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NURS 2500 > CLASS 6 - SKIN ASSESSMENT > Flashcards

CLASS 6 - SKIN ASSESSMENT Flashcards

1
Q

How does the stratum corneum (outer layer of the epidermis) change with age?

A

thins + flattens - allows chemicals easier access into the body

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2
Q

how does the dermis change w age?

A

thins + flattens, results in wrinkles

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3
Q

how does skin change w age in terms of elastin, collagen, subcut fat and muscle tone? What risks does this introduce for the older adult?

A
  • elastin, collagen, subcut fat + muscle tone is lost

- loss of collagen increases the risk for shearing + tearing injuries

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4
Q

How does the skin change w age in terms of sweat + sebaceous glands? What risks does this pose for the older adult?

A
  • Sweat + sebaceous glands decrease in # and function which results in dry skin
  • decreased response of the sweat glands to thermoregulatory demand puts older adults at greater risk for heat stroke.
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5
Q

how the skin change w age in terms of vascularity and fragility? What risks does this pose for the older adult?

A

Vascularity diminishes + fragility increases. As a result, minor trauma may produce senile purpura (red discoloured areas).

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6
Q

What questions would you ask a patient when collecting subjective data about a patient’s skin?

A
  • previous history of skin disease (allergies, hives, psoriasis, eczema)
  • changes in pigmentation
  • excessive dryness (xerosis) or moisture (seborrhea)
  • pruritis (itching)
  • excessive bruising
  • rash or lesion
  • medications
  • hair loss, change in nails
  • environmental or occupational hazards
  • self-care behaviours
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7
Q

What would you ask a patient about a previous history of skin disease?

A 
Any previous skin disease or problem?
How was this treated?
Any family history of allergies?
Any known allergies?
Any birthmarks or tattoos (bc risk for hep C)
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8
Q

What would you ask a patient about changes in pigmentation in their skin?

A

any change in skin colour or pigmentation?

is the colour change generalized or localized?

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9
Q

What would you ask a patient about changes in moles?

A

Have you experienced a sudden appearance of tenderness, bleeding, or itching?
Any sores that don’t heal?

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10
Q

What would you ask a patient about excessive bruising?

A

Any excessive bruising? Where on the body?

How did this happen? How long have you had it?

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11
Q

What would you ask a patient about rashes or lesions?

A

Onset - when did tou first notice it?
Location - where did it start?
Extent - have you noticed it spreading?
Describe the colour
Is it raised or flat> Any crust or odour? Does it feel tender or warm?
How long have you had it? Does anyone at work or at home have a similar rash? Have you been camping, acquired a new pet, tried a new food, or taken a new medication> Does the rash seem to come w stress?
What home care have you tried (baths, lotions, heat, cold)? Do they help or make it worse?
Associated symptoms - any itching or fever?
What do you think a rash or lesion means?
How has the rash or lesion affected your self care, hygiene, and ability to function at home + at work?
Any new increased stress in your life (stress can exacerbate chronic skin disease?

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12
Q

What questions would you ask a patient about medications?

A

What medications do you take? Prescription or over the counter? Have you noticed any changes in your skin since you started taking the medication?

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13
Q

What would you ask a patient about environmental or occupational hazards?

A

how much sun exposure do you get?
have you recently been bitten by an insect like a bee, tick, or mosquito?
any recent exposure to plants or animals in yard work or camping?

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14
Q

What questions would you ask a patient about their self-care behaviours?

A

What do you do to care for your skin, hair, and nails? What cosmetics, soaps, or chemicals do you use? Do you clip cuticles on nails or use adhesive for false fingernails? Do you use sunscreen? what SPF? Do you perform a skin self-examination?

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15
Q

What questions would you ask a patient about hair loss + changes in nails?

A

Any recent hair loss? Gradual or sudden onset? Symmetrical? Any unusual hair growth? Any recent change in texture or appearance>

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16
Q

What is alopecia?

What is hirsutism?

A 
alopecia = significant hair loss
hirsutism = shaggy or excessive hair
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17
Q

What are 5 potential causes of pallor?

A 
Anemia 
Shock 
Local arterial insuffiency 
Albinism
Vitiligo
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18
Q

How do anemia + shock present in light skin? Brown skin? Black skin?

A

Light skin: Generalized pallor
Brown Skin: appears yellow-brown, dull
Black Skin: appears ashen grey, dull

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19
Q

How does local arterial insufficiency present in light skin? dark skin?

A

light skin: marked localized pallor such as extremities

Dark skin: Ashen grey, dull, cool to palpation

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20
Q

What is albinism?

A

total absence of pigment melanin thoughout the integument

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21
Q

What is vitiligo?

