VITAL SIGNS & SKIN

EXAMINATION
ANPHY211 LABORATORY ACTIVITY #3
BSBSN 1ST Year 2ND Sem2021-2022
Dr. Sonnie P. Talavera
 VITAL SIGNS
ASSESSMENT
ANPHY
Physical
Assessment
page 2
BLOOD PRESSURE

PULSE RATE

RESPIRATORY RATE

BODY TEMEPRATURE
ANPHY
Physical
Assessment
page 3
Steps to Ensure Accurate Blood Pressure
Recordings
✓Ideally, ask the patient to avoid smoking or drinking
caffeinated beverages for 30 minutes before the blood
pressure is taken and to rest for at least 5 minutes.

✓Make sure the examining room is quiet and comfortably

warm.

✓Make sure the arm selected is free of clothing.

✓There should be no arteriovenous fistulas for dialysis,

scarring from prior brachial artery cutdowns, or signs of ANPHY
lymphedema (seen after axillary node dissection or radiation Physical
Assessment
therapy).
page 4
Steps to Ensure Accurate Blood Pressure
Recordings
✓Palpate the brachial artery to confirm that it has a viable
pulse.

✓Position the arm so that the brachial artery, at the antecubital

crease, is at heart level—roughly level with the 4th interspace
at its junction with the sternum.

✓If the patient is seated, rest the arm on a table a little above
the patient’s waist; if standing, try to support the patient’s arm
at the midchest level.
ANPHY
Physical
Assessment
page 5
Common or
Concerning Symptoms
✓Hair loss
✓Rash
✓Growths The Health History

ANPHY
Physical
Assessment
page 6
✓Skin cancers: types and
risk factors
Health Promotion and
✓Avoidance of excessive sun
exposure Counseling:

✓Counsel patients to avoid Evidence and

unnecessary sun exposure, Recommendations
tanning beds, and
sunlamps and to use ANPHY
sunscreen with at least Physical
Assessment
SPF-15. page 7
Teach the ABCDE screen for
dysplastic nevi/melanomas:

✓Asymmetry, Health Promotion and

✓irregular Borders
✓variation in Color
Counseling:
✓Diameter ≥6 mm
✓Evolution or change in size, Evidence and
symptoms, or morphology. Recommendations

ANPHY
Physical
Assessment
page 8
✓Survey skin at 3-year
intervals for patients 20 to
40 years of age and
annually for patients older
than 40 years. Health Promotion and
Counseling:
✓For those older than age 50
or with dysplastic nevi or
history of melanoma, Evidence and
encourage monthly self- Recommendations
examination and do regular
clinical screening.
ANPHY
Physical
Assessment
page 9
 SKIN

Examine the entire skin

surface under good lighting.

Inspect and palpate any

growths.
ANPHY
Physical
Assessment
page 10
SKIN EXAMINATION
NOTES POSSIBLE FINDINGS

Color Cyanosis, jaundice, carotenemia,

changes in melanin

Moisture Dry, oily

Temperature Cool, warm

Texture Smooth, rough

ANPHY
Physical
Assessment
page 11
SKIN EXAMINATION
NOTES POSSIBLE FINDINGS

Mobility—ease with which a fold Decreased if edema

of skin can be moved

Turgor—speed with which the Decreased if dehydration

fold returns into place

ANPHY
Physical
Assessment
page 12
SKIN EXAMINATION
Note Lesions and their: POSSIBLE FINDINGS

Anatomical location and Generalized, localized

Distribution

Patterns and shapes Linear, clustered, dermatomal

Type Macule, papule, pustule, bulla, tumor

Color Red, white, brown, heliotrope

ANPHY
Physical
Assessment
page 13
Brown:
✓Increased melanin (greater than a
person’s genetic norm)
✓ Sun exposure
✓ Pregnancy (melasma)
✓ Addison’s disease
Blue (cyanosis):
✓Increased deoxyhemoglobin from
hypoxia:
✓ Peripheral
✓ Central (arterial)
✓Anxiety or cold environment ANPHY
Physical
Assessment
✓Heart or lung disease page 14
Red:
Increased visibility of
oxyhemoglobin from:
✓ Dilated superficial blood vessels or
increased blood flow in skin
✓ Fever, blushing, alcohol intake,
local inflammation
✓ Cold exposure (e.g., cold ears)

Yellow:
✓Increased bilirubin of jaundice
(sclera looks yellow)
✓ Liver disease, hemolysis of red ANPHY
Physical
blood cells Assessment
page 15
Pale:
✓Decreased melanin
✓ Decreased blood flow to skin
✓ Decreased amount of
oxyhemoglobin
✓Edema
✓Albinism, vitiligo, tinea
versicolor
✓Syncope or shock
✓Anemia
ANPHY
Physical
Assessment
page 16
Flat, Nonpalpable Lesions With
Changes in Skin Color

Macule

✓Small flat spot, up to 1.0 cm

✓Examples: Hemangioma,
Vitiligo, Measles

ANPHY
Physical
Assessment
page 17
Papule
✓Up to 1.0 cm
✓Example: An elevated nevus

Patch
✓Flat spot, 1.0 cm or larger
✓Example: Café-au-lait spot
ANPHY
Physical
Assessment
page 18
Cyst
✓Nodule filled with
expressible material, either
liquid or semisolid
✓Example: Epidermal
inclusion cyst

Wheal
✓A somewhat irregular,
relatively transient,
superficial area of localized ANPHY
skin edema Physical
Assessment
page 19
Plaque
✓Elevated superficial lesion
✓1.0 cm or larger, often
formed by coalescence of
papules
✓Example: Psoriasis

