Question

Directions: Identify 3-4 expected assessment findings and 3-4 abnormal assessment findings for each of the physical assessment categories.

System                              Expected finding                           Abnormal                         Geriatric Finding

Nails                                  1.                                                      1.                                       1.

                                           2.                                                      2.

                                           3.                                                      3.

                                           Expected finding newborn/infant)         

                                           1.                                                                    

                                                                                                                  

                                           Expected finding (children/adolescents)             

Answer 1

The condition of the nails reflects the general health, a person’s occupation, level of personal care and the state of nutrition.

Expected assessment findings in the physical assessment of Geriatric Nails in New-born or Infant:

1. Generally oval in shape or have a flat curvature

2. Absence of lunula is seen in 50% newborn,

3. Toenails are triangular or round. The triangular nail plate induces a force that pushes the lateral folds down resulting in overlapping. Due to this, 73% of newborns have an apparent or pseudohypertrophy of the proximal and lateral nail fold.

Abnormal assessment findings in the physical assessment of Geriatric Nails in New-born or Infant:

1. Koilonychia- It is present in the toe of 33% of infants, and is characterised by flat or concave nail surface.

2. Onychoschizia and onycholysis: Onychoschizia is the transverse and lamellar splitting of the distal portion of the nail plate. Thumb sucking is an important exacerbating factor.

3. Leukonychia- It can be true, apparent or pseudo. It can be involved in the entire nail or partial. Punctate leukonychia is frequently seen in newborns.

Expected assessment findings in the physical assessment of Geriatric Nails in Children or Adolescents:

1. Colour:

Expected- Variations of pink with varying opacity. Pigment deposits in persons dark skin and white spots.

Unexpected- Yellow or green-black discolouration. Pigment deposits in persons with light skin. Diffuse darkening. Blue nail beds. Blue-black discolouration.

2. Length, configuration, symmetry:

Expected- Varying shape, smooth and flat or convex, with edges smooth and rounded.

Unexpected- Jagged, broken or bitter edges and cuticles. Peeling. Absence of nail.

3. Ridging and beading:

Expected- Longitudinal ridging and beading.

Unexpected- Longitudinal ridging and grooving with lichen planus. Transverse grooving, rippling and depressions. Pitting.

Abnormal assessment findings in the physical assessment of Geriatric Nails in Children or Adolescents:

1. Eczematous dermatitis- Itching may or may not be present. Atopic dermatis during childhood lesions involve flexures. In adolescence lichenified plaques affect the flexures.

2. Folliculitis- Acute onset of papules and pustules associated with pruritus or discomfort. Pustule may be surrounded by inflammation or nodular lesions.

3. Paronychia- Acute history of nail trauma or manipulation. Evolves slowly initially with tenderness and mild swelling. Redness, swelling, tenderness at lateral and proximal nail folds.

4. Oncychomycosis- Yellow and crumbling nail. Distal nail plate turns yellow or white as hyperkeratotic debris accumulates, causing the nail to separate from the nail bed.