CH 13 Skin, Hair, and Nails Flashcards
3 layers of skin
Epidermis
Dermis
Subcutaneous Layer (hypodermis)
Epidermis (structure/specifics)
- outermost layer of skin
- avascular
- layer most commonly shed
- Basal Cell Layer (innermost): new skin cell formation
- Horny Cell Layer (outermost): flattened above layer of dead keratinized cells
3 Sources for Skin Color
Melanin (brown) Carotene (orange) Vascular Bed (red-purple)
Dermis (structure/specifics)
- inner supportive layer
- nerves, sensory receptors, blood vessels, and lymphatics
Subcutaneous Layer (structure/specifics)
- layer of fat cells (stores for energy)
- provides insulation and protection for organs
Appendages (where? what?)
- Hair (embedded in dermis)
- vellus hair: soft/fine (arm/leg hair)
- terminal hair: darker/thicker (scalp/eyebrows)
(axialle and pubic area after puberty)
- Sebaceous Glands (embedded in dermis)
- produce sebum to lubricate skin and hair
- Sweat Glands (embedded in dermis)
- eccrine: open directly to skin surface
- apocrine: open into hair follicles
- Nails
- color indicates oxygenation status
Skin Functions
- protection/healing
- adaptation (temp regulation/prevention of fluid loss)
- production of vitamin D
- others: excretion of waste, sensory perception, and storage of fat
Developmental Consideration and Changes: Infants
- lanugo: fine hair (developed at 3 months of gestation)
- lanugo replaced with vellus (first few months after birth)
- many skin functions not fully developed
- more permeable (greater risk of fluid loss)
- insufficient subq layer (poor temp regulation)
Developmental Consideration and Changes: Children
- epidermis thickens and hair growth accelerates
Developmental Consideration and Changes: Pregnancy
- increased metabolism, secretion of sweat & sebaceous glands, and fatty deposits
- skin changes:
- striae: stretch marks
- linea nigra: brownish/black line down midline
- cholasma: hyperpigmentation of the face
- vascular spiders (legs and back)
Developmental Consideration and Changes: The Aging Adult
- skin atrophy, decreased elasticity
- epidermis and dermis thin/flatten (wrinkling)
- loss of collagen, subq fat, and muscle tone (risk for skin tearing)
Skin Assessment: Inspecting the Skin
why do assessment?
- skin assessment helps collect information of nutritional status, circulation, and systemic disease
- skin folds = perfect condition for moisture, irritation, and infection
Normal Findings of Skin
- general pigmentation (even skin tone)
- benign pigmented areas
Assessment for Abnormal Findings
ABCDEF Assessment A (asymmetry) B (border irregularity) C (color variation) D (diameter >6mm) E (elevation/evolution) F (funny looking)
Widespread Color Changes
Pallor (white)
- vasoconstriction/edema
Erythema (red)
- dilated superficial capillaries
Cyanosis (blue)
- decrease in perfusion/high level of de-oxygenated
blood
Jaundice (yellow)
- increased bilirubin in blood
Temperature (normal/abnormal)
Normal - warm and equal bilaterally
Abnormal
- Hypothermia (low temp)
- generalized (shock/cardiac arrest)
- localized (immobilized extremity) - Hyperthermia (high temp)
- generalized (increased metabolic rate -
fever/exercise)
- localized (trauma/infection/sunburn)
Moisture (normal/abnormal)
Normal - normal perspiration
Abnormal
- Diaphoresis (profuse perspiration) - Dehydration (dry mucosa are signs)
Edema (what is it? How to assess?)
- fluid accumulation in interstitial space
- imprint thumb for 3-4 sec
(if imprint left behind = pitting edema)
Mobility & Turgor
- assess elasticity in skin
- mobility: ease of skin to rise
- turgor: measures how skin returns to place
- abnormal = tenting (skin stays up for few sec)
Skin Assessment: Lesions (what is it? important findings? primary vs secondary)
- lesions: traumatic/pathologic changes in normal structures
- palpate and note surround temperature
- important findings
- color, elevation, patter/shape, size, location, exudate
- primary: develops on previously normal skin
- secondary: when primary lesion changes over time because of scratching or infection
Primary Lesions (7 types)
- Macule and Patch (flat, nonpalpable, circumscribed border)
- EX. freckles, vitiligo, measles
- macule <1cm
- patch >1cm
- Papule and Plaque (elevated, solid, palpable)
- EX. warts, psoriasis, actinic keratosis
- papule <0.5cm
- plaque >0.5cm
- Nodule and Tumor (more palpable mass/deeper in dermis than papule)
- EX. lipoma, carcinoma
- nodule 0.5-2cm
- tumor >2cm
- Vesicle and Bulla (elevated, fluid-filled, round/oval, superficial, translucent)
- EX. herpes, chickenpox, blister
- vesicle <0.5cm
- bulla >0.5cm
- Wheal (elevated, irregular shape, reddish/edematous)
- EX. insect bite, allergic reaction, hives
- Pustule (purulent-filled vesicle)
- EX. acne
- Cyst (elevated, walled off-encapsulated
- containing fluid or semi-solid material
Secondary Lesions (8 types)
- Crust (dry blood/pus from burst vesicle/pustule)
- Ex. scabs
- Scales (shedding flakes of dry skin)
- EX. dandruff, psoriasis, eczema
- Lichenification (rough and thickened)
- secondary to scratching
- EX. chronic dermatitis
- Erosion (wearing away of superficial epidermis w/o bleeding)
- No scar
- EX. ruptured vesicle
- Ulcer (deeper depression into dermis or subq, may bleed)
- will scar
- EX. pressure injury
- Fissure (linear break in skin surface)
- EX. cracks in corner of mouth
- Scar (fibrotic change where collagen replaces normal tissue)
- Keloid (elevated and irregular/overproduction of scar tissue)
- usually benign
- common from surgery, acne, piercing, infections
Common Patterns/Distribution of Lesions
Annular (circular)
Ex. ringworm (tinea corpori)
Confluent (lesions that run together)
Ex. Urticaria (hives)
Discrete (individual lesions/separate
Ex. warts, skin tags
Grouped (appear in clusters)
Ex. poison ivy
Zosterform (linear along unilateral nerve route)
Ex. herpes zoster (shingles)
Physical Variation in Skin Color (Vessel Bleeding)
Petechiae (bleeding from superficial capillaries)
- nonblanchable
- tiny hemorrhages (1-3mm)
Purpura (extensive patch of petechiae)
- red, nonblanchable
- > 3mm
Contusion (bruise)
Ecchymosis (severe bruising)
