PHYSICAL ASSESSMENT

HAIR
⮚ thick, silky hair is evenly distributed and has a variable amount of body hair. There
are also no signs of infection and infestation observed.

ALOPECIA

Hair loss (alopecia) can affect just your scalp or your entire body, and it can be temporary or UNUSUAL HEAD SIZE OR SHAPE
permanent. It can be the result of heredity, hormonal changes, medical conditions or a 1. HYDROCEPHALUS
normal part of aging. - an excess accumulation of cerebrospinal fluid in the
Types ventricular system resulting in the enlargement of the
intracranial cavity.
1. Alopecia areata - excessively large head at birth that grows abnormally
This is one of the most commonly reported types of hair loss, rapid; usually associated with distended scalp veins,
referring to bald patches or spots on the scalp. widely separated cranial sutures, large and tense anterior fontanel and “sunset
eyes”.
2. Alopecia totalis
hair loss affecting the whole of the head, including eyelashes 2. MICROCEPHALY
and eyebrows.  - Head circumference >2 standard deviations
below the mean for age, sex, and gestation;
3. Alopecia universalis - reflects an abnormally small brain, common
relates to hair loss all over the body, meaning that the entire causes are intrauterine infections (e.g.,
epidermis is free from hair. It is the most severe form of herpes, rubella, syphilis), genetic defects,
alopecia areata, and as such is quite rare, occurring only in drug usage during pregnancy (especially
around 1 in 100,000 people. alcohol

HEAD
• Head: The head of the client is rounded; normocephalic and symmetrical. 3. MACROCEPHALY
- head circumference >2 standard deviations above the
• Skull: There are no nodules or masses and depressions when palpated. mean for age, sex and gestation
• Face: The face of the client appeared smooth and has uniform consistency and with - common causes are hydrocephalus, masses, increased
no presence of nodules or masses. intracranial pressure, skeletal dysplasias (osteogenesis
imperfecta)
4. Caput succedaneum SKIN
- refers to swelling, or edema, of an infant’s scalp that
SKIN DISORDERS
appears as a lump or bump on their head shortly after
delivery. 1. Allergy-Related Rashes

1. CONTACT DERMATITIS

⮚ when the skin has a reaction to something that it has come

into contact with. 80% of cases are caused by an irritant,
and 20% are caused by allergens. Contact dermatitis is the
most common dermatologic diagnosis.

5. Cephalohematoma
- a subperiosteal collection of blood in between the A. IRRITANT CONTACT DERMATITIS
pericranium/periosteum and the flat bone of the
⮚ is very common and often occurs from exposures to heavy metals, strong acids,
skull, usually unilateral and over a parietal bone.
rubbing alcohol, and certain ingredients in soaps and lotions. Patients often
complain of pain or burning with some itching.

⮚ The skin will typically look erythematous, dry, and irritated. There may be pustules
present as well

B. ALLERGIC CONTACT DERMATITIS,

⮚ common causes include nickel, black hair dye, topical medications, latex, and
6. Anencephaly various cosmetics and environmental exposures (like poison ivy or poison oak).
- condition that prevents the normal development of the brain and the bones of Allergic dermatitis tends to be itchier with less pain or burning. There may be
the skull. This condition results when a structure called the neural tube fails to vesicles present as well.
close during the first few weeks of embryonic development.

2. ALLERGIC URTICARIA

⮚ Urticaria or hives are itchy raised wheals that are often

erythematous or pale. They are often a response to an
allergy such as in anaphylaxis, but many cases of urticaria
are non-allergic and some are idiopathic

⮚ Allergic urticaria occur after contact with an allergen. These allergens can be in the
environment (like dust or pollen), in food (like nuts or dyes), and in medications like
with antibiotics. Urticaria can also occur after bug bites and stings.

