Question

Select three from below Head, Skin, Neck, Hair, Nails, Face

Conduct a focused assessment on the three chosen.

Write a summary of the assessment and the skill utilized.

Answer the following 3 questions in the summary.

What skill was utilized during the focused assessment?

Describe how you felt during the assessment?

What can you do to improve your technique the next time?

Answer 1

1)Head and2) face assesment

Look at the patient’s head. Does it appear to be normally developed with normal features? Note any deviations that could signal a genetic or developmental disorder.

Inspect and palpate the skull. Look for symmetry, bleeding and bruises. Place your hands on the skull and feel for swelling or indentations in all regions. Does palpation produce pain? Look for bruising behind the ear (Battle’s sign) and bruising around the orbits (“raccoon eyes” or “panda eyes”), but keep in mind that these may take a while after injury to develop. If present, they may signal a skull fracture.

Inspect the ears for discharge and note whether it is bloody or clear. Inspect the eyes for pupillary size, shape, reaction to light and movement. (See our article in the May issue on assessment of the eye.)

Inspect and palpate the face for symmetry and obvious signs of trauma, and note any pain on palpation. Facial asymmetry indicates a problem with one or more cranial nerves. Is there facial droop on one side? Ask the patient to close her eyes as tightly as possible and note any differences in eyelid closure. Have her wrinkle her forehead and raise her eyebrows, noting any differences in left and right sides. Ask her to whistle, if she can, and to clench her teeth and smile as broadly as possible. Is the smile symmetrical or asymmetrical? Is there drooling? Ask her to wrinkle her nose and pout her lips, and look for any abnormalities.

Have the patient open her mouth and waggle her tongue. Note any weakness. Can she curl her tongue? Look at the uvula. Is it hanging down in the center of the oropharynx or deviated to one side? The tongue and uvula will deviate to the side away from the location of a stroke. Does the patient have an “open bite” that may suggest a maxillary or mandibular fracture?

3)Neck assesment

Inspect and palpate the neck. If trauma is involved, this should be done before applying a cervical collar. Inspect the front of the neck while your partner holds the patient’s head steady. Look at the jugular veins to see if they are flat, full or distended. Jugular veins should be full but not distended when a patient is lying supine. Flat jugular veins may indicate hypovolemia or hemothorax, and you will need to look elsewhere for injuries. Look for swelling that would indicate bleeding into the tissues or subcutaneous emphysema from damage to a lung or another part of the airway.

If there is no trauma involved, check for range of motion. Can the patient touch her chin to her chest and touch her ears to her shoulders without elevating the shoulder? Is the neck supple or stiff? Stiff neck can indicate meningitis.

Palpate the neck and underside of the jaw for swollen lymph nodes. Lymph nodes are found in many places in the head and neck, but are particularly easy to palpate in the occipital region of the head, the posterior cervical region and under the jaw.

Swollen lymph nodes may indicate an infection.

Feel the trachea with your thumb and first finger. It should be in the midline. Normal respirations will cause the trachea to move down a little, while a simple pneumothorax may cause it to “tug” in the direction of the pneumothorax. As pressure builds in a tension pneumothorax, the trachea will deviate away from the affected side, but this is a very late sign.

Question no 2

During assesment i was happy to understand how to handle a patient and do ASSESMENT .

Question no 3

I would like to do the assesment with being more patient interactive