Question: Select one of the following and conduct an assessment. Head Face Neck Skin Hair Nails You may c...
select one of the following and conduct an assessment.
You may conduct the assessment on a fellow student, friend, or family member. Remember to secure their permission.
Collect both subjective and objective data using the process described in the textbook.
Then, document your findings
An assessment in nursing is an on going process which will take place throughout the nursing process and will help the nurses to get direct contact with the patient as well as his true feelings towards his condition.
The assessment that I am going to do is on "skin" of my friend.
A prior permission has been secured from the person.
Subjective data: The person says; "My skin is very dry and irritating."
Objective data: On observation; person's skin looks dry and flaky.
Assessment:
Any changes in the skin can be due to the result of changes that occurs in an individual both externally as well as internally.
- before taking any physical assessment a brief health history of the patient should be collected from either the patient himself or from the family members. This may include:
a. Changes in the pigmentation was not present i.e., no colour change was present either to pale yellow colour or to red colour. Also the changes in the mole was not observed.
b. Presence of rashes and pruritis was not seen in the person's skin.
c. Asked about the person having any of the encounters of any kind of bruising or bleedings present over the skin as well as the moles (in order to eliminate clotting disorders or cancer). It was absent for the person.
d. Asked the person about any changes in the shape, size or colour in the mole or the nevi which was also absent.
e. Asked the person for the presence of any dryness or excessive sweating present over the palms as well as the other body parts (in cases such as endocrine disorders or tuberculosis). The person replied of having dryness over the skin from past few days.
f. Confirmed about any previous disease of the skin that might have occured to the person over the past years (such as psoriasis or eczema). It was absent in her.
Physical examination:
It is very important to note the appearance of the skin in order to identify the diseased skin with the healthy one.
The assessment starts with the general inspection leading to the detailed examination for more prominent results.
a. Colour of the skin: according to the person's race, the skin colour of the person was light brown.
b. Temperature: the person's skin temperature was warm which is normal (checked using back of the hand).
c. Skin turgority: skin turgority was checked by pinching the person's skin with a thumb and an index finger for few seconds, and the result was normal.
d. Moisture: the dryness of the skin was checked and the skin was dry which can be caused by using of irritating soap, over bathing or due to hypothyroidism.
e. Odour: no body odour was found.
f. Scars: absence of any kind of scars in the entire body.
g. Masses: no masses or tenderness over the skin was located.
h. Capillary refill: capillary refill was checked for presence of anemia. The finding was negative and the refill for the person was quick.
i. Nails: checked the mail bed colour which was pink in colour and the clubbing of finger was absent in the person.
j. Lesions: gently palpated over the skin to find the lesions on the person but it was not found.
k. Birthmarks or moles: both were identified and checked for any changes in shape, size and colour but it was negative.
Hence, the person was having the dryness over her skin which might be due to irritating soap or over bathing.
Question: Select one of the following and conduct an assessment. Head Face Neck Skin Hair Nails...
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