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Assessment


Basal Cell epithelioma

·         Mainly due to sun exposure.

 

BURNS

·         Rule of NINES: To determine the percentage of burn

 

 

In an adult who has been burned, the percent of the body involved can be calculated as follows: 

Head = 9%    Chest and abdomen = 18%

Upper/mid/low back and buttocks = 18%

Each arm = 9%      Groin = 1%     Each leg = 18%



 

·         Hypovolemia is a major issue for burn victims. To replace fluid loss, use the Parkland Formula (4ml x Wt in kilograms x % of burned body surface) to determine the amount of fluid needed to be replaced from a burnt victim.

·         Watch for stress ulcer, which can be evaluated by checking ph of stomach;  a decrease in

      ph is less acidic / or hydrogen ions are being released so predisposing one to stress ulcer

·         Wash burn with soap and water; don’t put oil over it since it can increase possibility of

      infection.

·         Sepsis is the major cause, post burn, so prevention of infection is a priority.

·         Muscle weakness and lethargy are signs of hypokalemia, which can occur on third day

      after burn; hypokalemia is caused by diuresis

·         Burns that occur around the face/neck area, be concerned of airway.

·         Use of silver nitrate dressings should be moistened with sterile water and dressing remains unchanged for at least 5 days before removal and replacement.

 

Carbon Monoxide Poisoning

·         Best determined by the cherry red color of the mucosal membrane.

 

CATARACT

·         As one ages. lenses lose moisture and density increases. Mydriatic, which dilates the pupil, are used for cataract patients to facilitate the removal of lens.

·         After removal of cataract, advise patient to avoid any type of bending that causes increase in intraocular pressure.

 

Ear

·         Hearing aids must be cleaned daily and kept in a warm place. Don’t use sharp objects to for cleaning

·         For a child, applying ear drops, one ought to pull the ear back and down.

·         For adults, apply ear drop by pulling ear back and up.

 

Eye

·         Detached retina can make a patient be sensitive to bright flashes and that the portion of visual field is dark.

·         Before applying eye drops, it would be good to clean the area with water first.

 

·         If more than one eye drop is to be given at the same time, allow about 5 minutes in   between the medications

·           Glaucoma – loss of peripheral vision, foggy vision, seeing halos, having pain; Patients undergoing open-angle glaucoma should avoid antihistamines since they cause the eye to dilate and prevent aqueous humor flow

                         - abnormal increase in Intraocular pressure (IOP) Use Miotics are used for glaucoma patients instead of Mydriatics. 

                         - normal IOP is 10-21 mmHg

 

·           Cataracts     – loss of acuity

                            - as one ages. Lenses lose moisture and density increases. Mydriatic, which dilates the pupil  are used for cataract patients to facilitate the removal of lens.

                            - After removal of cataract, advise patient to avoid any type of bending that causes increase in intraocular pressure. (normal IOP is 10-21 mmHg)

                     

·           Tonometry – measures pressure in the eye; for glaucoma

·           Flourescein angiography - measures circulation in the retina

·           If there is a metal object in eye good to cover both eyes to prevent the other from moving

 

Color BLindness

·         Difficulty distinguishing violets, blues and green

 

Detached retina

·         Veil like loss of visionre

 

            How to apply an eyedrop - Eye drop doesn’t have to be warmed. Before applying eyedrops, make sure eye is clear of any exudates.

                        1. Client should tilt head backwards and look upwards.

                        2. Lower eyelids should be pulled downwards to form a conjuctival sac where drop should be placed.

                        3. Apply pressure to inner canthus of eye (near the bridge of the nose) to prevent  systemic absorption of the eye drops and drainage in the nose and throat is minimized.

 

MOUTH

CARE - dont use glycerin, can cause dehydration and irritation; prefer to use 50/50 dilution of hydrogen peroxide and NS

 

NOSE

·         Never insert anything in the nose.

·         If there is bleeding, apply pressure at least 5-10 minute preferably with cold towel. If not working, one may need silver nitrate or Gelfoam.

·         Lean forward to prevent aspiration of blood. 

·         Do not apply pressure to the nose if the nose is deformed or clearly broken

·         Light should be able to penetrate the frontal and maxillary sinuses during assessment. If it does not, it may mean that the cavity is filled with fluid.  

 

 

Pressure Ulcer

Stage I

·         Non blanchable redness with tenderness and pain.

Stage II

·         Appears as a blister with redness. 

Stage III

·         Deep wound with muscle seen. Not deep enough for the bone to be seen.

Stage IV

·         Deep craterous wound. Bone can be seen.  


Skin Cancer (see Hematology section for other types of Cancer)

  • Encourage individuals to look for any change in size, color and shape of nodule on skin.

  • Exposure to sun is the main cause and light skin individuals are more at risk. So, encourage individuals to avoid exposure to sun usually from 10am to 3pm, the sun's peak and to use SPF (solar protection factor) containing sunscreens. Sunscreen should be reapplied after a swim or prolonged time under the sun.

  • Avoid tanning booths and encourage individuals to use hats

Main Types

  1. Basal cell carcinoma - the most coomon type of skin cancer but it rarely metastize but often reoccurs; appears small and waxy

  2. Squamous cell carcinoma - appears to be rough and scaly; May metastisixe.

  3. Malignant melanoma - color is irregular with irregular edges and it usually metastisize to bone, liver, spleen and lymph nodes. Common in 30-45 years old

 

 

Skin Turgor

·         Where is the best place to check skin turgor?  - Back of hand, abdomen, clavicle area

 

Sjogren Syndrome

·         An syndrome is an autoimmune disease characterized by the abnormal production of extra antibodies in the blood that are directed against various tissues of the body. This particular autoimmune illness causes inflammation in certain    glands of the body. For instance, inflammation of the glands that produce tears (lacrimal glands) leads to decreased water production for tears and eye dryness while inflammation of the glands that produce the saliva in the mouth      (salivary glands, including the parotid glands) leads to mouth dryness.

 

·         Sjogren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not    associated with another connective tissue disease is referred to as primary Sjogren's syndrome. Sjogren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjogren's

 

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