Integument & Quick Neuro

Question 1

What are the components of a quick neuro check?

Answer 1

LOC
Orientation 
- to person, place, time of day
Communication 
- Can they follow a conversation, appropriate responses, speech clear/articulate
Motor response 
- moving all limbs appropriately

Question 2

Identify and define the 5 levels of consciousness

Answer 2

1) Alert (awake and responsive)
2) Lethargic (tired/drowsy) – still able to answer questions but a bit fuzzy
3) Obtunded - difficult to arouse, one word answers, mumbling
4) Stupor (spontaneously unconscious)
- Sleep like state, little/no spont. activity, respond only with grimacing, withdraw to pain
5) Coma (deep state of prolonged unconsciousness)
Unable to arouse, no response to stimuli (including painful ones)
- May have reflexes but to purposeful movement

Question 3

When is a good time to do an integument assessment?

Answer 3

During a head-to-toe check or bedbath

Question 4

Name the 3 layers of skin from superficial to deep.

Answer 4

Epidermis -> dermis -> subcutaneous

Question 5

Identify and define the two layers of the epidermis

Answer 5

Basal Cell Layer – deepest layer of epidermis
- contains keratin (waterproof) & melanin (colour)
Horny Cell Layer – most superficial skin layer facing outside
- Has mainly dead skin cells

Question 6

T or F: the epidermis is avascular

Answer 6

True

Question 7

Nerves, blood & lymphatic vessels, hair follicle, and glands exist in the ______ layer of the skin

Answer 7

Dermis

Question 8

The dermis consists mainly of ______

Answer 8

collagen

Question 9

What are the functions of the subcutaneous layer

Answer 9

temperature control
cushion for underlying structures
gives skin mobility / ability to move across underlying structures

Question 10

Define Vellus vs. Terminal hair (epidermal appendages)

Answer 10

Vellus – fine, faint hair that covers most of the body

Terminal – darker thicker hair that grows on scalp, eyebrows, axillae, pubic area, (face & chest on men)

Question 11

_____ are muscles that surround the hair follicle and contract to elevate hair (goosebumps) during cold or emotional states

Answer 11

Arrector Pili

Question 12

Name 5/9 the functions of the skin

Answer 12

1) Protection
- From injury, infection, UV radiation, fluid balance
2) Guards the body
- Stops invasion of microorganisms and loss of water/electrolytes
3) Perception
- Sensory organ (touch, pain, temp, pressure)
4) Temperature regulation
- Sweating (cooling) & subcutaneous insulation
5) Identification
- self-image and identifying with other people, fingerprints
6) Communication
- Facial expressions, blushing (vascular mechanism) -> conveying emotion
7) Wound repair
- Cell replacement of surface wounds
8) Absorption and excretion (absorb UV light, excrete some waste)
9) Production of vitamin D
- skin converts cholesterol to vit D via UV light

Question 13

What is the fxn of sebaceous glands and where are they located?

Answer 13

Produce sebum (oily) which gets secreted through hair follicles and slows water loss from surface of skin (keeps skin hydrated/lubricated)
Everywhere except palms and soles

Question 14

What are the 2 types of sweat glands and where are they located?

Answer 14

1) Eccrine glands –open directly onto the skin surface and produce sweat aka dilute saline solution (important for temp regulation) – not present in infants until 2 months
2) Apocrine glands - produce a thick, milky secretion and open into the hair follicles
- Located in axillae, anogenital area, nipples, and navel
- Flora + aprocrine glands secretion = musky odour
- Become active during puberty

Question 15

What are the 4 epidermal appendages

Answer 15

hair
sebaceous glands
sweat glands
nails

Question 16

What are some developmental considerations for infants in an integument assessment

Answer 16

• Lanugo = fine downy hair of the newborn infant (all over body) NOTE: DIFF THAN VELLUS HAIR
• Vernix (aka vernix caseosa) = thick, white, lipity substance made up of sebum and shed epithelial cells (white stuff babies are covered in when they are born)
• Milia = acne bumps, on face and nose
• Eccrine glands (sweat glands) not functional until 2 months of age
• Subcutaneous layer insufficient until 6 months (newborns not good at thermoregulating)

Question 17

What are some developmental considerations for adolescents in an integument assessment

Answer 17

Increased secretion from the apocrine glands
- Become active during puberty, body odour starts
- Secretion occurs with emotional and sexual stimulation
Sebaceous glands become more active – skin gets oily
Subcutaneous fat deposits increase – especially in the pelvic area of females

