CANAZARES, CHARIEMAE
HEALTH ASSESSMENT
Choose 10 of the skin disorders mentioned in the presentation, make a table describing each of them and the possible subjective data
that a client with the disorder might give.
Skin Disorders/ Abnormal Description
Findings
1. Chickenpox (Vesicles) Chickenpox is an example of skin rash with
vesicles that can be characterized with
circumscribed, elevated, and palpable mass
containing serous fluid. The vesicles that can be
found in chickenpox have sizes that can be
estimated to less than 0.5 cm.
Chickenpox is an infection caused by the
varicella-zoster virus, which is the virus that causes
the itchy rash with small, fluid-filled blisters, which
are identified as vesicles. These blisters are called
as vesicles because they are smaller, with a size less
than 0.5 cm, compared to a bulla, which has a size
that can be estimated to more than 0.5 cm
[ CITATION May19 \l 13321 ].
The varicella zoster virus, the same virus that
causes chickenpox, can reactivate and cause Herpes
Zoster. Primary infected with the virus causes
chickenpox (varicella) and once the illness resolves,
the virus remains latent in the dorsal root ganglia.
Today, a vaccine is available that protects children
against chickenpox. Routine vaccination is
recommended by the Centers for Disease Control
and Prevention (CDC)[ CITATION Cen20 \l 13321
]).
FEBRUARY 22, 2021
BSN-1A
Possible Subjective Data
Subjective data would include reports of
the client such as being febrile. The client may
also report that he/she is experiencing
headache, tiredness, and in a state of malaise.
The client may also add that he/she is
experiencing loss of appetite [ CITATION
May19 \l 13321 ].
The client may be experiencing
uncomfortable itchiness all over the body,
specifically in specific areas where the rash can
be found. Subjective data may also depend
whether the client is a child or already an adult.
More often, chickenpox among children before
10 is milder than chickenpox among adults.
[ CITATION Mar18 \l 13321 ].
 The chickenpox vaccine is a safe, effective
way to prevent chickenpox and its possible
complications.

2. Cyanosis Cyanosis is a pathologic condition that is Patients or clients observed with

characterized by a bluish hue discoloration of the
skin or mucous membrane[ CITATION Kon20 \l
13321 ]. Cyanosis can be divided into to main
categories. It can be either categorized as central
cyanosis or peripheral cyanosis [ CITATION
Wik20 \l 13321 ].
Central Cyanosis is due to a circulatory or
ventilatory problem that leads to poor oxygenation
in the lungs. It is developed when the arterial
oxygen saturation drops below 85% or 75%.
Furthermore, central cyanosis may cause problems
in central nervous system, respiratory system,
cardiovascular diseases, and problems in the blood.
On the other hand, peripheral cyanosis is the blue
tint found in fingers and the extremities due to an
inadequate or obstructed circulation. This occurs
when the blood is directed to the central vital organs
to increase perfusion and can occur with the
absence of heart or lung failures. However, all
factors contributing to central cyanosis can also
cause peripheral symptoms to appear. Peripheral
cyanosis include the common causes of central
cyanosis, reduced cardiac output, cold exposure,
COPD, arterial obstruction, and venous obstruction.
Aside central and peripheral cyanosis, differential
cyanosis also exists, which is the bluish
cyanosis may have complaints about hunger for
air or gasping for breath, being febrile, having
headaches, shortness of breath or breathing
difficulties, chest pain, sweating profusely, pain
or numbness in and pallor or blanching of the
arms, legs, hands, fingers, or toes, and dizziness
or fainting [ CITATION Mur19 \l 13321 ].
Furthermore, central nervous system,
respiratory system, cardiovascular system, and
blood diseases may also be reported in the
client’s history of present health concern, past
health history, and family health history.
Furthermore, this can also be indicated in the
client’s lifestyle and health practices, such as
smoking or traveling to cold and high-altitude
places.
 discoloration of only the lower extremities.
Differential cyanosis can be found among patients
with a ductus arteriosus [ CITATION Wik20 \l 13321
].
3. Erythema Erythema is a skin rash, characterized by
redness of the skin, caused by injured or inflamed
blood capillaries. Erythema occurs due to a drug,
disease, skin injury and inflammation, or infection.
Its severity can range from mild to life threatening.
