STUDY - Technical - New Dacian's Medicine
Pallor
(Classical / Allopathic Medicine)
Pallor
is an abnormal paleness or loss of skin color, which may
develop suddenly or gradually. Although generalized pallor
affects the entire body, it's most apparent on the face,
conjunctiva, oral mucosa, and nail beds. Localized pallor
commonly affects a single limb.
How
easily pallor is detected varies with skin color and the
thickness and vascularity of underlying subcutaneous
tissue. At times, it's merely a subtle lightening of skin
color that may be difficult to detect in dark-skinned
persons; sometimes, it's evident only on the conjunctiva
and oral mucosa.
Pallor
may result from decreased peripheral oxyhemoglobin or
decreased total oxyhemoglobin. The former reflects
diminished peripheral blood flow associated with
peripheral vasoconstriction or arterial occlusion or with
low cardiac output. (Transient peripheral vasoconstriction
may occur with exposure to cold, causing nonpathologic
pallor.) The latter usually results from anemia, the chief
cause of pallor.
ALERT:
If generalized pallor develops:
- quickly take the patient's vital signs
- look for signs of shock, such as tachycardia, hypotension, oliguria, and decreased level of consciousness
- institute emergency measures, if appropriate.
If the patient's condition permits, perform a focused assessment.
If generalized pallor develops:
- quickly take the patient's vital signs
- look for signs of shock, such as tachycardia, hypotension, oliguria, and decreased level of consciousness
- institute emergency measures, if appropriate.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Review the patient's medical history for anemia or chronic disorders that might lead to pallors, such as renal failure, heart failure, ulcer disease, and diabetes. Ask the patient about a family history of anemia.
Ask the patient about his diet, particularly his intake of green vegetables.
Ask the patient when he first noticed the pallor and if it's constant or intermittent. Does it occur when he's exposed to the cold or under emotional stress?
Ask the patient about associated signs and symptoms, such as dizziness, fainting, orthostasis, weakness and fatigue on exertion, chest pain, palpitations, menstrual irregularities, or loss of libido. Ask him about the occurrence of melena or about obvious signs of bleeding, such as epistaxis or hematemesis.
If the pallor is confined to one or both legs, ask the patient whether walking is painful or if his legs feel cold or numb; if confined to his fingers, ask about tingling and numbness.
Review the patient's medical history for anemia or chronic disorders that might lead to pallors, such as renal failure, heart failure, ulcer disease, and diabetes. Ask the patient about a family history of anemia.
Ask the patient about his diet, particularly his intake of green vegetables.
Ask the patient when he first noticed the pallor and if it's constant or intermittent. Does it occur when he's exposed to the cold or under emotional stress?
Ask the patient about associated signs and symptoms, such as dizziness, fainting, orthostasis, weakness and fatigue on exertion, chest pain, palpitations, menstrual irregularities, or loss of libido. Ask him about the occurrence of melena or about obvious signs of bleeding, such as epistaxis or hematemesis.
If the pallor is confined to one or both legs, ask the patient whether walking is painful or if his legs feel cold or numb; if confined to his fingers, ask about tingling and numbness.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs. Be sure to check for orthostatic hypotension.
Auscultate the heart for gallops and murmurs and the lungs for crackles.
Perform an abdominal examination, especially checking for tenderness.
Check the patient's skin temperature - cold extremities commonly occur with vasoconstriction or arterial occlusion.
Note skin ulceration, and palpate peripheral pulses.
Take the patient's vital signs. Be sure to check for orthostatic hypotension.
Auscultate the heart for gallops and murmurs and the lungs for crackles.
Perform an abdominal examination, especially checking for tenderness.
Check the patient's skin temperature - cold extremities commonly occur with vasoconstriction or arterial occlusion.
Note skin ulceration, and palpate peripheral pulses.
SPECIAL
CONSIDERATIONS:
When pallor results from the low cardiac output, be prepared to administer blood and fluid replacements and a diuretic, a cardiotonic, or an antiarrhythmic, as ordered.
When pallor results from the low cardiac output, be prepared to administer blood and fluid replacements and a diuretic, a cardiotonic, or an antiarrhythmic, as ordered.
PEDIATRIC
POINTERS:
In children, pallor stems from the same causes as it does in adults. However, it may also stem from congenital heart defects or chronic lung disease.
In children, pallor stems from the same causes as it does in adults. However, it may also stem from congenital heart defects or chronic lung disease.
PATIENT
COUNSELING:
If the patient has chronic generalized pallor, prepare him for blood studies and, possibly, bone marrow biopsy. If the patient has localized pallor, prepare him for arteriography to accurately determine the cause.
If the patient has chronic generalized pallor, prepare him for blood studies and, possibly, bone marrow biopsy. If the patient has localized pallor, prepare him for arteriography to accurately determine the cause.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.