Question 18

What are some developmental considerations for pregnant women in an integument assessment

Answer 18

• changing hormone levels = increased pigmentation around nipples, vulva, linea nigra, chloasma
• striae gravidum

Question 19

What are some developmental considerations for older adults in an integument assessment

Answer 19

Decreased skin elasticity, subcutaneous fat & muscle tone -> hanging quality of muscle + wrinkles
Sweat and sebaceous glands decrease in number and function
Decreased melanocytes (causes hair to turn grey)
- Hair distribution changes (can occur in mid 30s)
- W-shaped balding in men
- axillary and pubic hair decreases
Women may have bristly facial hair

Question 20

Components of a subjective integument assessment

Answer 20

Hx of skin disease
change in pigmentation
excessive dryness or moisture
pruritus (itching)
excessive bruising 
rash or lesions
enviro or occupational hazards
change in a mole
hair loss
change in nails
self-care behaviours
medications

Question 21

Components of an objective skin assessment (inspect and palpate)

Answer 21

Colour - pallor, erythema, cyanosis, jaundice, pigmentations (ABCDE)
Temperature - normal, hypo/hyperthermia
Moisture - diaphoretic (profuse sweating), dehydration (look at mucous membranes)
Texture - too smooth (hyperthyroidism), too rough (hypothyroidism)
Thickness
Edema
Mobility and Turgor
Vascularity or bruising
Lesions

Question 22

Describe the edema 4 point scale

Answer 22

1+= mild pitting, slight indentation, no perceptible swelling
2+= moderate pitting, indentation subsides rapidly
3+= deep pitting, indentation remains for a short time, limb looks swollen
4+= very deep pitting, indentation lasts a long time, limb is very swollen

Question 23

Poor turgor aka “tenting” is a sign of _______

Answer 23

severe dehydration or weight loss

Question 24

Sclerodema is a sign of ______

Answer 24

“hard skin”

decreased mobility

Question 25

Components of an objective hair assessment (inspect and palpate)

Answer 25

Colour – unwanted changes
Texture – inconsistent texture throughout hair
Distribution – any missing or excess patches
Lesions (on scalp)
Lice, ringworm infection (school children)

Question 26

Components of an objective nail assessment (inspect and palpate)

Answer 26

• shape and contour: clubbing <160 degrees (associated with chronic hypoxia, heart disease, etc.)
• consistency: surface is smooth/regular not brittle or splitting
• colour: cap refill, brown linear streaks may indicate melanoma

Question 27

How do you assess skin pigmentation?

Answer 27

ABCDE 
Asymmetry
Border irregularity
Colour variation (multiple colours in a pigmentation)
Diameter >6mm
Elevation and evolution

Question 28

Describe the shape/configuration of the following skin lesions:
Annular
confluent
discrete
grouped
target
gyrate
linear
zosteriform
polycyclic

Answer 28

Annular - circles that spread from the middle ex. ringworm
confluent - any lesions that merge together ex. hives
discrete - distinct, individual lesions that remain separate ex. acne
grouped - clusters of lesions not merging
target - concentric rings ex. lime disease
gyrate - twisted, coiled, spiral lesions ex. parasite inf
linear - scratch, streak, line
zosteriform - linear arrangement along a nerve route ex. shingles
polycyclic - annular/circular lesions that grow together

Question 29

Primary Skin Lesions

Answer 29

When a lesion develops on unaltered skin

Ex.macule, patch, papule, plaque, nodule, wheal, tumpr, cyst, etc.

Question 30

Secondary Skin Lesions

Answer 30

When a lesion changes over time or changes because of a factor
Ex. crust, scale, fissure, erosion, ulcer, scar, etc.

Question 31

Describe the following vascular lesions:
hemangiomas
telangiectases
purpuric lesions

Answer 31

Hemangiomas
- caused by a benign proliferation of blood vessels in the dermis (present at birth and does not fade)
Telangiectases
- vascular dilation to the skins surface
Purpuric lesions
- blood flowing out of breaks in the vessels and depositing in the tissues (extravascularly)

Question 32

Give examples of:
hemangiomas
telangiectases
purpuric lesions

Answer 32

hemangiomas: port wine stain, strawberry mark, cavernous hemangioma
telangiectases: spider/star angioma, venous lake
purpuric lesions: petechiae (small pinpointed), purpura - patchy