3. ECZEMA
- also termed atopic dermatitis, is a chronic allergic-
related chronic skin condition which is very itchy.
- Ecezema involves very dry skin that is erythematous
with oozing and crusting, excoriation from scratching,
and eventual lichenification (when the skin becomes
thick and leathery).
- In adults, eczema skin rashes often occurs on skin flexures like the elbows and
behind the knees, on the face, neck, and hands, but can occur anywhere.
2. Autoimmune-Related Rashes
1. PSORIASIS
o a type of chronic autoimmune skin rash
condition. This is characterized by
erythematous flaking thick patches of skin.
They can be itchy and even burn
3. Viral Rashes
1. SHINGLES
⮚ also called Herpes zoster, occurs from reactivation
of inactive varicella virus within the body (the
chicken pox virus). Shingles almost always occurs in
adults and usually >50 years old.
• Pityriasis rosea starts as a herald patch which is a single oval-shaped
erythematous macule or patch on the trunk with central clearing. 1-2 weeks
later, a christmas tree pattern will appear on trunk with similar smaller lesions.
3. HAND-FOOT-MOUTH
⮚ Hand Foot and Mouth disease is a viral rash that occurs
due to the Coxsackie Virus A16 and some other
enteroviruses.
4. MEASLES
⮚ Measles, once nearly eradicated, has begun to
make a comeback, largely due to the growing Anti-
Vax movement.
⮚ The measles, caused by the morbillivirus, causes
150,000 deaths per year worldwide, usually in those
less than 5 years old.
⮚ The rash itself is an red-brown maculopapular rash
that starts 3-5 days after systemic symptoms of severe cough, nasal congestion, red
eyes, high fevers, and photophobia. 
⮚ The rash starts on the forehead and spreads to the face, neck, trunk, extremities. It
spreads to the palms and soles in 50% of patients. 
⮚ Koplik spots are small white spots with red halos in the mouth on the inside of the
cheeks that occur early in measles, which is very specific to measles.
4. Fungal Rashes

2. PITYRIASIS ROSEA 1. INTERTRIGO

• Pityriasis rosea is a self-limiting rash thought to be
⮚ an inflammation and infection of the skin folds, usually
secondary to viral infections. Skin rashes and
in obese individuals with diabetes. This is often a fungal
reactions secondary to viruses are termed viral
infection, but can have a bacterial component as well.
exanthems. This is often preceded by a viral
prodrome including headache, malaise, arthralgias,
and/or chills.
2. TINEA CORPORIS
⮚ also known as ringworm, is a fungal infection of the trunk or extremities. This is
spread via skin-to-skin contact with an infected individual or animal, but can also be
picked up by fomites. This is also common in athletes like wrestlers and in warm-
moist locker rooms where fungus likes to live.
⮚ Tinea corporis is a pruritic, round, erythematous or hyperpigmented, scaly patch
or plaque with a raised border. They can coalesce together as well. Pustules can
appear as well, although not as common.
5. Bacterial Rashes
1. CELLULITIS
⮚ a local bacterial skin infection. This starts as some
sort of breach to the skin barrier (small cut or
puncture), and subsequent infection of the skin and
surrounding soft tissue.
⮚ Cellulitis presents as localized erythema, edema,
pain, and warmth to touch. This often presents in a
unilateral leg, but can present anywhere on the
body.
⮚ Cellulitis may be associated with systemic symptoms such as fevers, chills, and
generalized malaise. Sometimes abscesses can form.
2. FOLLICULITIS
⮚ Folliculitis is a bacterial infection of the hair follicle,
usually caused by staph aureus.
⮚ This causes a tender, red, elevated papule/pustule.
These skin rashes can occur anywhere where hair follicles
are.
3. FURUNCLE & CARBUNCLE
• A furuncle is a larger painful infection of a hair
follicle which is deeper than folliculitis. Another
term for furuncle is a boil.
• A furuncle is a well-circumscribed painful
erythematous lesion which is full of purulent fluid.
This can extend into the dermis and soft tissue,
leading to skin abscess. These often occur in areas of friction such as the buttock,
axillae, extremities, breasts, etc.
6. Bite-Related Rashes
1. BED BUGS
⮚ Bed bugs inhabit typically houses and beds that are
somewhat unclean (very common in group homes and
homeless shelters). They feed on blood which causes a
local reaction in the skin.
2. FLEA BITES
⮚ Flea bites occur when fleas are transmitted from
animals to humans. This is usually due to infested
domesticated cats or dogs who transmit the fleas to
their owners.
3. SPIDER BITES
• Spider bites are actually pretty rare, as many spiders do
not have fangs strong enough to pierce human skin.
They also usually do not bite unless they are provoked
or about to be squished.
 ⮚ When there is a real spider bite – a papule, pustule, or wheal will appear. Two small
central fang marks can often be visualized in the center. The most common areas
are in the axillae, the waist, and the ankles/feet.
4. SCABIES
• Scabies is more common in children but can happen in
adults as well. It is also associated with poor hygiene and
crowded living conditions similar to bed bugs.
• Scabies is not exactly a bite, but rather an infestation of
the scabies mite into the patient’s skin where they
burrow and lay eggs, leaving behind nasty skin rashes.
• Scabies rash appears initially as tiny to small
erythematous papules, and will often form vesicles or pustules. They will often
present in lines as the mites burrow through the epidermis. This can be easily
noticeable in the web spaces of the fingers, wrists, and elbows.
• Scabies is very itchy as well, and itching may persist 2-6 weeks after treatment
Scabies is not exactly a bite, but rather an infestation of the scabies mite into the
patient’s skin where they burrow and lay eggs, leaving behind nasty skin rashes.
• Scabies rash appears initially as tiny to small erythematous papules, and will often
form vesicles or pustules. They will often present in lines as the mites burrow
through the epidermis. This can be easily noticeable in the web spaces of the
fingers, wrists, and elbows.
5. ERYTHEMA MIGRANS
⮚ Erythema migrans is the “bulls eye rash” of early lymes
disease.
SKIN LESIONS
1. Nodule
- Elevated, solid, hard mass that extends deeper into the dermis than a papule.
Nodules have a circumscribed border and are 0.5 to 2 cm (0.2 to 0.8 in.).
2. Cyst
- A 1-cm (0.4 in.) or larger, elevated, encapsulated, fluidfilled or semisolid mass
arising from the subcutaneous tissue or dermis. Small and movable
3. Bullae
- A circumscribed, round or oval, thin translucent mass filled with serous fluid or
blood. Bullae are larger than 0.5 cm (0.2 in.).
4. Macule
- Flat, unelevated change in color. Macules are 1 mm to 1 cm
5. Plaque
- Plaques are larger than 1 cm (0.4 in.). Examples: psoriasis, rubeola
6. Wheal
- A reddened, localized collection of edema fluid; irregular in shape. Size varies.
Examples: hives, mosquito bite. Superficial, pale skin swelling
7. Vesicle
- A circumscribed, round or oval, thin translucent mass filled with serous fluid or
blood. Vesicles are less than 0.5 cm (0.2 in.)
8. Pustule
- Vesicle or bulla filled with pus. Examples: acne vulgaris, impetigo. Yellowish
ETHICO-LEGAL CONSIDERATION BATTERY V.S. ASSAULT