There are several types of erythema, and it can
appear on all parts of the body in different patterns
and variations of color such as red, purple or brown.
Some forms of the rash may cause blisters that burst
and lead to sores [ CITATION Lla20 \l 1033 ].
Erythema multiforme (EM) is the most
common type of erythema. Viral and bacterial
infections cause it. Two of the most common causes
are Herpes simplex virus (HSV) type 1 and 2 and
Mycoplasma pneumoniae infections. EM can be
divided into two types [ CITATION Lla20 \l 1033 ].
Erythema multiforme minor (EM minor)
typically occurs on the peripheral parts of the body,
such as the fingers and toes. Rarely, it may manifest
as light mouth sores, however, clears up on its own.
Erythema multiforme major (EM major)
skin lesions are more extensive and serious. These
are more likely to be caused by a drug reaction than
an infection. For this reason, EM major may also be
known as Stevens-Johnson Syndrome (SJS), a
potentially life-threatening skin rash caused by a
medication.
The symptoms of erythema range
from mild to severe. Patients observed with
erythema may have reports of physical violence
or abuse, accidents, taking medications or other
drugs, or has diseases, such as respiratory and
immune diseases. Furthermore, patients may
have complaints such as flushing or hotness for
having high temperature. experiencing
headache and generally feeling unwell. The
patient may also report painful sores, such as
sores that can be found in the mouth, which
hinder the patient’s ability to eat and drink, or
sores found on the genitals, which disrupt the
patient’s ability to void. The client may also
report about his/her sensitivity to light and
blurred vision, and this may be accompanied
with sore and red eyes. Furthermore, in
general, the patient may also have reports and
complaints about the condition affecting his/her
psychosocial aspects and ADLs [ CITATION
NHS19 \l 1033 ].
 Unlike EM minor, EM major causes
extensive, blistering sores on the lips and in the
mouth. They can also appear on the eyes and
genitals.
4. Jaundice Jaundice is a condition in which the skin,
sclera, and mucous membranes turn yellow in hue.
The yellowish discoloration is caused by the high
level of bilirubin in the body, especially in the
blood. Bilirubin is the yellow-orange bile pigment.,
which is excreted by the liver. Bilirubin is formed
by the breakdown of red blood cells [ CITATION
Cle18 \l 1033 ]. Infants may experience jaundice
and this can be treated through feeding the infant
with milk so bilirubin can be excreted in the form of
feces. Furthermore, red blood cells in the body of an
infant are frequently broken down and replaced.
This causes the production of more bilirubin. Also,
the livers of infants are less developed and,
therefore, less effective at filtering bilirubin from
the body. Jaundice can happen to people of all ages
and is normally the result of an underlying
condition. Jaundice normally indicates a problem
with the liver or bile duct. Jaundice most often
happens as a result of an underlying disorder that
either causes the production of too much bilirubin
or prevents the liver from getting rid of it. Both of
these result in bilirubin being deposited in
tissues[ CITATION Ste17 \l 1033 ].
There are three main types of jaundice.
Hepatocellular jaundice occurs as a result of liver
disease or injury. Hemolytic jaundice occurs as a
Patients who have jaundice may report
certain diseases in their history of present
health concern and personal and family health
history. This may include Hepatitis A, B, and
C, hemolytic anemia, Gilbert’s syndrome,
Crigler-Najjar syndrome, and Dubin-Johnson
syndrome. It may also include cancer in the
liver or pancreas. It is also important to take
note on what medications the patient is taking
as mthe patient’s medication history may
associate to liver diseases. This may also
include other disorders, infection, and
inflammation of the liver or the gallbladder,
which blocks the hepatic duct. This can also be
shown on the nutritional pattern of the patients,
which indicates that jaundice is caused by the
excess of beta-carotene and not from an excess
of bilirubin [ CITATION Ste17 \l 1033 ]. The
patient may also report and have complaints
about the discoloration of his/her skin, for
having pale stools and darker urine, and
experiencing itchiness, which is already
affecting his/her activities in daily life at home
and within the society. Furthermore, there may
have other complaints such as fever, chills,
abdominal pain, and flu-like symptoms
[ CITATION Cle18 \l 1033 ].
 result of hemolysis, or an accelerated breakdown of
red blood cells, leading to an increase in production
of bilirubin. Obstructive jaundice occurs as a result
of an obstruction in the bile duct, which prevents
bilirubin from leaving the liver [ CITATION Ste17 \l
1033 ].
