Integumentary System Flashcards
Functions of the Skin
Protects against microbial/foreign substance invasion and minor physical trauma
Restricts body fluid loss; provides a restrictive barrier
Regulates body temperature
Provides sensory perception via free nerve endings and specialized receptors
Produces vitamin D from precursors in the skin
Contributes to blood pressure regulation through constriction of skin blood vessels
Repairs surface wounds by exaggerating the normal process of cell replacement
Excretes sweat, urea, and lactic acid
Expresses emotions
History of Present Illness: Skin
Changes in skin Temporal sequence Symptoms Location Associated symptoms Recent exposure Apparent cause Travel history Treatment response Adjustment to problem Medications Trauma Bites
HPI: Hair
Changes in hair Occurrence Associated symptoms Exposure Infestation Nutrition Treatment Adjustment Medication
HPI: Nails
Changes in nails Recent history Associated symptoms Temporal sequence Exposure Treatment response Medications
Skin - PMH
Previous skin problems
Lesions, treatment
Tolerance to sunlight, number of sunburns
Diminished or heightened sensitivity to touch
Cardiac, respiratory, liver, endocrine, or other systemic disease
Pruritis
Hair PMH
Previous hair problems
Systemic problems
Nail - PMH
Previous nail problems
Nail injury
Bacterial, fungal, or viral infection
Systemic problems
Associated skin disorder
Congenital anomalies
Respiratory, cardiac, endocrine, hematologic, or other systemic diseases
Family Hx
Current or past dermatologic diseases or disorders in family members
Allergic hereditary diseases: asthma, allergic rhinitis
Familial hair loss or pigmentation patterns
Personal and social history
Skin, hair, nail care habits
Skin self-examination
Exposure to environmental/occupational hazards
Recent psychologic or physical stress
Use of alcohol, tobacco, or recreational drugs
Sexual history
Equipment
Centimeter ruler
Flashlight or penlight
Handheld magnifying lens or dermatoscope
Wood’s lamp – to view fluorescing or depigmented lesions
Inspection
Adequate lighting
Inspect skin, re-drap or cover areas not inspecting for warmth and modesty
Inspect the skin in two ways
Overall visual sweep of the entire skin surface
Observe the skin as each part of the body is examined
Note 6 characteristics in each part of the body
Color Uniformity Thickness Symmetry Hygiene Presence of any lesions, which are any pathologic skin change or occurrence.
Palpation
Palpate to detect moisture..
Use the dorsal surface of your hands to assess temperature.
Check the texture, which should be smooth, soft, and even.
Roughness on exposed skin or areas of pressure may occur.
Evaluate turgor and mobility
Lesions - Note:
Size (measured in centimeters in all dimensions)
Shape
Color
Texture
Elevation or depression
Attachment at the base
If exudate – note color, odor, amount, and consistency
If more than one lesion, note if it is:
Annular (or ring-shaped) Arciform (or bow-shaped) Grouped Linear Diffuse.
Record lesions’ location and distribution
Generalized or localized
Affect a specific body region
Form a pattern
Discrete or confluent
Use a light and magnifying glass to determine
the lesion’s subtle details, including color, elevation, and borders.
To see if fluid is present in a cyst
or mass, trans-illuminate it in a darkened room.
A fluid-filled lesion trans-illuminates with a red glow; a solid lesion does not.
To further identify a lesion, shines a
Wood’s lamp on the area in a darkened room
Use inspection and palpation to assess
the hair:
Palpate its texture.
Inspect the hair for three characteristics: color, distribution, and quantity.
Palpate hair for texture and fragility
Hair distribution and quantity
Inspect the nails for six characteristics:
Color Length Condition Configuration Symmetry Cleanliness
Measure the nail-base angle
The nail-base angle should measure 160 degrees
If the nail-base angle is 180 degrees or more, clubbing is present, which suggests a cardiopulmonary or other disorder.
Inspect and palpate theproximal and lateral nail
folds Palpate the nail platefor four characteristics: Texture Firmness Thickness Adherence to the nail bed.
ABCDE’s of Mole Assessment
Asymmetry Border Color Diameter Evolving Additionally know the various types of skin cancer AND the most common type of skin cancer.
Infants and Children
Vernix caseosa, a mixture of sebum and cornified epidermis, covers the newborn’s body at birth.
Subcutaneous fat is poorly developed in newborns, predisposing them to hypothermia.
Lanugo is the fine silky hair that covers the newborn’s body, particularly on the shoulders and back.
Desquamation of stratum corneum may be present at birth or very shortly afterward.
Eccrine glands function after 1 month.
Apocrine glands do not function.
Adolescents
Apocrine glands enlarge and become active.
Increased axillary sweating and body odor
Increased sebum production in response to increased hormone levels, primarily androgen
Oily appearance predisposing the individual to acne
Coarse terminal hair appears in the axillae and pubic areas of both female and male adolescents, and on the face of males.
Pregnancy
Increased blood flow to skin, especially that of the hands and feet, results from peripheral vasodilation and increased numbers of capillaries.
Acceleration of sweat and sebaceous gland activity occurs.
Spider angiomas and cherry hemangiomas that are present may increase in size.
Skin thickens; fat is deposited in subdermal layers.
Skin stretching, increased pigmentation, nevi changes
Older Adults
Sebaceous and sweat gland activity decreases: results in dry skin and less perspiration.
Epidermis thins and fragility increases.
Loss of collagen and decreasing elasticity causes wrinkles.
Subcutaneous tissue decreases.
Gray hair from decreased melanocytes occurs.
Scalp and body hair decrease; baldness.
Facial hair develops in women.
Nail growth slows.
Annular
ring shapped
arciform
bow shaped
nail base angle should measure
160 degrees
if it is 180 degrees or more, clubbing is present, which suggests a cardiopulmonary or other disorder
Vernix caseosa, a mixture of
sebum and cornified epidermis, covers the newborn’s body at birth.
Subcutaneous fat is poorly developed in
newborns, predisposing them to hypothermia.
Lanugo is the fine silky
hair that covers the newborn’s body, particularly on the shoulders and back.
Desquamation of stratum corneum may be
Desquamation of stratum corneum may be
Eccrine glands function
after 1 month.
Children - Apocrine glands do not
function
Adolecents - Apocrine glands
Apocrine glands enlarge and become active.
Increased axillary sweating and body odor
Adolecents increased sebum
Increased sebum production in response to increased hormone levels, primarily androgen
Oily appearance predisposing the individual to acne
Adolecents - Course
Coarse terminal hair appears in the axillae and pubic areas of both female and male adolescents, and on the face of males.
Pregnancy - Increased blood
Increased blood flow to skin, especially that of the hands and feet, results from peripheral vasodilation and increased numbers of capillaries.
Pregnancy - Accerleration of
Acceleration of sweat and sebaceous gland activity occurs.
Pregnancy Spider
Spider angiomas and cherry hemangiomas that are present may increase in size
Pregnancy Skin does what
Skin thickens; fat is deposited in subdermal layers.
Skin stretching, increased pigmentation, nevi changes
Older Adults - Sebaceous and sweat
Sebaceous and sweat gland activity decreases: results in dry skin and less perspiration.
Older Adults - Epidermis
Epidermis thins and fragility increases
Older Adults - Loss of Collagen
Loss of collagen and decreasing elasticity causes wrinkles.
Older Adults - Subcutaneous
Subcutaneous tissue decreases.
Older Adults Gray hear
Gray hair from decreased melanocytes occurs
Older Adults - Scalp
Scalp and body hair decrease; baldness
Older Adults - Facial
Facial hair develops in women.
Older Adults Nail growth
slows
