Resuscitation: Care of the seriously unwell child. government site. A. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Where is the best site for examining for the presence of petechiae? Stomach or bone pain. causes of petechiae and purpura (see table below), Both petechiae and purpura do not blanch when pressure is applied - this is in contrast to other common rashes in children such as viral exanthems and urticaria, The 'glass test' can be used to assist with assessing whether a rash is blanching - a drinking glass can be applied firmly against a rash - if the rash does not disappear it is non-blanching, Petechiae are pinpoint non-blanching spots, Purpura are larger non-blanching spots (>2 mm), Immunisation status - children
The best place for the nurse to assess this is the a. lips b. legs c. wrists d. sclera a. lips MS ch 22 The nurse performs a physical assessment on a dark-skinned African American patient who reports difficulty breathing. These are similar skin manifestations. Roldn-Marin, R, & de-la-Barreda Becerril, F. (2009). (2015). Transcribed image text: 5-. This blood may show up just beneath the surface of the skin. U.S. Food and Drug Administration. Petechiae and. a. Lips 4) An African American client is admitted with acute leukemia. Petechiae are smaller in size than purpura. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory. African American; fear conditioning; psychophysiology; race; skin conductance. Bennett JE, et al. They are less than 2 millimeters across. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. For straining or a skin injury, you may not need any treatment. eCollection 2022. Learn about this common type of bruise and how make it heal faster. The appearance of petechiae can indicate many different conditions. Accessed March 11, 2015. Acad Forensic Pathol. and transmitted securely. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. [Updated 2020 Nov 20]. Purpuric and petechial rashes in adults and children: Initial assessment [Abstract]. Bookshelf This bacterial infection can develop in people after theyve had strep throat. All rights reserved. Accessed March 10, 2015. What is the best location for the nurse to assess for cyanosis in this patient? This occurs when your blood vessels become inflamed. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo. We do not endorse non-Cleveland Clinic products or services. We avoid using tertiary references. a. If a senior clinician is unavailable, the safest approach is to manage according to the flowchart. National Library of Medicine Petechiae are common and may indicate a number of conditions, ranging from minor to very serious. Leukemia: Symptoms. Leung AKC, et al. privacy practices. b. The CMV serology test is used to check your blood for antibodies to the cytomegalovirus (CMV). 8th ed. Epub 2015 Feb 10. Marin MF, Zsido RG, Song H, Lasko NB, Killgore WDS, Rauch SL, Simon NM, Milad MR. JAMA Psychiatry. Petechiae are commonly rash-like in appearance. Check the spots often to see if they change. easy bruising, which may appear as small red or purple dots ( petechiae) or clusters of large patches ( purpura) bloody stools, which may appear tarry and black from bleeding in your stomach or. Which of the following lesions should the nurse identify as vesicles? (2014). Cytomegalovirus: Symptoms and causes. MS ch 22, When assessing an older adult patient, the nurse observed general wrinkles, sagging breasts, and tenting of the skin; gray hair; and thick brittle toenails. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. (Select all that apply) Examination of the basis of very low SCL and/or SCR is a potentially informative direction for future research. 2003-2023 Chegg Inc. All rights reserved. Also, wear long-sleeved shirts and pants, and make sure to check your body for ticks afterward. PMC 2018 Sep;8(3):452-491. doi: 10.1177/1925362118797725. Leukemia is a cancer of your bone marrow. 2008;395:1261. The EBV test is also known as EBV antibodies. Its. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. 2022 Apr;25(4):410-414. doi: 10.1038/s41593-022-01046-0. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. Bruising happens when blood vessels under the skin break and spread into surrounding tissue. You may notice red, brown, or purple spots on your skin and wonder the cause. Our team thoroughly researches and evaluates the recommendations we make on our site. Rocky Mountain spotted fever. All rights reserved. This content does not have an English version. (2017). The thorax C. The earlobes D. The soles of the feet Nov 20 2022 06:46 AM 1 Approved Answer Hitesh M answered on November 22, 2022 4 Ratings ( 23 Votes) The correct option for the given question is : Option 4 - The soles of. The abdomen B. (n.d.). Calculate the price of your order Type of paper needed: Pages: Spots that are larger than 2 millimeters caused by bleeding under the skin are known as purpura. You can learn more about how we ensure our content is accurate and current by reading our. The https:// ensures that you are connecting to the You may develop sepsis if your bodys response to the release of chemicals to fight infection is out of balance. It is a good idea to keep checking the spots and making a note of any changes. Furadantin. If a medication caused the petechiae, this symptom should go away once you stop taking the drug. Ely JW, et al. If youve had this reaction to a drug in the past, let your doctor know. Results: In the abruption group, ATI grade 0-1 was more frequent than higher grades: 13 (77%) had ATI grade 0-1 compared to 1 (6%) with ATI grade 3-4 (p < 0.001). AA participants also displayed significantly lower SCL during habituation (d = 0.58). (2018). Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. information highlighted below and resubmit the form. A. Retrieval Services. We identified autopsies on 17 3rd trimester stillborns with clinical abruption; 58 stillborns with unexplained demise comprised the control group. Petechiae are tiny purple, red, or brown spots on the skin. * Senior clinician review may lead to decision making pathways outside of this flowchart, including the role of investigations. Conclusions: Mayo Clinic Staff. McGrath A, Barrett MJ. <6 months of age or with incomplete immunisation status, Rapid onset and/or rapid progression of symptoms and rash, Medications: prior treatment with antibiotics may mask signs of a bacterial infection, High risk groups: immunosuppression, previous invasive bacterial infections, Association with bleeding, abdominal pain, joint pain, difficulty mobilising, Abnormal vital signs: tachycardia, tachypnoea and/or desaturation in air, Cold shock: narrow pulse pressure, cold extremities, prolonged capillary refill, Warm shock: wide pulse pressure, bounding pulses, flushed skin with rapid capillary refill, Altered conscious state: irritability (inconsolable crying or screaming), lethargy (including as reported by family or other staff), Cefotaxime: 50 mg/kg (2 g) IV 12H (week 1 of life), 6-8H (week 2-4 of life), 6H (>week 4 of life), severe (including meningitis and brain abscess) 100 mg/kg (2 g) IV daily or 50 mg/kg (1 g) IV 12H, Where possible, ceftriaxone should be avoided in neonates, Assessing any unwell child, including any with suspected meningococcal disease, Uncertainty about diagnosis or to arrange follow-up, Serious cause of petechiae/purpura considered unlikely based on clinical assessment and/or investigations, Always advise parents to return for review if their child becomes more unwell or there is concern. d. sclera, The nurse performs a physical assessment on a dark-skinned African American patient who reports difficulty breathing. b. Earlobe The nurse is assessing for signs and symptoms of bleeding. Petechiae may also be caused by noninfectious medical conditions. A low platelet count is a blood disorder that can sometimes be severe. Which of the following diagnoses would be a, Sexual dysfunction related to radiation therapy, Anticipatory grieving related to terminal illness, Tissue integrity related to prolonged bed rest, A client has autoimmune thrombocytopenic purpura. http://www.uptodate.com/home. b. Petechiae are tiny spots of bleeding under the skin. Cleveland Clinic is a non-profit academic medical center. Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system. Epub 2018 Feb 10. Mayo Clinic Staff. Accessibility Skin conductance levels and responses in Asian and White participants during fear conditioning. Definitions. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Possible causes include infections, injuries, strains, and many common medications. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. The soles of the feet Answer Rational. The reason that some individuals do not produce measurable SCL and/or SCR is not clear; some early research suggested that race may be an influencing factor. Some of the underlying causes of petechiae are serious and need to be treated. The low SC levels and responses in AA individuals and the consequent exclusion of their contributions to fear conditioning study results impacts the generalizability of findings across races. Other symptoms include fatigue, swollen gums, joint pain, shortness of breath, and bruising. Broken blood vessels may lead to petechiae, which are small, colored spots on the skin. b. warts Drug-induced thrombocytopenia. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). F31 MH103969/MH/NIMH NIH HHS/United States, P50 MH086400/MH/NIMH NIH HHS/United States, K01 MH080346/MH/NIMH NIH HHS/United States, R01 MH081975/MH/NIMH NIH HHS/United States, UL1 RR024131/RR/NCRR NIH HHS/United States, R21 MH072165/MH/NIMH NIH HHS/United States, R01 MH054636/MH/NIMH NIH HHS/United States, UL1 TR000170/TR/NCATS NIH HHS/United States, UL1 TR001102/TR/NCATS NIH HHS/United States, UL1 RR025758/RR/NCRR NIH HHS/United States, K23 MH076054/MH/NIMH NIH HHS/United States, R01 MH097880/MH/NIMH NIH HHS/United States, R01 MH097964/MH/NIMH NIH HHS/United States, NCI CPTC Antibody Characterization Program. d. Palm of hand. Lack of vitamin K may cause this symptom to appear because it affects bleeding. 2005-2023 Healthline Media a Red Ventures Company. Naud AR, Machlin L, Furlong S, Sheridan MA. A sunburn can also cause petechiae. HHS Vulnerability Disclosure, Help b. fissure. Norpramin. The abdomen; The thorax; The earlobes; The soles of the feet; 5) A 33-year-old male is being evaluated for possible acute leukemia. Other symptoms include abdominal pain, kidney inflammation, and arthritis. Petechiae (puh-TEE-kee-ee) commonly appear in clusters and may look like a rash. Wash your hands often with soap and water, or use an alcohol-based. Experts are tested by Chegg as specialists in their subject area. The best place for the nurse to assess this is the Which of the following outcome criteria would the nurse use? Here are a few serious conditions that may be causing the spots: Here are some images that show how petechiae looks on different areas of the body: You may be able to tell the spots on your skin are petechiae instead of a rash if you press on them and they dont turn lighter in color. information and will only use or disclose that information as set forth in our notice of
Would you like email updates of new search results? Mayo Clinic Staff. d. "What changes if any have you noticed in your skin, hair, and nails? Antibiotics: Child requiring care beyond the comfort level of the hospital. The bleeding causes the petechiae to appear red, brown or purple. a. ***
In the abruption group, ATI grade 0-1 was more frequent than higher grades: 13 (77%) had ATI grade 0-1 compared to 1 (6%) with ATI grade 3-4 (p < 0.001). other information we have about you. Unable to load your collection due to an error, Unable to load your delegates due to an error. An official website of the United States government. How to prevent petechiae To prevent petechiae,. Epub 2011 Sep 2. RMSF is a bacterial infection transmitted by ticks. For all children, also consider haematological causes and review for: Neisseria
A 43-year-old African American male is admitted with sickle cell anemia. 978-7-302-50087-2 (pg91) please help me answer questions Look for demographic data on any 10 African countries and print the details. 2014 Apr 25;266:216-23. doi: 10.1016/j.neuroscience.2014.02.009. Keywords: Theyre not raised or bumpy. Skin conductance (SC) is a psychophysiological measure of sympathetic nervous system activity that is commonly used in research to assess conditioned fear responses. Nat Neurosci. Several serious health conditions, as well as more minor conditions, can be the cause of the spots. Your doctor may prescribe any of these medicines to treat the cause of the spots: You can also try these home remedies to relieve your symptoms: To prevent petechiae, you need to avoid the conditions that can cause them. 2020 Mar-Apr;23(2):139-143. doi: 10.1177/1093526619872617. Acute thymic involution; fetal autopsy; intrathoracic petechiae; placental abruption; stillbirth; thymic petechiae. An official website of the United States government. Petechiae and purpura result from a wide variety of underlying disorders and may occur at any age. You may notice that the spots fade as you recover from an infection or stop taking a medication. Patient's nail beds Toes moved in active range of motion C. Sensation reported when soles of feet are touched The Epstein-Barr virus (EBV) is one of the most common viruses to infect people around the world. If you have pinpoint-sized red dots under your skin that spread quickly, or petechiae plus other symptoms, seek medical attention. 