5. Lichenification (ex. Lichenifaction is the thickening and
Contact Dermatitis) roughening of the skin, which may be secondary to
repeated rubbing, irritation, and scratching, such as
contact dermatitis [ CITATION Red16 \l 1033 ].
When a wound or an area of skin itself is
continually scratched or is rubbed for a prolonged
period of time, the skin cells begin to grow, which
leads to the thickening of the skin and an
exaggeration of normal skin markings, such as
cracks, wrinkles, or scales that gives the skin a
leathery or bark-like appearance [ CITATION
Sul19 \l 1033 ].
Lichen simplex chronicus, which is also
known as neurodermatitis, is a patch of skin that’s
been lichenificated. Lichen simplex isn’t a primary
condition or disease, but rather a result of some
underlying causes [ CITATION Sul19 \l 1033 ]
The underlying cause is typically severe,
chronic (long-term) itching, but is sometimes
related to trauma to the skin, or severe anxiety or
obsessive-compulsive behavior such as scratching
or rubbing the skin over long periods of time
[ CITATION Sul19 \l 1033 ].
There can be various of underlying
causes that can be associated to lichenification,
which can also be shown in the subjective data
of the client. Patient may have complaints such
as excessive and uncomfortable itchiness,
which disrupts the client’s sleep-rest pattern. In
the history of present health concern, and
personal and family health history of the client,
the client may report about having allergies,
anxiety and stress disorders, obsessive
compulsive disorders, or skin disorders, such as
eczema and psoriasis. Furthermore, aside form
itchiness, this may also be characterized by the
client as tender and painful, such as among
those experiencing contact dermatitis. This is
also evident on clients who experienced skin
traumas, which can be seen in the subjective
data of clients with reports regarding violence,
abuse, or accidents. Furthermore, among clients
with dry skins, this might be common among
clients with renal diseases or those who are
experiencing dehydration [ CITATION Sul19 \l
1033 ].
6. Pallor Pallor, also known as paleness or having
pale complexion, is the unusual lightness of skin
color when compared to normal complexion. Pallor
is a condition that is caused by either reduced blood
flow and oxygen or by a decreased number of red
blood cells. Pallor can be all over the skin or more
localized [ CITATION Big19 \l 1033 ].
It is the pale color of the skin caused by
illness, emotional shock or stress, stimulant use,
or anemia. It is the result of a reduced amount
of oxyhemoglobin and may also be visible as pallor
of the conjunctivae of the eyes on physical
examination.
Pallor is more evident on
the face and palms. It can develop suddenly or
gradually, which depends on the cause. It is not
usually clinically significant unless it is
accompanied by a general pallor, such as
pale lips, tongue, palms, mouth, and other regions
with mucous membranes. It is distinguished from
similar presentations such as hypopigmentation,
whether lack or loss of skin pigment, or simply a
fair complexion [CITATION Wik \l 1033 ].
In regards to the patient’s personal
and family health history, it may include
genetic disorders such as hypothyroidism,
leukemia, anemia, albinism, and vitiligo.
Furthermore, this can include other types of
cancer reported by the patient. Furthermore, in
the patient’s subjective data, the patient may
report about his/her emotions, such as in fear,
embarrassed, or in extreme grief. This may also
include physiologic shock or trauma caused by
an injury or illness. This may also include
respiratory, cardiovascular, and peripheral
vascular diseases. In this state, the patient may
either be bradycardic or tachycardic.
Furthermore, mental and emotional disorders
may also be involved, such as panic attack and
anorexia. This can also include the patient’s
nutritional pattern, sleep-rest pattern, lifestyle
and health practices, or simply the ethnicity and
the address of the patient. Nutritional pattern
may indicate diet that resulted to iron and
Vitamin D deficiency, which can also associate
to other musculoskeletal disorders, such as
osteoporosis and fibromyalgia. Furthermore,
the patient may be experiencing loss of appetite
and is hypoglycemic. The patient may also be
dehydrated as pallor is also associated do
dehydration and hypovolemia. In the patient’s
sleep-rest pattern, the patient may be also sleep
deprived. This may also be indicated from the
patient’s medication history and substances
used by the patient, such as cannabis. In the
patient’s lifestyle and health practices, the

7. Pemphigus (Bulla) Pemphigus is a rare skin disorder that
causes large pus-filled blisters and sores,
categorized as bulla, on the skin or mucous
membranes, such as in the mouth or on the genitals
[ CITATION May20 \l 1033 ].
