N522PE Module Two: HEENT and Skin Assessment Discussion 2

As the largest part of the integumentary system, the skin has up to seven layers of ectodermal tissues, and it is responsible for protecting the underlying bones, muscles, ligament, and the internal organs (Bickley, 2017).  Skin serves a lot of purposes for the body such as protector, thermometer, waste disposal (sweat gland), production of Vit D, and as a sensor. It has the tendency of changing and adapting. It plays a very vital role in protecting the body against any pathogen and excessive fluid loss. Any damage to the skin will heal itself causing some scars or discoloration (Bickley, 2017). Skin can tell a thousand words, with a thorough assessment and clinical reasoning, an advanced nurse can draw a conclusion when a patient is dehydrated, malnourished, have hygiene problem or infectious skin diseases.  An article from Healthline mentioned that alterations to the body at a cellular level can lead to rash when there are some environmental changes or the skin comes in contact with bacteria or some harsh irritants.  The rash comes in different shapes and forms, it can be itchy, painful, irritating, red, ashy, blisters, patches, bumpy, and so on (Luo, 2018).

 Classification of Rashes

Atopic dermatitis appears in patches to body parts like feet, hands, ankle, neck, and upper body areas. Pityriasis rosea:  spread in small patches to a body part like chest area, back, and neck. Contact dermatitis: Produces a dry, scaly, and non-itching rash. Allergic contact dermatitis:  comes with a very itchy, red rash with a bump and blisters. Drug rash: This occurs because of a drug side effect, at times it can be severe and might require emergency care. Heat rash: caused by obstruction of body sweats, comes with red bumps, appears in small clusters. Intertrigo:  inflammation caused by skin to skin friction, grows in a warm moist area like skin folds around the abdomen, under the breast, and groin areas. Ringworms (tinea corporis):  caused by a fungus infection, slightly raised, red, scaly, itchy, and in circular like a ring that grows outward with the middle part less infected. Rosacea:  This type is a chronic skin disease that occurs in adults, causing small, red, pus-filled bumps on the face. Psoriasis:  Caused by an increase in the rapid life cycle of skin cells. Affected areas form a thick, silvery, scales red patches, that are very itchy and painful at times.

 Skin Lesions  

Macules, Patches, Plaques, Nodules, Vesicles, Bulla, Cysts, Pustules, Urticaria, Wheals or Hives, and telangiectasia (Benedetti, 2019).

Additional Resources in HEENT that I found beneficial.

As I Struggling this week with Shadow Health Digital Clinical Experience, on HEENT, the activity brought back old memories when I was working at the medical-surgical unit where we conduct a head to toe assessment on more than one patient per shift. Unlike my current job where the nurses are so guarded during an assessment. We must be careful how we touch our patients because some patients are delusional and paranoid, they might term it sexual harassment. No palpation of any body part such as scalp, sinus, carotid arteries, jaw, lymph nodes, and thyroid glands for assessment of abnormalities as I did with Ms. Tina Jones on the HEENT. Because most of the patients have a history of sexual abuse and might think the nurse is about to take advantage of them, so all the detailed assessments are done by the doctors at the clinic. Therefore, this week‘s DCE was very refreshing, it reminded me how those activities are being done and how to hold and position those instruments such as ophthalmoscope, penlight, otoscope, and audiometry, Rinne test, whisper test. Air conduction vs Bone conduction, evaluation of hearing loss, and what TMJ stands for.

The concept that I had difficulty with:

Remembering to click the Empathy and Education button when talking to Ms. Tina Jones was frustrating to me for a while. I kept forgetting to use it or to click the button when doing it. Right now, am getting the grip of it, after missing it several times. I made a little note on my desktop computer with Red and Green color that says, Empathy or Educate

 

                                                          Reference

Benedetti, J. (2019). Description of Skin Lesions. Retrieved from:

            https://www.merckmanuals.com/professional/dermatologic-disorders/approach-to-the

            -dermatologic-patient/description-of-skin-lesions

Bickley, L . ( 2017). Bates’s guide to physical examination and history taking (12^th ed.).

            Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins

Luo, E.K. (2018). Rash. Retrieved from: https://www.healthline.com/health/rashes

Mayo Clinic (2020), Common Skin Rashes. Retrieved from: https://www.mayoclinic.org/skin- 

            -rash/s/s-20077087?s=8

Mayo Clinic, (2020). Acanthosis nigricans. Retrieved from:  https://www.mayoclinic.org/disease-conditions/acanthosis-nigricans/symptoms-causes/syc-

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