Definitions of Ethics: • Battery – you’ve done something to the patient against its will, Action is done.

It can be viewed as a generic term for several ways of examining the morale of life. - • Assault – you’ve done nothing but your words are threatening the patient, Words
BEAUCHAMP TL only

Ethics is the study of good conducts, character, and motive. - POTTER PRIVACY VS. CONFIDENTIALITY

The contribution of nursing to the alleviation of suffering and to protection ,promotion, and  Privacy – patients’ information
restoration of health is a proud chapter in the history. The image of any organization  Confidentiality – Information obtained by the patient e.g. Patient shares about she
depends upon the behavior of people who constitute it. So there is a great obligation on the has STD.
part of employees to behave in an ethical way in at the work place.
TYPES OF INFORMED CONSENT
This is equally applicable to the nurses who are working in different sectors of health care
Depending upon the circumstances in each case, consent may be:
delivery system. The way nurses behave reflects the image of the organization.
 IMPLIED CONSENT
• Ethical considerations include patient autonomy, the quantity of information
provided, and the roles of all parties involved. The key legal considerations center  Occurs through the actions or conduct of the patient rather than direct
on consent, standard of care, and supervision. communication through words.
• Protect patients' rights, adequate staffing, advanced decision-making, and quality  Example:
patient care.
 Nodding of the head
• If nurses do not adequately deal with ethical issues, the result could be a decline in
patient care, tense clinical relationships, and moral distress.  Patient showing up at the agreed upon time for surgery.

