Skin, Hair and Nails Flashcards
What are you looking for when you inspect the hair/scalp?
Colour
Texture
Distribution
Lesions
What are you looking for when inspecting the skin?
Colour Temperature Moisture Texture Thickness Edema Mobility and turgor Vascularity or bruising Lesions
What are you looking for when you inspect the nails?
Shape and contour (profile sign)
Consistency
Colour (capillary refill)
How to inspect colour of skin?
General pigmentation
Normally consistent with genetic background; may find benign pigmented areas (freckles (ephelides), moles (nevus), birthmarks); widespread colour change: note colour change in skin over entire body; pallor (white), erythema (red), cyanosis (blue), jaundice (yellow)
How to inspect temperature of skin?
Hypo/hyperthermia
Note temperature using back of hand and checking bilaterally; skin should be warm and temperature equal bilaterally; warmth suggests normal circulatory status; hypothermia - generalized coolness (induced for surgery) or local coolness (site of IV infusion or immobilized limb in cast); hyperthermia - generalized heat (after increased metabolic energy, exercise, etc) or localized heat (after sunburn, trauma, infection, etc)
How to inspect moisture of skin?
Perspiration appears normally on face, hands, axilla, and skinfolds as a result of warm environment, activity, or anxiety; diaphoresis is profuse perspiration accompanying increased metabolic activity (exercise); note dehydration in oral mucosa - normally non, mucous membranes normally look smooth and moist
How to inspect texture of skin?
Normal skin feels smooth and firm, with an even surface.
How to inspect thickness of skin?
Epidermis uniformly thin over entire body, thicker in palms and soles; calluses are circumscribed over-growth of epidermis in adaption to excessive pressure from friction
How to inspect for edema?
Fluid that accumulates in intracellular spaces; normally is not present
Imprint thumb firmly against ankle or tibia - normally skin resumes smoothness immediately; if pressure leaves a dent, pitting edema is present
Edema normally masks skin colour and obscures pathological conditions because fluid lies between surface and pigmented/vascular layers; makes darker skin look lighter
How to grade edema?
1+ = mild pitting, slight indentation, no perceptible swelling of leg 2+ = moderate pitting, indentation subsides rapidly 3+ = deep pitting, indentation remains for a short time, legs look swollen 4+ = very deep pitting, indentation lasts a long time, leg is very swollen
How to inspect mobility and turgor of skin?
Pinch up a large skinfold on anterior aspect of chest, under clavicle or top of hand; mobility is the skin’s ease of rising and turgor is the ability to promptly return to place when released; together they comprise the skin’s elasticity
Tenting is not normal - sign of dehydration
How to inspect vascularity or bruising?
Cherry (senile) angiomas are small, smooth, slightly raised bright red dots that commonly appear on the trunk of all adults over 30; normally increase in number and size as you age; not significant
Bruising (ecchymosis) should be consistent with normal life trauma (normally not venous dilations or varicosities); document presence of tattoos.
What are the characteristics of lesions that should be noted?
Colour Elevation Pattern Size Location/distribution Exudate
How to inspect lesions?
Palpate lesions (wearing gloves in anticipation of mucosae, blood, or bodily fluids), roll nodules between thumb and index finger to assess depth, gently scrape lesion, note base, surrounding skin temperature, does lesion blanch with pressure?
How to inspect colour of hair?
Hair colour results from melanin, greying begins as early as 30 due to decreased melanin, genetic factors affect onset of greying
How to inspect texture of hair?
Scalp hair may be fine or thick, straight, curly, or kinky, should look shiny
How to assess distribution of hair?
Fine vellus hair coats the body, coarser terminal hair grows at eyebrows, eyelashes, and scalp; at puberty, distribution conforms to normal male and female patterns
How to assess lesions on scalp?
Separate hair into sections and lift and observe scalp; areas should be free of lesions of pest inhabitants; many people normally have seborrhea (dandruff)
How to assess shape and contour of nails?
Normally slightly curved or flat, posterior and lateral nail folds are smooth and rounded; view index finger at its profile and note angle of the nail base - should be 160 degrees; nail base is firm on palpation (curved nails are a variation of normal (160 degrees or less)); early clubbing is 180 degrees and feels spongy on palpation
How to assess consistency of nails?
Surface is smooth and regular, not brittle or splitting; nail thickness is uniform; nail is firmly adherent to nail bed; nail base is firm on palpation
How to assess colour of nails?
Translucent nail plate, even pink nail bed underneath, all people normally have white hairline linear markings from trauma or picking at cuticle; capillary refill – depress nail edge to cause blanching then release, noting the return of colour
Normally colour returns instantly or at least within a few seconds in a cold environment; sluggish colour return takes longer than 1 to 2 seconds; inspect toenails - separate the toes and note the smoothness of skin in between.
What is the best way to promote health and self-care?
Teach patient skin self-examination
What is the ABCDE mnemonic for pigmented lesions?
A - asymmetry B - border irregularity C - colour variation D - diameter (greater than 6mm) E - elevation and enlargement
What is the importance of self-examination?
Health care provider may only see patient once a year, but patient sees self every day.
