skin hair and nais

Question 1

the skins main function

Answer 1

Largest organ of the body.
Provides a physical barrier that protects the underlying tissues and
organs from microorganisms, physical trauma, ultraviolet radiation
(UVR), and dehydration.
Assists in temperature maintenance & fluid and electrolyte balance.
Absorption, excretion, sensation, immunity, and vitamin D synthesis.
Provides individual identity to a person’s appearance.

Question 2

layers of the skin

Answer 2

epidermis, dermis, subcutaenous layer

Question 3

epidermis

Answer 3

top layer of the skin, contain melanin and is replaced every 3-4 weeks

Question 4

dermis

Answer 4

Inner layer of the skin
◦ Contains sebaceous glands, hair follicles and sweat glands
◦ Sebaceous glands – secrete oily substance to waterproof skin and hair. Located everywhere except soles and palms
◦ Sweat glands:

Question 5

sweat glands

Answer 5

◦ Eccrine – primary function for sweat and thermoregulation – all over the body
◦ Apocrine – axillae, perineum, areolae / non-functional until puberty

Question 6

subcutaneous layer

Answer 6

contains fat, blood vessels, nerves, remaining sweat glands
◦ Stores fat an energy reserve
◦ Serves as cushion protection for body
◦ Provides insulation

Question 7

function of the hair

Answer 7

◦ Composed of keratin
◦ Develops within the hair follicle
◦ Hair protects the skin and provides thermoregulation
◦ Two types of hair

Question 8

vellus hair

Answer 8

peach fuzz

Question 9

terminal hair

Answer 9

longer darker hair - initiates in puberty

Question 10

nails function

Answer 10

◦ Composed of keratin
◦ Provides protection to fingers and toes

Question 11

what would you assess for in skin?

Answer 11

◦ Any skin problems? – rashes, lesions, dryness, oiliness, discolorations, bruising, swelling
◦ Any birthmarks or moles looking different? Always establish a baseline.
◦ Sweating changes?

Question 12

pruritis

Answer 12

pruritis = itching
◦ Any dryness? Is it seasonal?
◦ Xerosis – dryness
◦ Seborrhea - oily
my cat is very itchy

Question 13

rash or lesions

Answer 13

◦ Character?
◦ Itching may signal an allergic reaction

Question 14

hair loss or growth

Answer 14

◦ Gradual or sudden?
◦ Hirsutism – unusual growth

Question 15

Change in nails – coloration or shape?

Answer 15

o Bacterial infections may cause green, black or brown nail discoloration
o Nail changes may be seen in malnutrition

Question 16

personal health history

Answer 16

◦ Sunburns as a child? May link to increase in skin cancer
◦ Recent hospitalizations or surgeries?
◦ Females: hormone therapy or menstruation can cause skin changes
◦ Reactions to foods or environment?

Question 17

family health history

Answer 17

◦ Familial skin conditions or skin cancer?
◦ Recent illnesses in the household? Chickenpox / Measles are contagious and can demonstrate skin lesions

Question 18

lifestyle and health practices

Answer 18

o Sunbathing and tanning? Can increase skin cancer risk.
o Occupational risks of exposure to chemicals?
o Body piercings and tattoos – increase risk of Hepatitis C / infection
o Daily routine for skin and nail care

Question 19

benign pigmented areas include

Answer 19

◦ Freckles (macules) on sun exposed skin
◦ Nevi (moles)
◦ Birthmarks

Question 20

abnormal findings

Answer 20

oPallor – paleness
oCyanosis – blue hue
oJaundice – yellow tone

Question 21

pallor

Answer 21

◦ Pale, white color caused by decrease of blood flow (vasoconstriction) or anemia
◦ Shock or arterial insufficiency

Question 22

erythema

Answer 22

◦ Redness due to increased blood flow (vasodilation)
◦ Fever, inflammatory process, allergic reaction

Question 23

cyanosis

Answer 23

◦ Bluish, purplish hue due to decreased perfusion of tissues
◦ Hypoxemia due to heart failure or shock
◦ Central cyanosis can be seen in the oral mucosa

Question 24

jaundice

Answer 24

◦ Yellow, orange hue due to jaundice (increased bilirubin in blood)
◦ Due to liver problems such as hepatitis, cirrhosis

Question 25

vitiligo

Answer 25

absence of melanin in patchy areas – usually a benign finding

Question 26

albinism

Answer 26

generalized loss of pigmentation all over

Question 27

pallor in different skin tones

Answer 27

◦ Brown skinned people will be more yellow. Black skinned people will be more gray ◦ Palpebral conjunctiva and nail beds should be observed

Question 28

erythema in different skin tones

Answer 28

◦ Difficult to observe ◦ If fever suspected, check skin for warmth. If edema, check skin for tightness

Question 29

cyanosis in different

Answer 29

◦ Darker skinned people have normal bluish tone on lips ◦ Palms, but not clearly evident, other clinical signs should be observed

Question 30

jaundice in different skin tones

Answer 30

◦ Hard and soft palate must be observed in addition to sclera of eyes ◦ Dark urine may also present

