Skin Assessment Flashcards
Name the 3 layers of skin
Epidermis, Dermis, Subcutaneous
Deepest layer of epidermis
Stratum germinativum or basal cell layer
Most superficial layer of epidermis
Stratum corneum or horny cell layer
Derivation of skin color comes from the
epidermis
Includes connective tissue or collagen and elastic tissue
Dermis
Name the 4 epidermal appendages
- Hair 2. Sebaceous glands 3. Sweat glands 4. Nails
Name 2 types of sweat glands
Apocrine-open into hair follicle Eccrine-occur over most of your body and open directly onto surface of skin
The following are functions of the _______
Protection Prevents penetration Perception Temperature regulation Identification
Functions of Skin
The following are functions of the ____
Communication Wound repair Absorption and excretion Production of vitamin D
Functions of Skin
The following are what you would ask when conducting someone’s _____- Common or Concerning Symptoms Client’s Personal Health History Family History Lifestyle and Personal Habits
Subjective Health History
What items do you need when conducting a physical exam?
Strong direct lighting, Small centimeter ruler, Penlight, Gloves
When inspecting skin, you are looking for ___(4)
Color, Odor, Integrity, Lesions
You are looking for these things while _____ the skin Texture Thickness Moisture Temperature Mobility and Turgor Edema Lesions
Palpating
How do you test for skin turgor
Pinch skin underneath clavicle
What are you looking for while inspecting lesions?
Size include number of lesions, Shape or Pattern, Color, Texture Surface Relationships and Pattern Exudate Tenderness or Pain Body Location and Distribution
Distribution of skin lines include:
- Diffuse/Generalized
- Scattered
- Localized
- Regional
- Torso
- Extensor/Flexor Surfaces
- Dermatome Line
Hairy Areas
Circular lesions
Annular
Circular configurations that run together
Confluent
Separate lesions that are not joined to one another
Discrete or distinct lesions
Lesions that are very close to one another in a cluster
Clustered or grouped lesions
Twisted or coiled lesions
Gyrate
Lesions that look like little targets
Target, concentric rings of color
Lesions that look like a streak
Linear, streak or stripe
Annular lesions growing together
Polycyclic
Linear lesions growing along a nerve root
Zosteriform
Small, flat, nonpalpable skin color change (skin color may be brown, white, tan, purple, red). Less than 1 cm with a circumscribed border, include freckles, petechiae, and flat moles.
Macule
Flat, are greater than 1 cm, and may have an irregular border.
Patch
Elevated, palpable, solid mass. Have a circumscribed border and are less than 0.5 cm; include warts
Papule
Elevated, palpable, solid mass; are greater than 0.5 cm and may be coalesced with a flat top. Include psorias
Plaque
Elevated, solid, palpable mass that extends deeper into dermis than a papule. Are 0.5–2 cm and circumscribed; include keloid, lipoma, squamous cell carcinoma, poorly absorbed injection, and dermatofibroma
Nodule
Elevated, solid, palpable mass that extends deeper into dermis than a papule. Are greater than 1–2 cm and do not always have sharp borders. Examples include larger lipoma and carcinoma.
Tumor
Circumscribed elevated, palpable mass containing serous fluid; less than 0.5 cm; Examples include herpes simplex/zoster, varicella (chickenpox, pictured below), poison ivy, and second-degree burn.
Vesicle
Circumscribed elevated, palpable mass containing serous fluid; are greater than 0.5 cm; include pemphigus, contact dermatitis, large burn blisters, poison ivy, and bullous impetigo.
Bulla
Elevated mass with transient borders that is often irregular. Size and color vary. Caused by movement of serous fluid into the dermis; it does not contain free fluid in a cavity. Examples include urticaria (hives) and insect bites.
Wheal
Pus filled vesicle; Example is acne
Pustule
Encapsulated fluid-filled or semisolid mass that is located in the subcutaneous tissue or dermis.
Cyst
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
cyanosis
a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment
jaundice
an unhealthy pale appearance.
pallor
Characterized by, or causing, a morbid redness of the skin
erythematic
Loss of superficial epidermis that does not extend to the dermis. It is a depressed, moist area.
Erosion
Examples include rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore
Erosion
Skin loss extending past epidermis, with necrotic tissue loss. Bleeding and scarring are possible.
Ulcer
Examples include stasis ulcer of venous insufficiency
Ulcer
Skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue. Young scars are red or purple, whereas mature scars are white or glistening
Scar
Examples include healed wound and healed surgical incision.
Scar
Linear crack in the skin that may extend to the dermis and may be painful.
Fissure
Examples include chapped lips or hands and athlete’s foot.
Fissure
Flat, red or purple macules bleeding from superficial capillaries
Petechia
Thickened Skin
Lichentification
Excessive collagen formation
Keloid
How do you evaluate for moles/skin cancer? List the A’s through G’s and explain what each stands for
A—asymmetry
B—border
C—color
D—diameter
E—evolving
E - elevated
F - firm to palpation
G - growing progressively over several weeks
Symmetrical, Borders even, One color, Smaller than 6mm, Ordinary mole, flat or raised surface
Benign
Asymmetrical, borders uneven, two or more colors, larger than 6mm, changing in size, color or another shape, elevated, firm to palpation
Malignant
•Papule with Pearly borders – volcano like
Basal Cell Carcinoma
Central ulcer with reddened borders
Squamous Cell Carcinoma
A skin cancer that begins in cells called melanocytes; brown-to-black pigmented lesions
Malignant Melanoma
Risk factors of skin cancer
- Sun exposure
- Nonsolar sources of ultraviolet radiation
- Medical therapies
- Family history and genetic susceptibility
- Moles
- Pigmentation irregularities
- Fair skin that burns and freckles easily; light hair
- Age
- Male gender
- Chemical exposure
- Human papillomavirus
- Xeroderma pigmentosum
- Long-term skin inflammation or injury
- Alcohol intake; smoking
- Inadequate niacin in diet
How do you reduce risk of skin cancer
- Reduce skin exposure.
