BODY PART SKIN

NORMAL -it is tough, resilient, moist and virtually impermeable to aqueous solutions, bacteria or toxic compounds -has three primary layers: epidermis, dermis, subcutaneous -Evenly colored skin tones without unusual or prominent discolorations. -Slight or no odor of perspiration, depending on activity -White-skinned clientshave darker pigment around nipples, lips, and genitalia. Mongolian spots on thelower back, buttocks, or even on the upper back, arms, thighs, or abdomen occur in most blacks, Asians, NativeAmericans, and some whites. These bluish, bruiselike markings usually fade by 2 years of age -Skin is intact, and there are noreddened areas. -Smooth, without lesions. Stretch marks (striae), healed scars, freckles, moles, or birthmarks are common ndings -Lesion does not uoresce. -Normal lesions may be moles, freckles, birthmarks, and the like. They may be scattered over the skin in no particular pattern. -Skin is smooth and even. -Skin is normally thin, but calluses (rough, thick sections of epidermis) are common onareas of the body that are exposed to constant pressure. -Skin rebounds and does not remain indented when pressure is released

ABNORMAL *IMPETIGO -a contagious superficial skin infection, occurs in non-bullous and bullous

*FOLLICULITIS -bacterial infection of the hair follicle that causes the formation of a pustule

*FURUNCULOSIS -fulliculitis developed into furuncles

*CARBUNCULOSIS -involved multiple contiguous hair follicles *TINEA VERSICOLOR -a chronic, superficial, fungal infection and produces multicolored rash commonly on the upper trunk also known as pityriasis versicolor *DERMATOPHYTOSIS -commonly called tinea, may affect scalp, body, nails,hand, feet, groin and bearded skin *CUTANEOUS LARVA MIGRANS -also known as creeping eruption, a skin reaction to

infestation of nematodes , eruption associated with cutaneous larva migrans *VITILIGO -marked by stark-white skin patches that may cause a serious cosmetic problem *ROSACEA -a chronic skin eruption, it produces flushing dilation of the small blood vessels in the face especially the nose and cheeks *MELASMA -a patchy, hypermelanotic skin disorder also known as chloasma *DERMATITIS -inflammation of the skin, occurs in several forms atopic, seborrheic, nummular, contact, chronic, localized neuridermatitis, exfoliative and stasis *WARTS -also known as verrucae, commonly benign and viral infections of the skin and adjacent mucous membranes *PSORIASIS -is a chronic recurrent disease marked by epidermal proliferation *LITCHEN PLANUS -a benign but pruritic skin eruption, produces scaling, purple papules marked by white lines or spots *CORNS AND CALLUSES -usually located on areas of repeated trauma *PITYRIASIS ROSEA -an acute self limiting, inflammatory skin disease, usually produces a herald patch which usually goes undetected followed by a generalized eruption of papulosquamous lesions *HYPERHIDROSIS -excessive secretion of sweat from the eccrine gland that usually occurs on the axiilae *PRESSURE ULCERS -commonly called pressure sores or bedsores are localized areas of cellular necrosis that occur most

often in the skin and subcutaneous tissue over bony prominences HAIR -equally distributed hair -soft, smooth -Natural hair color, as opposedto chemically colored hair, varies among clients from pale blonde to black to gray or white. Thecolor is determined by the amount of melanin present. -Varying amounts of terminal haircover the scalp, axillary, body, and pubic areas according to normal gender distribution. Fine vellus hair covers the entire bodyexcept for the soles, palms, lips, and nipples. Normal male pattern balding is symmetric -appears pink and shiny with whitish crescent shaped area extending beyond the proximal nail fold -smooth nail beds -no blemishes -bend slightly when pressed -look strong and healthy -160 angle; slightly rounded or flat -capillary refill- color return to normal after 1-3 sec *PEDICULOSIS -caused by parasitic forms of lice *HIRSUTISM -excessive growth of body hair *ALOPECIA -or hair loss *ACNE VULGARIS -is an inflammatory disease of the sebaceous follicles *CYANOSIS -appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen *ONYCHOMYCOSIS - nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. *LINDSEY NAIL -proximal portion of the nail white and the distal half red, pink, or brown, with a sharp line of demarcation between the two halves *SPLINTER HEMMORHAGE *MELANONYCHIA -black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in black patients, as a result of trauma, systemic disease, or medications, or as a post inflammatory event from such localized events as lichen planus or fixed drug eruption *LEUKONYCHIA - white discoloration appearing on nails *LEUKONYCHIA TOTALIS - whitening of the entire nail *BEAUS LINE - deep grooved lines that run from side to side on the fingernail

NAIL

HEAD

-rounded spherical shape -Generally round, with prominences in the frontal and occipital area. (Normocephalic). No tenderness noted upon palpation. -smooth non-tender and no masses and depressions -temporal artery is weaker than peripheral pulse;artery is non- tender and readily compressible

