Physical Assessment 2 Assessing Appearance and Mental Status Physical Assessment + Spsematle comprehensive, continuous Sears orp ota ee + observe boy but ht an weit tent’ data using avaret of methods. Ses reneentel heat patient’ age, Hest, nd heath e regs owns oo coer Nr sone a fe ate eis What is the difference between Marfan syndrome and Gigantism? So aaa ‘Too Tall: Gigantism + Marfan syndrome Disorder of connective tissues manifested by changes in the skeleton, eyes, and cardiovascular system ~ inherited gene defects in fbi est in formation of abnormal laste ites * Gigantism . large soft tise and at closure of th : - agentes CONE Srcsaiutedete a sue eS LESSEE Concept of Dwarfism Disproportionate Propotonte ees ~ essentially a person with short stature ora wine Concept of Dwarfism Concept of Dwarfism + May be caused by: + Maybe cused by Gonadal dysgenesis (X0 > Turner syndrome) ~ Chen rutin) 5 ad nepet independ of Bone and metabolic diseases fags taser tone = No known cause (constitutional delayed growth) rf ~ Genet mutations ochonropls Achondroplasia and Dwarfism Achondropla: and Dwarfism + Achondroplasia + Achondroplaia = mast commen om of Sonor ~ tists gromth ot ~ Mappers when growth toate Ble chon ae Stesor Isis rom ‘i prolifer osc Stppresion ot‘What is the difference between proportionate and disproportionate dwarfism? Body Types vroelees—[o mepiaes =item . . ‘Coors Tus) I PP WP i + sthene « shen meee mh eu =, ; att soslon a wenn od Seema ee ote = ° = Stoniich tends tole = “transversely I ie f erg gta 9 - : ge ‘ es ! Body Types Body Types + tapers . = Very muscular, thick-set_ senate we So. Breer aS ; ° eran mt ae ier 22°.» ees ee ee hess, Body Types Body Types + Asthonie long nested ean India ~ Lower positioned organs (aphragm, stomach, base ano frnsversecolon Body Types + Hypostnenic — ei ty, ory Seapets, ree tanguartice iA Peg ses et bteeBody Types Body Types Season 2, Episode 1 BODY TYPES (OTHER CONDITIONS) a2 : : ©, Paws Other Conditions of the Body Other Conditions of the Body ‘Fallure to Thrive + cacheetc Caches) + Debittated = physical and developmental delay or retardation in infants and children ~ weak fel, ack of Strona with weakness nde of ney) = profound ae mares = seenfh children with illness but more in those 3 “mith psychosocial or a Pes 6 igi naperyglerivation BODY TYPES (ACCORDING TO BUILD AND WEIGHT) Ectomorph Body Types a Classifications — Physiological type that is oes tall with long and lean ~ sy 9 limbs 7 Body Typesif With Exercise + Mesomorph @ ehh, PF — Husky and muscular _ oy | bodySeason 2, Episode 1 ASSESSING HEIGHT AND WEIGHT + Remember: a 7 Body Mass Index emer: Most frequently used: + Ratio of your weight and height 2.2 lbs > 1kg Weight in llograms vou Weight (kg) Divided by height in Linch> 2.54cm meters squared : t Height (m?) 100 cm -> 1 meter : zs . a8 Body Mass Index Interpretation Body Mass Index + Sone 73s ee | | | oF 700" butdterence = ee i) 700 h “ies Height (inches - owaprmeiominn Height inches) ~ fatto ADNAN Another Way of Measuring Obesity + Determining wast circumference Male: £102em (40 inches) == SOFORSY[OSTHBY Bye Sale Obesity * Gynoid Obesity * Android Obesity dite) Symceid/qeid Fert) ~ Fats are located on the — Fats are located mainly ps and th ae con the waist ~ Peripheral type of obesity — Central type of obesity z ” = » Android Obesity Obesity Obesity + Remember tat obesty canbe eaused by 2 + Remember that bey canbe cused by 2 = increases risk for certain varetyof far, ncuding toner of factor, nbn diseases (diabetes — ror et hint andes) tenet ot eaten) mellitus I, high cholesterol and ~Sedentar ese a triglycerides, et nou steep (ronal cares testo : ieee che RRA cermnmleny disease) Paty owOTHER WEIGHT CONDITIONS Other Weight Conditions Other Weight Conditions + Unexplained weight loss Cushing syndrome = Due to excess cortisal in the body (rom aa OG e 5 medications or pituitary nits r | gland tumor), oon = tpn ~ Trunéal fat oe «Thin imbs relative) POSTURE AND GAIT Just Be Aware: Walking has 8 Phases Assessment of Posture and Gait + Standing position Let patent stand against the wall (with shoulders Wing fat) ~Letgptient ston a chair with backrest et him/her walk towards you Just Be Aware Walking has 8 Phases + Normal > evenly + Normal > evenly distributed weight distributed weight = Able to stand on heels — posture erect, and toes movements coordinated and rhythmic, arms — Toes pointed straight swpg