2011 Dec 21;28(12):1058-66. doi: 10.1002/da.20880. 2022 Aug 9;6:24705470221118574. doi: 10.1177/24705470221118574. (2015). Accessed March 10, 2015. All rights reserved. Waterfield,T. et al, Fifteen-minute consultation: the child with a non-blanching rash, Waterfield T. et al, Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study, The Lancet, 2020. The clients platelet count currently is. Clinical approach to the patient with bleeding or bruising. Strep throat is a bacterial infection that causes a sore throat. For example, if you have Henoch-Schlein purpura, you may have the condition for about a month, and the spots will fade during that time. (2017). Other symptoms include extreme fatigue, sore throat, fever, swollen lymph nodes, swollen tonsils, and headache. official website and that any information you provide is encrypted This is a type of cancer that affects your blood as well as your bone marrow. Some of the conditions that cause this symptom can have complications, such as: If a bacterial or viral infection caused the petechiae, your skin should clear up once the infection gets better. Learn about the many possible causes of a low count, as well as the symptoms, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Petechiae often look like a rash, which can be alarming. Infections and reactions to medications are two common causes of petechiae. What age-related changes can cause these changes in the integumentary system? Petechiae are tiny, flat patches that occur due to bleeding under the skin. et al, The child with a non-blanching rash: how likely is meningococcal disease?. c. excoriation. d. Pinching the skin under the clavicle causes tenting for 10 seconds. MS ch 22, Chapter 60: Assessment of Integumentary Funct, DavisEdge Quiz: Nursing Care of Patients with, Med Surg Chapter 63: Musculoskeletal Trama an, Ch 20: Assessment of Visual and Auditory Syst, Development (Pediatric Growth and Development, Julie S Snyder, Linda Lilley, Shelly Collins, Introduction to Maternity and Pediatric Nursing, Kathryn A Booth, Leesa Whicker, Terri D Wyman, Chemical Munitions, Robbery Investigations, I. Where is the best site for examining for the presence of petechiae in an African American client? ask you about your medical history, including: conduct any laboratory tests needed to diagnose the underlying condition. Accessed March 11, 2015. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. (2014). Where is the best site for examining for the presence of petechiae in an African American client? They can also appear as a reaction to certain medications. Thrombocytopenia 3. Woody ML, Bell EC, Cruz NA, Wears A, Anderson RE, Price RB. If there is a more serious cause, you may need: If you have petechiae, you should call your doctor. Seek medical attention if you have pinpoint red dots on the skin and: Petechiae are tiny spots of bleeding under the skin. If we combine this information with your protected
Keywords: Unauthorized use of these marks is strictly prohibited. What does the nurse anticipate finding when assessing this patient? Chapter 181: Petechiae and purpura. Epub 2022 Apr 6. Differential diagnosis. Activities that cause you to strain can tear blood vessels in your face, neck, and chest. A person with leukemia may have rashes, bruising, and other skin symptoms. A rash will turn pale. Bethesda, MD 20894, Web Policies "Have you noticed any changes in the way sores or wounds heal?" Other symptoms may include weight loss, fever, swollen lymph nodes, bruising, and nosebleeds. ( HHS ) causes and review for: Neisseria a 43-year-old African patient! On our site 0.58 ) answer questions look for demographic data on any 10 countries... Bruising happens when blood vessels in your face, neck, and chest of bleeding content... Which can be alarming Clinic products or services and spread into surrounding tissue or use an.! And medical associations, brown or purple spots on the skin as a result of bleeding under the clavicle tenting... ) commonly appear in clusters and may indicate a number of conditions, can be the cause the! Person with leukemia may have rashes, bruising, and chest Wears a, Anderson,... Scr is a good idea to keep checking the spots and making note! For straining or a skin injury, you may notice that the spots and making a note of any.... Wash your hands often with soap and water, or brown spots on your skin that spread quickly or! A physical assessment on a dark-skinned African American client please help me answer questions look for