assessing skin, hair, and nails Flashcards
Skin basics
epidermis outer, four layers. dermis inner
Four layers of epidermis
stratum corneum, lucid, granulosum, germinativum
Dermis contains
sebaceous glands - oily sebum waterproofs hair/skin. sweat glands - eccrine for sweat/thermoregulation all over. apocrine - puberty, milky sweat
Types of hair
vellus - short fine all over. terminal - longer darker coarser (head, eyebrows)
Nails
hard plates of keratin. cuticle, nail body, lunula
cuticle
where nails grow
nail body
extends over nail bed, pink b/c blood under nail bed
Lunula
half moon at base of nail (nail matrix)
Questions to ask about skin
dryness, oiliness, drainage, bruising, swelling, changes in skin color, pain/itching/tingling/numbness, aggravators, relieve symptoms, body odor/perspiration (too much?)
Old people sweat _____ than young people
less
Cultural considerations for sweat
asians/native Americans less. African americans/caucasians more
What do you do with a health assessment and history?
cluster symptoms
Hair condition
loss - could be normal (males), infections, stress, stress on the roots, chemo, meds
Nail conditions
malnutrition (different conditions), local irritation (biting), infections (ex: fungal)
Lifestyle and practices related to skin hair and nails
sunbathe/tanning booth, sunblock, self examination, immobility, extreme temps, body piercings, tattoos, daily routines (self care), prevent from living normal life?
Looking at health history for skin hair and nails
severe sunburns as child, recent hospitalizations/surgeries, skin allergies, recent infections, pregnancy, self injury. family - cancer, allergies, keloids
Equipment for physical exam
examination light, penlight, mirror, magnifying glass, centimeter ruler, gloves, wood light, gown, Braden scale, pressure ulcer scale for healing (PUSH)
Skin inspection
general coloration - fair at highest risk, older = pale, amount of melanin culturally
Abnormalities in skin color
pallor - pale, decreased blood supply. cyanosis - blue, oxygen deficiency (especially nail bed). jaundice - yellow (pale to pumpkin), mostly in sclera, oral mucosa, palms/soles. acanthuses nigricans - dark folds/creases
Central vs peripheral cyanosis
central from cardiopulmonary problem, look in oral mucosa. peripheral may be local problem, vasoconstriction. oxygen/perfusion concern
Inspect lesions
symmetry, border, shape, color, diameter, changes. use magnifying glass, centimeter ruler, wood light (suspected fungus)
skin integrity
intactness, reddened areas, Braden scale, lesions
Skin types
1 - always burns never tans (pale)
2 - usually burns sometimes tans (fair)
3 - may burn usually tans (darker skin)
4 - rarely burns always tans (Mediterranean)
5 - moderate constitutional pigmentation (Latin American/Middle Eastern)
6 - marked constitutional pigmentation (black)
Skin palpation
texture, thickness, temp, moisture, mobility/edema, turgor
texture
use palmar surface of three middle fingers
temp
dorsal surface of hands
moisture
older may be dryer