Skin Flashcards
Functions of the Skin
-PROTECTION FROM ENVIRONMENT
* BODY TEMPERATURE REGULATION
* PREVENTS PENETRATION
* PERCEPTION
* TEMPERATURE REGULATION
* PSYCHOSOCIAL
* IDENTIFICATION
* COMMUNICATION
* SENSATION
* VITAMIN D PRODUCTION
* IMMUNOLOGIC
* ABSORPTION
* ELIMINATION
MUCOUS MEMBRANES (functions)
- LINE BODY CAVITIES
- DIGESTIVE TRACT, RESPIRATORY PASSAGES, URINARY AND REPRODUCTIVE TRACTS
- SECRETE MUCOUS
- HAVE RECEPTORS THAT OFFER PROTECTION
- INSENSITIVE TO TEMPERATURE, BUT SENSITIVE TO PRESSURE
What are the two layers of the skin
Epidermis
Dermis
Epidermis layers and characteristics
- BASAL CELL LAYER- FORMS NEW SKIN CELLS- CONTAINS THE PROTEIN ‘KERATIN’
- MELANOCYTES – DERIVATION OF SKIN COLOR
- OUTER HORNY CELL LAYER OF DEAD KERATINIZED CELLS (OUTER LAYER)
- REPLACED Q4 WKS
Dermis layers and characteristics
INNER SUPPORTIVE LAYER
* CONNECTIVE TISSUE (COLLAGEN)
* ELASTIC TISSUE
Types of hair
- VELLUS HAIR
- TERMINAL HAIR
Types of glands
- SEBACEOUS GLANDS-SEBUM SECRETION
- SWEAT GLANDS: IMPORTANT FOR FLUID BALANCE AND THERMOREGULATION
* ECCRINE GLANDS
* APOCRINE GLANDS
Functions of the skin
- SKIN IS WATERPROOF, PROTECTIVE, AND ADAPTIVE
- PROTECTION FROM ENVIRONMENT
- PREVENTS PENETRATION
- PERCEPTION
- TEMPERATURE REGULATION
- IDENTIFICATION
- COMMUNICATION
- WOUND REPAIR
- ABSORPTION AND EXCRETION
- PRODUCTION OF VITAMIN D
Factors affecting the skin
- UNBROKEN AND HEALTHY SKIN AND MUCOUS MEMBRANES ACT AS A DEFENSE
- RESISTANCE TO INJURY IS AFFECTED BY AGE, AMOUNT OF UNDERLYING TISSUE, AND ILLNESS.
- ADEQUATELY NOURISHED AND HYDRATED BODY CELLS ARE RESISTANT TO INJURY.
- ADEQUATE CIRCULATION IS NECESSARY TO MAINTAIN CELL LIFE.
Risk factors affecting the skin
- IV DRUG USE
- PROLONGED SUN EXPOSURE
- BODY PIERCING
- INCREASED AGE
- DEHYDRATION AND MALNUTRITION
- REDUCED SENSATION
- DIABETES
- GI PREPARATIONS FOR TESTING
- BEDREST
- CASTS
- MEDICATIONS
- RADIATION THERAPY
DEVELOPMENTAL CONSIDERATIONS
- UNDER AGE 2 THE SKIN IS THINNER, BUT BECOMES INCREASINGLY RESISTANT TO INJURY AND INFECTION AS CHILDREN AGE
- AGING CHANGES OF SKIN:
- THINNER, MORE EASILY DAMAGED
- DECREASED SENSATION OF PRESSURE
- DECREASED SWEAT GLAND ACTIVITY – DRIER SKIN
- DECREASED CELL RENEWAL – DELAYED HEALING
- DECREASED MELANOCYTES – GRAY/WHITE HAIR AND UNEVEN PIGMENTATION OF SKIN
DEVELOPMENTAL COMPETENCE: INFANTS
NEWBORN INFANTS:
- LANUGO: FINE DOWNY HAIR OF NEWBORN INFANT
- VERNIX CASEOSA: THICK, CHEESY SUBSTANCE
- SEBUM: HOLDING WATER IN THE SKIN PRODUCING
Aging adults considerations/Changes
ELASTICITY
* LOSES ELASTICITY; SKIN FOLDS AND SAGS
* SWEAT AND SEBACEOUS GLANDS
* DECREASE IN NUMBER AND FUNCTION, LEAVING SKIN DRY
* SKIN BREAKDOWN DUE TO MULTIPLE FACTORS
* CELL REPLACEMENT IS SLOWER WOUND HEALING IS DELAYED
* SENILE PURPURA
* DISCOLORATION DUE TO INCREASING CAPILLARY FRAGILITY
* HAIR MATRIX
* FUNCTIONING MELANOCYTES DECREASE, LEADING TO GRAY FINE HAIR
* KERATOSES
* RAISED THICKEND AREA OF PIGMENTATION-CRUSTY OR WARTY IN APPEARANCE
* SKIN TAGS
* OVERGROWTH OF SKIN WITH A STALK.
