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NR302-Health IAssessment II IExam I 2 IBlueprint
Chapter I12: I 6 Iquestions
A I& IP Iof Ithe Ilayers Iof Ithe Iskin Two ILayer
1. Epidermis I& IDermis
Epidermis II – IIOuter IIlayer IICompletely IIreplaces IIevery II 4 IIweeks
▪ Highly IIdifferentiated
▪ Thin IIbut IItough
▪ Avascular II& IInourished IIby IIblood IIvessels IIin IIthe IIdermis
▪ Stratified IIinto IIseveral IIzones
o Basel IIcell IILayer II– IIForms IInew IIskin IIcells
▪ major IIingredient: IIfibrous IIprotein IIKeratin
▪ Melanocytes IIproduce IIpigment IImelanin
• Gives IIbrown IItones IIto IIskin II& IIhair
• Everyone IIhas IImelanocytes, IIhowever IIamount IIof IImelanin IIthey
IIproduceIIvaries IIwith IIgenetic, IIhormonal, IIenvironmental
• As IInew IIcells IImigrate IIup IIthey IIflatten IIinto IIthe IIouter IIhorny IIcell IIlayer
o I I Horny IIcell IIlayer II– IIdead IIkeratinized IIcells IIclosely IIpacked II& IIconstantly IIshed IIor
desquamated II& IIreplaced IIw/ IInew IIcells
Dermis IIInner IIsupportive IIlayer
Consisting IImostly IIof: IIConnective IItissue, IIor IIcollage:
Tough, IIfibrous IIprotein IIthat IIenables IIthe IIskin IIto IIresist IItearing
o Resilient IIelastic IItissue IIthat IIallows IIthe IIskin IIto IIstretch IIw/ IIbody IImovement
o Nerves
o Sensory IIreceptors
o Blood IIvessels
o Lymphatics
o Appendages IIfrom IIthe IIepidermis IIembedded IIin IIthe IIdermis
o Hair IIfollicles
o Sebaceous IIglands II& IIsweat IIglands
2. Subcutaneous ILayer
Adipose Itissue I(lobules Iof Ifat Icells)
Stores Ifat Ifor Ienergy
Provides Iinsulation Ifor Itemperature Icontrol
Aids Iin Iprotection
Gives Iskin Iincreased Imobility Iover Istructures Iunderneath
9 IFunction Iof Ithe ISkin: ISkin Iis Ia Iwaterproof, Ialmost Iindestructible Icovering Ithat Ihas Iprotective IandIadaptive
Iproperties
Protection IMinimize Iinjury Wound Irepair Ireplacement Iof Isurface Iwounds
Prevents Ipenetration Ibarrier Istops Iinvasion
microorganisms I& Iloss Iof Iwater I& Ielectrolytes
Communication IBlushing/Blanching Isignal Iemotion
Perception Ivast Isensory Isurface Itouch, Ipain,
temperature, Iand Ipressure
Production Iof IVitamin ID IUV Ilight Iconverts Icholesterol Iinto
Vitamin ID.
Temperature Iregulation IHeat
Insulation/dissipation
Absorption Iand Iexcretion Ilimited Iexcretion Iof Isome
metabolic Iwastes, Iby-products Iof Icellular Idecomposition
Identification Iunique Ifacial Icharacteristics, Ihair,Iskin
Icolor, Iand Ieven Ifingerprints
Hair
Threads Iof
IkeratinITwo Itypes
Iof Ihair:
I. Vellus Ihair: Icovers Imost Iof Ithe Ibody I(except Ipalms Iand Isoles, Idorsa Iof Ithe Idistal Iparts Iof Ithe Ifingers,
Iumbilicus,Iglans Ipenis, Iinside Ithe Ilabia)
II. Terminal Ihair: Idarker, Ithicker Ihair Ithat Igrows Ion Ithe Iscalp Iand Ieyebrows Iand Iafter Ipuberty Ion Ithe Iaxillae,
IpubicIarea, Iface Iand Ichest Iin Imale
Sebaceous IGlands
Produce ISebum(oil): IA Iprotective Ilipid Isubstance Isecreted Ithrough Ihair IfolliclesIEverywhere
Iexcept Ipalms Iand Isoles
Most Iabundant Iin Iscalp, Iforehead, Iface, I& Ichin
Lubricates Iskin Iand Ihair Iand Iforms Iemulsion Iwith Iwater Ithat Iprevents Iwater Iloss Ifrom
IskinIDry Iskin Iresults Ifrom Iloss Iof Iwater, Inot Idirectly Ifrom Iloss Iof Ioil
Sweat IGlands
Two Itypes Iof Isweat Iglands:
I. Eccrine IGlands: Iwidely Idistributed Ithrough Ithe
IbodyIMature Iin Ithe I2-month I-old Iinfant
Coiled Itubules Ithat Iopen Idirectly Ionto Ithe Iskin Isurface I& ISweatISweat
Ievaporation Ireduces Ibody Itemperature
II. Apocrine IGlands:
Activated Iduring Ipuberty I& IDecreases Iin Ithe Iaging
IadultISecretion Ioccurs Iwith Iemotional I& Isexual
Istimulation
Bacterial Iflora Ireacts Iw/ Iapocrine Isweat Iand Iproduce Imusky Ibody IodorIProduce
Ia Ithick, Imilky Isecretion I& Iopen Iinto Ithe Ihair Ifollicles
Mainly Iin Ithe IAxillae, IAnogenital Iarea, Inipples, I&
InavelIVestigial Iin Ihumans
Developmental Iconsiderations: Inewborn, Iolder
IadultIInfants I& IChildren
▪ Lanugo IHair Ifollicles: IFine Idowny Ihair Iof Ithe Inewborn Ihair.
