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NURS 202 > Lecture 4: Skin, Hair, and Nails > Flashcards

Lecture 4: Skin, Hair, and Nails Flashcards

1
Q

Layers of Skin + Function

A
  1. Epidermis
    - Thin, tough
  2. Dermis
    - Connective tissue (collagen)
    - Elastic tissue
    3 Subcutaneous layer
    - Adipose layer: store fat (energy), temperature, protection (cushion)
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2
Q

Function Of the Skin

A
  • Protection
  • Prevents penetration
  • Perception (sensory)
  • Temperature regulation
  • Identification
  • Communication
  • Wound repair
  • Absorption and excretion
  • Production of vitamin D
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3
Q

Developmental Considerations: Infant and children

A
  1. Newborn
    - Lanugo, vernix caseosa; skin thin and more permeable, greater risk for fluid loss, ineffective temperature regulation
  2. At puberty
    - Increased sweat gland secretions, more active sebaceous glands, evidence of secondary sex characteristics in skin
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4
Q

Developmental Considerations: Pregnant Women

A
  • Connective tissue becomes fragile
  • Striae (stretch marks)
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5
Q

Developmental Considerations: Older adults

A
  • Slow atrophy of skin structures
  • Loss of elasticity, collagen, subcutaneous fat
  • Thinning skin
  • Decreased sweat and sebaceous glands
  • Greater risk for heat stroke
  • Increased risk for skin disease
  • Change in hair distribution
  • Psychological impact of visible aging
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6
Q

Health History

A
  • Previous history of skin disease (allergies, hives, psoriasis, or eczema)
  • Change in pigmentation
  • Change in mole (size or colour)
  • Excessive dryness or moisture
  • Pruritus – itchiness
  • Excessive bruising
  • Rash or lesion
  • Medications
  • Hair loss
  • Change in nails
  • Environmental or occupational hazards
  • Self care behaviours
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7
Q

Additional Heath History Q’s: Infants and children

A
  • Birthmarks
  • Skin colour changes: jaundice, cyanosis
  • Allergic rash
  • Diaper rash
  • Burn or bruises
  • Exposure to contagious skin conditions
  • Sun protection
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8
Q

Additional Heath History Q’s: Adolescents

A
  • Skin problems
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9
Q

Additional Heath History Q’s: Older adults

A
  • Skin changes
  • Delay in wound healing
  • Skin pain
  • Foot/nail changes
  • Falling
  • Diabetes or cardiovascular disease
  • Skin care
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10
Q

Subjective Data (OPQRSTU)

A

O: Onset
- When did it start? When did you first notice it?
P: Provocative or Palliative
- What brings it on? What were you doing when you first noticed it? What makes it better? What makes it worse?
Q: Quality or quantity
- How does it look, feel? How intense/severe is it?
R: Region or Radiation
- Where is it? Does it spread anywhere?
S: Severity Scale
- How bad is it (on scale of 1-10)? Is it getting worse, better, staying the same?
T: Timing
- Onset - Exactly when did it first occur?
- Duration - How long did it last?
- Frequency - How often does it occur?
U: Understand Patient’s Perception
- What do you think it means?

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11
Q

Inspect and Palpate: Skin

A
  1. Colour
    - General pigmentation: Presence of freckles, moles, birthmarks
    - Widespread colour change: Pallor, erythema, cyanosis, jaundice
  2. Temperature: hypothermia/hyperthermia
  3. Moisture - diaphoresis/dehydration
  4. Texture
  5. Thickness
  6. Edema
  7. Mobility and turgor
  8. Vascularity or bruising
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12
Q

Lesions

A
  • Colour
  • Elevation
  • Pattern or shape
  • Size
  • Location and distribution on body
  • Exudate
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13
Q

What is the Braden Scale

A
  • For predicting pressure sore risk
    (an area of skin over a bony prominence and the circulation becomes compromised
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14
Q

Inspect and Palpate: Hair

A
  • Colour
  • Texture
  • Distribution
  • Lesions
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15
Q

Inspect and Palpate: Nails

A
  • Shape and Contour: Profile sign; index finger, angle of nail base, firm to palpation
  • Consistency; smooth and regular vs. brittle or splitting
  • Colour: Capillary refill; even pink nail bed, capillary refill
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16
Q

ABCDE Rule

A

A - Asymmetry
B - Border – irregularity
C - Colour – varied
D - Diameter – greater than 6mm
E - Elevation and enlargement, or evolving changes such as change in size, shape, symptoms (itching, tenderness), surface (bleeding) and shades of colour

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17
Q

Developmental Considerations: Older Adult

A
  • Senile lentigines (liver spots)
  • Keratoses: seborrheic
  • Skin tags
  • Sebaceous hyperplasia
  • Thin, parchment-like skin
  • Skin “tents” by itself
  • Decreased hair growth; changs in thickness, colour
  • Thickened, brittle, or yellow nails
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18
Q