*PARONYCHIA - often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail *KAILONYCHIA - abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape *ONYCHOLYSIS - detachment of the nail from the nail bed, starting at its distal and/or lateral attachment *TERRYS NAIL - appear white with a characteristic "ground glass" appearance, with no lunula *ACROMEGALY - generalized expansion of the skull at the fontanelle, a syndrome that results when the pituitary gland produces excess growth hormone (hGH) after epiphyseal plate closure at puberty *ARNOLD-CHIARI SYNDROME - downward displacement of the cerebellar tonsils through the foramen magnum, sometimes causing non-communicating [1] hydrocephalus as a result of obstruction of cerebrospinal fluid outflow *HYDROCEPHALUS - abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, tunnel vision, and mental disability *ANENCEPHALY - cephalic disorder that results from a neural tube defect that occurs when the cephalic (head) end of the neural tube fails to close, usually between the 23rd and 26th day of pregnancy, resulting in the absence of a major portion of the brain, skull, and scalp *PACHYDERMOPERIOSTOSIS - characterized by pachydermia (thickening of the

FACE

-oval, round, or slightly square shaped, -facial features are symmetrical -Palpebral fissure should be equal in both eyes -nasolabial fold is present bilaterally -Epicanthic fold in Asians -no edema - test for CN7( can identify sharp, dull, and soft)

skin), periostosis (excessive bone formation) and finger clubbing (swelling of tissue with loss of normal angle between nail and nail bed) *MICROCEPHALY - neurodevelopmental disorder in which the circumference of the head is more than two standard deviations smaller than average for the person's age and sex *CRANIOSYNOSTOSIS - one or more of the fibrous sutures in an infant skull prematurely fuses by ossification *PARKINSONS DISEASE -no facial expression *CUSHING SYNDROME -causes a moon shaped face *MASTOCYTOSIS - presence of too many mast cells *COLLAPSED FACE SYNDROME *GIANT HEAD SYNDROME *HALF FACE SYNDROME *HYPERTELORISM *MYXEDEMA *CACHEXIA *TRANSVERSE CREASE

NECK

-The neck is straight. -No visible mass or lumps. -Symmetrical No jugular venous distension (suggestive of cardiac congestion). -The trachea is palpable. -It is positioned in the line and straight. - Lymph nodes May not be palpable. Maybe normally palpable in thin clients. Non tender if palpable. Firm with smooth rounded surface. Slightly movable. About less than 1 cm in size. -Normally the thyroid is non palpable. Moves up with swallowing - Isthmus maybe visible in a thin neck. - No nodules and masses are palpable.

*METASTATIC NECK DISEASE *STIFF NECK *THYROID DISEASE *HIRAYAMA DISEASE *LYMPHADENITIS *GOITER

EYE

Eyes Evenly placed and inline with each other. Non protruding. Equal palpebral fissure. Both conjunctivae are pinkish or red in color. With presence of many minutes capillaries. Moist No ulcers No foreign objects Eyebrows Symmetrical and in line with each other. Maybe black, brown or blond depending on race. Evenly distributed. Eyelashes Color dependent on race. Evenly distributed. Turned outward. - The sclera appears white, although blacks occasionally have a gray-blue or muddy color to sclera. It should be moist and without lesions - iris are proportional to the size of the eye round &symmetrical; Pupils are from pinpoint to almost the size of the iris round, symmetrical, constricts with increasing light& accommodation; able to move eyes in full range ofdirection

EYELIDS

Upper eyelids cover the small portion of the iris, cornea, and sclera when eyes are open. No PTOSIS noted. (drooping of upper eyelids). Meets completely when eyes are closed. Symmetrical. Lacrimal Apparatus Lacrimal gland is normally non palpable. No tenderness on palpation. No regurgitation from the nasolacrimal duct. The ear lobes are bean shaped, parallel, and symmetrical. The upper connection of the ear lobe is parallel with the outer canthus of the eye. Skin is same in color as in the complexion. No lesions noted on inspection. The auricles are has a firm cartilage on palpation. The pinna recoils when folded.

EAR

*MYOPIA *HYPEROPIA *PRESBYOPIA *DOWN SYNDROME *OPTHALMOPLEGIA *VERTICAL GAZE *GLAUCOMA *CATARACT *TRACHOMA *RIVER BLINDNESS *DIABETIC RETINOPATHY *PTERYGIUM *MACULAR DEGENERATION *JAUNDICE *DACROCYSTITIS *DACROADENITIS *MUCOPURULENT DISCHARGE *EPIPHORA *PINGUECULA *OSTEOGENESIS IMPERFECTA *ARCUS SENILIS *KERATOCONUS *STRABISMUS *ESOTROPIA *EXOTROPIA *ENTROPION *ECTROPION *PTOSIS *HORDEOLUM *LID LAG *EXOPHTHALMUS *ANOPHTALMOS *CHALAZION *BLEPHARITIS *BATTLES SIGN *CARCINOMA *MICROTIA *AURICULAR HEMATOMA *MUTILATED EAR *PERICHONDRITIS

