Assessing Skin And Nails Flashcards
The __ is the largest organ of the body. It is a physical barrier that protects the underlying tissues and organs from micro-organisms, physical trauma, ultraviolet radiation (UVR), and dehydration.
It plays a vital role in temperature maintenance, fluid and electrolyte balance, absorption, excretion, sensation, immunity, and vitamin D synthesis.
It also provides individual identity to a person’s appearance.
skin
The skin is thicker on the ___ and is continuous with the mucous membranes at the orifices of the body.
palms of the hands and soles of the feet
It is composed of three layers:
the epidermal, dermal, and subcutaneous tissue
___, which contains varying amounts of fat, connects the skin to underlying structures.
Subcutaneous tissue
The ___, the outer layer of skin, is composed of four distinct layers: the stratum corneum, stratum lucidum, stratum granulosum, and stratum germinativum.
epidermis
The outermost layer consists of dead, ___ that render the skin waterproof.
keratinized cells
(___is a scleroprotein that is insoluble in water. The epidermis, hair, nails, dental enamel, and horny tissues are composed of it.)
Keratin
The innermost layer of the epidermis (____) is the only layer that undergoes cell division and contains melanin (brown pigment) and keratin-forming cells.
stratum germinativum
Connect the dermis to the epidermis. They are visible in the hands and feet and create the unique pattern of friction ridges commonly known as fingerprints.
Dermal papillae
The ___ is a well-vascularized, connective tissue layer containing collagen, elastic fibers, nerve endings, and lymph vessels. It is also the origin of sebaceous glands, sweat glands, and hair follicles.
dermis
are attached to hair follicles and, therefore, are present over most of the body, excluding the soles and palms.
They secrete an oily substance called ___ that waterproofs the hair and skin.
The sebaceous glands, sebum
The two types of sweat glands are ___.
eccrine and apocrine glands
The ___ are located over the entire skin. Their primary function is secretion of sweat and thermoregulation, which is accomplished by evaporation of sweat from the skin surface.
eccrine glands
The ___ are associated with hair follicles in the axillae, perineum, and areolae of the breasts. They are small and nonfunctional until puberty, at which time they are activated and secrete a milky sweat.
apocrine glands
a loose connective tissue containing fat cells, blood vessels, nerves, and the remaining portions of sweat glands and hair follicles
It stores fat as an energy reserve, provides insulation to conserve internal body heat, serves as a cushion to protect bones and internal organs, and contains vascular pathways for the supply of nutrients and removal of waste products to and from the skin.
subcutaneous tissue
Hair consists of layers of ___, found over much of the body except for the lips, nipples, soles of the feet, palms of the hands, labia minora, and penis.
keratinized cells
Hair develops within a sheath of epidermal cells called the __.
hair follicle
The ___ is visible above the skin;
hair shaft
Are the ___ muscles, which contract in response to cold or fright, decreasing skin surface area and causing the hair to stand erect (goose flesh).
arrector pili
The __, located on the distal phalanges of fingers and toes, are hard, transparent plates of keratinized epidermal cells that grow from the cuticle.
nails
The ___ extends over the entire nail bed and has a pink tinge as a result of blood vessels underneath.
nail body
The ___ is a crescent-shaped area located at the base of the nail. It is the visible aspect of the nail matrix.
lunula
refers to how easily the skin can be pinched.
Mobility
refers to the skin’s elasticity and how quickly the skin returns to its original shape after being pinched.
Turgor
Small, flat, nonpalpable skin color change (skin color may be brown, white, tan, purple, red).
They are less than 1 cm with a circumscribed border, whereas patches are greater than 1 cm, and may have an irregular border.
Examples include freckles, flat moles, petechiae, rubella (pictured be-low), vitiligo, port wine stains, and ecchymosis.
Macules and patch
Elevated, palpable, solid mass.
Examples of __ include elevated nevi, warts, and lichen planus. Examples of __ include psoriasis (psoria-sis vulgaris pictured below) and actinic keratosis.
Papules and plaques
Elevated, solid, palpable hard mass that extends deeper into dermis than a papule.
Examples of ___ include keloid (pictured below), lípoma, SCC, poorly absorbed in-jection, and dermatofibroma. Examples of __ include larger lipoma and carcinoma
Nodule and tumor
Circumscribed elevated, palpable mass containing serous fluid.
A circumscribed, round or oval, thin translucent mass filled with serous fluid or blood.
Examples of __ include herpes simplex/zos-ter, varicella (chickenpox, pictured below), poison ivy, and second-degree burn. Examples of ___ include pemphigus, contact dermatitis, large burn blisters, poison ivy, and bul-lous impetigo.
Vesicle and bulla
Pus-filled vesicle or bulla. Examples include acne (pictured below), impetigo, furuncles, and carbuncles.
