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NURS 307 > Chapter 12: Skin, Hair and Nails > Flashcards

Chapter 12: Skin, Hair and Nails Flashcards

1
Q

Epidermis

A

outermost layer, thin but tough, replaced every 4 weeks.

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2
Q

Basal Cell Layer (Stratum Germinativum)

A
  1. Forms new skin
  2. Major Ingredients: Keratin (tough fibrous protein), Melanin (brown tones to the skin and hair), Carotene Pigment (orange tones)
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3
Q

Stratum Corneum

A

horny cell layer consists of dead keratinized cells

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4
Q

Dermis

A

inner supportive layer, consists of connective tissue (collagen), nerves, sensory receptors, blood vessels, lymphatics, hair follicles, sebaceous glands, and sweat glands

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5
Q

Subcutaneous

A

adipose (fat) tissue

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6
Q

Parts of the Skin

A

A. Epidermis
B. Dermis
C. Subcutaneous
D. Appendages

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7
Q

Appendages of the skin include

A

hair, sebaceous glands, sweat glands, nails

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8
Q

Hair

A

shaft, root, bulb matrix.

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9
Q

Vellus hair

A

fine hair all over body

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10
Q

Terminal hair

A

scalp, eyebrows

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11
Q

Sebaceous glands

A

produce sebum

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12
Q

Sweat glands: 2 Types

A

Eccrine and Apocrine

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13
Q

Eccrine Glands

A

produces sweat (diluted saline solution) active at 2 months of age

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14
Q

Apocrine Glands

A

produce thick milky secretions, activated in puberty

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15
Q

Nails

A

hard plates of keratin

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16
Q

What are the functions of the skin?

A
  1. Protection
  2. Barrier
  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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17
Q

Functions of the Skin: Protection

A

minimizes injury from physical, chemical, thermal, and light-wave sources

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18
Q

Functions of the Skin: Barrier

A

stops invasion of microorganisms, loss of water and electrolytes from the body

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19
Q

Functions of the Skin: Perception

A

has a vast sensory surface holding the neurosensory end-organs for touch, pain, temperature and pressure

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20
Q

Functions of the Skin: Temperature Regulation

A

allows heat dissipation through sweat glands and heat storage through subcutaneous insulation

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21
Q

Functions of the Skin: Identification

A

people identify one another by unique combinations of facial characteristics, hair, skin color, and even fingerprints.

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22
Q

Functions of the Skin: Communication

A

emotions are expressed in the sign of language of the face and body posture. Vascular mechanisms such as blushing or blanching also signal emotional states.

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23
Q

Functions of the Skin: Wound Repair

A

skin allows cell replacement of surface wounds

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24
Q

Functions of the Skin: Absorption and excretion

A

skin allows limited excretion of some metabolic wastes, by-products of cellular decomposition such as minerals, sugars, amino acids, cholesterol, uric acid and urea

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25
Q

Functions of the Skin: Production of vitamin D

A

the skin is the surface on which UV light converts cholesterol into vitamin D

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26
Q

Cultural Considerations

A

A. Darker Pigment
B. Scarring
C. Hair

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27
Q

Cultural Considerations: Darker Pigment

A

(native americans and african americans) lower incidence of skin cancer

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28
Q

Cultural Considerations: Scarring

A

Darker pigmented population, especially african americans increased incidence of keloids.

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29
Q

Cultural Considerations: Hair

A

various texture: african americans tend to be more dry and coarse, while asians tend to have straight and silky hair

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30
Q

Types of Lesions

A

A. Primary Lesions
B. Secondary Lesions
C. Vascular Lesions

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31
Q

Primary Lesions

A

Macule, patch, papule, plaque, nodule, tumor, wheal, urticaria, vesicle, bulla, cyst, pustule

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32
Q

Secondary Lesions

A

Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, keloid

33
Q

Vascular Lesions

A

Pupura, petechiae, contusion, ecchymosis, hemangioma

34
Q

macule

A

color change, flat, <1cm (freckle, measles)

35
Q

patch

A

flat, macule that is >1cm (mangolian spot, cafe au lait)

36
Q

papule

A

elevated, solid lesion <1cm, lesion you can feel (mole, wart)

37
Q

plaque

A

papule >1cm in width, surface elevation wider than 1cm (psoriasis)

38
Q

nodule

A

solid, elevated, hard or soft >1cm, extends deeper into dermis (intradermal nevi)

39
Q

tumor

A

> 2cm, firm or soft mass (lipoma, hemangioma)

40
Q

wheal

A

superficial, erythematous, raised lesion - slightly irregular shaped (insect bite, hive)

41
Q

urticaria

A

hives. multiple wheal like lesions, very itchy - various sizes.

42
Q

vesicle

A

fluid filled, elevated lesion <1cm (herpes, chicken pox, small blister)

43
Q

bulla

A

> 1cm vesicle (burn, blister, bullous impetigo)

44
Q

cyst

A

fluid filled cavity extending to dermis or subcutaneous layer (sebaceous cyst)

45
Q

pustule

A

pus filled lesion (acne, pimple)

46
Q

crust

A

thickened, dried out exudate left when vesicles/pustules burst or dry up (impetigo)

47
Q

scale

A

flakes of skin, silvery or white (psoriasis, eczema, seborrhea dermatitis)

48
Q

fissure

A

linear crack with abrupt edges (athletes foot, cracks in the corners of mouth)

49
Q

erosion

A

shallow depression on epidermis, does not extend to dermis, usually no scar (superficial abrasion)

50
Q

ulcer

A

deep depression into dermis, irregular shape, leaves scar usually (decubitus ulcer)

51
Q

excoriation

A

self-inflicted abrasion, superficial crusting secondary scratching (scabies, insect bites, dermatitis, varicella)

52
Q

scar

A

healed lesion, normal tissue is replaced with collagen/connective tissue

53
Q

atrophic scar

A

skin level depressed with loss of tissue, thinning of epidermis

54
Q

lichenification

A

prolonged intense scratching eventually thickens skin

55
Q

keloid

A

elevated scar, feels smooth and rubbery. Benign excess scar tissue, increased incidence in darker pigmentation populations.