Pemphigus can occur at any age, but is
most often seen in people who are middle-aged or
older. It tends to be a long-lasting (chronic)
condition, and some types can be life-threatening if
left untreated.
Pemphigus is an autoimmune disorder
that can occur in otherwise healthy people. It is
sometimes confused with other autoimmune
blistering skin diseases such as bullous
pemphigoid, lupus erythematosus, and Hailey-
Hailey disease. Physicians identify pemphigus in
different types based on where and why blisters
developed. Pemphigus vulgaris s is the most
common in the U.S. Blisters essentially always
affect the mouth. Some affected people may also
form blisters on the skin and in other mucous
patient may not be active and has less exposure
from sunlight. This may relate to the external
environment of the patient as well and to what
substances the patient is exposed to, such as
chemicals causing lead poisoning [ CITATION
Wik \l 1033 ].
The patient may be also complaining
from palpitation, chest pain, shortness of
breath, low blood pressure, and dizziness or
loss of consciousness [ CITATION Big19 \l 1033
].
Since Pemphigus is highly rare and is more
common in specific age, race, and ethnicity, the
biographical data plays an important role within
the patient’s subjective data. People who are at
risk of developing pemphigus are those who are
aging from 40-60 years old, from southeast
Europe, India, or the middle east, and of those
who are of Jewish decent. Furthermore, this
may also include the personal and family health
history of the client. The previous surgeries,
medication, and accidents of the client must be
noted as pemphigus can be caused by an
autoimmune reaction to certain medications,
including penicillin, an antibiotic,
and piroxicam, a nonsteroidal anti-
inflammatory drug used for rheumatoid arthritis
[ CITATION Cle19 \l 1033 ].
Clients suspected with pemphigus may
have complaints, such as having painful,
burning, and itchy pus-filled blisters on the skin
[ CITATION Cle19 \l 1033 ]. Furthermore, for
 membranes. These lesions develop in deep layers of undiagnosed clients, they may be experiencing
the skin. They can be painful and slow to heal. malnutrition, from the difficulty in eating, and
Pemphigus vegetans is related to pemphigus infection of the skin. They may also have
vulgaris. It involves lesions that are thicker and reports and complaints regarding difficulty in
wart-like. These lesions usually form in the areas of performing and achieving their activities of
the body with skin folds such as the groin and daily living (ADLs) and disrupts the social
armpit. Drug-induced pemphigus are medication- client’s role and responsibilities and quality of
caused blistering. Some drugs that may cause this life.
condition include penicillin and piroxicam. Blisters
can develop up to six months after taking the
offending medicine. Pemphigus erythematosus
(Senear-Usher syndrome involves blisters that
develop on the upper back, chest, cheeks, and scalp.
When lesions form, they are usually red and crusty.
Pemphigus foliaceus is when blisters develop on the
scalp and often the face, neck, and back. Lesions
rarely appear in the mouth with pemphigus
foliaceus. This type of pemphigus affects the
outermost skin layer only. Small blisters may break
easily to form crusted lesions that spread to cover
large areas of skin [ CITATION Cle19 \l 1033 ].

8. Psoriasis (Scales and Psoriasis is a skin disorder that causes skin
Plaques) cells to multiply up to 10 times faster than normal,
which makes the skin build up into bumpy red
patches covered with white scales. They can grow
anywhere, but most appear on the scalp, elbows,
knees, and lower back. Psoriasis can't be passed from
person to person, however, can happen in members of
the same family. Psoriasis is characterized by scales
and plaques on the skin, which can be painful and
Psoriasis is an autoimmune disorder;
therefore, it can run down families. In this case,
it is important to note the client’s personal and
family health history. Patients with psoriasis
have frequent reports or complaints of
tenderness, soreness, and pain, which affects
their daily life. Since psoriasis is an
autoimmune disorder, it can be related to stress.