Pustules
Elevated mass with transient borders that are often irregular. Size and color vary. Caused by movement of serous fluid into the dermis; it does not contain free fluid in a cavity (e.g., vesicle). Examples include urticaria (hives, pictured below) and insect bites.
Wheal
Encapsulated fluid-filled or semisolid mass that is located is the subcutaneous tissue or dermis, Examples include seba ceous cyst and epidermoid cyst (pictured below).
Cyst
Loss of superficial epidermis that does not extend to the dermis. It is a depressed, moist area.
Examples include rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore, pictured below).
Erosion
Skin loss extending past epidermis, with necrotic tissue loss.
Bleeding and scarring are possible. Examples include stasis __ of venous insufficiency (stasis dermatitis with venous stasis ulcer, pictured below) and pressure injury.
Ulcer
Skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue.
Examples include healed wound and healed surgical incision.
Scar (cicatrix)
Linear crack in the skin that may extend to the dermis and may be painful. Examples include chapped lips or hands and athlete’s foot. Interdigital tinea pedis with fissures and maceration is pictured below.
Fissure
NAILS
Parallel ridges running lengthwise. May be seen in the elderly and some young people with no known etiology.
Longitudinal ridging
___ body odor is frequently related to poor hygiene,
Pungent
(excessive perspiration),
hyperhidrosis
(foul-smelling perspiration).
bromhidrosis
is the result of inadequate circulating blood or hemoglobin and subsequent reduction in tissue oxygen-ation.
In clients with dark skin, it is usually characterized by the absence of underlying red tones in the skin and may be most readily seen in the buccal mucosa.
In brown-skinned clients, pallor may appear as a yellowish brown tinge; in black-skinned clients, the skin may appear ashen gray.
___ in all people is usually most evident in areas with the least pigmentation such as the conjunctiva, oral mucous membranes, nail beds, palms of the hand, and soles of the feet.
Pallor
(a bluish tinge) is most evident in the nail beds, lips, and buccal mucosa. In dark-skinned clients, close inspection of the palpebral conjunctiva (the lining of the eyelids) and palms and soles may also show evidence of cyanosis.
Cyanosis
(a yellowish tinge) may first be evident in the sclera of the eyes and then in the mucous membranes and the skin.
Jaundice
is skin redness associated with a variety of rashes and other conditions.
Erythema
, seen as patches of hypopigmented skin, is caused by the destruction of melanocytes in the area.
Vitiligo
is the complete or partial lack of melanin in the skin, hair, and eyes.
Albinism
is the presence of excess interstitial fluid. An area of it appears swollen, shiny, and taut and tends to blanch the skin color or, if accompanied by inflammation, may redden the skin.
Edema
A __ is an alteration in a client’s normal skin appearance.
skin lesion
are those that appear initially in response to some change in the external or internal environment of the skin
Primary skin lesions
are those that do not appear initially but result from modifications such as chronicity, trauma, or infection of the primary lesion.
Secondary skin lesions
A translucent, dry, paper-like, sometimes wrinkled skin surface resulting from thinning or wasting of the skin due to loss of collagen and elastin.
Examples: striae, aged skin
Atrophy
Wearing away of the superficial epidermis causing a moist, shallow depression. They do not extend into the dermis, they heal without scarring.
Examples: scratch marks, ruptured vesicles
Erosion
Rough, thickened, hardened area of epidermis resulting from chronic irritation such as scratching or rubbing.
Examples: chronic dermatitis
Lichenification
Shedding flakes of greasy, keratinized skin tissue. Color may be white, gray, or silver. Texture may vary from fine to thick.
Examples: dry skin, dandruff, psoria-sis, and eczema
Scales
Dry blood, serum, or pus left on the skin surface when vesicles or pustules burst. Can be red-brown, orange, or yellow. Large crusts that adhere to the skin surface are called scabs.
Examples: eczema, impetigo, herpes, or scabs following abrasion
Crust
Deep, irregularly shaped area of skin loss extending into the dermis or subcutaneous tissue. May bleed.
May leave scar.
Examples: pressure injuries, stasis ulcers, chancres
Ulcer
Linear crack with sharp edges, extending into the dermis.
Examples: cracks at the corners of the mouth or in the hands, athlete’s foot
Fissure
Flat, irregular area of connective tissue left after a lesion or wound has healed. New scars may be red or purple; older scars may be silvery or white.
Examples: healed surgical wound or injury, healed acne
Scar
Elevated, irregular, darkened area of excess scar tissue caused by excessive collagen formation during healing. Extends beyond the site of the original injury. Higher incidence in people of African descent.
Examples: keloid from ear piercing or surgery
Keloid
Linear erosion.
