skin hair nails Flashcards
Functions of the skin
- protection
- prevents penetration( from microorganisms)
- perception ( pain touch)
- temperature regulation ( sweat)
- identification ( finger prints characteristics birth mark)
- communication ( blushing dilate/ pale)
- wound repair ( excrete vitamins)
- absorption of excretion
- production of vitamin d
Three layers of the skin
- epidermis
- dermis
- subcutaneous layer
e
epidermis
5 layers:
- stratum germinativum or basal cell layer ( inner) ( forms new skin cells melanocytes ) it consists of the tough fibrous protein KERATIN
- outer Horny cell layer: ( outer) the cells are constantly being shed and replaced with new cells below. dead keratinized cells
dermis
connective tissue or collagen
elastic tissue
nerve blood vessels lymphatics
innermost supportive layer made up of connective tissue or collagen. This is the tough, fibrous protein that helps the skin resist tearing. It also has elastic tissue that allows the skin to stretch with body movements.
subcutaneous layer
ADIPOSE TISSUE
epidermal appendages
Structures formed by tubular invagination of epidermis down into underlying dermis ex. hair sebaceous glands sweat glands eccrine glands apocrine glands nails
sebaceous glands
produce a protective lipid, sebum, which is secreted through the hair follicles
eccrine glands
coiled tubules that open directly onto the skin surface and produce the sweat that helps reduce body temperature
apocrine glands
open into hair follicles, become active during puberty, and produce sweat with emotional and sexual stimulation
nails
hard plates of keratin on the dorsal edges of the fingers and toes. The nail plate is clear with fine, longitudinal ridges that become prominent with older age.
take their pink color from the underlying nail bed of highly vascular epithelial cells.
subjective date for skin
- past history of skin diseases, allergies, hives, psoriasis, or eczema
- change in pigmentation or color, size, shape, tenderness
- excessive dryness or moisture
- pruritus or skin itching
- excessive bruising or burns
- rash or lesions
- medications: prescription or over the counter can this effect the color
- hair loss?
- change in nails shape, color, or brittleness
- environmental or occupational hazards ( very important- ex. welder- spots metal burnt on nails)
- self care behaviors
Infants and children ( age specific history questions)
exposure to contagious or communicable disease diaper rash burns or bruises chicken pox strep throat
Adolescents ( age specific history questions)
skin problems such as pimples, black heads, ACNE
Aging adults ( age specific history questions)
Any delay in wound healing? ( medication or disease)
Any change in feet, toenails, bunions, wearing shoes
falling: bruises or trauma
History of diabetes or peripheral vascular disease
preparation for skin exams
skin assessment integrated throughout examination
be aware of person’s normal skin color
separate skin folds
always always always inspect feet, toenails, and between the toes****
Equipment for skin exams
- good lighting
- small cm ruler
- penlight
- gloves ( for drainage)
- special procedures
- wood’s light ( for fungal disorders)
COLOR ( skin examination)
- palms
- soles
- fingertips
- nail beds
- mucous membranes
general pigmentation
The skin tone is consistent genetic background and varies from pinkish tan to ruddy dark tan, or from light to dark brown and may have yellow or live overtones.
melanin may mask other pigments such as jaundice
Temperature of the skin
Use the backs or doors of your hand and palpate bilaterally. The skin should be warm with equal temperature bilaterally. Hands and feet may be slightly cooler in environment.
Widespread color change
pallor pale
erythema- red
due to excess blood in dilated superficial capillaries
expected with fever, local inflammation, blushing
Cyanosis
bluish mottled color
Jaundice
yellow color
increased bilirubin levels
liver damage
RB hemolysis
Hypothermia
Generalized coolness may be induced such as in hypothermia used for surgery or high fever.
Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion
hyperthermia
Generalized hyperthermia occurs with an increased metabolic rate such as fever or after heavy exercise.
A localized area feels hyperthermic with trauma, infection or sunburn
Moisture
dry, wet, oily
Perspiration appears normally on the face, hands, axilla, and skin folds in response to activity, a warm environment or anxiety.
Diaphoresis
Excessive sweating
accompanies an increased metabolic rate such as occurs in heavy activity or fever
Dehydration
in the oral mucous membranes.
Normally there are none, and the mm look smooth and moist.