It is important to determine the patterns, and
itchy [ CITATION Jal19 \l 1033 ]. lifestyle and health practices of the client to
Psoriasis can be characterized into three determine whether the client is constantly
different symptoms. Psoriasis can be plaques of red exposed to stress. Including in the client
skin, often covered with silver-colored scales, which lifestyle and health practices and substance use
may be itchy and painful, and they sometimes crack is smoking, which can also cause psoriasis.
and bleed. In severe cases, the plaques will grow and Clients with cardiovascular diseases,
merge, covering large areas. It may also include autoimmune diseases, diabetes, obesity, and
disorders of the fingernails and toenails, including mental health conditions, such as low self-
discoloration and pitting of the nails. The nails may esteem and depression, are at higher risk of
also crumble or detach from the nail bed. Lastly, there psoriasis [ CITATION May201 \l 1033 ].
can be found plaques of scales or crust on the scalp. Furthermore, the client may be constantly
People with psoriasis can also get a type of arthritis complaining of panful, sore, and swelling skin
called psoriatic arthritis. It causes pain and swelling in or joints, which hinder their mobility, physical
the joints. The National Psoriasis Foundation and psychosocial wellbeing, and social roles
estimates that between 10% to 30% of people with and responsibilities. Reports may also include
psoriasis also have psoriatic arthritis. [ CITATION uncomfortable itching, burning, and soreness.
Jal19 \l 1033 ].
There are different types of psoriasis.
Plaque psoriasis is the most common form,
plaque psoriasis causes dry, raised, red skin patches
(lesions) covered with silvery scales. The plaques
might be itchy or tender, and there may be few or
many. They usually appear on elbows, knees, lower
back and scalp.
Psoriasis can affect fingernails and toenails,
causing pitting, abnormal nail growth and
discoloration. Psoriatic nails might loosen and
separate from the nail bed (onycholysis). Severe
cases may cause the nail to crumble.
Guttate psoriasis primarily affects young
adults and children. It's usually triggered by a
bacterial infection such as strep throat. It's marked
by small, drop-shaped, scaling lesions on the trunk,
 arms or legs.
Inverse psoriasis affects the skin folds of the
groin, buttocks and breasts. Inverse psoriasis causes
smooth patches of red skin that worsen with friction
and sweating. Fungal infections may trigger this
type of psoriasis.
Pustular psoriasis causes clearly defined pus-
filled lesions that occur in widespread patches
(generalized pustular psoriasis) or in smaller areas
on the palms of the hands or the soles of the feet.
Erythrodermic psoriasis is the least common
type of psoriasis, erythrodermic psoriasis can cover
your entire body with a red, peeling rash that can
itch or burn intensely.
Psoriatic arthritis causes swollen, painful
joints that are typical of arthritis. Sometimes the
joint symptoms are the first or only symptom or
sign of psoriasis. And at times only nail changes are
seen. Symptoms range from mild to severe, and
psoriatic arthritis can affect any joint. It can cause
stiffness and progressive joint damage that in the
most serious cases may lead to permanent joint
damage [ CITATION May201 \l 1033 ].

9. Skin Ulcer Subjective data should include the

A skin ulcer is an open sore caused by poor
blood circulation. Good blood flow is necessary for
wound healing, however, if a person has blood
circulation problems, minor injuries can’t heal
biographical data of the patient, especially the
age of the patient as age is highly associated to
the ability of the wounds to heal. This also need
to include personal and family health history
which include reports regarding conditions and

properly and can turn into a skin ulcer over time.
Infected skin ulcers are serious as the infection can
spread throughout the body. Skin ulcers are evident
and common among diabetics and older people.
Symptoms, treatment, and recovery will depend on
the specific cause of the skin ulcer.
Specifically, there are four different types
of skin ulcers. Decubitus or pressure ulcers are
caused by the continuous pressure or friction on the
skin. These ulcers can develop on body areas where
there is extra pressure on the skin between the bone
and on the surface to which the skin is lying on.
Venous skin ulcers are caused by poor blood
circulation in the leg veins, which are usually
between the knee and the ankle. Arterial skin ulcers
or ischemic ulcers are ulcers that occurred when
blocked arteries cause poor blood flow. These types
of ulcers are characterized by extreme pain, which
might get worse at night or when legs aren’t
moving. Neuropathic skin ulcers are caused by
nerve damage and narrow arteries. These are also
known as diabetic foot ulcers, and because there is
nerve damage, oftentimes, there is no longer
sensation of pain in this kind of ulcers [ CITATION
Cob19 \l 1033 ].