- Always use sunscreen when sun exposure is anticipated.
- Wear long-sleeve shirts and wide-brimmed hats.
- Avoid sunburns.
- Understand the link between sun exposure and skin cancer and the accumulating effects of sun exposure on developing cancers.
- Have annual skin cancer screenings.
Diet adequate in Vitamin B3 (Niacin)
How do you reduce pressure injury risk?
- Inspect the skin at least daily and more often if at greater risk using risk assessment tool (such as Braden Scale or PUSH tool) and keep flow chart to document.
- Bathe with mild soap or other agent; limit friction; use warm, not hot, water; set bath schedule that is individualized.
- For dry skin: use moisturizers; avoid low humidity and cold air.
Avoid vigorous massage.
- Use careful positioning, turning, and transferring techniques to avoid shear and friction or prolonged pressure on any point.
- Refer nutritional supplementation needs to primary care provider or dietitian, especially if protein deficient.
- Refer incontinence condition to primary care provider.
- Use incontinence skin cleansing methods as needed: frequency and methods of cleaning, avoiding dryness with protective barrier products
How do you assess nails?
Inspect and Palpate
Grooming and Cleanliness
Color and shape
Texture and Consistency
Capillary Refill
What happens to nails as you age?
Thickened, yellow, brittle, lackluster
Longitudinal ridges, striations
Ingrown toenails
How do you assess the scalp and hair?
Inspect and Palpate
- Color
- Texture
- Distribution
- Lesions
Increased hair growth on chin and around lips in older _____
females
Increased hair growth in ears, nostrils, and eyebrows in older_______
males
Spot baldness is called ______
Alopecia
In regards to hair with aging, there is loss of _______and decreased ________
pigment; axillary/pubic/extremity hair
What are some tips for maintaining healthy skin of the aged?
- Drink at least 2 quarts of water daily
- Maintain a well balanced diet with ample fruits, vegetables, and protein
- Use skin creams and lubricants that moisturize the skin at least twice daily
- Use mild, or super-fatted, non-perfumed soaps
- Bathe in warm water and rinse the skin well before drying thoroughly
- Keep the air in the home humidified
- When outside use sunscreen that cover UVA and UVB rays with an SFP of 30 or higher and lip balm even on cloudy days
- When in the sun wear cotton clothing that covers the body such as long pants, long sleeves, a wide brimmed hat, and sunglasses
- Limit time in the sun and exposure to cold and wind
- Limit full body bathing to two or three times a week
- If incontinent, make sure the skin is washed well and dried thoroughly, and that an emollient is applied
- Avoid, rough, irritating clothing or laundering clothes with harsh soaps, bleach, or starch
A warty or crusty pigmented lesion; appears as a waxy brown, black, or tan growth; noncancerous.
Seborrheic Keratosis
A thick, scaly patch of skin that may become cancer. It usually forms on areas exposed to the sun, such as the face, scalp, back of the hands, or chest. It is most common in people with fair skin.
Senile Keratosis
A small piece of soft, hanging skin that may have a peduncle, or stalk. They can appear anywhere on the body, but especially where skin rubs against other skin or clothing.
Skin Tags
Benign, easy bruising that affects older adults. This occurs because the skin and the blood vessels become more fragile as we age, making it easier for our skin to bruise from minor trauma.
Senile Purpura
A benign pigmented flat spot on sun-exposed skin in older adults, especially on the back of the hands and on the forehead. Also called a liver spot.
Senile Lentigines
Small raised spots (1–5 mm wide) typically seen with aging.
Cherry Angioma
The following are all symptoms of_______
Thinning epithelium
Wrinkles, looses turgor and becomes lax
Dry, itchy skin; Pale in color
aging
180-degree angle of nails with spongy sensation that can occur from hypoxia.
clubbing
Intact skin with nonblanchable redness of a localized area, usually over a bony prominence
Stage 1 Pressure Ulcer
Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured, serum-filled blister.
Stage 2 Pressure Ulcer
Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
Stage 3 Pressure Ulcer
Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.
Stage 4 Pressure Ulcer
Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined
Unstageable Pressure Ulcer
What are the most common sites for pressure ulcers?
Over a bony prominence, such as the butt, heels, hips, elbows, ankles, back and shoulders
Includes 6 categories; Sensory Perception, Moisture, Nutrition, Activity, Mobility, Friction and Shear
Braden Scale
Uses a score from less than or equal to 9 to as high as 23. The lower the number, the higher the risk for developing an acquired ulcer/injury; goes from completely limited-very limited-slightly limited-no impairment.
Braden Scale
Name 6 Pressure Injury Factors
- Perception
- Mobility
- Moisture
- Nutrition
- Friction or shear against surfaces
- Tissue tolerance decreased
Developed in the 1960s and is widely used to assess the risk for pressure ulcer in adult patients. The five subscale scores of are added together for a total score that ranges from 5-20. A lower score indicates higher levels of risk for pressure ulcer development.
Norton Scale
What are the 5 components of the Norton Scale?
Physical Condition
Mental Condition
Activity
Mobility
Continence
When palpating nails, they should _______
Return with normal color (pink)
What do the following ranges for the Braden Scale mean?
19-23
15-18
13-14
less than 9
no risk; mild risk; moderate risk; severe risk
What do the following scores interpret to for the Norton Scale?
<10
10 – 14
14 – 18
>18
very high risk; high risk; medium risk, low risk