INFORMED CONSENT  EXPRESS CONSENT

• Doctors will give information about a particular treatment or test in order for the  This may either be oral or written.
patient to decide whether or not they wish to undergo a treatment or test. This  EXPRESS ORAL CONSENT
process of understanding the risks and benefits of treatment is known as informed
consent.  Is obtained for relatively minor examinations, therapeutic
procedures, preferably in the presence of a disinterested third
• Informed consent is based on the moral and legal premise of patient autonomy: the party.
patient have the right to make decisions about his/her own health and medical
conditions.  EXPRESS WRITTEN CONSENT

• The patient must give your voluntary, informed consent for treatment and for most  Is to be obtained for all major diagnostic procedures, general
medical tests and procedures. The legal term for failing to obtain informed consent anaesthesia and for surgical operations.
before performing a test or procedure on a patient is called battery.
  INFORMED CONSENT 1. The patient must have the capacity (or ability) to make the decision.

 Where the patient is told what their information is being used for and there
is a record of understanding.
 All information must be obtained in a comprehensible non-medical terms
preferably in local language about the:
2. The medical provider must disclose information on the treatment, test, or
procedure in question, including the expected benefits and risks, and the
likelihood (or probability) that the benefits and risks will occur.
3. The patient must comprehend the relevant information.

 Diagnosis 4. The patient must voluntarily grant consent, without coercion or duress.

 Nature of treatment

 Risk involve PATIENTS BILL OF RIGHTS

 Prospects of success 1. Right to Appropriate Medical Care and Humane Treatment.

 Prognosis if the procedure is not performed 2. Right to Informed Consent.

 Alternative method of treatment 3. Right to Privacy and Confidentiality.

 PROXY CONSENT 4. Right to Information.

 Occurs when an individual is provided with the legal right to make 5. The Right to Choose Health Care Provider and Facility.
decisions on behalf of another who is unable to do so for himself or
6. Right to Self-Determination.
herself.
7. Right to Religious Belief.
 Example:
8. Right to Medical Records.
 Parent for child
9. Right to Leave – when the patient insist to go home despite its health status before
 Close relative for mentally unsound/unconscious patient
leaving it is a MUST to refer it to the doctor and let the patient sign the Home
Under certain circumstances, there are exceptions to the informed consent rule. The most Against Medical Advice (HAMA) or you will be sued Illegal detention
common exceptions are these:
10. Right to Refuse Participation In Medical Research.
• An emergency in which medical care is needed immediately to prevent serious or
11. Right to Correspondence and to Receive Visitors.
irreversible harm
12. Right to Express Grievances.
• Incompetence in which someone is unable to give permission (or to refuse
permission) for testing or treatment 13. Right to be Informed of His Rights and Obligations as a Patient.

There are 4 principles of informed consent:

PATIENT’S BILL OF RIGHTS
DATA PRIVACY ACT

Republic Act No. 10173

The Congress of the Philippines passed the Republic Act No. 10173 in 2012, also known as
the Data Privacy Act (DPA) of 2012.

The Data Privacy Act, protects individuals from unauthorized processing of personal
information that is private, not publicly available; identifiable.

WHY IS IT IMPORTANT?

The act is necessary and important precaution in a world which is moving into digital age.

• Protects the privacy of individuals while ensuring free flow of information to

promote innovation and growth.

• Regulates the collection, recording, organization, storage, updating or modification,

retrieval, consultation, use, consolidation, blocking, erasure or destruction of
personal data.

• Ensures that the Philippines complies with international standards set for data
protection through National Privacy Commission (NPC).

WHAT NEEDS TO BE PROTECTED?

• Personal information - refers to any information whether recorded in a material

form or not, from which the identity of an individual is apparent or can be
reasonably and directly ascertained by the entity holding the information, or when
put together with other information would directly and certainly identify an
individual. - (R.A 10173)

• Examples are as follows:

• Bank Accounts

• Names and Contact number

• Email address

• Place of Birth or Address

• Salary Amount
 ●Social Security Numbers

8 rights to be remembered

 Right to be informed
 Right to access
 Right to object
 Right to erasure or blocking
 Right to damages
 Right to file a complaint
 Right to rectify
 Right to data potability

Sensitive information - is a type of personal information. Unlike some personal

information, however, sensitive information may result in discrimination or harm if it is
mishandled. For example, sensitive information includes any information or opinion
about an individual’s:

●race or ethnic origin

●political opinions or membership of a political organization

●religious beliefs and affiliations

●philosophical beliefs

●sexual preferences and orientation

●criminal record

●health information

WHO WILL ADMINISTER?

NATIONAL PRIVACY COMMISSION

The National Privacy Commission (NPC) is an independent body created under Data Privacy
Act of 2012 (RA 10173) which mandated to administer and implement the provisions of the
act.