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Health Assesment > 1.3 Skin Assessment > Flashcards

1.3 Skin Assessment Flashcards

1
Q

Skin Layers

A

Epidermis - Surface layer consisting of fibrous protein, keratin, and melatonin which gives skin and hair tone.

Dermis - Supportive layer consisting of collagen, nerves, sensory receptors, blood vessels and lymphatics.

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2
Q

Epidermal Appendages

A
  1. Hair - Vellus (fine, grows over most of body)
    Terminal (coarse and thick. Pubic area, scalp,
    eyebrows)
  2. Sebaceous Glands - Lubricate skin with sebum
  3. Eccrine Glands - Produce Sweat
  4. Apocrine Glands - Milky secretion. Reacts with flora
    to produce body oders.
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3
Q

Function of Skin

A
  1. Protection from environment
  2. Prevention of penetration
  3. Perception
  4. Temperature regulation
  5. Identification
  6. Communication
  7. Wound Repair
  8. Absorption and excretion
  9. Production of Vitamin D
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4
Q

Subjective Data for Assessing Skin

A

History, Changes, Irritation/Injury, Medications, Environmental or Occupational Hazards, Self-Habit Cares

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5
Q

History of Skin

A

Allergies, Hives, Psoriasis, Eczema

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6
Q

Changes in Skin/Hair/Nails

A
  1. Loss or increase in color tone (hypo- hyperpigmentation)
  2. Change in mole size
  3. Hair loss or excessive hair growth (hirsutism)
  4. Change in nail shape, color, or brittleness
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7
Q

Irritation/Injury in Skin

A
  1. Excessive dryness (xerosis) or moisture oil (seborrhea)
  2. Itchiness (Pruritis most common. Related to allergies, jaundice, aging and dry skin)
  3. Bruising (Abuse, falls or sports injury)
  4. Rash/Legions (Look at migration, patterns, and evolution)
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8
Q

Medications for skin

A

Medications can cause dry or oily skin, brittle nails, and sometimes changes in skin color.

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9
Q

Environmental/Occupational hazards

A

Extreme heat/cold

Working in/with water

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10
Q

Self Care Habits

A

Tattoos (Risk of Hepatitis C)
Stress (Exacerbates chronic skin illness)
Hygiene Practices

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11
Q

Skin questions for infants and children

A

Exposure to

Contagious Skin Conditions
 - Scabies, Impetigo, Lice
Communicable Diseases
- Measles, Chicken Pox, Scarlet Fever
Toxic Plants (Poison Ivy)

Habits of biting nails/twisting hair

Protection from sun exposure

Diaper use and how often they are changed.

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12
Q

Skin Questions for Adolescents

A

Are there skin problems pimples/blackheads

- How are pimples treated

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13
Q

Skin Questions for Older Adults

A

History of pruritis? Dry Skin? Systemic Disease? (Kidney/liver/Cancer)
- Dry skin possible from frequent baths or excoriations from scratching with dry nails.

What changes have you noticed in skin in the last few years? (Older adults may have dryer skin and thin skin)

Delay in wound healing?
Change in feet? (toenails, bunions, changes from wearing shoes)
Have there been any recent falls/bruises/trauma?
History of Diabetes or Peripheral Vascular Disease?
(Can cause impaired wound healing and thin skin)

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14
Q

Objective Data for Skin Assessment

A

Color, Temperature/Moisture, Texture, Edema, Turgor, Vascularity, Lesions, Hair/Nails

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15
Q

Color

A

Color/General Pigmentation. Birthmarks/Moles

  1. Yellow - Jaundice, may indicate liver disease
  2. Pallor (Pale/Ashen in darker skin patients) - May be vasoconstriction, cold weather, smoking, anemia, shock or arterial insufficiency.
  3. Blue (Cyanosis) - Hypoxia, cardiac arrest, seen in lips and fingers.
  4. Redness (Erythema) - Excessive blood in capillaries, allergic reaction, fever, venous stasis, carbon monoxide poisoning.
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16
Q

Assessing Mole/Lesions

A

ABCDE

A - Asymmetry
B - Border Changes
C - Color
D - Diameter
E - Elevation/Evolution
17
Q

Temperature/Moisture

A

Temperature should be felt with back of hand.
Warm = Normal circulation. Hands/feet may be cooler

Moisture (dry/oily/excessive perspiration)

Extreme abnormalities

  1. Hypothermia - Cold (cardiac arrest, shock, peripheral artery insufficiency, Raynauds disease.) Localized hypothermia painful (toes, fingers, other extremities)
  2. Hyperthermia - Increased metabolic rate, fever, hyperthyroidism.)
  3. Diaphoresis - Profusive sweat (heart attack, anxiety, pain)
  4. Dehydration - Dry/flaky skin, dry mucosa, dry membranes, cracked lips.
18
Q

Texture/Edema/Turgor/Vascularity

A

Texture/Thickness - Smooth and Firm

  • Thin maybe Arterial Insufficiency
  • Scleroderma (Hard Skin) connective tissue disorder

Edema - Swollen skin from excessive fluid

  • Starts in feet and travels upward (stage 1-4 pitting)
  • Unilateral maybe due to local infection/deep vein thrombosis
  • Bilateral is Systemic (Heart/Kidney failure)

Turgor - “Tenting” of skin. Poor elasticity due to dehydration

Vascularity/Bruising -
Excessive above knees/elbows physical abuse
Needle or Track marks maybe street drugs.

