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Health Assessment > Skin, Hair and Nail Assessment > Flashcards

Skin, Hair and Nail Assessment Flashcards

1
Q

Layers of skin

A
  • Epidermal
  • Dermal
  • Subcutaneous tissue
  • Hair
  • Sebaceous glands (work to lubricate, protect, and moisture seal)
  • Sweat glands (cool)
  • Think about depth of injury of burn
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2
Q

Which layer of skin do 1st degree burns affect?

A
  • Mildest form of skin injury, affecting the epidermis.

- Red/Non-blistered

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3
Q

Which layer’s of skin do 2nd degree burns affect?

A
  • Dermis
  • Blisters and some thickening of the skin
  • Can destroy nerve endings
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4
Q

What are 3rd degree burns?

A

Extend through every layer of skin, and are the most severe

-Char, waxy white, brown, leathery

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5
Q

What are some functions of the skin?

A
  • Protection
  • Perception- touch, pain, pressure, heat
  • Temperature
  • Identification of self, self image
  • Absorption and excretion
  • Production of vitamin D
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6
Q

Subjective Data:

A
  • Previous history of skin disease
  • Change in pigment
  • Change in size or colour in mole (ABCD)
  • Excessive dryness, or moisture (xerosis)
  • Pruritus (itching)
  • Excessive bruising
  • Rash or lesion
  • Medication
  • Hair loss
  • Change in mails
  • Environmental or occupational hazards
  • Self-care behaviours
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7
Q

Additional History: Infant and Children

A
  • Birthmarks
  • Change in colour since birth (cyanosis, jaundice)
  • Rashes or sores (related to food changes, related to exposure such as change in soap, detergents, sun, diapers)
  • Burns or bruises
  • Exposure (disease, toxins, plants, scabies/lice, insects)
  • Self-destructive habits (scratching, nail-biting, and self harm
  • Anal scratching (parasites)
  • Sun protection practices
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8
Q

Additional History: Adolescents

A

•Hormonal skin changes: acne, blackheads

-Emotional response, nutritional patterns, self-care

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9
Q

Additional History: Aging

A
  • Dry skin
  • Bruising
  • Breakdown, delays in healing
  • Change in moles of new lesions
  • Skin pain (shingles/herpes zoster)
  • Foot changes (diabetic foot)
  • Self-care (toe-nails, moisturizers, UV protection)
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10
Q

Inspection of the hair/scalp:

A
  • Texture
  • Distribution of hair
  • Note any scalp lesions
  • Separate hair and check for infestation
  • Alopecia: hair falling out
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11
Q

Inspection and palpation of the nails:

A
  • Shape and colour
  • Cleanliness, Condition
  • Normal filling in 1-2 seconds
  • Profile sign (clubbing)
  • Consistency
  • Markings
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12
Q

Inspection: Skin

A
  • Observe for skin tone, normally it is consistent with their genetic background
  • Observe for lesions, rashes, bruising
  • Normal to observe freckles, moles (nevus), and birthmarks (pigmented areas
  • Acquired Pigment Loss: Vitiglio
  • Freckles and Moles also called Nevus
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13
Q

Widespread Color Change:

A
  • Pallor
  • Erythema (fever, carbon monoxide poising, venous stasis)
  • Cyanosis (blue)
  • Jaundice (yellow)
  • Ecchymosis (vascularity and bruising)
  • May need to check sclera, buccal mucosa, under tongue in dark skinned individuals
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14
Q

Inspect: Lesions

A
  • Inspect with gloves in exudate present
  • Note the colour, elevation, pattern, size, location, and exudate
  • Palpate and blanche
  • Consider using wood light
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15
Q

ABCDE’s of a lesion

A

A-Asymmetry not round or oval and the two sides do not appear the same
B-Border irregularity- ragged edges or poorly defined margins
C-Colour variations multi-coloured
D-Diameter
E-Elevation and enlargement
Location

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16
Q

Palpate Skin For:

A
  • Texture- normal skin feels smooth and firm with even surface
  • Thickness- epidermis is thin over most of the body
  • However it is normal to be thickened (calloused) over palms and soles of feet
  • Mobility and turgor of skin
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17
Q

Define Mobility and Turgor:

A
  • Mobility= ease of rising

* Turgor= ability to return to place

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18
Q

What is Edema? how would you grade it?

A
  • Fluid accumulating in the intracellular spaces
  • Checked by imprinting thumb firmly aginst ankle malleolus or tibia
  • A dent created by your finger indicates “pitting edema

Grading:
1+ =mild pitting- slight indent, no particular swelling of leg
2+= moderate pitting,- indent subsides rapidly
3+= deep pitting- indent remains for short time, leg looks swollen
4+= very deep pitting, indent lasts a long time

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19
Q

Developmental considerations: Infants

A
  • Thin, smooth, elastic, more permeable
  • Sweat glands underdeveloped- heat regulation problematic
  • Less subcutaneous tissue- less insulation
  • Pigment system less efficient – sun protection is an issue
20
Q

What is vernix?

A

Thick white film on babies after birth, cottage cheese-like

21
Q

What are normal neonatal changes?

