Lecture 4: Skin, Hair, and Nails Flashcards
Layers of Skin + Function
- Epidermis
- Thin, tough - Dermis
- Connective tissue (collagen)
- Elastic tissue
3 Subcutaneous layer
- Adipose layer: store fat (energy), temperature, protection (cushion)
Function Of the Skin
- Protection
- Prevents penetration
- Perception (sensory)
- Temperature regulation
- Identification
- Communication
- Wound repair
- Absorption and excretion
- Production of vitamin D
Developmental Considerations: Infant and children
- Newborn
- Lanugo, vernix caseosa; skin thin and more permeable, greater risk for fluid loss, ineffective temperature regulation - At puberty
- Increased sweat gland secretions, more active sebaceous glands, evidence of secondary sex characteristics in skin
Developmental Considerations: Pregnant Women
- Connective tissue becomes fragile
- Striae (stretch marks)
Developmental Considerations: Older adults
- 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
Health History
- 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
Additional Heath History Q’s: Infants and children
- Birthmarks
- Skin colour changes: jaundice, cyanosis
- Allergic rash
- Diaper rash
- Burn or bruises
- Exposure to contagious skin conditions
- Sun protection
Additional Heath History Q’s: Adolescents
- Skin problems
Additional Heath History Q’s: Older adults
- Skin changes
- Delay in wound healing
- Skin pain
- Foot/nail changes
- Falling
- Diabetes or cardiovascular disease
- Skin care
Subjective Data (OPQRSTU)
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?
Inspect and Palpate: Skin
- Colour
- General pigmentation: Presence of freckles, moles, birthmarks
- Widespread colour change: Pallor, erythema, cyanosis, jaundice - Temperature: hypothermia/hyperthermia
- Moisture - diaphoresis/dehydration
- Texture
- Thickness
- Edema
- Mobility and turgor
- Vascularity or bruising
Lesions
- Colour
- Elevation
- Pattern or shape
- Size
- Location and distribution on body
- Exudate
What is the Braden Scale
- For predicting pressure sore risk
(an area of skin over a bony prominence and the circulation becomes compromised
Inspect and Palpate: Hair
- Colour
- Texture
- Distribution
- Lesions
Inspect and Palpate: Nails
- 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
ABCDE Rule
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
Developmental Considerations: Older Adult
- 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
Abnormal Findings
Common shapes and configurations of lesions:
- Annular or circular
- Confluent
- Discrete
- Grouped
- Gyrate
- Target or iris
- Linear
- Polycyclic
- Zosteriform
Primary Skin Lesions
- Macule, papule, patch, plaque, nodule, wheal, tumour, urticaria (hives), vesicle, cyst, bulla, or pustule
Secondary Skin Lesions
- Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, or keloid
Annular or Circular Lesions
Appear as circular or ovoid macules or patches with an erythematous periphery and central clearing
Confluent Lesions
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
Confluent Lesions
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
Discrete Lesions
Are distinctly separate from each other with identifiable borders
Grouped Lesions
- Lesions appear in clusters or groups
Gyrate Lesions
Group of reactive inflammatory vascular dermatoses that are distinguished primarily by their morphologic pattern. Arranged in rings or convolutions (like worms)
Target Lesions
Round skin lesions with 3 concentric colour zones
Linear Lesions
Exactly what it sounds like.
Polycyclic Lesions
- Present as configurations arranged in more than one ring (Almost look like circular big blisters in an area)
Zosteriform Lesions
Boomerang blisters/cuts on shoulder
Macule Lesions
flat, nonpalpable lesions usually < 10 mm in diameter ex. freckles or flat moles
circular flat
discoloration
<1cm
brown, blue, red, or hypo pigmented
Papule Lesions
A circumscribed elevated solid lesion up to 1 cm in size ex. acne
Superficial Solid
Elevated <0.5cm
Colour Varies
Nodule Lesion
Slightly elevated lesions on or in the skin over 5 mm in diameter comprise of solid materials
Circular, elevated, solid lesion
>1cm
Wheal Lesion
Fluid collection under the skin
May last few hours
Vesicle Lesion
Thin-walled sac filled with a fluid, usually clear and small
- Circular collection of free fluid
< 1cm
Cyst
Deeper and firmer than vesicle lesion. Benign, round, dome shaped encapsulated containing fluid or semi fluid material
Pustule
Like a pimple, contains pus
Scale Lesion
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
Fissure Lesion
Linear, often painful breaks within the skin surface, as a result of excessive
- Crack or split
Erosion Lesion
Loss of epidermis, usually heals without scarring
Ulcer Lesion
A lesion or sore on the skin or mucous membrane resulting from the gradual disintegration
Excoriation Lesion
Characterized by the conscious repetitive picking of skin that leads to skin lesions and significant distress or functional impairment
Scar
Healed over, skin doesn’t look like original skin
Atrophic Scar
An indented scar that heals below the normal layer of skin tissue
Lichenified Lesion
The skin has become thickened and leathery
Keloid
Healed a bit larger than normal scar (elevated)
What is a pressure ulcer?
- Appear on the skin over a bony prominence when circulation is impaired (confined to bed, immobilized)
- Assessed by stage (1-4), depending on depth
Risk factors of a pressure ulcer
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
What is the Braden Scale
For predicting pressure sore risk
Lesions by Trauma or Abuse (2 things to look for)
- Pattern of Injury
- Hematoma
A patient who is admitted for liver failure would be likely to show which of the following skin changes?
Jaundice
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:
- Dehydration
