagnosis)
  • Local Cyanosis localized venous stasis or
    arterial obstructions, Raynaud phenomenon,
    extravasations of blood in superficial tissues.
  • Central cyanosis Central cyanosis is often due
    to a circulatory or ventilatory problem that
    leads to poor blood oxygenation in the lungs.

77
Changes in Skin Color
SKIN COLORATION
  • Constitutive Diffuse Brown Skin
  • Normal melanin pigmentation. This is the
    inherited constitutive skin color.
  • Acquired Diffuse Brown Skin
  • Melanism, hemochromatosis.
  • Blue-grey Color
  • Silver(argyria),
  • Acquired Diffuse Yellow Skin
  • Jaundice
  • Carotenemia

78
SKIN COLORATION
  • Carotenemia
  • The carotene surplus occurs
  • (1) from excessive ingestion of the pigment in
    oranges, mangos, carrots, and all green
    vegetables.
  • (2) when the liver fails to metabolize the
    carotene in myxedema and diabetes mellitus.
  • Excessive deposition of carotene appears as
    yellowness of the skin, especially on the
    forehead, the nasolabial folds, behind the ears,
    and in the palms

79
SKIN COLORATION
Jaundice
Carotenemia
80
SKIN COLORATION
  • Erythema
  • Erythema is a diffuse reddening of the skin
    caused by dilation of the cutaneous
    vasculature. It is often accompanied by increased
    skin temperature. The borders are not discrete.
  • Depigmentation
  • Loss of normal skin pigmentation may be
    patchy or diffuse,usually with discrete
  • Hyperpigmentation
  • Increased melanin deposition in the skin can
    result from either local or systemic factors.

81
SKIN MOISTURE
82
SKIN MOISTURE
  • 1.Dry skin
  • Loss of adequate sebaceous and (or) sweat gland
    function lead to excessive drying of the skin.
  • The skin is dry, often cracked and leathery in
    texture.

83
SKIN MOISTURE
  • 2.Decreased Skin Turgor
  • Skin turgor is the skin's ability to change shape
    and return to normal.
  • The turgor of the skin is decreased with losses
    of extracellular fluid volume. Loss of
    extracellular fluid leads to increased viscosity
    of the interstitial space fluid.
  • Skin turgor is a sign commonly used by health
    care workers to assess the degree of fluid loss
    or dehydration. Dehydration can occur with
    vomiting, diarrhea, or fever.

84
SKIN MOISTURE
  • Evaluation of skin turgor

85
SKIN MOISTURE
  • 3.Decreased Skin Elasticity
  • Destruction or disruption of the elastic fibers
    in the skin results in decreased elasticity.
    Decreased elasticity is evident wrinkling and
    redundancy of the skin.

86
SKIN ERUPTION
87
SKIN ERUPTION
  • Macules
  • These are localized changes in the skin color or
    appearance. But, by definition, they are not
    palpable. The areas may be small or large. They
    occur in many shapes and colors. There may be
    desquamation or scaling.

88
SKIN ERUPTION
  • Maculopapules
  • These are macules with slightly elevated portions
    of the lesion.
  • The term Maculopapular comes from two words
    macules meaning flat, small, non-elevated spots
    on the surface of the skin and papules meaning
    small, swollen bumps.

89
SKIN ERUPTION
  • Papules
  • The lesions are solid and elevated. They are
    defined as less than 5mm in diameter. Their
    borders and tops may assume various forms.

90
SKIN ERUPTION
  • Plaques
  • Because papules have a diameter of less than
    5mm,any elevated area of greater size is a
    plaque, usually formed from confluent papules.

91
SKIN ERUPTION
  • Nodules
  • The lesions are solid and elevated. They are
    distinguished from papules by extending deeper
    into the dermis or even the subcutaneous tissue.
    They are usually greater than 5mm in diameter.

