ch 13 jarvis skin,nails, hair Flashcards
1
Q
is the largest organ system in the body
A
skin
2
Q
the outer, highly differentiated epidermis and the inner, supportive dermis
-Beneath these is the subcutaneous layer of adipose tissue.
A
skin has 2 layers:
3
Q
forms new skin cells. Their major ingredient is the tough, fibrous protein keratin. The melanocytes interspersed along this layer produce the pigment melanin,
A
basal cell layer
4
Q
the basal layer the new cells migrate up and flatten into the outer .
-consists of dead keratinized cells
A
horny cell layer
5
Q
is completely replaced every 4 weeks
-avascular, nourished by blood vessel in dermis
A
epidermis
6
Q
is thicker because of work and weight bearing
A
palms and soles skin
7
Q
(1) mainly from the brown pigment melanin,
(2) from the yellow-orange tones of the pigment carotene, (3) from the red-purple tones in the underlying vascular bed.
A
Skin color is derived from 3 sources:
8
Q
is the inner supportive layer consisting mostly of connective tissue, or collagen.
- resilient elastic tissue that allows the skin to stretch with body movements.
- appendages from the epidermis such as the hair follicles, sebaceous glands, and sweat glands are embedded in the
A
dermis
9
Q
stores fat for energy, provides insulation for temperature control, and aids in protection by its soft cushioning effect
A
subcutaneous tissue
10
Q
are threads of keratin
A
Hairs
11
Q
is the visible projecting part
A
hair shaft
12
Q
is below the surface embedded in the follicle
A
root (hair)
13
Q
at root the bulb matrix is the expanded area where new cells are produced at a high rate
A
bulb matrix
14
Q
, which contract and elevate the hair so it resembles “goose flesh” when the skin is exposed to cold or in emotional states.
A
hair follicle are the muscular arrector pili
15
Q
.1. Fine, faint vellus hair
2. terminal hair,
A
two types of hair
16
Q
abundant in the scalp, forehead, face, and chin.
-produce a protective lipid substance, sebum,
A
Sebaceous Glands
17
Q
- eccrine
2. apocrine
A
2 types of sweat glands
18
Q
mature in the 2-month-old infant.
- produce sweat
- evaporation of sweat reduces body temperature
A
eccrine (type sweat gland)
19
Q
- located mainly in the axillae, anogenital area, nipples, and navel and are vestigial in humans
- active during puberty
- produce musky body odor
A
apocrine (type sweat gland)
20
Q
is the white, opaque, semilunar area at the proximal end of the nail.
A
lunula (nail)
21
Q
where new keratinized cells are formed.
A
nail matrix
22
Q
, which holds water in the skin
-produce milia (pimple looking) in 1st wks of life
A
Sebum
23
Q
decrease in size and production and do not resume functioning until puberty
A
sebaceous glands (infant)
24
Q
do not secrete in response to heat until the first few months of life and then only minimally throughout childhood
A
Eccrine sweat glands (infant)
25
- cannot contract and shiver and because the subcutaneous layer is inefficient
- not protected against cold
Temp regulation dont work (infant)
26
is inefficient at birth
pigment system (infant)
27
, the epidermis thickens, toughens, and darkens, and the skin becomes better lubricated.
- Hair growth accelerates.
- At puberty secretion from apocrine sweat glands increases in response to heat and emotional stimuli= body odor
- skin oily & acne develop
child grows (skin alterations)
28
female: areola enlarges and darkens, and breast tissue develops, Coarse pubic hair develops in males and females, then axillary hair, and then coarse facial hair in males.
Secondary sex characteristics
29
Metabolism is increased in pregnancy
| -way to dissipate heat, the peripheral vasculature dilates, - sweat and sebaceous glands increase secretion.
pregnancy metabolism
30
- loses its elasticity; it folds and sags. By the 70s to 80s, it --looks parchment thin, lax, dry, and wrinkled.
- loss of elastin, collagen, and subcutaneous fat and reduction in muscle tone occur.
- Sweat and sebaceous glands decrease in number and function, leaving dry skin.
- vascularity of the skin diminishes
- increasingly sedentary lifestyle, and the chance of immobility.
aging skin
31
minor trauma may produce dark red discolored areas, or
senile purpura.
