N112 Quiz 1: chapter 12 Flashcards
What are some subjective questions you could ask a patient with a rash?
When did it begin? Does anyone at home have a similar rash? Do you have a new pet,tried a new food, been gardening or camping? Are you itchy? pruritis Have you had a fever? (children >100.5 adults depends on population)
What 4 types of skin color should you look for while performing objective assessment?
Pallor (white)
Erythema (redness)
Cyanosis (blue)
Jaundice (yellow)
What would pallor indicate during objective skin assessment?
pale/white. look at fingertips; some process of hypoxia is going on Ex include anemia; pt in high stress state (anxiety causes vasoconstriction); exposure to cold
What would erythema indicate during objective skin assessment?
redness. generalized redness caused by fever. Erythema occurs with polycythemia, venous stasis, carbon monoxide poisoning, and the extravascular presence of red blood cells (petechiae, ecchymosis, hematoma)
What would cyanosis indicate during an objective skin assessment?
blue color around lips; not perfusing oxygenated blood; hard to see in dark skinned pts. Cyanosis indicates hypoxemia and occurs with shock, heart failure, chronic bronchitis, and congenital heart disease.
What would jaundice indicate during objective skin assessment?
high bilirubin (broken down RBCs); liver decreased function due to hepatitis for example; first seen in eyes and roof of mouth hard palate. Normal in newborns expect yellow babies; everyone else is abnormal. If baby has jaundice eyes it’s gone on too long. Jaundice occurs with hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.
During the physical exam of skin, what objective data would you look for? (7)
Temperature Moisture Texture Thickness Edema Mobility Turgor Vascularity or bruising
During the physical exam of skin, what would hot or cold temperatures indicate?
If hot at specific site (i.e. not bilateral), clot or infection
Overall: Hypothermia or Hyperthermia
During the physical exam of skin, what aspects of moisture should be evaluated?
Diaphoresis: excessive sweating; gown is soaked, face is soaked, breathing hard
Dehydration: excessively dry skin, look in mouth, extremely chapped lips; mucous membrane in mouth is dry
What does tenting indicate when testing skin turgor?
dehydrated or loss of elasticity in skin (if old age). Must check turgor for skin dehydration
What is Ecchymosis and what can it indicate during objective skin assessment?
black and blue indicates bruising
Indicates abuse if bruising on trunk
Indicates leukemia if bruising in weird places.
Severe anemia can cause bruising.
How is edema measured?
Test for pitting: Press w/index or thumb on shin, ankle and top of foot. Scale: \+1 mild pitting \+2 moderate (rapidly dissipates) \+3 deep pitting (remains for short time) \+4 very severe edema.
When is edema normal?
pregnancy (should be symmetric for normal finding); only in one leg think deep vein thrombosis (symptom: very painful);
What can edema in only one leg indicate?
Deep Vein Thrombosis. Very painful
What are risk factors for clots? and how will they present in the skin?
immobility, sugery.
If swollen with clot then skin/swelling will be warm
When inspecting and palpating lesions, what attributes should be evaluated?
Color Elevation Pattern or shape Size Location Distribution on body Exudate
When inspecting and palpating hair, what attributes should be evaluated?
Color.
Texture
Distribution
Lesions
Ex. why would 20 year old have grey hair? metabolic issue?
thyroid issue: rough, dry brittle hair (hypothyroidism)
What is alopecia?
abnormal loss of hair, spotty or all, not just on top of head; can go along with thyroid issues.
What is hirsutism?
excessively hairy where you shouldn’t be; ie women with male pattern distribution; excessive testosterone in body of women; mostly if thyroid or ovaries are not working properly.
When inspecting and palpating nails, what attributes should be evaluated?
Look for clean, rounded and slightly curved
look for 160 degree angle; early clubbing: 1st gets flat then clubs.
Color: Capillary refill: in person w/o disease, cap refill should occur immediately (normal brisk cap refill less than 2 seconds); Pt w/ circ problems, >2 seconds from blanching to refill, then be concerned with circulation.
Shape and contour
Profile sign
Consistency
Color
What is clubbing (w/ regard to nails)?
Angle >160 degrees (normal is 160 and curved is <160)
Clubbing can indicate poor circulation, anemia, heart disease, pulm disease pts are emphysemic have callused finger tips and clubbed nails.
What is Onychomycosis?
fungus growing on/under nails. obvious with work in garden, less obvious activities of daily living, cleanliness
What skin changes occur in the aging adult?
Loss of elastin, collagen, subcutaneous fat, may look more wrinkled. Epidermis thins and flattens
Reduction of muscle tone
Wrinkling occurs because the underlying dermis thins
Sweat glands decrease in number: leaves skin dry, increases risk of heat stroke.
Senile purpura thinning of skin makes risk of blood pooling under skin visible. fairly normal finding in aging people. have to be careful of skin of aging person; ex sheet can rip off skin of elderly.
What are Seborrheic kerotosis and Senile lentigines?
- Seborrheic kerotosis: benign raised/thickened area
- Senile lentigines: liver spots
neither require treatment, both are normal with aging.
What changes occur in the aging adults hair and nails?
Decreased function of melanocytes causes hair to turn grey and thin
Change in hair distribution
Female facial hair not hirsutism, hair on lip or chin
Nails may appear thickened, yellow, and brittle because of decreased circulation in extremities.
Describe differences b/w following cancers: basal cell, squamous cell and melanoma.
basal cell primarily from sun exposure
squamous cell usually has central ulcer and grows rapidly
melanoma highest mortality rate. looks black/ugly/angry.
Describe cause/difference b/w Psoriasis
Roscea / Eczema
bbb
Describe cause/ difference b/w Spider bite, impetigo and lymes disease (include vector if caused by vector)
Impetigo: around mouth
Lymes: deer tick, bulls eye rash
What method should be used to evaluate moles during a skin cancer check?
ABCDE
check every month, requires 2 mirrors and a light; searching whole body
A asymmetrical (healthy moles are perfectly round)
B border
C Color variation abnormal will have multiple colors
D diameter if >6mm (top of pencil erasure)
E Elevated or enlarged
Is a bleeding and/or itching mole cancerous?
YES, always assume not benign.
For promoting self care, what should patients be taught to avoid skin cancer?
Teach patients:
- ABCDE
- Avoid sun exposure in peak hours (10-3pm)
- Wear sunscreen everyday
- if in sun wear clothing to prevent sun damage
- Dangers of tanning beds.
What are the functions of the skin?
Protection. Prevents penetration. Perception. Temperature regulation. Identification. Communication. Wound repair. Absorption and excretion. Production of vitamin D
What is linea nigra and cholasma in the pregnant women?
linea nigra: The change in hormone levels results in increased pigment in the areolae and nipples, vulva, and sometimes in the midline of the abdomen or in the face (chloasma)
striae gravidarum
stretch marks
Describe skin conditions found among Blacks.
1 Keloids
2 Areas of either postinflammatory hypopigmentation or hyperpigmentation that appear as dark or light spots
3 Pseudofolliculitis—“razor bumps” or “ingrown hairs” caused by shaving too closely with an electric razor or straight razor
4 Melasma—the “mask of pregnancy,” a patchy tan to dark brown discoloration of the face
marasmus
Severe malnutrition
vitiligo
An acquired condition with complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices. Vitiligo can occur in all races, although dark-skinned people are more severely affected and potentially suffer a greater threat to their body image.
ephelides
freckles—small, flat macules of brown melanin pigment that occur on sun-exposed skin