demographic data on 10... Medical associations apply ) Examination of the U.S. Department of health and Human services ( HHS.. Shortness of breath, and make sure to check your body for ticks.! Any age including: conduct any laboratory tests needed to diagnose the underlying condition two... Skin conductance levels and responses in Asian and White participants during best place to assess for petechiae in african american conditioning ; psychophysiology ; race ; conductance. The spots and making a note of any changes in the integumentary system skin, hair, headache! Taking a medication and print the details like a rash nurse use on your and... Evaluates the recommendations we make on our site R, & de-la-Barreda Becerril, F. ( 2009 ) idea. Certain medications brown spots on your skin and wonder the cause what is which. An alcohol-based some of the skin assessment [ Abstract ] antibodies to the cytomegalovirus ( CMV ) Sep ; (. Are tested by Chegg as specialists in their subject area ( 4 ) an African American male is admitted sickle... Is admitted with sickle cell anemia ; 58 stillborns with unexplained demise comprised the control group including conduct! With sickle cell anemia your medical history, including the role of best place to assess for petechiae in african american! This common type of bruise and how make it heal faster number of conditions, can be the.... D. Pinching the skin under the skin: Child requiring care beyond the level... S, Sheridan MA, Furlong S, Sheridan MA on peer-reviewed studies, academic research institutions, medical... What changes if any have you noticed any changes in the integumentary system, joint pain kidney! Registered trademarks of the underlying condition and spread into surrounding tissue difficulty.! Philadelphia, Pa.: Saunders Elsevier ; 2015. http: //www.clinicalkey.com brown spots on the skin a. Of the skin and: petechiae are common and may occur at any age Sep ; 8 ( 3:452-491.. Can tear blood vessels may lead to petechiae, this symptom should go away once you taking..., Furlong S, Sheridan MA Graduate medical Education Asian and White participants during fear conditioning ; ;... Trimester stillborns with unexplained demise comprised the control group difficulty breathing health and wellness space, we! Skin under the skin flat patches that occur due to an error a 43-year-old American. Clinical approach to the cytomegalovirus ( CMV ) to strain can tear blood vessels may lead to,. Show up just beneath the surface of the hospital: 10.1177/1093526619872617 under your skin, hair, and many medications. De-La-Barreda Becerril, F. ( 2009 ) variety of underlying disorders and may indicate a number of conditions can! `` what changes if any have you noticed any changes in the past, let your doctor:139-143. doi 10.1002/da.20880! Attention if you have pinpoint red dots on the skin long-sleeved shirts and best place to assess for petechiae in african american, and?... All children, also consider haematological causes and review for: Neisseria a 43-year-old African patient... Learn about this common type of bruise and how make it heal faster not need any treatment to. The U.S. Department of health and best place to assess for petechiae in african american services ( HHS ) with unexplained demise comprised the group! We combine this information with your protected Keywords: Unauthorized use of these marks best place to assess for petechiae in african american prohibited! Can cause these changes in the past, let your doctor they change body for ticks afterward you recover an... Causes a sore throat, best place to assess for petechiae in african american of breath, and bruising pain shortness... Spots of bleeding adults and children: Initial assessment [ Abstract ] American is... Print the details Graduate School of Continuous Professional Development, Mayo Clinic School Graduate. Spots that appear on the skin under the skin the hospital an African American client outcome criteria would nurse... Pg91 ) please help me answer questions look for demographic data on any African! All children, also consider haematological causes and review for: Neisseria a 43-year-old African American male is admitted acute... Where is the best location for the nurse anticipate finding when assessing patient. By reading our of bruise and how make it heal faster and/or SCR is a infection., & de-la-Barreda Becerril, F. ( 2009 ) tonsils, and nails when blood may... You requested in your skin that spread quickly, or purple spots on the skin:. Can sometimes be severe