Seventy-Four Years of Sun, Squinting and Needlework: A Skin, Head, Eyes, Ears, Nose and Throat Assessment of a Retired Seamstress, With Age-Related Findings Separated From Disease
[Student Name]
University of Phoenix
NSG/502: Pathophysiology, Assessment Variables and Pharmacology II
Week 2 Assignment
[Instructor Name]
[Date]
The patient and all findings are a composite written for a model paper.
Identifying Data
Mrs. E. F., 74, a retired seamstress, seen for an annual wellness visit. History from Mrs. F. herself, who answered questions easily and in detail.
Subjective Data
Skin: she noticed a "new mole" on her left upper back three months ago when her daughter saw it; it does not itch or bleed. She has many "age spots" on her face and hands, bruises easily on her forearms and uses a moisturizer for dry skin. She worked outdoors on the family farm as a child and teenager without sunscreen and had several blistering sunburns.
Head: no headaches, dizziness or head injury.
Eyes: she has worn reading glasses since her forties and needs "more light than ever" to thread a needle. She notices glare from oncoming headlights at night and has stopped driving after dark. Last eye examination four years ago.
Ears: her daughter says she turns the television up too loud. She has trouble following conversation in restaurants. No ear pain, discharge or ringing.
Nose and sinuses: no congestion or nosebleeds; sense of smell "not what it used to be."
Mouth and throat: upper partial denture; no sores, bleeding gums or difficulty swallowing; dry mouth at night.
Objective Findings: Skin
Skin is thin, dry and loose, with reduced turgor on the back of the hand. Multiple flat, well-demarcated tan-brown macules, 2 to 8 mm, on the backs of both hands and the cheeks, consistent with solar lentigines. Several waxy, raised, brown, "stuck-on" papules on the trunk, consistent with seborrheic keratoses. Scattered 1 to 3 mm red papules on the trunk, consistent with cherry angiomas. Purple macules on both dorsal forearms without tenderness, consistent with senile purpura.
Left upper back: a single pigmented lesion measuring 7 mm by 5 mm, asymmetric in shape, with an irregular, notched border and two shades of brown with a darker area at one edge. It is flat. No other lesion on her body looks like it.
Objective Findings: Head, Eyes, Ears, Nose and Throat
Head: normal shape and size; hair thinning diffusely; scalp without lesions.
Eyes: visual acuity with her glasses, 20/40 right and 20/50 left by Snellen chart. Pupils equal, round and reactive to light, slightly small and slow, which is common with age. Both corneas show a thin gray-white arc along the limbus. Red reflex dimmed in both eyes. Extraocular movements intact. Fundus poorly visualized through the small pupils.
Ears: moderate cerumen in the right canal partly obscuring the tympanic membrane; left membrane pearly gray with visible landmarks. Whispered voice test: not passed on the right, passed on the left.
Nose: mucosa pink and moist; septum midline; no polyps.
Mouth and throat: upper partial denture removed for examination; underlying gums pink without sores. Tongue midline, slightly dry. Several teeth with receded gums. Tonsils not visible. Uvula midline.
Neck: no lymphadenopathy; thyroid not enlarged.
Analysis: Age-Related, Follow-Up or Normal
Expected age-related changes: thin, dry, less elastic skin; solar lentigines; seborrheic keratoses; cherry angiomas; senile purpura on the forearms; thinning hair; presbyopia, the need for reading glasses and more light; smaller, slower pupils; the gray-white corneal ring, arcus senilis, which in older adults is usually not significant; mild loss of smell; and gum recession. Each reflects known changes of aging in skin structure, lens flexibility, pupil muscles and sensory cells (Bickley et al., 2021). None requires treatment beyond comfort measures and sun protection.
Findings needing follow-up:
1. The pigmented lesion on the left upper back. It is the one finding on her skin that aging does not explain, and it meets several warning criteria at once. Its two halves do not match, its edge is notched and irregular, it holds more than one shade, is larger than 6 mm and is new, which means it meets every one of the five ABCDE warning signs for melanoma, the letters standing for asymmetry, border, color, diameter above 6 mm and evolving over time (Abbasi et al., 2004). Her history of blistering childhood sunburns adds risk. It warrants prompt referral to dermatology for dermoscopy and biopsy, not a wait-and-see plan.
