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By: Mary Hazel S.

Facundo, RN, MN
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*To identify what are included in the
general survey
*To be able to perform a general
survey to a client
*To review the anatomy and fuctions
of the skin, hair, and nails
*
*Include collecting information
about the patients

Includes Height & Weight
Physical presence
Psychological presence
Signs and Symptoms of Distress
*Observe the patients

Stated age versus apparent age
General appearance
Body fat
Stature
Motor activity
Body and breath odors
*
*Stated Chronological age should
be congruent with apparent age

*Hormone deficiencies or genetic
syndromes can make a patient
appear younger or older than the
stated chronological age
*
Observe for

* body symmetry
*Any obvious anomaly
*Apparent level of wellness
*
*Should be evenly distributed
*Difficult to estimate accurately w/o the
use of calipers
*An excess caloric intake and/or
decreased energy expenditure are the
most common causes of obesity.
*Energy expenditures that exceed caloric
intake will result in decreased fat stores.
*
*Limbs and trunk should appear
proportional body height
*Posture should be erect
*Slumped or humpbacked is abnormal

Marfans syndrome results in the
development of long limbs
*
*Walking gait as well as other body
movts are smooth and effortless
*All body parts should have
controlled, purposeful movement

Tics, paralysis, or ataxia may be due
to neurologic disturbances
Arthritis can result to slow and
difficult movement
*
*Normally, no apparent odor
*The type of foods ingested or
individual digestive process may
result to bad breath
*Severe body or breath odor is
abnormal
*Observe the patientss
Dress, grooming, and personal
hygiene
Mood and Manner
Speech
Facial expressions
*
*Patient should appear clean and neatly
dressed
*Clothing is appropriate for the weather
*Norms and standards of dress and
cleanliness may vary among cultures
*Psychological or psychiatric disorders
may be reflected in inappropriate
appearance or inappropriate clothing
*Abuse or neglect may result to unclean
appearance
*
*Generally cooperative and pleasant
*Further assessment is needed if
uncooperative, hostile, tearful adult or
unusually elated, or has flat affect
*Psychiatric conditions and psychotic
disorders produce a distortion in reality,
resulting in abnormal behaviours.
*Dementia or confusion in elderly can
result in disturbance of mood and
manner
*
*Should respond to questions and
commands easily
*Should be clear and
understandable
*Pitch, rate, and volume should be
appropriate to the circumstances
*Slow, slurred, mumbled, very loud,
or rapid needs further assessment
*
*Should appear awake and alert
*Should be appropriate for what is
happening in the environment and
should change naturally
*Apathy or depression may cause lack of
facial expression due to feeling of
lethargy and sadness
*Bells palsy may cause the mouth to
droop and side of the face to appear
flaccid
*Observe for
Laboured breathing, wheezing or
cough, laboured speech
Painful facial expression,
sweating, physical protection of
painful area
Serious or life-threatening
occurrences
Signs of emotional distress or
anxiety
*
*S- Severity
*L- Location
*I- Influencing factors
*D- Duration
*A- Associated Symptoms

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*Protective barrier against invasion from
environmental hazards and pathogens
*Temperature regulation
*Contains receptors for pain, touch,
pressure, and temperature
*Acts as an organ of excretion for
substances
*
*Provides warmth, protection,
and sensation to the
underlying systems
*A status symbol of beauty and
wealth
*
*Provides protection to the
distal surface of the digits and
can be used for self -
protection
*Length in both men and
women is a qualifier of social
and economic status
*
*
*Colour
Normally, uniform whitish pink or
brown
Dark skinned may have freckling
of the gums, tongue border, and
lining of the cheeks.
*
*Cyanosis
*Jaundice
*Yellow discoloration
of the palmar and
digital creases
*Orange yellow
coloration of palmar
and plantar surfaces
and forehead
*Grayish cast
*Bright red/ruddy
*Pale cast
*Brown cast
*Albinism
*Vitiligo

*
*Bleeding, ecchymosis, or
increased vascularity
Petechia
Purpura
Ecchymosis
Spider angioma
Chery angiomas
Strawberry Hemangiomas
Gas gangrene
*
LESIONS
*Non palpable macule, patch
*Palpable papule, plaque, nodules,
tumor, wheal
*Fluid filled cavities vesicle, bullae,
pustule, cyst
*Above the skin surface Scales, crust,
lichenification
*Below the skin surface erosion,
ulcer, keloid, fissures, scar,
excoriation (abrasion)

*Lesions

*Lesions

*Lesions

*
I Area is reddened
II Epidermal and dermal layers have sustained
injury
III Subcutaneous tissues have sustained
injury
IV Muscle tissue and perhaps bones have
sustained injury


*
*
MOISTURE
*Normally dry with minimum perspiration
*Excessive dryness (xerosis) is abnormal
(hypothyroidism)
*Diaphoresis (increased metabolism,
hyperthyroidism, anxiety or pain)
*
TEMPERATURE
*Normally warm and equal bilaterally
*Hands and feet may be slightly cooler than
the rest of the body
*Abnormal hypothermia, hyperthermia
*
TENDERNESS
*Normally nontender
TEXTURE
*Normally feel soft even, and firm
*A certain amount of roughness in areas are
normal
*
TURGOR (elasticity)
*Reflects the skins state of hydration