Abnormal Findings

A

Common shapes and configurations of lesions:
- Annular or circular
- Confluent
- Discrete
- Grouped
- Gyrate
- Target or iris
- Linear
- Polycyclic
- Zosteriform

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19
Q

Primary Skin Lesions

A
  • Macule, papule, patch, plaque, nodule, wheal, tumour, urticaria (hives), vesicle, cyst, bulla, or pustule
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20
Q

Secondary Skin Lesions

A
  • Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, or keloid
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21
Q

Annular or Circular Lesions

A

Appear as circular or ovoid macules or patches with an erythematous periphery and central clearing

22
Q

Confluent Lesions

A

Lesions that arise due to spatially separate sources of structural damage in the brain, usually separated in time, occur near each other and create a larger connected region of lesion tissue

23
Q

Confluent Lesions

A

Lesions that arise due to spatially separate sources of structural damage in the brain, usually separated in time, occur near each other and create a larger connected region of lesion tissue

24
Q

Discrete Lesions

A

Are distinctly separate from each other with identifiable borders

25
Q

Grouped Lesions

A
  • Lesions appear in clusters or groups
26
Q

Gyrate Lesions

A

Group of reactive inflammatory vascular dermatoses that are distinguished primarily by their morphologic pattern. Arranged in rings or convolutions (like worms)

27
Q

Target Lesions

A

Round skin lesions with 3 concentric colour zones

28
Q

Linear Lesions

A

Exactly what it sounds like.

29
Q

Polycyclic Lesions

A
  • Present as configurations arranged in more than one ring (Almost look like circular big blisters in an area)
30
Q

Zosteriform Lesions

A

Boomerang blisters/cuts on shoulder

31
Q

Macule Lesions

A

flat, nonpalpable lesions usually < 10 mm in diameter ex. freckles or flat moles
circular flat
discoloration
<1cm
brown, blue, red, or hypo pigmented

32
Q

Papule Lesions

A

A circumscribed elevated solid lesion up to 1 cm in size ex. acne
Superficial Solid
Elevated <0.5cm
Colour Varies

33
Q

Nodule Lesion

A

Slightly elevated lesions on or in the skin over 5 mm in diameter comprise of solid materials
Circular, elevated, solid lesion
>1cm

34
Q

Wheal Lesion

A

Fluid collection under the skin
May last few hours

35
Q

Vesicle Lesion

A

Thin-walled sac filled with a fluid, usually clear and small
- Circular collection of free fluid
< 1cm

36
Q

Cyst

A

Deeper and firmer than vesicle lesion. Benign, round, dome shaped encapsulated containing fluid or semi fluid material

37
Q

Pustule

A

Like a pimple, contains pus

38
Q

Scale Lesion

A

A visible peeling or flaking of outer skin layers, area of irritation
- Epidermal thickening, consists of flakes or plates of compacted desquamated layers of stratum corneum

39
Q

Fissure Lesion

A

Linear, often painful breaks within the skin surface, as a result of excessive
- Crack or split

40
Q

Erosion Lesion

A

Loss of epidermis, usually heals without scarring

41
Q

Ulcer Lesion

A

A lesion or sore on the skin or mucous membrane resulting from the gradual disintegration

42
Q

Excoriation Lesion

A

Characterized by the conscious repetitive picking of skin that leads to skin lesions and significant distress or functional impairment

43
Q

Scar

A

Healed over, skin doesn’t look like original skin

44
Q

Atrophic Scar

A

An indented scar that heals below the normal layer of skin tissue

45
Q

Lichenified Lesion

A

The skin has become thickened and leathery

46
Q

Keloid

A

Healed a bit larger than normal scar (elevated)

47
Q

What is a pressure ulcer?

A
  • Appear on the skin over a bony prominence when circulation is impaired (confined to bed, immobilized)
  • Assessed by stage (1-4), depending on depth
48
Q

Risk factors of a pressure ulcer

A

Impaired mobility, thin fragile skin of aging, decreased sensory perception, impaired level of consciousness, moisture from urine or stool incontinence, excessive perspiration or wound drainage, shearing injury, poor nutrition, and infection

49
Q

What is the Braden Scale

A

For predicting pressure sore risk

50
Q

Lesions by Trauma or Abuse (2 things to look for)

A
  • Pattern of Injury
  • Hematoma
51
Q

A patient who is admitted for liver failure would be likely to show which of the following skin changes?

A

Jaundice

52
Q

The nurse is doing a general survey and notices that the mucous membranes look dry and the lips look parched and cracked. The nurse identifies these as signs of:

A
  • Dehydration

NURS 202 (8 decks)

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