Skin, Hair, and Nails

Question 1

Skin Functions

(4)

Answer 1

1. Provide boundaries for body fluid
2. Protect underlying tissue from microorganisms, harmful substances, and radiation
3. Modulate body temp
4. Synthesize vitamin D

Question 2

Skin Structure

(% BW, 3 components, 4 appendages)

Answer 2

Largest organ of the body, at 16% of total BW

Components:

Layers

1. Epidermis
2. Dermis
3. Subcutaneous tissue

*Appendages *

1. Hair
2. Nails
3. Sebaceous glands
4. Sweat glands

Question 3

Hair

(describe 2 types)

Answer 3

1. Vellus hair – short, fine, less pigmentation
2. Terminal hair – coarser, pigmented (scalp/eyebrows)

Question 4

Nail Function

Answer 4

Protect distal ends of fingers/toes

Question 5

Sebaceous Glands

(locations, function)

Answer 5

Location: all skin surfaces except palms/soles

Function: produce fatty substance secreted into skin surface thru hair follicles

Question 6

Sweat Glands

(list and describe 2)

Answer 6

1. Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature
2. Apocrine glands – found in axilla and groin, stimulated by emotional stress

Question 7

Common Concerning Hair/Nail/Skin Symptoms

(3, and how to ask abou them in a health hx)

Answer 7

Symptoms:

1. Hair loss
2. Rash
3. Moles

Ask the patient:

“Have you noticed any changes in your skin or your hair?”

“Have you noticed any moles that have changed size, shape, color, or sensation?”

“Have you noticed any new moles?”

Question 8

Pt Education for Healthy Skin

(3 points)

Answer 8

1. Early detection of suspicious moles
2. Protective measures for skin care
3. Hazards of excessive sun exposure

Question 9

Prevalence, Skin Cancer

Answer 9

Most common cancers in the U.S., c most cases presenting on

1. Hands
2. Neck
3. Head

Question 10

Skin Cancers

(3 types, % of cancers, description)

Answer 10

1. Basal cell carcinoma
   
   • Comprises 80% of skin cancers
   • Shiny and translucent, they grow slowly and rarely metastasize
2. Squamous cell carcinoma
   
   • Comprises 16% of skin cancers
   • Crusted, scaly, and ulcerated, they can metastasize
3. Melanoma
   
   • Comprises 4% of skin cancers
   • Rapidly increasing in frequency, they spread rapidly

Question 11

Melanoma Risk Factors

(7)

Answer 11

1. ≥50 common moles
2. ≥1-4 atypical or unusual moles (especially if dysplastic)
3. Red or light hair
4. Actinic lentigines, macular brown or tan spots (usually on sun exposed areas)
5. Heavy sun exposure (especially severe childhood sunburns)
6. Light eye or skin color (especially freckles/burns easily)
7. Family history of melanoma

Question 12

Melanoma Screening Tool

Answer 12

ABCDE of Melanoma:

A for asymmetry

B for irregular borders, especially ragged, notched, or blurred

C for variation or change in color, especially blue or black

D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding

E for elevation or enlargement

Question 13

Logistics of a Quality Skin Exam

(2)

Answer 13

1. Make sure pt wears a gown, and drape appropriately
2. Use good light, preferably natural light, to prevent color distortion

Question 14

Notable Skin Characteristics on Inspection/Palpation

(6)

Answer 14

1. Color
2. Moisture
3. Temperature
4. Texture
5. Mobility and turgor
6. Lesions

Question 15

Skin Color Examination Points

(1 tool, 4 colors and where to find them)

Answer 15

Tool: use your pts, they will often notice skin color changes before the examiner

Location Specifics:

1. Pigmentation concentration - global
2. Redness (from oxyhemoglobin) - fingertips, lips, mucus mem, and palms/soles for darker skinned people
3. Central cyanosis - lips oral mucosa, tongue
4. Jaundice - sclera

Question 16

Skin Moisture Variations

(3)

Answer 16

1. Dryness
2. Sweating
3. Oiliness

Question 17

Skin Temperature Evaluation Technique

Answer 17

Use back of fingertips

Question 18

Skin Mobility/Turger Eval

(2 steps)

Answer 18

1. Lift fold of skin
2. Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)

Question 19

Notable Skin Lesion Characteristics

(6)

Answer 19

1. Location
2. Distribution
3. Pattern
4. Shape
5. Category (macule, papule, nevus, vesicle)
6. Color

Question 20

Skin Lesion Identification

(2 guidlines)

Answer 20

1. Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology
2. To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical

Question 21

Hair Evaluation

(2 techniques, 3 observations)

Answer 21

Techniques:

1. inspect
2. palpate

Points to look for:

1. quality
2. distribution
3. texture

Question 22

Nail Observations

Answer 22

1. Color
2. Shape
3. Lesions

longitudinal bands of pigment may be normal finding in people c darker skin

Question 23

Hair/Skin/Nail Eval of a Bedbound Patient

(3 guidlines)

Answer 23

1. People confined to bed are particularly susceptible to skin damage and ulceration, so take note to do frequent and thorough skin checks
   
   • Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin
2. Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels
3. Roll patient onto one side to see sacrum and buttocks

Question 24

Skin/Hair/Nail Documentation

Answer 24

Initially you may use sentences to describe findings;
later you will use phrases

Examples:

“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”

“Marked facial pallor, with circumoral cyanosis. Palms cold and moist. Cyanosis in nailbeds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”