module 3: skn, hair, nails Flashcards
when inspecting and palpating the hair, look for
- color
- texture
- ditribution
- lesions
when inspecting and palpating the nails, look for:
- shape & contour (slightly curved/flat) → The profile sign (view of index finger at its profile and note angle of nail base) ~160 degrees
- consistency: smooth and regular, not brittle or splitting
-color: translucent to pink nail bed - Capillary refill: healthy color return takes 1-2 sec.
degree of normal, curved, and early clubbing nails.
normal: 160 degrees
curved nail: 160 degrees or less
ealy clubbing: flat 180 degrees
clubbing of nails occurs with:
congenital cyanotic heart disease, lung cancer, and pulmonary diseases
widespread color change of the skin
Pallor, erythema, cyanosis, jaundice
Pallor
(PALE) loss of color; red-pink tones from oxygenated
hemoglobin in the blood are lost
Erythema
intense redness of skin(infection/fever); due to excess blood in dilated superficial capillaries
cyanosis
bluish mottled color; signifies decreased perfusion
of oxygenated blood to the tissues
jaundice
yellowish skin color; indicates rising amounts of bilirubin in blood.
First place you’ll see? Soft and hard palate of mouth.
Danger signs or abnormal characteristics of pigmentd lesions: ABCDEF (ABNORMAL)
A - asymmery
B - border
C - color
D - diameter (measure in mm)
E - elevation and enlargement
F - funny looking
When inspecting and palpating the skin
-temp (palpate using back of both hands)/should be wam and equal bilaterally.
-moisture (dehydrated? Look in mouth)
- texture (smooth, even, firm)
- thickness
- edema
- mobility (ease of rise) or turgor (ability of skin to return/snap back to place
- vascularity or bruising
- lesions
Edema:
-pitting vs non pitting (on tibia bone/both side @ same time)
If edema is pitting, grade on scale
- 1+ Mild pitting
- 2+ Moderate pitting
- 3+ Deep pitting (short time indentation)
- 4+ Very deep pitting (long term indentation)
What are lesions?
Primary vs secondary
Traumatic/pathological changes, abnormal development
Primary: something you wake up with
Secondary: changed over time
If any lesions are present note:
- Color
- Elevation: flat/raised skin tag
- Pattern or shape
- Size: lesion in cm / mole in mm
- Location and distribution on body
- Any exudate: note color and odor
Common shapes/ configurations of lesions: refer to p228
ANNULAR
(Or circular) begins in center & spreads to periphery (outer limits or edge)
Ex: tinea corporis or ringworm, tinea versicolor, pityriasis rosea)
Common shapes/ configurations of lesions: refer to p228
CONFLUENT
Lesions run together/ touching
Ex: urticaria (hives)
Common shapes/ configurations of lesions: refer to p228
DISCRETE
Distinct, individual lesions that remain separate (ex: acrochordon or skin tags, acne)
Common shapes/ configurations of lesions: refer to p229
GROUPED
Cluster of lesions (ex: vesicles of contact dermatitis)
Common shapes/ configurations of lesions: refer to p229
LINEAR
A scratch, streak, line, or stripe.
Common shapes/ configurations of lesions: refer to p229
TARGET
Or iris, resembles iris of eye, concentric rings of color in lesions
Ex: erythema multiforme
Common shapes/ configurations of lesions: refer to p229
ZOSTERIFORM
Linear arrangement along a unilateral nerve route
Ex: herpes zoster
Primary skin lesions; refer to page 230
MACULE
Solely a color change, flat & circumscribed, of < 1 cm.
Ex: freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever
Primary skin lesions; refer to page 230
PATCH
Same as macule, but > 1 cm.
Ex: Mongolian spot, vitiligo, café au lait spot, chloasma, measles rash,
Primary skin lesions; refer to page 230
PAPULE
Something you can feel (solid, elevated, circumscribed, < 1 cm diameter) caused by superficial thickening in epidermis.
Ex: elevated nevus (mole), lichen planus, molluscum, wart (verruca).
Primary skin lesions; refer to page 230
PLAQUE
Papules coalesce to form surface elevation wider than 1 cm. A plateaulike, disk-shaped lesion.
Ex: psoriasis, lichen planus
Primary skin lesions; refer to page 230
WHEAL
Superficial, raised, transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in tissues)
Ex: mosquito bite, allergic reaction, dermographism
Primary skin lesions; refer to page 230
VESICLE/BULLA
Vesicle: elevated cavity containing free fluid, up to 1 cm; a “blister.” Clear serum flows if wall is ruptured.
Ex: herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatitis.
Bulla: > 1 cm diameter; usually single chambered (unilocular); superficial in epidermis; thin-walled and ruptures easily.
Ex: friction blister, pemphigus , burns, contact dermatitis
Primary skin lesions; refer to page 231
Cyst
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin.
Ex: sebaceous cyst, wen.