32
, the number of functioning melanocytes decreases; therefore the hair looks gray or white and feels thin and fine.
aging hair matrix
33
determines the onset of graying and the number of gray hairs
person's genetic script
34
against harmful UV rays, a genetic advantage accounting for the lower incidence of skin cancer among darkly pigmented African Americans
Melanin protects the skin
35
are scars that form at the site of a wound and grow beyond the normal boundaries of the wound (among BLACK)
Keloids
36
appear as dark or light spots after acne has resolved (IN BLACKS)
Areas of postinflammatory hypopigmentation or hyperpigmentation
37
, also known as “razor bumps” or “ingrown hairs,” is caused by shaving too closely with an electric or straight razor. (IN BLACKS)
Pseudofolliculitis
38
or the “mask of pregnancy,” is a patchy tan-to–dark brown discoloration of the face(IN BLACKS)
Melasma
39
(loss of color);
Hypopigmentation
40
INCREASE COLOR
HypERpigmentation
41
in pigmented nevus
neoplasm
42
occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice.
Pruritus is the most common skin symptom
43
Oily. SKIN
Seborrhea
44
Dry. skin
Xerosis
45
sulfonamides, thiazide diuretics, oral hypoglycemic agents, tetracycline
Drugs may increase sunlight sensitivity and give burn response
46
antimalarials, anticancer agents, hormones, metals, and tetracycline.
drugs cause hyperpigmentation:
47
is shaggy or excessive hair.
Hirsutism
48
is usually caused by dry skin (xerosis), too-frequent bathing, or use of soap.
senile pruritus
49
, the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, and body folds and around orifices
vitiligo (patchy skin tone)
50
—Small, flat macules of brown melanin pigment that occur on sun-exposed skin
Freckles (ephelides)
51
—A clump of melanocytes, tan-to-brown color, flat or raised. Acquired nevi have symmetry, small size (6 mm or less), smooth borders, and single uniform pigmentation
Mole (nevus)
52
is macular (distinct spots) only and occurs in children and adolescents.
junctional nevus
53
In young adults it progresses to the which is macular and papular (small pimple). The intradermal nevus (mainly in older age) has nevus cells in only the dermis.
compound nevus
54
- development of itching, burning, or bleeding in a mole
| - rapidly changing lesion; a new pigmented lesion;
signs or suspicion of malignant melanoma
55
least pigmentation such as under the tongue, the buccal mucosa, the palpebral conjunctiva, and the sclera.
black ppl places to check for skin lesions
56
skin occurs with anemia, shock, and arterial insufficiency
Ashen gray color in dark skin or marked pallor in light
57
with rapid pulse rate, oliguria, apprehension, and restlessness.
pallor of shock presents
58
anemia may show “spoon” nails, with a concave shape. Fatigue, exertional dyspnea, rapid pulse, dizziness, and impaired mental function accompany most severe anemias.
Chronic iron deficiency
59
lips, nose, cheeks, ears, and oral mucous
| -cause decreased oxygenation of the brain,
cyanosis occurs mainly in
60
first noted in the junction of the hard and soft palate in the mouth and in the sclera.
-Light or clay-colored stools and dark golden urine
Jaundice
61
scleral yellow of jaundice extends up to the edge of the iris
scleral yellow
62
occurs with hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic (rupture of RBC) disease of the newborn.
Jaundice occurs along w/
63
accompanies shock, cardiac arrest.
General hypothermia
64
occurs in peripheral arterial insufficiency and Raynaud disease
Localized hypothermia
65
has an increased metabolic rate, causing warm, moist skin.
| -skin feels smoother and softer, like velvet.
Hyperthyroidism
66
occurs with an increased metabolic rate such as in fever or after heavy exercise
Generalized hyperthermia
67
feels hyperthermic with trauma, infection, or sunburn.
localized hyperthermia
68
with thyrotoxicosis, heart attack, anxiety, or pain.
Diaphoresis occurs
69
mucous membranes are dry, and lips look parched and cracked. With extreme dryness the skin is fissured, resembling cracks in a dry lake bed.
dehydration
70
skin feels rough, dry, and flaky.
| -Loss of eyebrows and scalp hair
hypothyroidism
71
Very thin, shiny skin (atrophic) occurs with
arterial insufficiency.