92
SKIN ERUPTION
  • Wheals
  • Caused by edema of the skin, are edema areas in
    the epidemis and dermis. these areas are
    circumscribed, irregular, and relatively
    transient . Their color varies from red to pale,
    depending on the amount of fluid in the skin.

93
SKIN ERUPTION
  • Vesicles
  • An accumulation of fluid in the superficial
    layers of the skin produces an elevation covered
    by a translucent epithelium that is easily
    punctured to release the fluid. By definition,
    their diameter is limited to less than 5mm.

94
SKIN ERUPTION
  • Bullae
  • Accumulations of fluid between the layers of the
    skin that are larger than 5mm in diameter are
    bullae. If the layer of separation is deep to the
    epidermal basal layer, the bullous will be tense
    if it is superficial to the basal layer, it will
    be flaccid and more easily ruptured.

95
SKIN ERUPTION
  • Pustules
  • Vesicles or bullae that become filled with pus
    and tiny abscesses in the skin are termed
    pustules.Through the translucent skin covering,
    their contents appear milky,orange,yellow,or
    green,depending somewhat on the infecting
    organisms.

96
SKIN ERUPTION
  • Vegetations
  • Elevated irregular growths are called
    vegetations. When their covering is keratotic or
    dried, they are verrucous. When covered by normal
    epidermis, they are papillomatous.

97
SKIN ERUPTION
  • Scales
  • Thin plates of partly separated dried cornified
    epithelium cling to the epidermis.

98
SKIN ERUPTION
  • Macules
  • entirely flat
  • Maculopapules
  • macules with slightly elevated portions of the
    lesion.
  • Papules
  • solid and elevated. less than 5mm in diameter.
  • Plaques
  • greater size, confluent papules.
  • Nodules
  • deeper into the dermis. greater than 5mm in
    diameter.

99
SKIN ERUPTION
  • Wheals---edema areas in the epidemis and dermis
  • Vesicles-- An accumulation of fluid in the
    superficial layers.
  • diameter less than 5mm.
  • Bullae-- Accumulations of fluid between the
    layers ,larger than
  • 5mm in diameter.
  • Pustules---Vesicles or bullae that filled with
    pus and tiny
  • abscesses, milky, yellow,
  • Vegetations---Elevated irregular growths.
    covering is keratotic
  • or dried, they are
    verrucous. When covered by
  • normal epidermis,
    they are papillomatous.
  • .

100
intradermal hemorrhage
101
INTRADERMAL HEMORRHAGE
INTRADERMAL HEMORRHAGE
  • Petechia a round, discrete hemorrhagic area
    less than 2mm in diameter. The bleeding causes
    the petechiae to appear red, brown or purple.
    Usually flat to the touch, petechiae don't lose
    color when you press on them.
  • Ecchymosis a larger spot

102
INTRADERMAL HEMORRHAGE
INTRADERMAL HEMORRHAGE
  • Purpura when hemorrhages of either size occur in
    groups, the condition is termed Purpura. purpuric
    lesions may become confluent and they usually do
    not elevate the skin or mucosa.
  • Hematoma is an area in which underlying
    hemorrhage causes elevation of the skin or
    mucosa(gt5mm)

103
INTRADERMAL HEMORRHAGE
  • Arterial Spider
  • A telangiectatic arteriole in the skin having
    capillary branches that radiate from a central
    area in a manner similar to legs from the body of
    a spider. Also called arterial spider.

104
INTRADERMAL HEMORRHAGE
  • Arterial Spider
  • Spiders occur commonly in the face and neck
    and,in diminishing order of frequency,on the
    shoulders,anterior onest,back,arms ,forearms,and
    dorsa of the hands and fingers rarely are they
    found below the umbilicus.

105
INTRADERMAL HEMORRHAGE
  • Arterial Spider
  • Clinical Occurrence
  • Occasionally ,in normal persons, hepatic disease,
    pregnancy (disappearing after delivery).