Question 31

skin assessment

Answer 31

Temperature, texture and thickness ◦ Check skin with back of hand ◦ Hyperthyroidism may cause increase of temp Moisture ◦ Diaphoresis may occur during fever or exercise ◦ Dehydration can be observed by dry mucous membranes in mouth and cracked skin Mobility and Turgor ◦ Mobility is ease of skin rising when pinched. Turgor is returning back to its place. Use 2 fingers to pinch the skin over the clavicle. Recoil should be immediate. ◦ Slow turgor can be indicative of dehydration. “Tenting” if severe dehydration. (May not be a good assessment tool in elderly)

Question 32

lesions

Answer 32

◦ A lesion is any traumatic or pathological change in skin ◦ Describe using ABCDE, also noting location and exudate ◦ Roll nodule gently between fingers to assess depth ◦ Ultraviolet light is used if fungal infection suspected (Wood’s light) – positive findings would be a blue-green fluorescent

Question 33

annular

Answer 33

◦ Circular, beginning in center and spreading to periphery (ringworm)

Question 34

polycyclic

Answer 34

◦ Annular lesions that grow together

Question 35

confluent

Answer 35

◦ Lesions run together (hives)

Question 36

discrete

Answer 36

◦ Individual lesions that remain separate

Question 37

primary skin lesions

Answer 37

* Variations in color or texture that may be present at birth or may develop later in life * These include vesicles, bulla, pustule, macule, nodule, wheal & plaques.

Question 38

secondary skin lesions

Answer 38

◦ Changes in the skin that result from primary skin lesions, either as a natural progression or as a result of a person manipulating the wound. ◦ These include: crust, scale, excoriation & scars.

Question 39

macule

Answer 39

◦ Small, flat, non-palpable color change less than 1 cm ◦ Freckles, flat moles, hypopigmentation, petechiae

Question 40

patch

Answer 40

◦ Small, flat, non-palpable color change more than 1 cm ◦ Mongolian spots, vitiligo, chloasma

Question 41

papule

Answer 41

◦ Elevated, palpable, solid mass ◦ less than 0.5cm in diameter ◦ Due to elevation in epidermis ◦ Ex: wart, elevated nevus

Question 42

plaque

Answer 42

◦ Elevated, palpable, solid mass with a flat top ◦ More than 0.5cm in diameter ◦ Ex: psoriasis

Question 43

nodule

Answer 43

◦ Elevated solid mass extending deeper into the dermis than a papule : 0.5-2cm and circular

Question 44

tumor

Answer 44

◦ Greater than 1-2 cm in diameter ◦ May be firm or soft

Question 45

wheal

Answer 45

◦ Superficial, raised, transient, and erythematous lesion ◦ May indicate allergic reaction ◦ Ex. Hives, multiple insect bites

Question 46

vesicle

Answer 46

◦ Elevated cavity containing free fluid, clear ◦ Less than 0.5cm diameter ◦ Ex: herpes simplex (shingles), varicella zoster

Question 47

bula

Answer 47

◦ Elevated cavity containing free fluid, clear ◦ More than 0.5cm diameter

Question 48

pustule

Answer 48

◦ Pus in cavity ◦ Ex: impetigo, acne

Question 49

fissure

Answer 49

◦ Linear cracks extending into dermis

Question 50

ulcer

Answer 50

◦ Deep depression extending into dermis ◦ May bleed. Leave scar.

Question 51

excoriation

Answer 51

◦ Self inflicted abrasion often from scratching

Question 52

echymosis

Answer 52

◦ Bruising – may be brown, green, yellow

Question 53

hematoma

Answer 53

◦ Collection of blood created elevation – occurs with trauma

Question 54

petechia

Answer 54

◦ Collection of blood created elevation – occurs with trauma

Question 55

aids-karposis sarcomma

Answer 55

Patch stage ◦ Early lesions are faint and pink Advanced stage ◦ Widely disseminated lesions involving skin, mucous membranes, and visceral organs ◦ Violet colored tumors on nose and face Epidemic stage ◦ Lesions develop into raised papules of thickened plaques. ◦ Oval in shape and vary in color from red to brown.

Question 56

hair and scalp in children

Answer 56

Ringworm may develop in scalp of school age children Abnormalities in amounts and location of hair can be attributed to hormonal problems ◦ Hirsutism – excess body hair Observe for head or pubic lice, which are white ovals on hair shafts. Dandruff is indicated by loose white flakes

Question 57

tinea capitus

Answer 57

◦ Lesions fluoresce blue-green under Wood’s light ◦ Highly contagious

Question 58

toxic alopecia

Answer 58

◦ Asymmetric balding that accompanies severe illness or chemotherapy ◦ Regrowth after discontinuation of toxin

Question 59

folliculitis

Answer 59

◦ Superficial infection of hair follicles ◦ Single or multiple pustules

Question 60

furuncle and abscess

Answer 60

◦ Red, swollen, hard, tender, pus-filled lesion due to acute localized bacteria ◦ Usually on back of neck, buttocks, wrists, or ankles ◦ Furuncle is due to infected hair follicles ◦ Abscess is due to traumatic introduction of bacteria into the skin. Deeper than furuncle