A

Patchy depigmentation from destruction of melanocytes

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22
Q

How does albinism present in light skin + dark skin?

A

whitish pink

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23
Q

How does vitiligo present in light + dark skin?

A

Patchy milky white spots, often symmetrical bilaterally

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24
Q

What is cyanosis? What causes it?

A

Blueish hue to the skin - caused by increased amount of unoxygenated Hgb, signifies decreased perfusion

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25
Q

How does cyanosis present in light skin? Dark skin?

A

Light skin: blue

dark skin: dark, but dull + lifeless. only sever cyanosis is apparent in dark skin

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26
Q

what causes central cyanosis? How does it present in light skin + dark skin?

A

Central cyanosis results from chronic heart and lung diseases that cause arterial desaturation
light skin: grey coloration
dark skin: hard to detect

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27
Q

what causes peripheral cyanosis? How does it present in light + dark skin?

A

Caused by exposure to cold, anxiety
Light skin: dusky nail beds
Dark skin: hard to detect

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28
Q

What is erythema?

How does it present in light + dark skin?

A

Intense redness of the skin from excess blood (hyperemia) ‘
Light skin: red / bright pink
Dark skin: purple tinge, difficult to see

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29
Q

what is hyperemia?

A

increased blood flow through engorged arterioles such as inflammation, fever, alcohol intake, blushing

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30
Q

what is polycythemia? How does it present in light + dark skin?

A

increased numbers of RBCs
light skin: ruddy blue in face, oral mucosa, conjunctiva, hands + feet
dark skin: hard to detect, check for redness in lips

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31
Q

What are 4 potential causes of erythema?

A

Hyperemia
Polycythemia
Carbon monoxide poisoning
venous stasis

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32
Q

How does carbon monoxide poisoning present in light skin? dark skin?

A

light skin: bright cherry red in face + upper torso

dark skin: cherry-red colour in nail beds, lips, and oral mucosa

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33
Q

what is venous stasis?

A

decreased blood flow from an area

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34
Q

how does venous stasis present in light skin? dark skin?

A

light skin: rubor of dependent extremeties,

dark skin: easily masked, palpate for warmth or edema

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35
Q

what is jaundice?

A

jaundice is caused by increased serum bilirubin ( > 2 mg / 100 mL) as a result of liver inflammation or hemolytic disease.

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36
Q

how does jaundice present in light skin? dark skin?

A

light skin: yellow in sclera, hard palate, mucous membranes, and over skin
dark skin: check sclera for yellow tinge near limbus of eye. jaundice is best noticed in junction of hard and soft palate + also palms

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37
Q

what is carotenemia?

A

increased serum carotene from ingestion of large amts of carotene-rich foods

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38
Q

how does carotenemia present in light skin? dark skin?

A

light skin: yellow-orange in forehead, palms + soles, and nasolabial folds (smile lines)
dark skin: yellow-orange in palms + soles

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39
Q

what is uremia?

A

occurs in renal failure - urochrome pigments are retained in the blood

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40
Q

how does uremia present in light skin? dark skin?

A

light skin: orange-green or grey overlying pallor of anemia, ecchymoses and purpura
dark: easily masked, rely on lab findings

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41
Q

what is purpura?

A

purple coloured spots from burst blood vessels

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42
Q

what is Brown-Tan?

A

eternal tan

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43
Q

What is Addison’s disease? How does it present in light skin? dark skin?

A

Increased melanin production stimulation by cortisol deficiency
light skin: bronzed appearance and eternal tan, most apparent around nipples, perineum, genitalia, and pressure points
dark skin: easily masked, rely on laboratory and clinical findings

44
Q

what are cafe au lait spots? how do they present in light skin? dark skin?

A

Caused by increased melanin pigment in basal cell layer
tan to light brown, irregularly shaped oval patches w well-defined borders
dark skin: easily masked, rely on laboratory and clinical findings

45
Q

what is skin turgor?

A

Skin turgor refers to the elasticity of your skin. If you pinch the skin, it should go back to normal in a few seconds . Having poor skin turgor means that your skin takes longer to return to its normal position (tenting). This is often a sign of dehydration/

46
Q

What is skin atrophy?

A

thinning of the skin, looks v shiny

47
Q

When palpating the skin for temperature, what could a low temperature indicate?

A

Decreased perfusion, vasoconstriction, or poor central control

48
Q

When palpating the skin for temperature, what could a high temperature indicate?

A

vasodilation, local inflammation, febrile patient

49
Q

What is edema?

A

Accumulation of fluid in intracellular spaces?

50
Q

What is pitting edema?