72
can indicate cyanosis or jaundice
| - fluid lies between the surface and the pigmented and vascular layers.
Edema
73
a has a local or peripheral cause.
Unilateral edem
74
over the whole body
Bilateral edema or edema that is generalized
75
—consider a central problem such as heart failure or kidney failure.
anasarca
76
is evident in severe dehydration or extreme weight loss;
Poor turgor
77
literally “hard skin,” is a chronic connective tissue disorder associated with decreased mobility.
Scleroderma
78
are small (1 to 5 mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years
Cherry (senile) angiomas
79
Wood's light, lesions with blue-green fluorescence indicate (e.g., tinea capitis [scalp ringworm]).
fungal infection
80
occurs with congenital cyanotic heart disease, lung cancer, and pulmonary diseases.
-normal is 160 degrees
Clubbing of nails (profile sign)
81
180 degrees, and the nail base feels spongy to palpation.
abnormal indictaion (clubbing)
82
is a common variation of hyperpigmentation in African-American, Asian, American Indian, and Latino newborns
mongolian spot
83
is a large round or oval patch of light brown pigmentation
| -usually present at birth
café au lait spot
84
Six or more café au lait macules, each more than 1.5 cm in diameter, are diagnostic of neurofibromatosis, an inherited neurocutaneous disease
neurofibromatosis (cause tumor to form in the brain)
85
newborn's skin has a beefy red flush for the first 24 hours because of
vasomotor instability;
86
occurs when the baby is in a side-lying position. The lower half of the body turns red, and the upper half blanches with a distinct demarcation line down the midline.
harlequin color change
87
is a common rash that appears in the first 3 to 4 days of life. Sometimes called the flea bite rash or newborn rash, it consists of tiny punctate red macules and papules on the cheeks, trunk, chest, back, and buttocks
erythema toxicum
88
1. Acrocyanosis
| 2. Cutis marmorata
2 temporary cyanotic conditions may occur
89
is a bluish color around the lips, hands and fingernails, and feet and toenails. This may last for a few hours and disappear with warming.
Acrocyanosis
90
is a transient mottling in the trunk and extremities in response to cooler room temperatures
- forms a reticulated red or blue pattern over the skin.
- occurs with down syndrome or premature
Cutis marmorata
91
Jaundice on the 1st day of life may indicate
hemolytic disease.
92
Jaundice after 2 weeks of age may indicate
biliary tract obstruction
93
also produces a yellow-orange color in light-skinned persons but no yellowing in the sclera or mucous membranes. (vitamin A percusor)
- color is best seen on the palms and soles, forehead, tip of the nose and nasolabial folds, chin, behind the ears, and over the knuckles;
- it fades to normal color within 2 to 6 weeks of withdrawing carotene-rich foods from the diet.
Carotenemia
94
is a common variation (Fig. 13.21); you will note tiny white papules on the forehead and eyelids, also on cheeks, nose, and chin, caused by sebum that occludes the opening of the follicles.
-do not squeeze lesiona, go away w/in few weeks
Milia
95
occurs with a pilonidal cyst or sinus
red sacrococcygeal dimple
96
r over the abdomen in an infant.
Test mobility and turgo (infant)
97
is a nevus simplex (stork bite, or salmon patch); it is a flat, irregularly shaped red or pink patch found on the forehead, eyelid, or upper lip but most commonly at the back of the neck (nuchal area)
vascular birthmark
98
(blackheads)
comedones
99
(whiteheads)
closed comedones
100
are jagged linear “stretch marks” of silver-to-pink color that appear during the 2nd trimester on the abdomen, breasts, and sometimes thighs
Striae
101
change in hormone levels causes numerous color changes. On the abdomen is the linea nigra, a brownish-black line down the midline
linea nigra (striae after change hormone)
102
is an irregular brown patch of hyperpigmentation on the face. It may occur with pregnancy or in women taking oral contraceptive pills.
Chloasma
103
are common in pregnancy because of increased estrogen and may resolve after childbirth.