106
INTRADERMAL HEMORRHAGE
  • Palmar Erythema
  • Palmar erythema is a reddening of the skin on the
    palmar aspect of the hands, usually over the
    hypothenar eminence. It may also involve the
    thenar eminence and fingers.
  • Clinical occurrence
  • Hepatic disease
  • Pregnancy (disappearing
  • after delivery),

107
SCAR
SCAR
  • Injury to epidermis can heal without scarring.
    but may leave alterations in pigmentation.
  • Injury to the elastic and collagen fibers in the
    dermis results in scarring.
  • Deeper injury to the subcutaneous fat and muscle
    can result in visible depressions or masses.
  • All cutaneous scars are initially raised and
    red. They fade through pink to a pallid
    hypopigmented hue over months to years as the
    vascularity of the fibrous tissue diminishes.

108
LYMPHATIC SYSTEM
109
LYMPHATIC SYSTEM
  • EXAMINATION OF THE LYMPH NODES
  • Enlarged nodes may be visible by inspection.
  • Examination is primarily by palpation.

110
EXAMINATION OF THE LYMPH NODES
LYMPHATIC SYSTEM
  • Palpation
  • Note six major qualities
  • number
  • size
  • consistency
  • Degree of tenderness
  • mobility
  • Whether they are discrete or matted together.

111
LYMPHATIC SYSTEM
  • Palpation of the Cervical Lymph Nodes
  • Seat the patient in a chair stand behind the
    patient to palpate the neck with your fingertips.
    Examine, in sequence ,the various lymph node
    sites
  • (1)submental, under the chin in the midline and
    on either side.
  • (2)submandibular,under the jaw near its angle.
  • (3)jugular, along the anterior border of the
    sternocleidomastoid.
  • (4)supraclavicular,behind the midportion of the
    clavicle.
  • (5)poststernocleidomastoid (posterior triangle),
    behind the posterior border of the upper half of
    the sternocleidomastoid.
  • (6)postauricular,behind the pinna on the mastoid
    process.
  • (7)preauricular,slightly in front of the tragus
    of the pinna.
  • (8)suboccipital, in the midline under the occiput
    and to either side.
  • (9)pretrapezius, in front of the upper border of
    the trapezius.

112
EXAMINATION OF THE LYMPH NODES
113
LYMPHATIC SYSTEM
  • Palpation of Axillary Infraclavical and
    Supraclavicular Lumph Nodes
  • The central group of nodes occurs near the middle
    of the thoracic wall of the axilla.
  • The lateral axillary group is located near the
    upper part of the humerus and is beat
    dimonstrated by having the patients arm elevated
    so that you can feel along the axillary vein.
  • the pectoral group with the patients arm
    elevated,feel along beneath the lateral edge of
    the pectoralis major muscle .
  • the subscapular nodes Palpate the subscapular
    nodes from behind the patient with the arm
    raised,palpating with the left hand under the
    anterior edge of the latissimus dorsi muscle.
  • the infraclavicular group Palpate under the
    clavicle for the infraclavicular group.
    Enlargement in the supraclavicular group is
    sought by feeling the soft tissues above and
    behind the clavicle.

114
EXAMINATION OF THE LYMPH NODES
115
LYMPHATIC SYSTEM
  • Palpation of the lnguinal Nodes
  • Palpate at and just below the inguinal ligament
    then distally along the course of the greater
    saphenous vein.

116
INOCULATION LESION WITH REGIONAL LUMPHADENOPATHY
LYMPHATIC SYSTEM
  • Cutaneous inoculation of infectious agents is
    followed by spread through the subcutaneous
    lymphatics,with varying degrees of inflammation
    and induration,to regional lymph nodes.The
    cutaneous inoculation site may show minimal signs
    or may be marked by local inflammation,ulceration,
    and/or necrosis with eschar formation.A careful
    history, including the time of year and
    occupational or avocational exposures,is
    essential to an accurate and timely diagnosis.

117
Some questions for you
  • What are the vital signs?
  • How to calculate body mass index?
  • When will cyanosis occur?

118
Thank You !
About PowerShow.com