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Health Assessment NU 311 > Skin, hair, and nails > Flashcards

Skin, hair, and nails Flashcards

1
Q

Structure: Epidermal Appendages

A
  • 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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2
Q

Skin Function:

A

Skin is waterproof, protective, and adaptive

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3
Q

Developmental Competence: The Aging Adult:

A

-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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4
Q

Genetic attributes of dark-skinned individuals afford

A

protection against skin cancer due to melanin

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5
Q

Subjective Data Health History Questions

A

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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6
Q

Health History Questions: Aging adults

A

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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7
Q

Objective Data: Preparation

A

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

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8
Q

Objective Data: equipment needed

A

-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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9
Q

Complete Physical Examination:

A
  • 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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10
Q

Inspection and Palpation: Skin Color

A
  • General pigmentation, freckles, moles, birthmarks

- Widespread color change

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11
Q

Inspection and Palpation: Skin Temperature

A
  • 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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12
Q

Vitiligo:

A

decrease in melanin, more visible in dark skinned

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13
Q

Detecting color variations in dark-skinned people: Cyanosis

A

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

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14
Q

Detecting color variations in dark-skinned people: Edema

A

Examine the area for decreased color and palpate for tightness

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15
Q

Detecting color variations in dark-skinned people: Erythema

A

palpate the area for warmth

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16
Q

Detecting color variations in dark-skinned people: Jaundice

A

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

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17
Q

Detecting color variations in dark-skinned people: Pallor

A

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

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18
Q

Detecting color variations in dark-skinned people: Petechiae

A

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

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19
Q

Detecting color variations in dark-skinned people: Rashes

A

Palpate the area for skin texture changes

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20
Q

Also Inspection and Palpation: Skin

A
  • 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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21
Q

Measurement of Edema: how deep it intends

A 
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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22
Q

Lesions: if any are present, note the following-

A 
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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23
Q

Inspection and Palpation: Hair

A
  • 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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24
Q

Inspection and Palpation: Nails

A
  • 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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25
Q

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

A 
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
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26
Q

Aging for skin

A 
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
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27
Q

Inspection of the skin, hair, and nails

A

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

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28
Q

Palpation of the skin, hair, and nails

A

Temperature and texture

Edema, mobility, and turgor

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29
Q

Shapes and Configurations of Lesions

A 
Annular or circular
Confluent
Discrete
Grouped
Gyrate
Target or iris
Linear
Polycyclic
Zosteriform
30
Q

Annular or circular:

A

Example = ring worm

31
Q

Confluent:

A

clustered run together

Ex. hives

32
Q

Discrete:

A

singular

Ex. acne, skin tags

33
Q

Grouped:

A

Clustered specific pattern

Ex. poison ivy, allergies

34
Q

Gyrate:

A

Coiled, twisted

35
Q

Linear:

A

line, streak

Ex. scratches, poison ivy possibly

36
Q

Target or iris:

A

Bullzeye

Ex. Limes disease

37
Q

Polycyclic:

A

Circular lesions that go together

Ex. psoriasis

38
Q

Zosteriform:

A

follows a nerve

Ex. Shingles, herpes zoster

39
Q

Primary Skin Lesions:

A 
Macules
Papules
Patches
Plaques
Nodules
Wheals
Tumors
Urticaria (hives)
Vesicles
Cysts
Bullas 
Pustules
40
Q

Macules:

A

flat, color change, less than 1 cm

Patch = more than 1 cm Ex. Vitiligo

41
Q

Papules:

A

raised, solid, less than 1 cm - can feel it

plaque: papules joined together

42
Q

Nodules:

A

raised more than 1 cm, extend into dermis

Ex. tumor - longer than few cm, firm or soft

43
Q

Wheal:

A

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

44
Q

Vesicle/bulla:

A

fluid filled

  • Vesicle: less than 1 cm, Ex. chickepox
  • Bulla: more than 1 cm Ex. burn blisters, friction blister
45
Q

cyst:

A

encapsulated fluid filled, in dermis tight and firm

46
Q

Pustule:

A

full of pus

Ex. acne

47
Q

Secondary Skin Lesions:

A 
-Debris on skin surface:
Crusts
Scales
-Break in continuity of skin surface:
Fissures
Erosions
Ulcers
Excoriations
Scars
Atrophic scars
Lichenifications
Keloids
48
Q

Fissure:

A

Linear crack, extends to dermis

Ex. heel fissure

49
Q

Erosion:

A

superficial, no bleeding, loss epidermis

50
Q

Ulcer:

A

Deeper = ulcer in dermis

Ex. pressure ulcer

51
Q

Excoriation:

A

self inflicted
-Abrasion, superficial
Ex. scratching

52
Q

Scar:

A

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

53
Q

Atrophic scar:

A

Scar does not heal properly, skin is thin and intended

Ex. strita

54
Q

Lichenifications:

A

prolonged intense scratching chronic excessive itchiness

55
Q

Keloids:

A

excessive amount of scar tissue, elevated smooth

56
Q

Vascular Lesions:

A

Telangiectases
Purpuric lesions
Hemangiomas
Lesions caused by trauma or abuse

57
Q

Telangiectases

A

Spider or star angioma

Venous lake

58
Q

Purpuric lesions

A

Petechiae

Purpura

59
Q

Hemangiomas

A 
Port-wine stain (nevus flammeus)
Strawberry mark (immature hemangioma)
Cavernous hemangioma (mature)
60
Q

Lesions caused by trauma or abuse

A

Pattern injury
Hematoma
Contusion (bruise)

61
Q

Alopecia:

A

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

62
Q

Facial hirsutism:

A

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

63
Q

Tinea capitis:

A

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

64
Q

Abnormal conditions of nails

A 
Scabies
Paronychia
Beau’s line
Splinter hemorrhages
Late clubbing
Onychomycosis
Pitting
Habit-tic dystrophy
65
Q

Paronychia:

A

infected skin fold of nail

66
Q

Splinter hemorrhages:

A

red brown linear streaks infection

67
Q

Onychomycosis:

A

fungal infection

68
Q

Pitting:

A

rough, deep

69
Q

Habit-tic dystrophy:

A

constantly picking at cuticle area = rigid down nail

70
Q

Common nail abnormalities:

A

Clubbing
Paronychia
Onychomycosis
Splinter hemorrhages

Health Assessment NU 311 (5 decks)

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