19
Q

Lesions

A
  1. ABCDE (Asymmetry, Border, Change, Color, Diameter, Elevation/Evolution)
  2. Pattern or shape
  3. Size
  4. Location/distribution on body
  5. Any exudate (cells that seeped out of blood vessel)
    (Color and odor)
  6. Primary lesion (mole, freckle etc.)
  7. Secondary Lesion (Changes in lesion from scratching or infection)
20
Q

Hair/Nails

A

Hair Note

  • Distribution/Location
  • Texture/Thickness
  • Lice, Dandruff, Scaly/Patchy (Ringworm), Absence or Sparse Genital Hair (Endocrine Abnormalities).
Nails Note
- Shape/Contour of nail bed
  Nail base should be 160 degree angle
- Consistency of nail (Hard, Brittle)
Color Changes (Cyanosis or darkening) 
- Capillary Refill
Depress nail edge and release noting return of color. This notes circulation issues. Sluggish return means poor circulation (over 1-2 seconds)
21
Q

Common Abnormalities in Nails

A

Jagged - Anxiety (Nail Biting)
Clubbing - Angle of nailbed is 180 and spongy base. Due to air trapping and CO2 in COPD patients.
Marked Linear Streaks - Normal in dark skinned patients. Could be melanoma in light-skinned people.

22
Q

Lesion Patterns

A
  1. Annular/Circular - Start in center and spread
    (Tinea Corporis, Ringworm)
  2. Confluent - Run Together (Urticaria, Hives)
  3. Discrete - Remain Separate (Acne)
  4. Gyrate - Snake/Spirals
  5. Zosteriform - Linear and follow nerve route (Painful)
  6. Grouped - Clustered together (extreme pruritis)
    (Dermatitis)
  7. Polycyclic - Annular that grow together (psoriasis)
  8. Bullseye - Lyme Disease (From Ticks). Can result in neuro and cardiac problems if not treated.
23
Q

Primary Lesions

A
  1. Macules - Flat skin lesions less than 1 cm
    (Freckles, Flat Nevi, Petechia, Measles)
  2. Papules - Elevated skin lesions. Superficial thickening of epidermis. Possible to feel lump.
    (Elevated Nevi, Warts, Psoriasis Plaques)
  3. Nodules - Deeper in dermis than Macules or Papules
    ( Fibromas - Benign Tumors, Intradermal Nevi)
  4. Wheals - Irregular shaped elevations of skin caused by edema (fluid trapped).
    (Mosquito bites, hives (urticaria))
  5. Vesicles - Elevated blisters ooze clear liquid.
    (Chickenpox, Shingles)
  6. Bullae - Blisters with thin walls that rupture easily
    (Wearing new shoes)
  7. Pustules - Elevated lesions that contain turbid fluid (pus) in cavity.
    (Impetigo, Acne)
24
Q

Secondary Lesion

A
  1. Crust - Thickened dry exudate result from vesicles/pustules bursting/drying up
  2. Fissure - Linear crack with abrupt edges that extend to dermis. (Cheilosis in corners of mouth. Painful)
  3. Ulcer - Deeper depression into dermis. Irregular shape and may bleed. (Chancre sores, Pressure Sores)
  4. Keloid - Excess scar tissue beyond original injury. “Clawlike” higher incidence in African Americans, Hispanics, and Asians.
25
Q

Vascular Lesions (Birthmark)

A

Hemangiomas - Caused by benign proliferations of blood vessels in dermis.

Port wine - flat along facial surface
Strawberry Mark - Bright red (immature capillaries)
Cavernous - Solid, spongy, mass of blood vessels.

26
Q

Trauma related Lesions

A

Hematomas - Internal bruises you can feel. Appear swelling

Petechiae - Tiny bruises, purple dots on skin

27
Q

Common Lesions in Children

A

Diaper Dermatitis - Rash. Red, moist maculopapular patches.

Impetigo - Bacterial infection honey-colored crust

Eczema - Oozing crust, usually from allergen, cause pruritus.

Chicken Pox - Small vesicles on trunk and face that cause pruritis.

28
Q

Malignant Skin Lesions

A

Basal-cell Carcinoma - Most common. Skin colored papule, usually sun exposed area

Squamous-cell Carcinoma - Scaly Erythema with central ulcers.

Malignant Melanoma - Potentially lethal. Purple/brown/black pigment with irregular borders. Can spread to other organs. (Transformation of melanocytes).

29
Q

Nail Conditions

A

Scabies - Pruritic burrowing parasite. Contagious.

Paronychia - Red, swollen, inflamed toe. Chronic and fungal. Common with people who work in water.

Onycholysis - Common fungal infection in older adult nails.

Pitting - Crumbling of nails that occurs with psoriasis.

Habit-tic - Results from continued picking of nails. Due to mental health issue.

Clubbing - Results from interrupted pulmonary circulation, such as COPD and emphysema.

30
Q

Abnormal Findings in Hair

A

Cradle Cap - Thick, Yellow/White greasy condition that resembles eczema lesions.

Trichotillomania - Mental illness pulling out hair

Folliculitis - Inflamed hair follicles. Look like razor bumps or whiteheads around follicles.

Hirsutism - Excess body hair growth in females following male pattern (lips, face, chest, etc)

Health Assesment (14 decks)

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