2. Reduced visual acuity, night glare and a dimmed red reflex together suggest cataracts. Her last eye examination was four years ago, and she has already changed her driving. She should see an ophthalmologist, both for cataract evaluation and for a dilated fundus examination, since age-related macular degeneration and glaucoma cannot be excluded through small pupils.
3. Hearing: the failed whispered voice test on the right, with her daughter's report, suggests hearing loss. The test is a reasonable screen; a systematic review found that the whispered voice test had high sensitivity and specificity for detecting hearing impairment in adults when performed with a standard technique (Pirozzo et al., 2003). Her right-sided cerumen should be removed first, and the test repeated; if she still fails, she should have formal audiometry.
4. Dry mouth at night and gum recession with a partial denture justify a dental visit, since dry mouth increases the risk of cavities and denture sores.
Examination Technique and Adaptations
Several adaptations made the examination accurate for an older adult. The room was brightened and the skin examined in natural light where possible, since subtle color variation in a pigmented lesion is easy to miss under dim fluorescent light. The whole skin surface was examined, including the back, scalp and feet, because older adults often cannot see their own backs and new lesions there go unnoticed, as this one did until her daughter saw it. Visual acuity was tested with her own reading glasses and distance glasses separately. The whispered voice test was performed from behind her, at arm's length, while she occluded the other ear, so she could not lip-read, which older adults with hearing loss often do without realizing it. Her partial denture was removed so the gums beneath could be inspected, since sores under dentures are a common and painless source of problems. Each adaptation reflects a principle of assessment across the life span: the examination must fit the person's abilities and habits to find what is really there.
Plan Based on Findings
Refer to dermatology within two weeks for the left upper back lesion. Refer to ophthalmology for cataract and fundus evaluation. Remove right cerumen and repeat the hearing screen, with audiology referral if failed. Recommend a dental visit. Teach skin self-examination with a hand mirror or help from her daughter, sun protection and fall precautions related to reduced vision at night.
Reflection on Life-Span Variation
The same examination in a 24-year-old would look very different. Her skin would be firm and elastic, her pupils larger and quicker, her lenses clear and her hearing intact. The skill this week teaches is not memorizing abnormal findings but knowing what normal looks like at each age, so that the truly abnormal finding stands out. In Mrs. F., most findings were expected for 74 years of sun and time, which is exactly why the single new lesion on her back needed to be noticed.
Conclusion
Mrs. F.'s skin and HEENT examination shows many expected changes of aging and four findings that need follow-up, the most urgent a new pigmented lesion that meets all five melanoma warning criteria. Documenting findings precisely and sorting them by what age explains is the core of an assessment across the life span.
References
Abbasi, N. R., Shaw, H. M., Rigel, D. S., Friedman, R. J., McCarthy, W. H., Osman, I., Kopf, A. W., & Polsky, D. (2004). Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. JAMA, 292(22), 2771-2776. https://doi.org/10.1001/jama.292.22.2771
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Pirozzo, S., Papinczak, T., & Glasziou, P. (2003). Whispered voice test for screening for hearing impairment in adults and children: Systematic review. BMJ, 327(7421), 967. https://doi.org/10.1136/bmj.327.7421.967
How this NSG 502 Week 2 example is structured
The NSG/502 description asks for assessment across the life span with attention to developmental variables. This sample documents a focused skin and HEENT examination in clinical form, subjective data first, then objective findings, and then does the analytic work the course rewards: separating what aging explains from what it does not. Students search this week as NSG 502 Week 2, NSG502 Wk 2 or NSG/502 Wk 2; all three are the same assignment.
NSG/502 Week 2 questions, answered
What does NSG/502 Week 2 usually ask for?
Many sections focus on the skin and the head, eyes, ears, nose and throat in the early weeks, asking for a documented examination with attention to how normal findings change across the life span.
What skin changes are normal with aging?
Thinner, drier skin, reduced elasticity, senile purpura on the forearms, seborrheic keratoses and cherry angiomas are common and benign. New or changing pigmented lesions are not explained by age and need evaluation.
What is the whispered voice test?
A simple hearing screen in which the examiner whispers a combination of numbers and letters from behind the patient at arm's length while masking the other ear. Failure suggests hearing loss worth formal testing.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.