In opposition, ahead (equal on both stridéllength is sides) appropriate + Abnormalities: + Abnormalities: = Limping/discomfort reer aie mniics, = Loss of balance = WidegBroad base gait — Movgment disorderABNORMALITIES IN SPINE CURVATURE Spinal Curvature Abnormalities Scoliosis SPINAL DEFORMITY TYPES + "S" formation * Lateral curvature in the normally straight vertical line of the spine Lordosis Lordosis Increased forward + Excessive inward curve g curvature of the spine of the spine ed ote ne + Exaggerated lumbar baperted Causes hunching of the concavity one’ back . OTHER POSITION TENDENCIES - Chronic Obstructive Pulmonary Disease eee eee one. (oes TRIPOD POSITION + Tend to: ~ Lean forward = race selves with armsTensed/Anxious Depression + Shoulders elevated + Simos ee BODY AND BREATH ODOR Body Odors Breath Odors Acetone breath idiabeti lit Note presence or * Alcohol breath Aiinbestes relies) absence (bromhidrosis) — Same smell as the one a i, * Halitosis eed ral pollsis Asians and Native Ga Americans have fewer ~ Bad breath (caused by sweat glands food particles, and = Sweet and fruity breath - = indicates diabetic ~ Less obvious body odor ketoacidosis {than Caucasians and » “black africans) fanaa ‘ Note presence or absence (bromhidrosis) Asians and Native ‘Americans have fewer sweat glands ~tessoiousdyedor SIGNS OF DISTRESS IN POSTURE OR (Betacam "*- FACIAL EXPRESSION. a eS Distress (Posture or Facial Expression) Distress (Posture or Facial Expression) + Observe at est (or smote during conversation) ; Rater ee + js with poor eye “Cotas Conte (preston saad ‘ebinting/ re + berefed ee contact : + Smiles and frownsDistress (Posture or Facial Expression) Distress (Posture or Facial Expression) ' E ' ae + Stare of + Drooping or gross See oe asymmetry in aoe neurologic dlsordersinjuries: ~ byelection ~ ses pty Ab phe ge Poor Nutritional Status + Ustlessness/Apathy + Poor muscle tone OBVIOUS SIGNS OF senso HEALTH AND ILLNESS = emis: tircrsmssh an * Glossitis (inflammation of the tongue) + Poor muscle tone . ir’ Cheilosis * Acute/Chronically ill aad * Frail/Feeble > + Listlessness/Apathy + Gloss * Acute/Chronically ill Frail/Feeble . . », * ® . iat Lod ae? nt CLIENT’S ATTITUDE * Cooperative/Willing + Unresponsive/Unwilling AFFECT AND Moop vameg (APPROPRIATE RESPONSES)Emotional Variations and Kesponses Affect and Mood (Appropriate Responses) te Proper and rok + Facial features are symmetric, good eye peice Sree contact, smiles and frowns appropriately ney essing, nd sont aca manner ‘Alou patert overt cigs . | . , ‘avoid arguing + Facial expression appropriate to question reat pater ee PirEGEE Depressed Sores ners andundesanang ia eta % nip Strate sess + Appropriate response: Posen Devecroconttiettel "Wh, what, when or where * Affect Assessment of Speech — Behavioral expression of mood * Listen to quality, quantity, organization of speech * Mood . Able to answer in organized manner (and with appropriate words) ~ Psychological state _ SPEECH : ; a Fed + Abnormality: disorganized speech consistent (non-stop) speech long periods of silence . RELEWANCE AND ORGANIZATION Do: consider neurologic/psychiatric diSorders Bale oot fey OF THOUGHTS Thoughts » Must have relevance and organization in Never Forget answer to questions (evident) * Document everything Abnormality: Disorganized speech Word salad LIFESPAN CONSIDERATIONSLifespan Considerations Infants Children — Preschool, school-age, and adolescent Elderly Children + Weigh children without shoes and with as little clothing as possible (patient's gown) + Anxiety in preschool children may be decreased (let them handle and be familiar with examination SOR Elderly * Elders with osteoporosis may lose several inches in height i — document and assess awareness of this loss of height * = Masts Nurse inane Infants + Observation of behavior provides important data for the ‘general survey: May be helpful: = Have parents hold their Infants or very young children for some parts of the assessment ~ Pyscl development = Neurtmucule uncon Children Elderly + Allow extra time for + School-age children answering questions may be very modest and shy about exposing. arts of the body * Adapt questioning techniques appropriately (for hearingor visual limitations) + Adolescents should be examined without parents present Elderly + Be specific when asking about weight oss (amount and timeframe) “Have you lost more than 5 Ibs inthe last 2 months?”