A

V/ watery. If pressure leaves an indentation in the skin, pitting edema is present.

51
Q

What is non-pitting edema?

A

less watery + more firm, fluid doesn’t move + doesn’t dent in

52
Q

What is dependent edema?

A

edema settles in lowest parts of patient’s body - follows gravity

53
Q

What is lymph edema?

A

not as free-flowing and watery as dependent edema

54
Q

Describe 1+, 2+, 3+ and 4+ edema

A

1+ : mild pitting, slight indentation, no perceptible swelling
2+ : moderate pitting, indentation that subsides rapidly
3+ : deep pitting, indentation remains for a short time, swelling evident
4+ : very deep pitting, indentation lasts a long time, gross swelling + distortion

55
Q

what is an annular lesion?

A

circular lesion

56
Q

what are confluent lesions?

A

legions that merge + are multi shaped

57
Q

what are discrete lesions?

A

distinct + separate

58
Q

what are grouped lesions?

A

clusters of lesions

59
Q

what are gyrated lesions?

A

twisted, coiled, spiraled, snake-like

60
Q

what are target lesions?

A

bullseye

61
Q

what are linear lesions?

A

scratch, streak, line or stripe

62
Q

what are polycyclic lesions?

A

annular lesions that grow together

63
Q

what are zosteriform lesions?

A

linear arrengement along a nerve route

64
Q

macules, patches, papules, plaques, nodules, tumors, wheals, urticaria (hives), vesicles, bullas, cysts, and pustules are examples of what types of lesions?

A

Primary

65
Q

what are macules?

give examples of these types of lesions.

A

colour change; flat + circumscribed, < 1 cm in diameter

freckles, hypopigmentation, measles, scarlet fever

66
Q

what are patches? give examples of these types of lesions.

A

macules > 1 cm in diameter.

mongolian spot, vitiligo, cafe au lait spot, measles rash

67
Q

what are papules?

give examples of this type of lesion.

A

solid, elevated, circumscribed, < 1 cm diameter; caused by superficial thickening in the epidermis

elevated nevus (mole), molluscum, wart

68
Q

what is a plaque? give an example this type of lesion

A

papules that come together to form surface elevation wider than 1 cm; plateau-like, disk-shaped

psoriasis, lichen planus

69
Q

what is a nodule? give an example of this type of lesion.

A

solid, elevated, hard or soft, > 1 cm in diameter; may extend deepr into epidermis than papule

xanthoma, fibroma, intradermal nevi

70
Q

what is a tumor? give an example of this type of lesion.

A

larger than a few cm diameter, firm or soft, deeper into dermis, may be benign or malignant

lipoma, hemangioma

71
Q

what is a wheal?

A

superficial, raised, transient, and erythematous; slightly irregular shape bc of edema

72
Q

what are urticaria (hives)?

A

wheals that coalesce to form extensive reacion; intensely priuretic

73
Q

what are vesicles?

give examples of this type of lesion

A

blisters. elevated cavities containing free fluid, up to 1 cm in diameter; clear serum flows if wall is ruptured

herpes simplex, early varicella, herpes zoster, contact dermatitis

74
Q

what is a bulla? Give examples of this type of lesion

A

single-chambered (unilocular); superficial in epidermis; > 1 cm diameter; thin-walled and therefore ruptures easily

friction blister, pemphigus, burns, contact dermatitis

75
Q

what is a cyst? give examples.

A

encapsulated fluid-filled cavity in dermis or subcutaneous layer; tensely elevates skin

sebaceous cyst, trichilemmal cyst

76
Q

what is a pustule? give examples of this type of lesion.

A

cavity filled w pus; circumscribed and elevated

impetigo, acne

77
Q

crusts, scales, fissures, erosion, ulcers, excoriations, scars, keloids, and lichenification are examples of which types of lesions?

A

Secondary skin lesions

78
Q

What is a crust? What causes it? What colours can it be?

Give examples of this type of lesion.

A

thickened, dried out exudate left when vesicles or pustules burst or dry up.

colour depends on the fluid’s ingredients (blood, serum, pus) - red-brown, honey-like, or yellow

impetigo (dry, honey-coloured), weeping ecxematous dermatitis, scab after abrasion)

79
Q

What is a scale? What causes it? Give examples of this type of lesion.

A

Compact, dessicated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells

lesions after scarlet fever or medication rxn, psoriasis, seborrheic dermatitis, eczema, ichthyosis, dry skin.

80
Q

What is a fissure? Are they dry or moist? Give examples of this type of lesion.

A

Linear crack w abrupt edges extending into dermis. Can be dry or moist.

