N 522P E Module Two: HEENT and Skin Assessment
Discussion 2
This week you have studied advanced physical assessment of the eyes, ears, nose, throat, head, neck and skin (HEENT). Describe the classification of rashes. N 522PE Module Two: HEENT and Skin Assessment. What additional resources for HEENT advanced health assessment skills have you found beneficial in developing your knowledge and psychomotor skills this week?
Post a concept to the discussion board that you have had difficulty with and note where you are with resolution of your difficulties. Please describe the issue completely, citing your sources so that your classmates can reference the information and provide additional “clinical pearls”. In other words, please include primary sources and/or reliable electronic sources to support your arguments.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.
Example Solution and Responses
When conducting a skin assessment and looking for rashes and lesions, classification is based on many morphological findings. First, it is essential to establish if the rash is accompanied by other symptoms that could be life-threatening like fever, shortness of breath, tongue swelling, etc. Once that is ruled out, then the evaluation should start with locating the lesion or rash on the body. That includes finding if the lesions/rashes are spread out all over the body or localized. The lesion should be examined to establish if it is primary or secondary to another lesion. Shape, margins, and borders, the texture and pigmentation of the lesions are assessed. The lesions are measured for size. Rashes can be acute or chronic and could be accompanied by itching and pain (Dains, Baumann, & Scheibel, 2016). These are all crucial parts of the assessment that could determine the origin of rash or lesions.
Since I have not done a full assessment of a patient in a decade, the most helpful feature I found is a detailed examination of patient Tina Jones in Shadow health. I got to see abnormal and normal characteristics of HEENT assessment close up, and it was made to look so realistic. A beneficial video on HEENT examination is the one I found on Youtube that shows a Family Nurse Practitioner performing a full HEENT exam on a patient. She made it look so easy to follow steps, and it was almost seamless (Nishikawa, 2012).
The most challenging thing I found was to recall all the medical terms for each condition of the eye, for example, or even normal findings. Also, to visualize and recognize when something is normal and abnormal in those body sites, I have not been familiar with assessing. It was difficult to even solicit further questions from Tina, as I was unsure what to ask further.
HEENT assessment is extremely detailed and requires a lot of practice to establish what is normal. I do feel that I am still just a beginner when it comes to the eyes and ears assessment, although the nose and head/neck exam seem to be much easier for me.
Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). Advanced Health Assessment and Clinical
Diagnosis in Primary Care (5th ed.). Elsevier.
Nishikawa, J. (2012, August 12). How to conduct the HEENT exam [Video]. Youtube. https://www.youtube.com/watch?v=FHWw8opmQdg
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https://nursingassignmentacers.com/n522pe-module-tw…-skin-assessment/ In reply to Merima Sestovic
Re: Discussion 2
by Ihuoma Aguoru – Thursday, October 1, 2020, 11:29 AM
Hi Merima, good post. I agree with you on identifying lesions by morphology. It is very important to identify and classify a patient’s skin problem first before making any diagnosis. Also, it is important to use a layman term when explaining to the patient what their diagnosis is, rather than using a bunch of overwhelming and confusing medical terminology.
For instance, one of the nurses that I work with told a story of how his grandfather lost half of his left area from malignant skin cancer that started as a red rash to a boil and continued to grow for years. His doctor told him that it looks like malignant growth without telling him what malignancy means and without following up with him.
The patient went home thinking the doctor said that the rash will melt and go away after a while. Using appropriate terminology and clear communication and putting the patient level of understanding into consideration helps to increase patient safety and minimize confusion and misunderstanding.
Reference
Soutor, C, Hordinsky, M (2017). Morphology and Terminology of skin lesions. retrieved from:
https://ccessmedicine.mhmedical.com/content.aspx?bookId=2184§ionId=165458 490
In reply to Ihuoma Aguoru
Re: Discussion 2
by Tola Fakunmoju – Sunday, October 4, 2020, 3:43 PM Greetings Ihuoma,
I enjoy and commend you for your post. It is vital to explain terminology to patients. Most healthcare language is foreign to patients. Also, demonstrations and thorough discussions can lead to less treatment in the future. When it comes to skin rashes, effective communication is essential. (Leung, L., & Soeyonggo, T. (2013).Most skin conditions are treated with topicals, which have very specific and critical instructions. A fluid understanding between you and your patient is vital in their aftercare process.
references:
Leung, L., & Soeyonggo, T. (2013). Approach to Patient with a Generalized Rash. Journal
of family medicine and primary care, 2(4), 311–314. https://doi.org/10.4103/2249-4863.123775
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In reply to Merima Sestovic
Re: Discussion 2
by Taylor Carroll – Thursday, October 1, 2020, 12:33 PM
Hi! I enjoyed your post. I agree with your approach to assessment. I too found the importance of determining if the rash is related to a life threatening illness. To do so, the provider will need to assess if the patient has a fever, is short of breath, has difficulty swallowing, if the rash is tender, and if it involves mucous membranes (Themes, U,2017).
I have difficulty performing a primarily focused assessment. During the shadow health assessments, I have found them very beneficial to help me figure out the details of a focused assessment.Themes, U. (2017, April 10). Rashes and skin lesions. Nurse Key. https://nursekey.com/rashes-and-skin-lesions/
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In reply to Merima Sestovic
Re: Discussion 2
by Kirby Brown – Sunday, October 4, 2020, 4:06 PM
Great Post. I agree with you about the feature within the assessment for a detailed examination, this was very helpful. It has been at least 6 years since I have done a complete assessment. When doing an assessment of a rash, we need to get the full patient’s history. When assessing a rash we need to determine if it’s primary or secondary. To determine the etiology and treatment we will need to look at the appearance, location and color of the rash.
Thompson, Patricia A. RN, MS; Langemo, Diane RN, PhD, FAAN; Hanson, Darlene RN, MS; Anderson, Julie W. RN, CCRC, PhD; Hunter, Susan RN, MSN Assessing skin rashes, Nursing2008: April 2008 – Volume 38 – Issue 4 – p 59 doi:
10.1097/01.NURSE.0000314801.45844.f4
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