NOSE

There is no pain or tenderness on the palpation of the auricles and mastoid process. The ear canal has normally some cerumen of inspection. No discharges or lesions noted at the ear canal. On otoscopic examination the tympanic membrane appears flat, translucent and pearly gray in color. -vVOice Whisper Test : The patient should be able to repeat words whispered from a distance of 2 feet -Tuning fork test : Measures hearing by air conduction (AC) or by bone conduction (BC), in which the sound vibrates through the cranial bones to the inner ear. -Weber Test: The patient should perceive the sound equally in both ears or in the middle. No lateralization of sound is known as negative Webster test. -Rinne Test: Air conduction is heard twice as long a bone conduction when the patient hears the sound through the external auditory canal ( air ) after it is no longer heard at the mastoid process ( bone ). This is denoted as AC>BC. - The shape of the external nose can vary greatly among individual. Normally, it is located symmetrically on the midline of the face that is without swelling, bleeding, lesions, or masses. No discharge or flaring and uniform color, there is a sense of smell.Non-tender; absence of painThe nasal mucosa should be pink or dull red without swelling. The septum is at the midline and without perforation, lesions or bleeding, the small amount of watery discharge is normal. - The patient should not feel pain during palpation and no tenderness felt. - The sound should be flat or dull on percussion - There is no evidence of swelling around the nose and eyes.The patient should not feel any pain and tenderness during palpation. - The glow on each side is equal, indication air-filled frontal and maxillary sinuses on transillumination. -The lips should be pink, soft moist, smooth texture with no evidence of lesions or inflammation. Not crack and symmetrical.There is no presence of lumps and pain. It is tender. -The gums should be pink, moist, firm texture, no retraction, no swelling or bleeding. The gum margins at the teeth are tight and well-defined - There should be no pain felt during palpation, no lumps and non-tender. - The adult normally has 32 teeth, which should be white, straight and smooth edges in proper alignment or evenly placed, clean and free of debris and decay - The tongue is in the midline of the mouth, the dorsal surface should be pink, moist, rough and without lesions. The tongue is symmetrical and moves freely. The strength of the tongue is symmetrical and strong.The ventral surface of the tongue ahs prominent blood vessels and should be moist without lesions, looks smooth and glistening. There is

*CLEAR/BLODDY DRAINAGE *PURULENT DRAINAGE *OTITIS MEDIA *OTITIS EXTERNA *FURUNCULOSIS *OTOMYCOSIS *CERUMEN *PERFORATED EARDRUM *EAR TAGS *CONDUCTIVE HEARING LOSS *SENSORINEURAL HEARING LOSS

*EPISTAXIS *NASAL POLYPS *SEPTAL PERFORATION *ANOSMIA *SINUSITIS

MOUTH

*HALITOSIS *CYANOSIS *CHEILITIS *APHTHOUS ULCER *LEUKOPLAKIA *PALE MUCOSA *PERIODONTITIS *GLOSSITIS *FISSURED TONGUE *CANCER OF THE TONGUE *ASYMMETRIC PROTRUSION *CLEFT PALATE

a sense of taste. - There should be no presence of nodules, lumps and pain. -Frenulum should be attached to the tongue, pinkish in color and moist. -sublingual area should be pink in color, moist and no presence of lesions. -The hard palate is concave and lighter in pink in color, it has many ridges and it is moist, without any lesion or malformation. - The soft palate is also concave and light pink in color, it is smooth and no lesions or malformations noted. -uvula normally looks like a flesh pendant hanging in the midline of soft palate. -tonsils is pink in color and smooth. Oval in shape. No discharge. Of normal size or not visible, no inflammation, and not swollen.There should be no pain felt during palpation. BREAST -The overlying the breast should be even. - May or may not be completely symmetrical at rest. - The areola is rounded or oval, with same color, (Color va,ies form light pink to dark brown depending on race). - Nipples are rounded, everted, same size and equal in color. -. No orange peel skin is noted which is present in edema. --The veins maybe visible but not engorge and prominent. - No obvious mass noted. - Not fixated and moves bilaterally when hands are abducted over the head, or is learning forward. - No retractions or dimpling. - No lumps or masses are palpable. -No tenderness upon palpation. - No discharges from the nipples. - Quiet, rhythmic, and effortless respirations. Breathing pattern should be smooth. Costal angle is less than 90, and the ribs insert into the spine at approximately a 45 angle. Normal rate of breathing in adult is 46/16 per min. red patches present, ribs sloping downward with symmetric interspaces. Colors should be even and consistent with the color of the patients face. Shoulder should be at the same height. -shape of thorax elliptical shapeIt should be full symmetric excursion; thumbs normally separate to 3-5 cm (1 to 2 in). Equal expansion, no tenderness, no masses, skin should be warm and dry, no pulsation should be present. Fremitus is normally decreased over heart and breast tissue. -Normal lung tissue-resonant sound, rib flat sound.Air brushing through the respiratory tract during inspiration expiration generates different breath sounds. - Bronchial (loud, tubular) breath sounds heard over trachea; expiration longer than

*TONSILLITIS

*BREAST CANCER *

THORAX

*LUNG CANCER *

inspiration; short silence between inspiration and expiration. -Alveolar Tube :Bronchovesicular breath sound heard over main stem bronchi: below clavicles and between scapulae (inspiratory phase equal to expiatory phase) -Lung Field: Vesicular (low, soft, breezy) breath sounds heard over lung periphery(inspiration longer than expiration).