EDEMA (accumulation of fluid)
* Rate the degree of edema.
*
4 point scale rating of EDEMA
* +0 No pitting
*+1, 0 inch Mild
*+2, - inch Moderate
*+3, - 1 inch Severe
*+4, greater than 1 inch Severe
*
*Have the client remove any hair clips, hair
pins, or wigs.
*Wear gloves if lesions are suspected or if
hygiene is poor. Then inspect the scalp and
hair.
*Inspect amount and distribution of scalp, body,
axillae, and pubic hair. Look for unusual growth
elsewhere on the body.
*Excessive generalized hair loss may occur with
infection, nutritional deficiencies, hormonal
disorders, thyroid or liver disease, drug
toxicity, hepatic or renal failure
*It may also result from chemotherapy or
radiation therapy.
*Nutritional deciencies may cause patchy gray
hair in some clients.
*Severe malnutrition in African-American
children may cause a copper-red hair colour
*Older clients have thinner hair because of loss
of hair follicle

*
*Inspect nail grooming and cleanliness
Dirty, broken, or jagged ngernails may be seen
with poor hygiene. They may also result from the
clients hobby or occupation.
*Inspect nail color and markings.
*Check capillary refill on all four extremities.
Pale or cyanotic nails may indicate hypoxia or
anemia.
Splinter haemorrhages may be caused
by trauma.
Beaus lines occur after acute illness and
eventually grow out.
Yellow dis coloration may be seen in fungal
infections or psoriasis. Nail pitting is common in
psoriasis.
*
*
*
*
Many clients have nails
with lines, ridges,
spots, and uncommon
shapes that suggest an
underlying disorder.
Some examples follow:
*
*

*Head and neck assessment focuses on cranium ,
face ,thyroid gland , lymph node structure.
1. Cranium : ( frontal , parietal, temporal , occiptial ,
ethmiod , spheniod)
2. Face : ( maxilla, zygomatic, lacrimal , mandible ,
nasal )
3. Neck
4. Muscles and cervical vertebrae
5. Blood vessels : ( jugular, carotid)
6. Thyroid gland
7. Lymph node of the head and neck
*
* Have you noticed any lesion or lumps on your head or
neck that not heal or disappear ?
* Do you have any difficulty moving your head or neck ?
* Do you have experience neck pain ? Describe
* Do you have any facial pain? Describe .
* Describe any pervious head or neck problems ? ( past
history)
* Have you ever undergone radiation therapy for
problem in your neck region? (past history)
* Is there history of head neck cancer in your family ? (
family history )
* PQRST
* Headaches
* Jaw tightness/pain
* Neck pain
* Nasal congestion/nose bleeds
* Mouth lesions
* Sore throat/hoarseness

*Position: Sitting
*Approach : anterior
posterior
*Technique :
Inspection , Palpation ,
Percussion , Auscultation

1. Penlight,
Transilluminator of light
2.Stethoscope
3.Glass of water
4.Tongue depressor
5.Tape measure
6.Gloves
7.Gauze 44
8.Nasal speculum or
ophthalmoscope
*
*Check for shape and symmetry
*Head should be normocephalic and
symmetrical
*Abnormalities: hydrocephalus, acromegaly,
craniosynostosis
*
*Place finger pads on the head and palpate all
its surfaces:
Frontal-parietal-temporal-occipital
Contour, masses, depressions, tenderness
Superficial temporal artery (weaker pulse)
*Abnormalities:
Masses hard or soft
Craniotabes softening of the skull caused by
hydrocephalus or demineralization of the bone
due to rickets
Laceration and bleeding of scalp


*
*Symmetry of facial structures, expression, shape
*Shape and features
Shape can be oval, round or slightly square
No edema, disproportionate structures, or
involuntary movements
*Abnormalities:
Downs Syndrome,hypertelorism, scleroderma,
exophthalmos, myxedema, cachexia, immobile
and expressionless (Parkinsons), nasal crease,
moon face

*
*Place the middle three finger of each hand
bilaterally over each joint then gently press on
the joint , ask the client to open and close the
mouth
*Palpate the muscle on both sides of the face
while the client smiles, frown , grits the teeth
and puffs out of the cheek.
*Check temporal artery pulse the should equal
and strength and rhythm.
*Auscultate for any sound while the client opens
and closes the mouth


*
*Normal:
No discomfort with movement
Joint should articulate smoothly and w/o
clicking or crepitus

*Abnormal:
+ for tenderness, clicking, crepitus
+ snapping sound

*
*Assess for:
Range of motion (ROM)
Muscle strength
Lymph nodes
Cervical vertebrae
Trachea
Thyroid Gland
*
*Full range of motion is assessed by asking
the client to tilt the head backward and
side to side.
*Neck should be symmetrical. No neck vein
distention should be visible.
*Trachea should be centered , move easily.
place your fingers in the sternal notch feel
each side of the notch and palpate the
tracheal rings when the clients swallow.
*On the posterior aspects of the neck
the cervical vertebrae are inspected and
palpated for symmetry, tenderness, masses
or swelling.


*
*Normal :
*Muscles are symmetrical w/o palpable masses
or spasm; head in a central position
*Able to move head through full ROM w/o
discomfort
*Abnormal:
*Pain w/flexion; reduced ROM
*Slight or prominent lateral deviation of neck
(Torticollis)


*
*To inspect :Face client and ask him to look
straight ahead w/ the head slightly extended
*Have him drink a sip of water and swallow
twice
*As patient swallows, observe the front neck in
the area of thyroid and the isthmus for masses
and symmetrical movement
* Lower the chin slightly to
relax neck muscles
* Flex the head slightly
forward
*
*Normal:
No enlargement, masses or tenderness

*Abnormal:
Smooth and soft
Gland reveals to be 2 to 3 times larger than normal
size
Lateral deviation
Tenderness
Presence of bruits on auscultation
*
*
*Normal:
Not visible or inflamed
Should not be palpable (small, discrete
movable nodes are sometimes present)
*Abnormal:
Enlargement and inflammation
Palpable nodes