Cheilosis at corners of mouth as a result of excess moisture, athlete’s foot

81
Q

What is erosion? It is dry or moist? Does this type of lesion leave a scar?

A

Scooped-out but shallow depression; superficial. Moist but no bleeding. Does not leave a scar because it does not extend into dermis

82
Q

What is an excoriation? What causes it? Give examples of this type of lesion.

A

Self- inflicted scratch or abrasion. Superficial. Sometimes crusted scratches from intense itching.

Lesions caused by scratching of insect bites, scabies, dermatitis, varicella

83
Q

what is a scar? give examples of how scars can occur.

A

Permanent change; CT (collagen) that replaced normal tissue after a skin lesion heals.

healed area of surgery or injury, acne scars

84
Q

What is an atrophic scar? Give an example of this type of lesion.

A

Depression of skin level as a result of loss of tissue; a thinning of the epidermis

striae

85
Q

what is a keloid? among which population are keloids more prevalent?

A

hypertrophic scar; elevation of the skin level by excess scar tissue which is invasive beyond the site of original injury. may increase long after healing occurs. looks smooth + rubbery, “claw-like”. Has a higher incidence among those of African descent.

86
Q

What is lichenification? What causes it?

A

Thickening of the skin w production of tightly packed sets of papules caused by prolonged intense scratching. Looks like lichen or surface of moss.

87
Q

What are the 2 types of vascular lesions?

A

Hemangiomas + Purpuric lesions

88
Q

What are hemangiomas?

A

Lesions caused by proliferation of blood vessels in the dermis.

89
Q

What are purpuric lesions?

A

Caused by blood flowing out of breaks in the vessels.

These lesions are difficult to see in dark-skinned people.

90
Q

Identify the 6 types of Hemangiomas.

A 
= Port-Wine Stain
= Stawberry Mark
= Cavernous Hemangioma
= Telangiectasis
= Spider or star angioma 
= Venous lake
91
Q

What is a Port-Wine Stain?

A
  • Large, flat, macular patch covering the scalp or face.
  • Frequently along distribution of cranial nerve V
  • Dark red, bluish, or purpleish
  • intensifies w crying, exertion, or exposure to heat or cold
92
Q

What is a strawberry mark? Does it require treatment?

A

Immature hemangioma. Formed from immature capillaries.

Does not necessitate treatment as it disappears by age 5-7

93
Q

What is a Cavernous Hemangioma?

A

Mature hemangioma.

Reddish-blue, irregularly shaped, solid, and spongy mass of blood vessels

94
Q

What is telangiectasis?

A

Appearance of blood vessels on the skin surface - caused by vasodilation. Vessels are permanently enlarged and dilated.
(some people call these spider veins_

95
Q

What are spider/star angiomas?

A

Star-shaped marking w solid circular center.

May be normal or may be associated w pregnancy, chronic liver disease, or estrogen therapy.

96
Q

What is a venous lake?

A

Clusters of dilated venules. Pressure causes them to empty / disappear. Located on legs near varicose veins and also on the face, lips, ears, and chest.

97
Q

What are the 5 types of purpuric lesions?

A
  • Petechiae
  • Purpura
  • Ecchymosis
  • Hematoma
  • Contusion / Bruise
98
Q

What are petechiae? What causes them?

A

tiny hemorrhages, 1-3 mm, round + discrete
caused by bleeding from superficial capillaries - do not blanche
may indicate abnormal clotting factors

99
Q

What are purpura?

A

Extensive patch of confluent petechiae and ecchymoses, > 3 mm flat, red-purple, macular hemorrhage.

100
Q

What is an ecchymosis?

A

Purple patch resulting from extravasation of blood into the skin, > 3 mm in diameter

101
Q

What is a hematoma?

A

Palpable bruise. Elevates the skin and is seen as swelling.

102
Q

What is a pattern injury?

A

*Sign of abuse
bruise or wound whose shape suggests which instrument or weapon caused it (ex - belt buckle, cigarette, pinch marks, bite marks, scalding hot liquid)

ex - inflicted scalding immersion burns usually have a clear border, like a glove or sock, indicating that body part was held under water intentionally

103
Q

What is a contusion / bruise?

A
  • sign of abuse

large patch of capillary bleeding into tissues; caused by blunt force trauma

104
Q

What is the ABCDE rule for assessing for malignant skin neoplasms?

A 
Asymmetry
Border Irregularity
Colour Change / Variation
Diameter of 6 mm +
Elevated or Evolving in appearance
105
Q

A patient comes in reporting a skin lesion that will not heal. What might this be a sign of?

A

This would raise suspicion of malignancy.

NURS 2500 (22 decks)

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