Skin Flashcards
3 Layers of Skin
- Epidermis
- Stratum germinativum or basal cell layer
- Stratum corneum or horny cell layer - Dermis
- Connective tissue or collagen
- Elastic tissue - Subcutaneous layer
4 parts of epidermal appendage
- Hair
- Sebaceous Glands
- Sweat Glands
- Eccrine Glands
- Apocrine Glands - Nails
Purpose of the Skin (9)
Protection Prevents Penetration Perception Temperature Regulation Identification Communication Wound Repair Absorption and Excretion Production of Vitamin D
Subjective Data:Health History Questions (13)
- Previous history of skin disease (allergies, hives, psoriasis, or eczema)
- Change in mole
- Change in pigmentation (size or colour)
- Excessive dryness or moisture
- Pruritus
- Excessive bruising
- Rash or lesion
- Medications
- Hair loss
- Change in nails
- Environmental or occupational hazards (i.e., 12. Outdoor sports enthusiasts and coal workers)
- Self-care behaviours
Preparation for the Physical Exam of the Skin
External variables that influence skin colour
Equipment needed for the Skin Physical Exam
- Strong direct lighting
- Small centimetre ruler
- Penlight
- Gloves
- For special procedures
- Wood’s light
- Magnifying glass
- Materials for laboratory tests: KOH, glass slide
In the physical exam of the skin, inspect and palpate any widespread ____.
colour change
The more reliable sites are those with the least pigmentation, such as ____. (4)
- Under the tongue,
- the buccal mucosa,
- the palpebral conjunctiva, and the
- sclera.
Variables that influence skin colour include: (6)
- emotional states
- temperature
- smoking
- prolonged elevation/dependent position of 5.extremities
- prolonged inactivity.
- When the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the colour of connective tissue (collagen), which is mostly WHITE.
- Impending Shock = Vasoconstriction and decreased perfusion (i.e., hemorrhage)
- Anemias = Decreased hematocrit
- Local Arterial Insufficiency (i.e., Raynaud’s Syndrome)
Pallor
- is an intense REDness of the skin from excess blood (hyperemia) in the dilated superficial capillaries.
- Fever, local inflammation, or with emotional reactions such as blushing in vascular flush areas (cheeks, neck, and upper chest).
Erythema
- A BLUISH, mottled discoloration that signifies decreased perfusion; the tissues are not adequately perfused with oxygenated blood.
- Hypoxemia and occurs with shock, heart failure, chronic bronchitis, and congenital heart disease.
- Given that most conditions causing this also cause decreased oxygenation of the brain, OBSERVE for other clinical signs—such as changes in level of consciousness and signs of respiratory distress—will be evident.
Cyanosis
Persistent blue or cyanotic discoloration of the extremities, most commonly occurring in the hands, although it also occurs in the feet and distal parts of face.
Acrocyanosis
- Exhibited by a YELLOW colour, indicating rising amounts of BILIBURIN in the blood. It is first noted in the junction of the hard and soft palates in the MOUTH and in the SCLERA.
- Increased serum bilirubin, more than 2 to 3 mg/100 mL from liver inflammation or hemolytic disease;
- Severe burns and some infections.
- Sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.
Jaundice
Diseases that cause orange-green colour of the skin.
Hepatitis and cirrhosis
Renal failure causes retained urochrome pigments in the blood thus making the skin ______ in colour.
Orange-grey colour.
Light or clay-coloured stools and dark golden urine often accompany this.
Jaundice
- Note the temperature of your own hands. Then use the backs (dorsa) of your hands to palpate the person and check bilaterally.
- The skin should be warm, and the temperature should be equal bilaterally; warmth suggests normal circulatory status.
- Hands and feet may be slightly cooler in a cool environment.
- Hypothermia & Hyperthermia
Temperature
- Generalized coolness may be induced, such as in ______ used for surgery or high fever. Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion.
- Abnormal Findings
General _____ accompanies central circulatory problem such as shock.
Localized ______ occurs in peripheral arterial insufficiency and Raynaud’s Syndrome
Hypothermia
- Generalized _____ occurs with an increased metabolic rate, such as in fever or after heavy exercise. A localized area feels ____ with trauma, infection, or sunburn.
- Abnormal Findings
Hyperthyroidism has an increased metabolic rate, causing warm, moist skin.
Hyperthermia
Has an increased metabolic rate, causing warm, moist skin.
Hyperthyroidism
_____ appears normally on the face, hands, axilla, and skinfolds in response to activity, a warm environment, or anxiety.
Perspiration
____, or profuse perspiration, accompanies an increased metabolic rate, such as occurs in heavy activity or fever.
Diaphoresis
______ in the oral mucous membranes. With _____, mucous membranes look dry and the lips look parched and cracked. With extreme dryness the skin is fissured, resembling cracks in a dry lake bed.
Dehydration
Normal skin feels _____, with an even surface.
smooth and firm
With _______—Skin feels smoother and softer, like velvet.
Hyperthyroidism
With ____ —Skin feels rough, dry, and flaky.
Hypothyroidism
The ______ is uniformly thin over most of the body, although thickened callus areas are normal on palms and soles.
epidermis
A ____ is a circumscribed overgrowth of epidermis and is an adaptation to excessive pressure from the friction of work and weight bearing.
callus
Abnormal Findings
Very thin, shiny skin (atrophic) occurs with ____.
arterial insufficiency.
- Pinch up a large fold of skin on the anterior chest under the clavicle. ____ is the skin’s ease of rising, and _____ is its ability to return to place promptly when released. This reflects the elasticity of the skin. “No tenting”.
Mobility; turgor
Fluid loss of 5% of the body weight is considered ____.
mild dehydration
Fluid loss of 10% of the body weight is considered ____.
moderate dehydration
Fluid loss of 15% or more of the body weight is considered ____.
severe dehydration
True or False
Mobility is decreased when edema is present.
True
Its presence is graded on a four-point scale:
1+ Mild pitting, slight indentation, no perceptible swelling of the leg.
2+ Moderate pitting, indentation subsides rapidly.
3+ Deep pitting, indentation remains for a short time, leg looks swollen.
4+ Very deep pitting, indentation lasts a long time, leg is very swollen.
Pitting Edema
Mild pitting, slight indentation, no perceptible swelling of the leg.
1+
Moderate pitting, indentation subsides rapidly.
2+
Deep pitting, indentation remains for a short time, leg looks swollen.
3+
Very deep pitting, indentation lasts a long time, leg is very swollen
4+
____ is fluid accumulating in the intercellular spaces; it is not present normally. To check for this, imprint your thumbs firmly against the ankle malleolus or the tibia. Normally the skin surface stays smooth.
Edema
If your pressure leaves a dent in the skin, _____ is present.
“pitting” edema
Edema is most evident in ______ parts of the body, where the skin looks puffy and tight.
dependent
eg. (feet, ankles, and sacral areas)