10. Skin Cancer (Tumor) Skin cancer is the abnormal growth of skin
diseases such as skin cancer or cancers of the
head, neck, genital areas, mouth, and breasts,
diabetes, high blood pressure, nerve damage
(neuropathy, which may be due to accidents or
other illnesses, poor circulation, vascular and
cardiovascular diseases, and lymphedema. This
also include previous accidents or surgeries that
might have caused skin infections which are
left untreated. This also needs to include the
nutrition patterns, such as obesity, sleep-rest
patterns, nutritional patterns, substance use,
such as smoking, and lifestyle and health
practices, such as exposure to the sun and how
mobile the person is, whether he/she is too
sedentary or not. Ulcers are most common on
people who are less mobile and who are
bedridden. Symptoms vary among individuals
depending on the type of skin ulcer they have.
If nerve damage is involved, less or no pain is
felt, however, this can be more itchy than
painful. Some ulcers are very painful, while
others are itchy, tender and painful at the same
time. Clients may also complaint about
bleeding, uncomfortable discharge, and smell
of their ulcers. Furthermore, chronic ulcers can
cause psychological problems, such as low
mood, depression, anxiety, low self-esteem,
loss of mobility and being unable to perform
and fulfil social roles and responsibilities, thus,
not being able to perform ADLs. [ CITATION
Cob19 \l 1033 ].
The subjective data of the patient plays
cells, which most often develops on skin exposed to
the sun. However, this common form of cancer can
also occur on areas of your skin not ordinarily
exposed to sunlight and can run through families.
There are three major types of skin cancer: basal
cell carcinoma, squamous cell carcinoma, and
melanoma. Skin cancer can be characterized as a
tumor with elevated, palpable, and solid mass that
extends deeper into the dermis than a papule with 1-
2 cm size.
 Basal cell carcinoma is the most common;
squamous cell carcinoma is the second most
common, which originate from skin cells, and
melanoma, which originates from the pigment-
producing skin cells (melanocytes) but is less
common, though more dangerous, than the first two
varieties. Other rare forms of skin
cancer include lymphomas, Merkel cell cancers,
and cancers of other tissue in the skin, including
sarcomas as well as hair and sweat gland tumors.
Skin cancer develops primarily on areas of
sun-exposed skin, including the scalp, face, lips,
ears, neck, chest, arms and hands, and on the legs in
women. It can also form on areas that rarely see the
light of day, such as the palms, beneath the
fingernails or toenails, and the genital area.
Skin cancer affects people of all skin
tones, including those with darker complexions.
When melanoma occurs in people with dark skin
tones, it's more likely to occur in areas not normally
exposed to the sun, such as the palms of the hands
and soles of the feet [ CITATION May202 \l 1033 ].
an important role in determining skin cancer. In
the patient’s biographic data, the patient’s age,
address, gender, ethnicity, race, occupation and
cultural background should be noted. Race with
fairer skin is more prone to skin cancers, clients
who reside in hotter areas and who have jobs
that requires more sun exposure are more prone
to having skin cancer. Personal and family
health history also play an important role in this
aspect. Skin cancers may reoccur after 2 years
of being treated and healed. Skin cancers also
run-in families, therefore, it is important to note
which families had or have skin cancer.
Furthermore, autoimmune diseases also need to
be noted as people with these diseases are more
prone to any type of cancer, such as skin cancer
itself. The client’s lifestyle also needs to be
noted, whether the client is more indulged to
activities that require much sun exposure as
well. In this aspect, history of sunburns must be
noted. In the client’s environmental
background, exposure to radiation and certain
substances at home, at work, or within the
community should also be noted [ CITATION
May202 \l 1033 ].
In skin cancers, clients usually do not
feel ill. Therefore, in this case, complaints or
reports of clients are more associated on what
they have observed on the changes of their skin
or moles and how much they worry about the
changes they have observed from their own
skin and body. However, in most melanomas,
the client may have painful lesions that are
 itchy and burning. Furthermore, itchiness, pain,
tenderness, soreness, and bleeding may also
cause discomfort and become the client’s main
concern [ CITATION May202 \l 1033 ].

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