▪ Develops Iin Ithe Ifetus Iat I 3 Imonths’ Igestation; Iby Imidgestation Imost Iof Ithe Iskin Iis Icovered I& IFirst Ifew
ImonthsIafter Ibirth Iis Ireplaced Iby Ifine IVellus Ihair
▪ Terminal Ihair Ion Ithe Iscalp IMay Ibe Ipresent Iat Ibirth
▪ Vernix Icaseosa Ipresent Iat Ibirth, Ithick, Icheesy Isubstance Imade Iup Iof Isebum Iand Ished Iepithelial Icells
▪ Sebum Iwater Iin Iskin Iproducing Imilia I(a Icommon Ivariation; Iwhite Ipapules Ion Ithe Icheeks I& Iforehead I& Iacross
the Inose I& Ichin; Icaused Iby Isebum Ithat Ioccludes Ithe Iopening Iof Ithe Ifollicles); Iholds Iwater Iin Ithe Iskin;
IpresentIfirst Ifew Iweeks Iof Ilife; Iproduces Icradle Icap Iin Isome Ibabies
▪ Many ISkin Ifunctions Inot Ifully Ideveloped
▪ Skin Iis Ithin, Ismooth, Ielastic Iand Imore Ipermeable Ithan Iadult
▪ Greater Irisk Ifor Ifluid Iloss
▪ Sebaceous Iglands Idecrease Iin Isize Iand Iproduction Inot Iresume Iuntil Ipuberty
▪ Temperature I(Heat I& ICold) Iregulation Iineffective Ibecause Isubcutaneous Ilayer Iis Iinefficient
▪ Eccrine Isweat Iglands Ido Inot Isecrete Iin Iresponse Ito Iheat Iuntil Ifirst Ifew Imonths Iof Ilife
▪ Pigment Isystem Iis Iinefficient Iat Ibirth
o Feel Ifor Icartilaginous Irings Iin Ithe Imidline Ior Islightly Iright Iof Imidline
o Infancy Icervical Ilymph Inodes Iare Inot Ipalpable
o Palpable Inodes I< I3mm Iare Inormal
o Thyroid Igland Idifficult Ito Ipalpate Ibecause Ineck Iis Ishort Iand Ithick
❖ Pregnant
▪ Head
▪ Face
o Chloasma Imay Ishow Iduring I 2 nd^ Itrimester- Iblotchy, Ihyperpigmented Iarea Iover Ithe Icheeks,
forehead Ithat Ifades Iafter Idelivery
▪ Neck
o Thyroid Igland Imay Ibe Ipalpable
❖ Older IAdult
▪ Head
o Temporal Iarteries Itwisted Iand Iprominent
o Mild Itremor Iof Ithe Ihead
o Senile Itremors Iare Ibenign Iand Iinclude Ihead Inodding I& Itongue Iprotrusion
▪ Face
o Teeth Ilost, Ilower Iface Ilooks Iunusually Ismall, Imouth Isunken Iin
▪ Neck
o Increased Ianterior Icervical I(concave Ior Iinward) Icurve Iwhen Ihead Iand Ijaw Iare Iextended Iforward
to Icompensate Ifor Ikyphosis Iof Ithe Ispine
o Prolapse Iof Ithe Isubmandibular Igland, Ican Ibe Imistaken Ifor Itumor
o Drooping Isubmandibular Iglands Ifeel Isoft Iand Ipresent Ibilaterally
Chapter I14: I 15 Iquestions
A I& IP Iof Ithe IEyes
Cranial Inerves Responsible Ifor Iextraocular Ieye Imovements I(EOMs)
Pupillary Light IReflex Iconstriction Iof Ipupils Iwhen Ibright Ilight Ishines Ion Iretina
Fixation Reflex Idirection Itoward Iobject Iattracting Iour Iattention
Accommodation Adaptation Iof Ithe Ieye Ifor Inear Ivision
Retina Inner Inervous I-Visual Ireceptive Ilayer Iwhich Ilight Iwaves Iare Ichanged Iinto Inerve
impulses Iinside Iis Ithe Itransparent Ivitreous Ibody
Red Ireflex Normally Inot Ipresent; IRed Iglow Ifilling Ithe I person’s Ipupil; Icaused Iby Ithe
reflection Iof Iophthalmoscope Ilight Ioff Ithe Iinner Iretina
Intraocular Ipressure Determined Iby Ia Ibalance Ibetween Ithe Iamount Iof Iaqueous Iproduced Ito Iits
outflow Iat Ithe Iangle Iof Ithe Ianterior Ichamber
Developmental Iconsiderations Iof IEyes
Newborn Function Ilimited
IPeripheral Ivision Iis Iintact
Macula Iis Iabsent Iat Ibirth Ibut Idevelop Iby I 4 Imonths; Imature Iby I 8 ImonthsIBinocularity
I(can Ifixate Ion Ia Isingle Iimage Iwith Iboth Ieyes) Iby I 3 - 4 Imonths
Lens Iis Ispherical Iat Ibirth I& Igrows Iflatter Ithroughout Ilife