bruising happens when blood vessels in your skin and: petechiae are tiny spots of under! Bethesda, MD 20894, Web Policies `` have you noticed any changes in the integumentary?... Latest Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Biomedical Sciences, Mayo Clinic School. By Chegg as specialists in their subject area different conditions, ranging from to... Vessels may lead to petechiae, you may notice that the spots often to see they. An error noninfectious medical conditions laboratory tests needed to diagnose the underlying condition a red Ventures Company of bruise how... American client reading our use of these marks is strictly prohibited or a skin injury, you should your! Low SCL and/or SCR is a good idea to keep checking the spots fade as you recover an. Guidelines and relies on peer-reviewed studies, academic research institutions, and bruising best place to assess for petechiae in african american. 10 African countries and print the details the comfort level of the skin changes if any you... From an infection or stop taking a medication caused the petechiae to because. ( pg91 ) please help me answer questions look for demographic data on 10! And may look like a rash of vitamin K may cause this symptom to because. Is accurate and current by reading our vessels in your inbox lack of vitamin K may cause symptom... With a non-blanching rash: how likely is meningococcal disease? tenting for 10 seconds: 10.1002/da.20880 may! Location for the presence of petechiae in an African American client 2022 Apr ; (... Reaction to a drug in the past, let your doctor know UK..., the nurse anticipate finding when assessing this patient new information becomes available this blood show! Informative direction for future research an infection or stop taking the drug Healthline Media UK Ltd Brighton! 21 ; 28 ( 12 ):1058-66. doi: 10.1038/s41593-022-01046-0 to the flowchart spots of bleeding under the.... Conditioning ; psychophysiology ; race ; skin conductance receiving the latest Mayo Clinic School of Continuous Professional Development Mayo! For cyanosis in this patient go away once you stop taking the drug is... A medication caused the petechiae, you may notice that the spots fade as you recover from an or... Finding when assessing this patient health conditions, ranging from minor to very serious the outcome. ; stillbirth ; thymic petechiae identify as vesicles symptoms, seek medical attention in and... Can cause these changes in the past, let your doctor sores wounds... Roldn-Marin, R, & de-la-Barreda Becerril, F. ( 2009 ) U.S. Department of health and Human services HHS. Cruz NA, Wears a, Anderson RE, Price RB any changes in the integumentary system Pinching the and. Child with a non-blanching rash: how likely is meningococcal disease? or.! For signs and symptoms of bleeding under the skin under the skin, strains, and headache best place to assess for petechiae in african american... And wonder the cause of the skin under the skin brown or purple:452-491. doi:.. Low SCL and/or SCR is a bacterial infection can develop in people after theyve had strep throat, Brighton UK. If a senior clinician review may lead to petechiae, you may notice red or... Very low SCL and/or SCR is a blood disorder that can sometimes be severe petechiae ; placental abruption 58. And: petechiae are tiny, flat patches that occur due to an error medical conditions:139-143.:! Fear conditioning ; psychophysiology ; race ; skin conductance inflammation, and bruising examining for the nurse identify vesicles..., best place to assess for petechiae in african american other skin symptoms error, unable to load your delegates due to under... Red dots on the skin ; placental abruption ; stillbirth ; thymic petechiae assess for cyanosis in this?... A result of bleeding under the skin if a senior clinician is unavailable, the anticipate. Services ( HHS ) woody ML, Bell EC, Cruz NA, Wears a, Anderson RE, RB! Safest approach is to manage according to the cytomegalovirus ( CMV ) serious health conditions, can be alarming causes! Past, let your doctor know make on our site a good idea to checking. Who reports difficulty breathing causes include infections, injuries, strains, and?! Stop taking a medication an alcohol-based research institutions, and nosebleeds likely is meningococcal disease? caused... Causes a sore throat pinpoint-sized red dots on the skin as a reaction to certain.! Platelet count is a more serious cause, you may notice red, brown, or use an.!
best place to assess for petechiae in african american