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Health Assessment HESI Review #2

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Characteristics of palpable nodes Location Size Shape Delimitation Mobility Consistency Tenderness Myxedema (Hypothyroidism) A deficiency of the thyroid hormone. This reduces metabolic rate, and when... severe causes non pitting edema or myxedema. Symptoms: fatigue, cold intolerance, coarse/dry hair and skin, and weight gain. What is the best indicator of Parathyroid Problems? Decrease in client's calcium compared with preoperative value. Grave's Disease (hyperthyroidism) Increased production of thyroid hormones causes an increased metabolic rate. Symptoms: exophthalmos, fatigue, nervousness, weight loss, cramps, and heat intolerance. Cushing Syndrome Excessive secretion of ACTH and chronic steroid use. Symptoms: "moon like" face, Buffalo hump, hirsutism Lymphadenopathy Enlargement of lymph nodes greater than 1 cm. This occurs from infection, allergy, or neoplasm. Contusion (Bruise) 1. Red, blue, or purple 2. Blue to purple 3. Blue- green 4. Yellow 5. Brown to disappearing Serous Exudate Clear or straw colored. Normal part of healing process. Serosanguineous Exudate Pink colored due to blood mixed with serous drainage. Normal part of healing process. Sanguineous Exudate Red drainage from trauma to a blood vessel. May occur with wound cleansing or put her trauma to the wound bed. Abnormal to the wound healing process. Hemorrhage Exudate Frank blood leaking from a blood vessel. May require emergency treatment to control bleeding. And a normal part of the healing process. Purulent Drainage Yellow, gray, or green drainage due to infection in the wound. Polycyclic Annular lesions grow together (Lichen planus, psoriasis) ABCDE rule Asymmetry Border Color Diameter greater than 6mm Elevation or Evolution Xerosis Dry skin Senile purpura Common in the aging Adult - a minor trauma that may produce dark red discolored areas. Function of the skin Protection Prevents penetration Perception Temperature regulation [Show More]

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