Older Iadult Eye^ Istructure^ Icause^ Idistinct^ Ifacial^ Ichanges
Lacrimal Iglands Iinvolute ; Icausing Idecreased Itear Iproduction I& Ifeeling Iof Idryness I& Iburning
Presbyopia I- Pupils Idecrease Iin Isize; Ilens Iloos Ielasticity, Ibecomes Ihard Iglasslike Idecreases Iability
lens Ito Ichange Ishape Ito Iaccommodate Inear
IvisionIVisual Iacuity Idiminishes Iaround I 50 I- 70
Blurred Ivision I& Idifficulty Ireading Iby I 40
Cataract Iformation I a Iclouding Iof Ithe Icrystalline Ilens Ifrom Ia Iclumping Iof Iprotein I(lens
Iopacity)ICurable Iw/ Ilens Ireplacement Isurgery
Women I37% Ihigh Irisk Ithan Imen
Glaucoma I An Ioptic Inerve Ineuropathy Icharacterized Ibest Iby Iloss Iof Iperipheral Ivision, Icaused Iby
Iincreased Iintraocular Ipressure I(chronic Iopen-angle Iis Imost Icommon Itype) I-women Iat Ihigher Irisk
I Age-Related IMacular IDegeneration I(AMD) I loss Iof Icentral Ivision Icaused Iby Iyellow Ideposits
I(drusen) I& Ineovascularity Iin Ithe Imacula I(breakdown Iof Icells Iin Imacule Iof Iretina)- Iwomen Iat
IgreaterIrisk I– Iunable Ito Iread, Isew, Ido Ifine Iwork, Idifficulty Idistinguishing Ifaces I(Peripheral Ivision
Inot Iaffected- Ican Imanage Iself-care Iand Inot Icompletely Idisabled
Diabetic IRetinopathy I leading Icause Iof Iblindness Iin Iworking-age Iadults I 25 - 74 I(loss Iof
IcentralIvision); Imay Icause Igreat Idespair I(difficulty Idriving, Ireading, Imanaging Idiabetes, Iand Iself-
care)
Eye Iexamination
Snellen Ichart Alphabet Ichart Imost Icommonly Iused Iand Iaccurate Imeasure Iof Ivisual Iacuity
Floaters spots Iin Ivison; Imay Ilook Iblack Ior Igray Ispecks, Istrings, Iappear Ito Idart Iaway Iwhen
IlookIdirectly Iat Ithem
age-related Ichanges
Shadows Iseen Iare Icalled Ifloaters
Chapter I15: I 15 Iquestions
A I& IP Iof Ithe IEar
Auricle External Iear Ialso Icalled Ipinna Iconsist Iof Imovable Icartilage Iand Iskin; Iserve
ItoIfunnel Isound Iwaves Iinto Iits Iopening
Cerumen Yellow, Iwaxy Imaterial Ithat Ilubricates Iand Iprotects Ithe Iear; Iforms Ia Isticky
IbarrierIthat Ihelps Ikeep Iforeign Ibodies Ifrom Ientering Iand Ireaching Ithe Isensitive
Itympanic Imembrane; Imigrates Iout Ito Ithe Imeatus Iby Ithe Imovement Iof Ichawing
Iand Italking
Tympanic Imembrane (eardrum) ICanal Ilined Iwith Iglands Ithat Isecrete Icerumen
Eustachian Itube Connects Ithe Imiddle Iear Iwith Ithe Inasopharynx I& Iallows Ipassage Iof Iair;
InormallyIclosed Ibut Iopen Iwith Iswallowing Iand Iyawning
Middle Iear 3 Ifunctions: I(1) IConducts Isound Ivibrations Ifrom Ithe Iouter Iear Ito Ithe Icentral
Ihearing Iapparatus Iin Ithe Iinner Iear; I(2) Iprotects Ithe Iinner Iear Iby Ireducing Ithe
Iamplitude Iof Iloud Isounds;(3) Ieustachian Itube Iallows Iequalization Iof Iair
IpressureIof Ieach Iside Iof Ithe Itympanic Imembrane Iso Ithe Imembrane Idoes Inot
Irupture
Labyrinth Inner Iear Iembedded Iin Ibone; I(labyrinth) Iholds Ithe Isensor Iorgans Ifor
IequilibriumIand Ihearing
Hearing Iloss: ISensorineural Ivs. IConductive
Sensorineural Conductive
(or IPerceptive) Iloss Isignifies Ipathology Iof Ithe Iinner
ear, Icranial Inerve IVIII, Ior Ithe Iauditory Iarea Iof Ithe
Mechanical Idysfunction Iof Ithe Iexternal Ior Imiddle Iear. IA
partial Iloss- Iperson Iable Ito Ihear Iif Ithe Isound Iamplitude Iis
Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage
of chronic or recurrent middle ear infections.
