Skin, hair, and nails Flashcards by Katie Hostetter

Structure: Epidermal Appendages

Structures formed by tubular invagination of epidermis down into underlying dermis
Hair
Sebaceous glands
Sweat glands: important for fluid balance and thermoregulation
-Eccrine glands
-Apocrine glands

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Skin Function:

Skin is waterproof, protective, and adaptive

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Developmental Competence: The Aging Adult:

-Elasticity: Loses elasticity; skin folds and sags
Sweat and sebaceous glands: Decrease in number and function, leaving skin dry
Senile purpura: Discoloration due to increasing capillary fragility
Skin breakdown due to multiple factors: Cell replacement is slower and wound healing is delayed
Hair matrix: Functioning melanocytes decrease, leading to gray fine hair

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Genetic attributes of dark-skinned individuals afford

protection against skin cancer due to melanin

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Subjective Data Health History Questions

Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation or color, size, shape, tenderness?
Excessive dryness or moisture?
Pruritus or skin itching?
Excessive bruising?
Rash or lesions?
Medications: prescription and over-the-counter?
Hair loss?
Change in nails’ shape, color, or brittleness?
Environmental or occupational hazards?
Self-care behaviors?

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Health History Questions: Aging adults

What changes have you noticed in your skin in past few years?
Any delay in wound healing?
Any change in feet: toenails, bunions, wearing shoes?
Falling: bruises, trauma?
History of diabetes or peripheral vascular disease?

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Objective Data: Preparation

Consciously attend to skin characteristics; the danger is one of omission

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Objective Data: equipment needed

-Strong direct lighting, gloves, penlight, and small centimeter ruler
-For special procedures:
Wood’s light
Magnifying glass
Materials for laboratory tests: potassium hydroxide (KOH) and glass slide

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Complete Physical Examination:

Skin assessment integrated throughout examination
Scrutinize the outer skin surface first before you concentrate on underlying structures
Separate intertriginous areas (areas with skinfolds) such as under large breasts, obese abdomen, and groin, and inspect them thoroughly
Always inspect feet, toenails, and between toes
SKILLS INSPECTION AND PALPATION

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Inspection and Palpation: Skin Color

General pigmentation, freckles, moles, birthmarks

- Widespread color change

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Inspection and Palpation: Skin Temperature

Use backs of hands to palpate person
Skin should be warm, and temperature equal bilaterally; warmth suggests normal circulatory status
Hands and feet may be slightly cooler in a cool environment
-Hypothermia
-Hyperthermia

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Vitiligo:

decrease in melanin, more visible in dark skinned

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Detecting color variations in dark-skinned people: Cyanosis

Examine the conjunctivae, palms, soles, buccal mucosa, and tongue, look for dull, dark color

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Detecting color variations in dark-skinned people: Edema

Examine the area for decreased color and palpate for tightness

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Detecting color variations in dark-skinned people: Erythema

palpate the area for warmth

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Detecting color variations in dark-skinned people: Jaundice

Examine the sclerae and hard palate in natural, not fluorescent, light if possible. Look for a yellow color

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Detecting color variations in dark-skinned people: Pallor

Examine the sclerae, conjunctivae, buccal mucosa, lips, tongue, nail beds, palms, and soles, Look for an ashen color

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Detecting color variations in dark-skinned people: Petechiae

examine areas of lighter pigmentation such as the abdomen. Look for tiny, purplish red dots

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Detecting color variations in dark-skinned people: Rashes

Palpate the area for skin texture changes

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Also Inspection and Palpation: Skin

Moisture: Diaphoresis (sweating) and Dehydration
Texture
Thickness (callous)
Edema (can measure)
Mobility and turgor (best place = under clavicle)
Vascularity or bruising (cannot determine age by color)

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Measurement of Edema: how deep it intends

0 = absent
1 = mild slight intend
2= moderate
3 =deep pitting = tissue swollen
4 = very deep, swollen pitting edema - "swallows finger'

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Lesions: if any are present, note the following-

Color
Elevation (pudunculated = skin tag)
Pattern or shape
Size = cm
Location and distribution on body
Any exudate: note color and odor
Use a Wood’s light to detect fluorescing lesions

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Inspection and Palpation: Hair

Color
Texture
Distribution: age, Tanner staging identifies gender patterns of hair distribution
Lesions: ID by looking at scalp and dividing hair into sections

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Inspection and Palpation: Nails