Risk factors for skin issues
- HIGH EXPOSURE TO UV RADIATION (SUN\TANNING BEDS)
- FAMILY HISTORY OF MELANOMA
- ATYPICAL OR NUMBERS MOLES (>50)
- INCREASE RISK FOR: EASY BURNERS, NATURAL BLOND\RED HAIR
Subjective Data: Health history questions
- PAST HISTORY OF SKIN
DISEASE, ALLERGIES, HIVES, PSORIASIS, OR ECZEMA? - CHANGE IN PIGMENTATION OR COLOR?
- CHANGE IN MOLE SIZE, SHAPE, COLOR, TENDERNESS?
- EXCESSIVE DRYNESS OR MOISTURE?
- PRURITUS OR SKIN ITCHING?
- EXCESSIVE BRUISING?
- RASH OR LESIONS?
- MEDICATIONS: PRESCRIPTION and OTC drugs
- HEALTH HISTORY
- HAIR LOSS?
- CHANGE IN NAILS’ SHAPE, COLOR, OR BRITTLENESS?
- ENVIRONMENTAL OR OCCUPATIONAL HAZARDS?
- SELF-CARE BEHAVIORS?
Objective data when assessing the skin
- PREPARATION
* CONSCIOUSLY ATTEND TO SKIN CHARACTERISTICS; THE DANGER IS ONE OF
OMISSION - EQUIPMENT NEEDED
* STRONG DIRECT LIGHTING, GLOVES, PENLIGHT, AND SMALL CENTIMETER RULER - COMPLETE PHYSICAL EXAMINATION
* SKIN ASSESSMENT INTEGRATED THROUGHOUT EXAMINATION
* SCRUTINIZE THE OUTER SKIN SURFACE FIRST BEFORE YOU CONCENTRATE ON
underlying structure - SEPARATE INTERTRIGINOUS AREAS (AREAS WITH SKINFOLDS) SUCH AS UNDER LARGE BREASTS, OBESE ABDOMEN, AND GROIN AND INSPECT THEM THOROUGHLY
* THESE AREAS ARE DARK, WARM, AND MOIST AND PROVIDE PERFECT CONDITIONS
FOR IRRITATION OR INFECTION - ALWAYS INSPECT FEET, TOENAILS, AND BETWEEN TOES
Objective inspection of the skin
- COLOR-KNOW BASELINE!