Primary skin lesions; refer to page 231
PUSTULE
Turbid fluid (pus) in cavity/ bacterial infection of skin. Circumscribed and elevated.
Ex: impetigo, acne
Secondary skin lesions; refer to page 231
CRUST
Thickened/ dried up exudate (ex:after popping pimple)
Ex: impetigo (dry, honey-colored), weeping eczematous dermatitis, scab after abrasion.
Secondary skin lesions; refer to page 231
SCALE
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding or dead cells.
Ex: after scarlet fever or drug reaction, psoriasis, eczema, etc.
Secondary skin lesions; refer to page 232
FISSURE
Earthquake/linear crack in dermis w/ abrupt edges. (Dry or moist)
Ex: cheilosis: @ corners of mouth caused my excess moisture ; athletes foot
Secondary Skin Lesions; refer to pg 232
EROSION
Scooped-out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals w/o scar bc erosion does not extend into dermis.
Secondary Skin Lesions; refer to pg 232
ULCER
deeper depression extending into dermis, irregular shape; leaves scar when heals.
Ex: stasis ulcer, pressure injury, chancre
Secondary Skin Lesions; refer to pg 232
SCAR
After a skin lesion is repaired, normal tissue is lost and replaced with CT (connective tissue) aka collagen. This is a permanent fibrotic change.
Ex: healed area of surgery or injury , acne.
Secondary Skin Lesions; refer to pg 232
ATROPHIC SCAR
The resulting skin level is depressed with loss of tissue; a thinning of the epidermis
Ex: striae
Secondary Skin Lesions; refer to pg 232
KELOID:
Skin trying to heal, lots of collagen. Looks smooth, rubbery, shiny, and “clawlike”; feels smooth & firm.
Found in earlobes, back of neck, scalp, chest, and back; may occur months-years after initial trauma.
Vascular lesions:
HEMANGIOMAS
Caused by a benign proliferation of blood vessels in dermis
Vascular lesions: Hemangiomas
PORT-WINE STAIN
Flat, purple birthmark on face or scalp (frequently along distribution of cranial nerve V).
*intensifies w/ crying, exertion, or exposure to heat or cold.
Vascular lesions: Hemangiomas
STRAWBERRY MARK (INFANTILE HEMANGIOMA)
2-3 cm in diameter.Raised bright red area w/ well-defined borders.
Vascular veins: infants
Vascular lesions: Hemangiomas
CHERRY ANGIOMA
Red spots/ papules (age)
Vascular lesions: Hemangiomas
TELANGIECTASES
A fiery red, star-shaped marking w/ a solid circular center.
Develops on face, neck, or chest; may be associated with pregnancy, chronic liver disease, or estrogen therapy or may be normal
Vascular lesions: Purpuric lesions (caused by blood flowing out of breaks in the vessels, RBCS & blood pigments are deposited in tissues (extra vascular)
PETECHIAE
Tiny hemorrhages (1-3mm) round & discrete
- prolonged straining or thrombocytopenia (not a lot of platelets)
Vascular lesions: Purpuric lesions (caused by blood flowing out of breaks in the vessels, RBCS & blood pigments are deposited in tissues (extra vascular)
PURPURA
CONFLUENT and extensive patch of petechiae and ecchymoses; >3mm, flat, red to purple macular hemorrhage.
Seen is disorders such as thrombocytopenia, coagulation disorders, &scurvy
Vascular lesions: Purpuric lesions (caused by blood flowing out of breaks in the vessels, RBCS & blood pigments are deposited in tissues (extra vascular)
ECCHYMOSIS
A purplish patch resulting from extravasation of blood into the skin, > 3mm in diameter.
NOT CAUSED BY BLUNT FORCE TRAUMA
Ex: hitting a table
Vascular lesions: Purpuric lesions (caused by blood flowing out of breaks in the vessels, RBCS & blood pigments are deposited in tissues (extra vascular)
CONTUSION (bruise)
Mechanical injury results in hemorrhage into tissues. Skin is intact.
Ex: punch/car accident (be mindful of abuse)
How is a contusion (bruise) different from petechiae, ecchymosis, and purpura?
B/c these 3 are not caused by blunt force trauma.
Is there are any lesions present on your pt, you should note:
- Color
- Elevation
- Pattern/shape
- Size: cm measurement
- Location and distribution on body
- Any exudate: note color and odor
Braden scale (6 sub-scales)
Scale for predicting pressure score risk: how much @ risk for pressure ulcer
1. Sensory perception (can they feel? Are they limited?)
2. Moisture: incontinent
3. Activity: if they’re only in bed/chair, they’re @ greater risk.
4. Mobility
5. Nutrition: high risk yo getting a pressure ulcer
6. Friction and shear: bone/skin rub together —> injury
Braden scale: the lower the score… vs the higher the score
Lower score = grater risk
Higher score = less risk