Vascular spiders (spider angioma)
104
More than 5 spider angioma occur with significant liver disease when the liver cannot metabolize estrogen.
liver disease
105
are common variations of hyperpigmentation. Commonly called liver spots, these are small, flat, brown macule
- forearms and dorsa hands (normal)
- caused by sun
Senile lentigines
106
are raised, thickened areas of pigmentation that look crusted, scaly, and warty.
Keratoses
107
looks dark, greasy, and “stuck on
seborrheic keratosis, (type of keratoses)// not cancerous
108
, is less common These lesions are red-tan scaly plaques that increase over the years to become raised and roughened. They may have a silvery-white scale adherent to the plaque. They occur on sun-exposed surfaces
actinic (senile or solar) keratosis (squamous cell carcinoma.)
109
, or “skin tags,” are overgrowths of normal skin that form a stalk and are polyp-like
Acrochordons
110
consists of raised yellow papules with a central depression
| -have pebbly look
Sebaceous hyperplasia
111
skin may feel thicker over the abdomen and chest.
| -Thinner skin is evident over the dorsa of the hands, forearms, lower legs, dorsa of feet, and bony prominences
Aging adult skin thickness
112
Total absence of pigment melanin throughout the integument
Albinism
113
, or circular, begins in center and spreads to periphery (e.g., tinea corporis or ringworm, tinea versicolor, pityriasis rosea).
ANNULAR (Common Shapes and Configurations of Lesions)
114
, lesions run together (e.g., urticaria [hives]).
CONFLUENT (Common Shapes and Configurations of Lesions)
115
, distinct, individual lesions that remain separate (e.g., acrochordon or skin tags, acne).
DISCRETE (Common Shapes and Configurations of Lesions)
116
, twisted, coiled spiral, snakelike
GYRATE (Common Shapes and Configurations of Lesions)
117
, clusters of lesions (e.g., vesicles of contact dermatitis).
GROUPED
118
, a scratch, streak, line, or stripe.
LINEAR
119
, or iris, resembles iris of eye, concentric rings of color in lesions (e.g., erythema multiforme).
TARGET
120
, linear arrangement along a unilateral nerve route (e.g., herpes zoster).
ZOSTERIFORM
121
annular lesions grow together (e.g., lichen planus, psoriasis).
POLYCYCLIC,
122
Solely a color change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever.
Macule (Primary Skin Lesions)
123
Something you can feel (i.e., solid, elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in epidermis. Examples: elevated nevus (mole), lichen planus, molluscum, wart (verruca).
papule
124
Macules that are larger than 1 cm. Examples: mongolian spot, vitiligo, café au lait spot, chloasma, measles rash.
Patch
125
Papules coalesce to form surface elevation wider than 1 cm. A plateaulike, disk-shaped lesion. Examples: psoriasis, lichen planus.
Plaque
126
Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule. Examples: xanthoma, fibroma, intradermal nevi.
Nodule
127
Superficial, raised, transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in the tissues). Examples: mosquito bite, allergic reaction, dermographism.
Wheal
128
Larger than a few centimeters in diameter, firm or soft, deeper into dermis; may be benign or malignant, although “tumor” implies “cancer” to most people. Examples: lipoma, hemangioma
tumor
129
Wheals coalesce to form extensive reaction, intensely pruritic.
Urticaria (Hives)
130
Elevated cavity containing free fluid, up to 1 cm; a “blister.” Clear serum flows if wall is ruptured. Examples: herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatitis.
Vesicle
131
Larger than 1 cm diameter; usually single chambered (unilocular); superficial in epidermis; thin-walled and ruptures easily. Examples: friction blister, pemphigus, burns, contact dermatitis.
Bulla
132
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin. Examples: sebaceous cyst, wen.
Cyst
133
Turbid fluid (pus) in the cavity. Circumscribed and elevated. Examples: impetigo, acne.
Pustule
134
thickened, dried-out exudate left when vesicles/pustules burst or dry up. Color can be red-brown, honey, or yellow, depending on fluid ingredients (blood, serum, pus). Examples: impetigo (dry, honey-colored), weeping eczematous dermatitis, scab after abrasion.