Nodule
✓Knot-like lesion larger than
0.5 cm, deeper and more
firm than a papule ANPHY
Physical
✓Example: Leprosy nodule Assessment
page 20
Vesicle
✓Up to 1.0 cm; filled with
serous fluid
✓Example: Herpes
simplex,Herpes zoster

Bulla
✓1.0 cm or larger; filled
with serous fluid
✓Example: Insect bit,
Burn

Pustule ANPHY
Physical
✓Filled with pus (yellow Assessment
page 21
Excoriation
✓Linear or punctate erosions caused by
scratching
✓Example: Cat scratches

Fissure
✓A linear crack in the skin, often
resulting from excessive dryness
✓Example: Athlete’s foot

Ulcer ANPHY
✓A deeper loss of epidermis and Physical
Assessment
page 22
Scars
✓Increased connective tissue
that arises from injury or
disease
✓Example: Hypertrophic scar
from steroid injections

Keloids
✓Hypertrophic scarring that
extends beyond the borders of
the initiating injury ANPHY
✓Example: Keloid—ear lobe
Physical
Assessment
page 23
Crust
✓The dried residue of skin
exudates such as serum,
pus, or blood
✓Example: Impetigo

Lichenification
✓Visible and palpable
thickening of the epidermis
and roughening of the skin
with increased visibility of ANPHY
the normal skin furrows Physical
Assessment
(often from chronic rubbing) page 24
Scale
✓A thin flake of dead,
exfoliated epidermis
✓Example: Ichthyosis
vulgaris, Dry skin

ANPHY
Physical
Assessment
page 25
Cherry Angioma
✓Bright or ruby red, may
become purplish with age; 1–
3 mm; round, flat,
sometimes raised;may be
surrounded by a pale halo
✓Found on trunk or
extremities
Spider Angioma
✓Fiery red; very small to 2
cm; central body, sometimes
raised, radiating with ANPHY
Physical
erythema Assessment
page 26
Ecchymosis
✓Purple or purplish blue,
fading to green, yellow, and
brown over time; larger than
petechiae;
✓bruising or trauma; bleeding
disorders

Petechia/Purpura
✓Deep red or reddish purple;
fades over time; 1–3 mm or ANPHY
larger; rounded, Physical
Assessment
page 27
Squamous Cell Carcinoma
✓sun-exposed skin of fair-
skinned adults > 60 years
✓develop in an actinic
keratosis
✓firmer, and looks redder
✓Face and the dorsum of the
hand are often affected.

ANPHY
Physical
Assessment
page 28
Basal Cell Carcinoma
✓malignant, grows slowly
✓never metastasizes.
✓Most common in fair-
skinned adults >40 years
,face
✓Initial translucentred
macule or papule may
develop a depressed center
and firm elevated border.
ANPHY
Physical
Assessment
page 29
NEVI MALIGNANT
✓Diameter <6 mm MELANOMA
✓Symmetric; ✓Asymmetric
regular borders;
even in color

✓Borders irregular

✓Color varied
ANPHY
✓Diameter >6 mm Physical
Assessment
page 30
SKIN, NAILS, AND HAIR
EXAMINATION
Lorem ipsum dolor sit amet, ANPHY
consectetur adipiscing elit. Physical
Assessment
page 31
HAIR EXAMINATION
NOTE POSSIBLE FINDINGS
Inspect and palpate the hair.

Quantity Thin, thick

Distribution Patchy or total alopecia

Texture Fine, coarse

ANPHY
Physical
Assessment
page 32
NAIL EXAMINATION
NOTE POSSIBLE FINDINGS
Inspect and palpate the fingernails
and toenails.

Color Cyanosis, pallor

Shapes Clubbing

Any lesions Paronychia, onycholysis

ANPHY
Physical
Assessment
page 33
Alopecia Areata
Clearly demarcated round
or oval patches of hair loss,
usually affecting young
adults and children. There is
no visible scaling or
inflammation.

ANPHY
Physical
Assessment
page 34
Tinea Capitis (“Ringworm”)
Round scaling patches of alopecia.
Hairs are broken off close to the
surface of the scalp. Usually
caused by fungal infection from
Trichophyton tonsurans from
humans, microsporum canis from
dogs or cats. Mimics seborrheic
dermatitis.

ANPHY
Physical
Assessment
page 35
Clubbing
Paronychia
✓Dorsal phalanx rounded and
✓Inflammation of proximal
bulbous; convexity of nail
and lateral nail folds, acute
plate increased. Angle
or chronic. Folds red,
between plate and proximal
swollen,may be tender
nail fold increased to 180° or
more. Proximal nail folds
feel spongy. Onycholysis
✓chronic hypoxia and lung ✓Painless separation of nail
cancer. plate from nail bed, starting
distally. Many causes.

ANPHY
Physical
Assessment
page 36
Recording Your Findings

“Color pink. Skin warm

and moist. Nails without Recording the Physical
clubbing or cyanosis. No Examination
suspicious nevi, rash,
petechiae, or The Skin
ecchymoses.”

ANPHY
Physical
Assessment
page 37
✓Submitted by pair (you
work as a group to
improve on your report…,
help each other)

VITAL SIGNS
✓Any household member
or self
REPORT
SKIN EXAM
✓But it is self examination
(patient is your self) ANPHY
Physical
✓You can include picture of Assessment
page 38
LEARNING

ANPHY
Physical
Assessment
page 39
✓Learn how to perform
vital signs

✓Learn how to do skin

examination
LEARNING

ANPHY
Physical
Assessment
page 40
Thank You
Dr. Sonnie P. Talavera

09272292700
drjohntalavera @gmail.com
ANPHY
olfuac.hwc Physical
Assessment
page 41