A
  • Red flush for the first 24 hours
  • Harlequin sign: occurs in side-lying position, bottom half of body flushed, top half pale
  • Erythema toxicum: common rash in first 3-4 days (flea bit rash, transient in newborns)
  • Acrocyanosis: blue lips, hand, fingernails, toenails, first few hours of life, dissaperaing with warming
  • Curtis Marmorata: mottling in trucking and extremities in response to cool room
22
Q

Infant: Normal Changes

A
  • Physiologic jaundice
  • Milia
  • Storkbites
  • Mongolian spot (common in aboriginal and European children, looks like brusing)
23
Q

Assessing Hydration in infants:

A
  • Assessing capillary refill, skin tugor, fontanels
  • Skin tugor tested by pinching fold of abdominal skin and watching return to expected state
  • Fontanels should be even with cranium (no depression)
24
Q

Skin considerations: Children and Adolescents

A
  • Epidermis thickens and toughens
  • Skin better lubricated
  • More dark pigment
  • Increased body hair
  • Sweat glands click in during adolescence
  • Sebaceous glands increase oil production
  • Rashes in children usually associated with contact or infectious disease (poison ivy, soap, chicken pocks, measles)
  • Hormonal changes in teens leads to increased sweat glands (body odour) and increased sebaceous gland secretions (acne)
  • Adult hair distribution axilla, genitals
25
Q

Skin Considerations: Pregnancy

A
  • More hormones increase change to in pigment to areola, nipples, vulva, axilla, inner thighs
  • More sweat and sebaceous glands: worsened acne, sweating
  • Hair retention followed by increased loss of retained hairs post delivery
  • Melisma
  • Linea nigra
  • Striae gravidum (stretch marks)
26
Q

Skin Considerations: Older Adults

A

•Loss of elastin, collagen, subcutaneous fat, turgor
•Reduced peripheral blood flow
-Easy to tear, bruise, lose heat
-Slow to heal
-Reduced sweat glands, less oil production
-Risk of heat stroke, dry skin
• Reduced pigmentation
-Risk of sunburns
•Hair follicles atrophy, reduces pigmentation
-Hair loss and greying
•Nail growth slows, flat, brittle

27
Q

Normal changes: Older Adults

A
  • Senile lentigines (liver spots)
  • Keratosis
  • Skin tags
  • Cherry angimoas
  • Tenting (loss of fat layer)
  • Purpura (bruising due to loss of fat layer)
28
Q

Cultural Considerations:

A

•Biocultural differences in amount of melanin in skin
•Produces colour, provides better UV protection
•Nipples, areola, scrotum and labia are generally darker in African and Asian descent
•Inuit adaptation: minimal sweat glands on trunk, increased sweat glands on face
•Alcohol flush syndrome:
-Redness and flushing
-Heat and red splotches on face
-Faster intoxication with alcohol
-90% aboriginals, 50% Asians
•Copper red hair colour in malnourished Africans

29
Q

Cultural Considerations CONT’D

A 
•Cultural variations
-Practice differs around disrobing, direct touch, and gender
•African Canadians
-Keloid formation
-Mongolian spots
-Skin is commonly excessively dry 
-Ashy dermatitis 
•Asian Population
-Men have less body and facial hair 
•Darker skin pigments
-Lower Vit D levels- supplements recommended
30
Q

Acute Assessment:

A

•Most skin issue are non-emergent
•Prompt evaluation and interventions recommended for:
-Bleeding, major burns, dirty lacerations, injury with streaking to the lymphatic’s, pressure sores.
•Acute dehydration
•Cyanosis
•Pallor with diminished or absent pulse

31
Q

Sun Safety: Children/Adults

A
  • Limit exposure from 11am-4pm
  • Cover up (loose, light, tightly woven clothes, ears and eyes, uses sun screen)
  • SPF 15+ or higher, reapply every 2 hours
  • Winter reflection of snow doubles UVA and UVB
32
Q

Sun Safety: 0-6 months

A
  • Sunscreen is considered toxic
  • Cover up, no direct exposure
  • Sun screen filters on car windows
33
Q

Sun Safety: 6-12 months

A

Safe to apply sunscreen

34
Q

Primary Skin Lesions:

A
  • Macule
  • Papule
  • Nodule
  • Wheal
  • Vesicle
  • Cyst
  • Pustule
  • Patch
  • Plaque
35
Q

Secondary Skin Lesions:

A
  • Scar
  • Keloid (excessive fibrous tissue in scar)
  • Crust (dried secreations from primary lesion)
  • Scale (rapid turnover of epidermal layer)
  • Fissure
  • Lichenification (skin lines accentuated due to scratching, chronic irritation resembles tree bark)
  • Excoriation
  • Erosion
  • Ulcer
36
Q

What is Petechiae?

A

Small red/purple macules or papules that develop in response to trauma, haematological issues (fragile capillaries, small haemorrhages under the skin, trauma, anticoagulant therapy, liver disease)

37
Q

What is ecchymosis?

A

Bruising from damaged capillaries

38
Q

What is purpura?

A

Bleeding under the skin due to loss of clotting mechanism (flat reddish blue patched, caused by subcutaneous bleeding, fragility of capillaries, bleeding disorders, senile Purpura)

39
Q

What is a laceration?

A

Skin tear (superficial, deep)

40
Q

What is abrasion?

A

Friction against skin removes layers exposing the dermis

41
Q

What is a puncture wound?

A

Occurs when something punctures the skin

42
Q

What is avulsion?

A

Trauma forces skin to separate from underlying structures

43
Q

What is a hematoma?

A

Similar to bruising but with elevated skin, trauma causes leakage of blood into skin and subcutaneous tissue

44
Q

Why should you look for injury patterns?

A

Could be signs of child abuse (bruising, bites, burns, belt marks)

45
Q

Other Wound Observations:

A
  • Shape, length, width, depth
  • Superficial, deep
  • Clean, contaminated, infected
  • Partial of full thickness
  • Presence of necrotic tissue
  • Presence of drainage
46
Q

Wound Drainage

A
  • Serous (clear)
  • Sanguineous (bloody)
  • Serosanguinous (mixed)
  • Purulent (Pus)

Health Assessment (10 decks)

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