Crust
135
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells. Examples: after scarlet fever or drug reaction (laminated sheets), psoriasis (silver, micalike), seborrheic dermatitis (yellow, greasy), eczema, ichthyosis (large, adherent, laminated), dry skin
Scale
136
Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella.
Excoriation
137
Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals. Examples: stasis ulcer, pressure injury, chancre.
Ulcer
138
The resulting skin level is depressed with loss of tissue; a thinning of the epidermis. Example: striae.
Atrophic Scar
139
After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic change. Examples: healed area of surgery or injury, acne.
Scar
140
Prolonged, intense scratching eventually thickens skin and produces tightly packed sets of papules; looks like surface of moss (or lichen).
Lichenification
141
benign excess of scar tissue beyond sites of original injury: surgery, acne, ear piercing, tattoos, infections, burns.16 Looks smooth, rubbery, shiny and “clawlike”; feels smooth and firm. Found in ear lobes, back of neck, scalp, chest, and back; may occur months to years after initial trauma. Most common ages are 10-30 years; higher incidence in blacks, Hispanics, and Asians.
Keloid
142
Intact skin is red but unbroken. Localized redness in lightly pigmented skin does not blanch (turn light with fingertip pressure). Dark skin appears darker but does not blanch. May have changes in sensation, temperature, or firmness.
Stage 1—Non-Blanchable Erythema
143
Loss of epidermis and exposed dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed. No visible fat or deeper tissue.
Stage 2—Partial-Thickness Skin Loss
144
PI extends into subcutaneous tissue and resembles a crater. See subcutaneous fat, granulation tissue, and rolled edges, but not muscle, bone, or tendon.
Stage 3—Full-Thickness Skin Loss
145
PI involves all skin layers and extends into supporting tissue. Exposes muscle, tendon, or bone, and may show slough (stringy matter attached to wound bed) or eschar (black or brown necrotic tissue), rolled edges, and tunneling.
Stage 4—Full-Thickness Skin/Tissue Loss
146
Localized, non-blanchable color change to deep red, maroon, purple in intact or nonintact skin. Dark skin appears darker but does not blanch. Or, epidermis may separate, revealing dark wound or blood-filled blister.12 Preceded by pain and temperature change. Begins in the muscle closest to the bone, in older adults and those with a lower BMI, commonly on skin over coccyx, sacrum, buttocks, heels.13
Deep Tissue Pressure Injury (DTPI)
147
Skin or mucosa has PI that looks like pattern or shape of medical device, e.g., IV hub, endotracheal tube, cervical collar, anti-thromboembolism stocking
PI Caused by Medical Device
148
(Bruise)
Contusion
149
(1) red-blue or purple immediately after or within 24 hours of trauma and generally progresses to
(2) blue to purple, (
3) blue-green,
(4) yellow,
(5) brown to disappearing.
(blacks= recent bruise is dark purple)
stages of Bruise
150
Red-purple maculopapular blotchy rash in dark skin (on left) and light skin (on right) appears on 3rd or 4th day of illness. Rash appears first behind ears and spreads over face and then over neck, trunk, arms, and legs; looks “coppery” and does not blanch. Also characterized by Koplik spots in mouth—bluish white, red-based elevations of 1 to 3 mm
Measles (Rubeola)
151
- varicella zoster virus (VZV), a reactivation of the dormant virus of chickenpox
- lasting in aging adults, called postherpetic neuralgia.
Herpes Zoster (Shingles)
152
Lyme disease (LD) is not fatal but may have serious arthritic, cardiac, or neurologic sequelae. It is caused by a spirochete bacterium carried by the black or dark brown deer tick, which is common in the Northeast and upper Midwest (with cases in people who spend time outdoors) in May through September.
Erythema Migrans of Lyme Disease
153
- distinctive bull's-eye, red macular or papular rash
- caused by a spirochete bacterium carried by the black or dark brown deer tick,
- tick bite (5 cm or larger)
- Rash fades in 4 weeks
- disseminated disease with fatigue, anorexia, fever, chills, or joint or muscle aches.
Erythema Migrans of Lyme Disease
154
1. Basal Cell Carcinoma (most common form)
2. Squamous Cell Carcinoma
3. Malignant Melanoma
three forms of skin cancer
