Tuesday, April 23, 2013

Physical Assessment: Hearing and Ear

Nursing is an interesting, practical course. That is why, I am always excited to learn how to do physical assessment because there are some things that I find helpful for my client when it comes to assessing first their physical condition and in this way, I can make a quality nursing care plan effective for them. 

Assessing the ears (sense hearing) is this simple.

External Ear Structures
1. Inspect the auricle, tragus and lobule for size and shape, proportion, lesions/discoloration and discharge.
2. Palpate the auricle and mastoid process for tenderness.

Otoscopic Examination
1. Inspect the external auditory canal with the otoscope for discharge, color and consistency of cerumen, color and consistency of canal walls, and nodules.
2. Inspect the tympanic membrane, using the oroscope, for color and shape, consistency and landmarks.
3. Have client perform the Valsalva maneuver, and observe the center of the tympanic membrane for a flutter. (Except for the older client for this may interfere with equilibrium and cause dizziness.)

Hearing and Equilibrium Tests
1. Perform the whisper test by having the client place a finger on the tragus of one ear. Whisper a two-syllable word 1 and 2 feet behind the client. Repeat on the other ear.
2. Perform the Weber test by using a tuning fork placed on the center of the head or forehead and asking whether the client hears the sound better in one ear or the same in both ears.
3. Perform the Rhinne Test by using a tuning fork and placing the base on the client's mastoid process. When the client no longer hears the sound, note the time interval, and move it in front of the external ear. When the client no longer hears a sound, note teh time interval.
4. Perform the Romberg test to evaluate equilibrium. WIth feet together and arms at the side, close eyes for 20 seconds. Observe for swaying.

Analysis of the Data
1. Formulate nursing diagnoses.
2. Formulate collaborative problems.
3. Make necessary referrals.

Source: Lab Manual to Accompany Health Assessment in Nursing, Third Edition by Janet Weber, Jane Kelley and Ann Sprengel

Engagement Rings

True love comes to everyone as the saying goes, "we are all lovers".

In life, when you found the right one that you feel deserves your love, then it is best not to pass the days unattended. How?

Through marriage, it ties not only the heart of two lovers, but it shows their great commitment of their love through richer or poorer, in sickness and in good health. That is why, tying the knot of two persons who are inlove with each other deeply need engagement rings to face the altar and take the lifetime vow of promises for each other, to be there whenever, whatever life may lead them.

The greatest meaning of life is to fight for one's love for each other and it is through the evidence of the engagement rings that the life of marriage dwell to help every lover commit to the whole meaning of what is love really all about.

Life is really meaningful if you share it with someone who you really love.

Friday, April 12, 2013

Physical Assessment: Skin, Hair and Nail

In the field of nursing or in any medical field, it is essential to do the physical assessment because this will serve as the basis for giving the patient the right intervention. When regards to assessing the skin, hair and nail, I want to share this information with you from the book that I have read authored by Janet Weber, Jane Kelley and Ann Sprengel, Health Assessment in Nursing Laboratory Manual, 3rd Edition on page 51. 

Assessment Skill
1. Gather equipment (gloves, exam light, pen light, magnifying glass, centimeter ruler, Wood's land if available).
2. Explain the procedure to the client. 
3. Ask client to gown.

Skin
1. Note any distinctive odor. 
2. Inspect for generalized color variations (browness, yellow, redness, pallor, cyanosis, jaundice, erythema, vitiligo).
3. Inspect for skin breakdown. 
4. Inspect for primary, secondary or vascular lesions. (Note size, shape, location, distribution and configuration.) Use Wood's lamp if fungus is suspected. 
5. Palpate lesions.
6. Palpate texture (rough, smooth) of skin, using palmar surface of three middle fingers. 
7. Palpate temperature (cool, warm, hot) and moisture (dry, sweaty, oily) of skin, using dorsal side of hand.
8. Palpate thickness of skin with finger pads.
9. Palpate mobility and turgor by pinching up skin over sternum.
10. Palpate for edema, pressing thumbs over feet of ankles.

Scalp and Hair
1. Inspect color. 
2. Inspect amount and distribution.
3. Inspect and palpate for thickness, texture, oiliness, lesions and parasites.

Nails
1. Inspect for grooming and cleanliness.
2. Inspect for color and markings.
3. Inspect shape.
4. Palpate texture and consistency.
5. Test for capillary refill.

Analysis of Data
1. Formulate nursing diagnoses (wellness, risk, actual)
2. Formulate collaborative problems.
3. Make necessary referrals.
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