56
Q

purpura

A

> 3 mm red/purple patch, flat macular hemorrhage

57
Q

petechiae

A

1-3 mm tiny, pinpoint, round hemorrhages, tiny flat blood spots ranging in color - red, purple or brown (abnormal clotting, sepsis)

58
Q

contusion

A

bruise, flat macular lesion of various colors depending on stage of bruise. Injury results in hemorrhage into tissues.

59
Q

ecchymosis

A

a purplish patch resulting from blood into the skin >3 mm

60
Q

hemangioma

A

reddish/blue, solid, spongy collection of benign blood vessels

61
Q

What are the color variations?

A
  1. pallor
  2. erythema
  3. cyanosis
  4. jaundice
62
Q

pallor

A

pale, white

63
Q

erythema

A

redness

64
Q

cyanosis

A

bluish, mottled color

65
Q

jaundice

A

yellow color

66
Q

History/Subjective Data

A
  1. history of skin disease: treatments, skin allergies, birthmarks, tattoos, piercings
  2. change in skin color/pigmentation - general or localized
  3. changes in moles, skin lesions, freckles, sores, etc.
  4. changes in skin texture: excessive dryness or moisture
  5. pruritis
  6. excessive bruising
  7. rash/lesions
  8. medications
  9. hair loss - pattern, location, change in hair texture, color
  10. change in nail texture, color, or shape
  11. environmental/occupational hazards/exposures - excessive sun exposure
  12. self-care behaviors - skin self-examination, type of skin care products, etc.
67
Q

Exam/Objective Data

A

Inspect and Palpate:

  1. color/general pigmentation
  2. temperature
  3. excessive moisture/dryness
  4. texture
  5. edema
  6. skin mobility/skin turgor
  7. vascular lesions/bruising
  8. intactness
  9. lesions
  10. IV’s/Drainage tubes, etc.
  11. Hair/Scalp
  12. Nails
68
Q

Excessive Moisture/Dryness

A
  1. diaphoresis- profuse perspiration

2. dehydration- mucous membranes dry, lips cracked

69
Q

Edema

A

a. 1+ mild pitting: slight indentation, no visible swelling
b. 2+ moderate pitting: indentation subsides rapidly
c. 3+ deep pitting: indentation remains for a short time, swollen appearance
d. 4+ very deep pitting: indentation lasts a long time, very swollen

70
Q

When doing exam/objective data, with lesions note:

A

note location, color, size, symmetry, pattern, shape, elevated or flat, odor, drainage or discharge

71
Q

Common Skin Abnormalities

A

impetigo, eczema, candidiasis, varicella, tinea corporis, tinea pedis, tinea capitis, allergic drug reaction, psoriasis, herpes zoster/shingles, melanoma, kaposi’s sarcoma, seborrheic dermatitis, alopecia areata, pediculosis capitis, folliculitis, nail clubbing, hirsutism and decubitus ulcer (stage I-IV)

72
Q

Subjective Data Health History Questions R/T Skin

A
  • past history of skin disease, allergies, hives, psoriasis, or eczema?
  • changes in pigmentation or color, size, shape, tenderness
  • excessive dryness or moisture?
  • pruritus or skin itching?
  • Excessive bruising? How did it happen?
  • rash or lesions? When did it start? Where? How has it spread?
  • medications: prescription and over the counter
  • hair loss
  • change in nails’ shape, color, or brittleness
  • environmental or occupational hazards?
  • self-care behaviors
73
Q

With a rash

A

Check all areas of the body as you cannot rely on the history that rash is only in one place

74
Q

Checking for temperature

A
  • Use backs of hands to palpate person
  • Skin should be warm and temperature equal bilaterally (warmth suggests normal circulatory status)
  • Hands and feet may be slightly cooler in a cool environment (hypothermia and hyperthermia)
75
Q

Vascularity and Bruising

A
  • multiple bruises at different stages of healing and excessive bruises above knees or elbows should raise concern about physical abuse
  • needle marks or tracks from intravenous injection of street drugs may be visible on ante cubical forsake, forearms or on any available vein.
76
Q

With IV’s/drainage tubes

A

Note location, describe site - including color, surrounding tissue (soft, hard, tender, hot, etc.) and drainage.

77
Q

ABCDE Skin Assessment

A

A (asymmetry)
B (border): is it smooth? Concerning if it’s irregular or jagged.
C (color): is it red, white, blue, black?
D (diameter): concerning if it’s greater than 6 mm
E (elevation and enlargement): has it gotten bigger? Did it go from flat to raised?

78
Q

When inspecting and palpating nails

A

Note shape, contour (nl 160’), consistency/texture, color, check cap refill)

79
Q

Shapes and configurations of lesions

A
  • annular or circular
  • confluence
  • discrete
  • grouped
  • gyrate
  • target or iris
  • linear
  • polycyclic
  • zosteriform

NURS 307 (29 decks)

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