- GENERAL PIGMENTATION, FRECKLES, MOLES, BIRTHMARKS
- WIDESPREAD COLOR CHANGE
* NOTE COLOR CHANGE OVER ENTIRE BODY SKIN, SUCH AS PALLOR (PALE), ERYTHEMA
(RED), CYANOSIS (BLUE), OR JAUNDICE (YELLOW) - WHITE (PALLOR)
* REFLECTS ANEMIA - RED
* ERYTHEMA - BLUE
* CYANOSIS - YELLOW-ORANGE
* JAUNDICE
Objective Palpation of the skin
- TEMPERATURE
* USE BACKS OF HANDS TO PALPATE PERSON
* SKIN SHOULD BE WARM, AND TEMPERATURE EQUAL BILATERALLY; WARMTH
SUGGESTS NORMAL CIRCULATORY STATUS
* HANDS AND FEET MAY BE SLIGHTLY COOLER IN A COOL ENVIRONMENT
* HYPOTHERMIA
* HYPERTHERMIA
* MOISTURE
* DIAPHORESIS
-Dehydration
* TEXTURE
* THICKNESS
* EDEMA (0-4)
* MOBILITY AND TURGOR
Objective Inspection- VASCULARITY OR
BRUISING
- CHERRY ANGIOMAS
- MULTIPLE BRUISES AT DIFFERENT STAGES OF HEALING AND EXCESSIVE BRUISES ABOVE KNEES OR ELBOWS SHOULD RAISE CONCERN ABOUT PHYSICAL ABUSE
- NOTE TATTOOS
- NEEDLE MARKS OR TRACKS FROM INTRAVENOUS INJECTION OF STREET DRUGS MAY
BE VISIBLE ON ANTECUBITAL FOSSAE. - PROMOTING HEALTH AND SELF-CARE
* SELF INSPECTION
* SUNSCREEN
* HATS, CLOTHING - EMOLLIENTS/LUBRICANTS
ABCDE-EFG (name them, not specific)
TEACH SKIN SELF-EXAMINATION USING ABCDEF RULE TO DETECT SUSPICIOUS LESIONS
* A – ASYMMETRY
* B – BORDER
* C – COLOR
* D – DIAMETER
* E – EVOLVING
- A – ASYMMETRY
- B – BORDER
- C – COLOR
- D – DIAMETER
- E – EVOLVING
-ELEVATED
* FIRM TO PALPATION
* GROWING PROGRESSIVELY OVER SEVERAL WEEKS
* LESIONS: IF ANY ARE PRESENT ALSO NOTE:
* PATTERN OR SHAPE
* SIZE
* LOCATION AND DISTRIBUTION ON BODY
* ANY EXUDATE: NOTE COLOR AND ODOR
* PALPATE LESION
* ROLL FOR DEPTH
* BLANCHING
LESIONS- SHAPES AND CONFIGURATION
- ANNULAR OR CIRCULAR
- CONFLUENT
- DISCRETE
- GROUPED
- TARGET OR IRIS “BULLS EYE”
- LINEAR
- ZOSTERIFORM
- CONFLUENT
- DISCRETE
- GROUPED
SECONDARY SKIN LESIONS: How do they develop?
RESULTING FROM A CHANGE IN A PRIMARY LESION FROM THE PASSAGE OF TIME; AN EVOLUTIONARY CHANGE
Types of Primary Skin Lesions
- MACULES: FLAT
- PAPULES: SOLID, RAISED
- PUSTULES: PUS
- VESICLES/ BULLA: TRAPPED FLUID UNDER SKIN
- URTICARIA (HIVES): RED, ITCHY WELTS
CYST: BENIGN, ROUND, DOME-SHAPED ENCAPSULATED LESION, CONTAINS FLUID OR SEMI-
FLUID MATERIAL - NODULE: SOLID, ELEVATED, HARD OR SOFT.
- WHEAL: SUPERFICIAL RAISED, TRANSIENT AND REDDENED, IRREGULAR SHAPE FROM EDEMA.
PRIMARY SKIN LESIONS: Where do they develop?
PRIMARY LESIONS DEVELOP ON PREVIOUSLY UNALTERED SKIN
Types of secondary skin issues
- DEBRIS ON SKIN SURFACE:
* CRUSTS: DRYING OF PLASMA OR EXUDATE ON THE SKIN
* SCALES: FLAKES REPRESENTING COMPACTED DESQUAMATED LAYERS - BREAK IN CONTINUITY OF SKIN SURFACE
- FISSURES: LINEAR CLEAVAGE OF SKIN
- EROSIONS: SLIGHTLY DEPRESSED AREAS
- ULCERS: NECROSIS
- EXCORIATIONS: ABRADED SKIN
- SCARS: PERMANENT FIBROTIC
- LICHENIFICATION: THICK AND LEATHERY SKIN
ABNORMAL FINDINGS: VASCULAR AND PURPURIC
- VASCULAR LESIONS
- PORT-WINE STAIN (NEVUS FLAMMEUS)
- STRAWBERRY MARK (IMMATURE HEMANGIOMA)
- SPIDER ANGIOMA
- TELANGIECTASIA
- PURPURIC LESIONS
- PETECHIAE
- PURPURA
LESIONS CAUSED BY
TRAUMA OR ABUSE - PATTERN INJURY
- HEMATOMA
- CONTUSION
(BRUISE)
