Exam 1 - Integumentary System Flashcards
Nails
Nails
Protect the distal end of the fingers and toes
Lunula
Lunula-white area, part of matrix
Cuticle
Cuticle: prevents infection/moisture from getting under the skin
Common or concerning symptoms?
What do you ask?
Hair loss, rash, moles
“Have you noticed any changes in your skin or your hair?”
“Have you noticed any moles that have changed size, shape, color, or sensation?”
“Have you noticed any new moles?”
Skin cancers are most common cancers in the US. Where is it most prevalent?
Most prevalent on hands, neck, and head
Role of PA and Skin
Early detection of suspicious moles
Protective measures for skin care
Hazards of excessive sun exposure
Basal cell carcinoma
Comprises 80% of skin cancers
Shiny and translucent, they grow slowly and rarely metastasize
Squamous cell carcinoma
Comprises 16% of skin cancers
Crusted, scaly, and ulcerated, they can metastasize
Melanoma
Melanoma
Comprises 4% of skin cancers
Rapidly increasing in frequency, they spread rapidly
Most lethal, but if found early almost 100% curable
Common between age 25-29, indoor tanning increases risk 75%
ABCDE: screening lesions for possible melanoma
A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for evolution
Health Promotion Tips
Examine your body front and back in mirror
Look at right and left sides with arms raised
Bend elbows and look carefully at forearms, upper underarms, and palms
Look at backs of legs and feet
Spaces between toes
Soles
Examine back of neck and scalp with hand mirror
Part hair for closer look
Check back and buttocks with a hand mirror
Patient education on sun exposure
Avoiding excess sun exposure
Use umbrellas/protective hats, sunglasses, clothing
SPF 15 minimum to all sun exposed skin
SPF 15 blocks over 90% of UVB
SPF
SPF rating denotes #minutes it takes for skin to redden when exposed to UVB
Indoor tanning beds considered “carcinogenic to humans”
Skin Exam
Color, moisture, temperature, turgor, mobility, texture, lesions
Color of skin
Patients often notice change in color before physician
Look for increased pigmentation, loss of pigmentation
Look for redness, pallor, cyanosis, and yellowing
Where is red color best assessed?
Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
In dark-skinned people, palms and soles
Where is cyanosis best assessed?
For central cyanosis, look in lips (circumoral cyanosis), oral mucosa, and tongue
Where is jaundice best assessed?
Jaundice - sclera
Parts of skin exam:
Moisture
>Dryness, sweating, and oiliness
Temperature
>Use back of fingertips
>Identify warmth or coolness of skin
Texture
>Roughness or smoothness
Mobility and turgor
>Lift fold of skin
>Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)
What do you do when you encounter a lesion?
Note characteristics Anatomic location and distribution Patterns and shapes Type of lesion (macules, papules, nevi, vesicles) Color
Hair
Note quantity, distribution, and texture
Nails
Inspect and palpate fingernails/toenails
Note color, shape, lesions
Longitudinal bands of pigment may be a normal finding in people with darker skin
Decubitus ulcers
People confined to bed are particularly susceptible to skin damage and ulceration (decubitus ulcers)
When do ulcers occur?
Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin
How are bed sores assessed?
Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.
Nonpalpable flat lesions
Nonpalpable flat lesions
Macule
Patch
Depressed Lesions
Depressed lesions Erosion Excoriation Fissure Ulcer
Palpable raised lesions
Palpable raised lesions Papule Plaque Nodule Cyst Wheal Vesicle Bulla Pustule Burrow Scale crust Lichenification Scar keloid
Good skin and bad skin documentation examples
“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”
“Marked facial pallor, with circumoral cyanosis. Palms cold and moist. Cyanosis in nailbeds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”