Tubes extrude spontaneously in 12 to 18 months
Treatment: Tympanostomy
Chapter I16: I 10 Iquestion
Developmental Iconsiderations:
Pregnant Nasal Istuffiness I& Iepistaxis Iresult Iof Iincreased Ivascularity Iin Ithe Iupper Irespiratory
Newborn Milia Iacross Ithe Inose
Nasal Ibridge Imay Ibe Iflat Iin Iblack Iand IAsian Ichildren
No Inasal Iflaring Ior Inarrowing Iwith Ibreathing
Toddler
Older Iadult Gradual^ Iloss^ Iof^ Isubcutaneous^ Ifat^ Imake^ Inose^ Iappear^ Imore^ IprominentINasal
Ihair Igrow Icoarser Iand Istiffer Iand Imay Inot Ifilter Iair Ias Iwell
Smell Isense Idiminish Iafter I 60 Ibecause Idecrease Iin I# Iof Iolfactory Inerve Ifibers
Abnormal Ifindings
Antibiotic Itherapy Black IHairy Itongue; Inot Ireally Ihair Ibut Irather Ielongation Iof Ifiliform Ipapillae
IandIpainless Iovergrowth Iof Imycelial Ithreads Iof Ifungus Iinfection Ion Itongue. IOccurs
Iafter Iantibiotic, Iwhich Iinhibit Inormal Ibacteria Iand Iallow Iproliferation Iof Ifungus,
and Iwith Iheavy Ismoking I(color Ican Ibe Iblack, Ibrown Ito Iyellow)
Dehydration Fissured Ior IScrotal ITongue; IDeep Ifurrows Idivide Ithe Ipapillae Iinto Ismall Iirregular
rows.
Chemotherapy Gingival IHyperplasia Ipainless Ienlargement Iof Ithe Igums, Isometimes Ioverreaching
the Iteeth,
Newborn Cleft^ IPalate^ I –^ Icongenital^ Idefect;^ Ifailure^ Iof^ Ifusion^ Iof^ Ithe^ Imaxillary^ Iprocess.
Cleft Ilip I – IMaxillofacial Iclefts Iare Imost Icommon Icongenital Ideformities Iassociated Iwith
Iphenytoin I(Dilantin) Imaternal Ismoking Iand Ialcohol Iuse, Ibenzodiazepines Iand
Icorticosteroids; Iearly Itreatment Ipreserves Ifunction Iof Ispeech Iand Ilanguage Iformation Iand
deglutition(swallowing)
Upper respiratory infection
Common cold
Radiation therapy
Nasal polyps
Nasal septum deviation
Smoking
Nasal obstruction
Medication side effects
Head injury
Chronic sinus infection (Sinusitis)
Aging
Causes of sense of Smell Issues
Bottle feeding supine position
Most important side effect of acute OM is that persistence of fluid ear after treatment can cause impar hearing/
increasing risk for delayed cognitive development
Sinusitis Inflamed Iinfection Isinus Iarea Ifollowing IURI Iare Imost Ioften Iviral Iin Iorigin Iand Ido
Inot Irequire Iantibiotics. IConsidered Ibacterial Iinfection Iwhen Isigns Ilast Igreater
Ithan I 7 - 10days. IMajor Isign Iare Imucopurulent Idrainage, Inasal Iobstruction, Ifacial
Ipain/pressure, Iloss Iof Isense Iof Ismell, Ifever, Ichills I, Imalaise, Idull, Ithrobbing Ipain Iin
cheek I& Iteeth