Examples: scratches, some chemical burns
Excoriation
In people with __(kwashiorkor), the hair color is faded and appears reddish or bleached, and the texture is coarse and dry.
severe protein deficiency
Some therapies cause __ (hair loss), and some disease conditions and medications affect the coarseness of hair. For example, hypothyroidism can cause very thin and brittle hair.
alopecia
The __ is normally colorless and has a convex curve.
Nail plate
The angle between the fingernail and the nail bed is normally ___ degrees
160
One nail abnormality is the spoon shape, in which the nail curves upward from the nail bed (Figure 29.10B). This condition, called ___, may be seen in clients with iron deficiency anemia.
koilonychia
is a condition in which the angle between the nail and the nail bed is 180 degrees, or greater (Figures 29.10C and D). It may be caused by a long-term lack of oxygen.
Clubbing
___ are horizontal depressions in the nail that can result from injury or severe illness (Figure 29.10E).
Beau’s lines
Should the client report a history of nail fungus (___), a referral to a podiatrist or dermatologist for treatment of nail fungus may be appropriate.
Symptoms of nail fungus include brittleness, discoloration, thickening, distortion of nail shape, crumbling of the nail, and loosening (detaching) of the nail.
onychomycosis
is an inflammation of the tissues surrounding a nail. The tissues appear inflamed and swollen, and tenderness is usually present.
Paronychia
A ___ can be carried out to test the capillary refill, that is, peripheral circulation. Normal nail bed capillaries blanch when pressed, but quickly turn pink or their usual color when pressure is released. A slow rate of capillary refill may indicate circulatory problems.
blanch test
Round red or purple macule that is 1 to 2 mm in size. It is secondary to blood extravasation and associated with bleeding tendencies or emboli to skin.
PETECHIA (PL. PETECHIAE)
Round or irregular macular lesion that is larger than pete-chial lesion. The color varies and changes: black, yellow, and green hues. It is secondary to blood extravasation and associated with trauma and bleeding tendencies.
ECCHYMOSIS (PL. ECCHYMOSES)
A localized collection of blood creating an elevated ecchy-mosis. It is associated with trauma.
HEMATOMA
● “Bronzing Color” OR Tan to Brown
● Generalized, more on exposed areas, mucous
membranes of mouth
Addison’s disease
● usually seen in miners
● Dusky with Pallor Spots
● Trunk, Upper & Lower Extremities
Arsenic poisoning
● iron metabolism disorder
● Brown to Grayish Brown d/t ↑ iron absorption
● Generalized
HEMOCHROMATOSIS
● thickening of skin d/t thickening of fibrous tissue; common in farmers
● Yellow to Tan
● May also have depigmentation
● Generalized
SCLERODERMA
● instead eliminated, urine went to skin
● Yellow to Brown
● Retention if urinary chromogens OR
● Renal Yellow Pigment
● Generalized but more on exposed areas
● DOES NOT involve conjunctiva & other mucous
membrane
Uremia
multiple groups of vehicles erupting unilaterally
Herpetiform or zosteriform
● Merged together, not discrete (separated)
CONFLUENT OR COALESCENT
● pitlike or depression at the center
UMBILICATED
Fine, irregular red lines d/t dilation of capillaries; spider veins
TELANGIECTASIA
Loose keratinized cells, flaky exfoliation, irregular, thick or thin, dry or oily, varied size, silver in white color (ex. dry skin, dandruff, psoriasis, eczema)
Scale
Dried surface fluids either blood or pus; large crusts that adhere to skin are called SCABS (ex. Eczema, impetigo, herpes, scabs following abrasion)
Crust
Scratch mark, loss of epidermis, linear or hollow crusted area, dermis exposed, linear erosion (ex. scratches, some chemical burns)
Excoriation
● Complete absence of nail; maybe caused d/t trauma or infection
ANONYCHIA
Flattening of nails; color & thickness not altered; hereditary & forerunner of koilonychias
PARONCHIA
● “Spoon nail”
● Fingernails are thin and curved inwardly from
side to side; generally spoon shape; tip portion is fragile and breaks easily
KOILONYCHIA
● Flattened and expanded (usually thumb); considered a sign of secondary syphilis
RACKET NAIL
● Complete White Nails of entire nail plate associated with Hepatic Disease, Anemia, Leprosy, Arsenic Poisoning
LEUKONYCHIA TOTALIS
● Presence of brown color in nail plate d/t distribution of melanocytes
MELANONYCHIA
● Single black or brown streak in a nail of a white person
PIGMENT BAND
Separation of nail to nail bed; originates at the free edge & progressing proximally
Onycholysis
Separation of nail at the roof part and progressing to free margin
Onychomadesis