Shape and contour: normal is 160 degrees or less, diamond shape
-Profile sign
Consistency: smooth
Color: pink
Capillary refill: blanch 2-3 sec, more accurate in toe nails

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Teach skin self-examination using ABCDE rule to detect suspicious lesions

``` A: asymmetry: possible problem B: border: irregular C: color: one solid color or multicolor (bad) D: diameter: no more than 6 cm E: elevation and enlargement ```

Aging for skin

``` Senile lentigines- flat spots Keratoses- raised, thickened, scaly, pigmentation Xerosis-dryness Skin tags or acrohordons Thin parchment Decreased hair growth Decreased nail growth and brittle nails ```

Inspection of the skin, hair, and nails

Color and pigmentation Texture and distribution Shape, contour, and consistency

Palpation of the skin, hair, and nails

Temperature and texture | Edema, mobility, and turgor

Shapes and Configurations of Lesions

``` Annular or circular Confluent Discrete Grouped Gyrate Target or iris Linear Polycyclic Zosteriform ```

Annular or circular:

Example = ring worm

Confluent:

clustered run together | Ex. hives

Discrete:

singular | Ex. acne, skin tags

Grouped:

Clustered specific pattern | Ex. poison ivy, allergies

Gyrate:

Coiled, twisted

Linear:

line, streak | Ex. scratches, poison ivy possibly

Target or iris:

Bullzeye | Ex. Limes disease

Polycyclic:

Circular lesions that go together | Ex. psoriasis

Zosteriform:

follows a nerve | Ex. Shingles, herpes zoster

Primary Skin Lesions:

``` Macules Papules Patches Plaques Nodules Wheals Tumors Urticaria (hives) Vesicles Cysts Bullas Pustules ```

Macules:

flat, color change, less than 1 cm | Patch = more than 1 cm Ex. Vitiligo

Papules:

raised, solid, less than 1 cm - can feel it | plaque: papules joined together

Nodules:

raised more than 1 cm, extend into dermis | Ex. tumor - longer than few cm, firm or soft

Wheal:

superficial, raised, come and go Ex. mosquito bties, TB test -Urticaria: hives

Vesicle/bulla:

fluid filled - Vesicle: less than 1 cm, Ex. chickepox - Bulla: more than 1 cm Ex. burn blisters, friction blister

cyst:

encapsulated fluid filled, in dermis tight and firm

Pustule:

full of pus | Ex. acne

Secondary Skin Lesions:

``` -Debris on skin surface: Crusts Scales -Break in continuity of skin surface: Fissures Erosions Ulcers Excoriations Scars Atrophic scars Lichenifications Keloids ```

Fissure:

Linear crack, extends to dermis | Ex. heel fissure

Erosion:

superficial, no bleeding, loss epidermis

Ulcer:

Deeper = ulcer in dermis | Ex. pressure ulcer

Excoriation:

self inflicted -Abrasion, superficial Ex. scratching

Scar:

skin damaged - now repair, replaced w/ collagen, weaker than original skin

Atrophic scar:

Scar does not heal properly, skin is thin and intended | Ex. strita

Lichenifications:

prolonged intense scratching chronic excessive itchiness

Keloids:

excessive amount of scar tissue, elevated smooth

Vascular Lesions:

Telangiectases Purpuric lesions Hemangiomas Lesions caused by trauma or abuse

Telangiectases

Spider or star angioma | Venous lake

Purpuric lesions

Petechiae | Purpura

Hemangiomas

``` Port-wine stain (nevus flammeus) Strawberry mark (immature hemangioma) Cavernous hemangioma (mature) ```

Lesions caused by trauma or abuse

Pattern injury Hematoma Contusion (bruise)

Alopecia:

loss of hair toxic = chemotherapy Attraction = pulling, twisting, braiding

Facial hirsutism:

terminal hair growth is visible on females due to hormonal imbalance, steroid use

Tinea capitis:

“scalp ringworm;” gray, scaly, well-defined areas with broken hairs

Abnormal conditions of nails

``` Scabies Paronychia Beau’s line Splinter hemorrhages Late clubbing Onychomycosis Pitting Habit-tic dystrophy ```

Paronychia:

infected skin fold of nail

Splinter hemorrhages:

red brown linear streaks infection

Onychomycosis:

fungal infection

Pitting:

rough, deep

Habit-tic dystrophy:

constantly picking at cuticle area = rigid down nail

Common nail abnormalities:

Clubbing Paronychia Onychomycosis Splinter hemorrhages

Skin, hair, and nails Flashcards

(70 cards)