Question 61

nail base common indicator of respiratory health

Answer 61

◦ Normal is about 160° ◦ Clubbing is the decrease of the angle of nail base (<160°) that occurs as a result of respiratory insufficiency, common in COPD (emphysema, chronic bronchitis)

Question 62

nail assessment

Answer 62

Consistency ◦ Variant thickness may suggest malnutrition ◦ Thickening of nails is sign of arterial insufficiency Color ◦ Note any pigmentations ◦ Cyanotic nail beds = poor peripheral circulation Capillary refill ◦ Indicator of peripheral circulation ◦ Measured by depressing the nail bed until it is white and observing the time it takes for blood to return back to the nail ◦ Normal time is less than 2 seconds and is indicated as “brisk.” “Sluggish” if greater than 2 seconds.

Question 63

infant skin

Answer 63

Infants ◦ Lanugo – fine soft hair present at birth ◦ Skin is thinner, less fat – more prone to dehydration and hypothermia ◦ Yellow skin indicates jaundice and is considered an abnormal finding

Question 64

acrocyanosis

Answer 64

◦ Bluish color around lips, hands, and feet ◦ Usually is due to coolness and disappears after warming up ◦ Persistent cyanosis is indicative of congenital heart disease

Question 65

physiologic jaundice

Answer 65

◦ Common yellowing of skin in newborns, which usually appears after 4th day. UV light helps. ◦ Treatment may include light therapy

Question 66

mongolian spots

Answer 66

◦ Hyperpigmentation of sacrum, buttocks, abdomen, thighs, shoulders, or arms ◦ Very common in dark skinned patients. Should not be confused with abuse.

Question 67

cafe au lait

Answer 67

◦ “Coffee with milk” ◦ Patches of hyperpigmentation ◦ Normal

Question 68

developmental consideration adolescents

Answer 68

Acne ◦ Most common skin problem ◦ Acne occurs when the hair follicles, which are connected to sebaceous glands, become plugged with oil and dead skin cells. ◦ Usually appear on face, shoulders, back, and chest ◦ Can include papules, pustules, and nodules

Question 69

pregnancy

Answer 69

◦ Linea nigra – line down midline of abdomen ◦ Chloasma – face of pregnancy- darkened areas of skin due to increased hormones- usually goes away after pregnancy ◦ Striae gravidarum – stretch marks

Question 70

aging

Answer 70

◦ Loss of collagen, elastin, and fat, decrease of sebaceous and sweat glands ◦ More prone to dehydration and hypothermia ◦ Dry skin is common ◦ Lentigines: hyperpigmentation in sun exposed areas=brown, patches ◦ Cherry angiomas: small, round red spots

Question 71

senile lentigines

Answer 71

◦ Loss of collagen, elastin, and fat, decrease of sebaceous and sweat glands ◦ More prone to dehydration and hypothermia ◦ Dry skin is common ◦ Lentigines: hyperpigmentation in sun exposed areas=brown, patches ◦ Cherry angiomas: small, round red spots

Question 72

skin tags

Answer 72

◦ Overgrowths of skin – normal ◦ Frequently occur on back, eyelids, axillae

Question 73

developmental consideration s aging

Answer 73

Decreased turgor, tenting of skin occurs Hair growth decreases, thins. Sebum production decreases causing dry skin. Fungal infections of toenails are common. * Pinching of skin is not accurate test of turgor in older adults. Look for other assessment findings such as sunken eyes, dry mucous membranes.

Question 74

port wine stain

Answer 74

◦ Flat macular patch of mature capillaries ◦ Benign

Question 75

hemangioma

Answer 75

◦ Rubbery, bright red nodule of extra blood vessels

Question 76

ABCDE

Answer 76

assymetry, border, color, diameter, evolving

Question 77

stage i

Answer 77

◦ Intact skin. A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.

Question 78

stage ii

Answer 78

◦ Shallow open ulcer or blister. The area around the sore may be red and irritated. There may be drainage noted.

Question 79

stage iii

Answer 79

◦ Full thickness tissue loss. The skin breakdown now looks like a crater where there is damage to the tissue below the skin.

Question 80

stage iv

Answer 80

◦ The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

Question 81

unstageable

Answer 81

◦ Ulcers covered with slough or eschar (dead skin) are UNSTAGEABLE because you can’t see the wound bed.

Question 82

braden scale

Answer 82

Braden Scaleused to predict pressure sore Risk Areas Assessed Sensory Perception Moisture Activity Mobility Nutrition Friction and Shear Results 19-23 = no risk 15-18 = mild risk 13-14 = moderate risk 10-12 = high risk Less than 9 = severe riskBraden Scaleused to predict pressure sore Risk

Question 83

head to toe physical examination

Answer 83

Inspect general skin coloration and variations. Pallor, cyanosis, jaundice all ABNORMAL findings Assess skin integrity – look and note head to toe “skin is intact and there are no reddened areas” Abnormal findings as you see (lesions, rashes, etc.) Palpate skin – head to toe Texture – smooth/even? Thickness Moisture – dry / moist / clammy Document as felt – “skin is moist and cool to the touch” “ skin is dry and hot to the touch