Dark skin may normally look dry and flaky but this does not necessarily mean dehydration
Texture
smooth, soft, rough
Normal skin feels smooth and firm with an even surface.
Thickness
uniform
The epidermis is uniformly thin over most of the body, although thickened callus areas are normal on palms and soles.
Callus
A circumscribed over growth of epidermis and is an adaptation to excessive pressure.
Edema
Fluid accumulating in the intercellular spaces and normally is NOT present.
To check for this: imprint your thumbs firmly against the ankle malleolus or the tibia. Normally the skin surface stays smooth when you lift your thumbs. If your pressure leaves a dent in the skin—- “ Pitting edema” is present.
1+ for mild edema
4+ for deep pitting edema
Masks normal skin color and obscures pathological conditions ( jaundice or cyanosis) because the fluid lies between the surface and the pigmented and vascular layers.
makes dark skin look lighter
Tugor
The ability to return to place promptly when released
reflects elasticity of the skin and hydration status
pinch up large fold of skin on the anterior chest under the clavicle.
the skins ability to return to place promptly when released
Mobility
the skins ease of rising
vascularity/ brusing
Cherry angiomas: small, smooth, slightly raised, bright red dots that commonly appear on the trunk in older adults ( over 30)
Increase in size and number with aging and are not significant
Lesions
note the following
1.color
2. elevation: flat, raised, or pedunculated
3. pattern or shape: the grouping or distinctness of each lesion….. annular, grouped, confluent, linear
4. size in cm—- use a ruler to measure
5. location and distribution on the body
is it generalized or localized? to ear of specific irritant
6. any exudate? note its color and odor.
annular
begins in the center and spreads to periphery
ex. ringworms
linear
a scratch, streak line, or stripe
confluent
lesions run together
ex. hives
discrete
distinct individual lesions that remain seperate
ex. skin tags, acne
target or iris
resemble a target or iris of eye
concentric rings of color in lesions
ex. lime disease
clustered or grouped
clusters of lesions
poison ivy
zostiform
linear arrangements along a unilateral nerve route
ex. herpes, shingles
ABCDE skin assessment
A: Assymetry B: borders C: color D: diameter E: elevation
bulla
circumscribed collection of free fluid > 1 cm
ex. friction blister, pemphigus, burns, contact dermatitis
primary skin lesion
macule
circular flat discoloration < 1 cm
brown, blue, red or hyper pigmented
example: freckle, flat nevus, petechia, measles, scarlet fever
primary skin lesion
nodule
circular solid elevated lesion >1 cm
may extend deeper into the dermis
ex. xanthoma, fibroma, intradermal nevus
primary skin lesion
papule
something you can palpate
solid, elevated, circumscribed lesion <1 cm in diameter.
ex. mole, or wart
primary skin lesion
patch
macule larger than 1 cm.
ex. mongolian spot, vitiligo, cafe-au last spot, chloasma, measles rash
primary skin lesion
plaque
papules coalesce wider than 1 cm. to form platelike disc-shaped lesion
ex. psoriasis
primary skin lesion
Wheal
primary skin lesion
superficial, raised, transient, and erythematous lesion
slightly irregular shape caused by EDEMA
ex. mosquito bite, allergic reaction
Tumor
primary skin lesion
Lesion larger than a few cm in diameter. firm or soft. deeper into the dermis. may be benign or malignant.
ex. lipoma, hemangioma
uticaria or hives
primary skin lesion
wheal coalesce to form extensive reactions, intensely itchy!!
vesicle
primary skin lesion
elevated cavity containing free clear fluid up to 1 cm.
ex.
herpes simplex, chicken pox, shingles, contact dermatitis
cyst
primary skin lesion
ENCAPSULATED, fluid-filled cavity in the dermis or subcutaneous layer that tensely elevates the skin.
ex. sebaceous cyst
Pustule
primary skin lesion
turbid fluid ( pus) in the cavity
circumscribed and elevated.
ex. impetigo, acne
crust
secondary skin lesion
thickened, dried out exudate left when vesicles or pustules burst or dry up. color can be red-brown, honey, or yellow ( depends on the fluid’s ingredients) ..blood, serum, pus
ex. impetigo ( dry honey pus)
weeping eczematous dermatitis
scab following abrasion
scale
secondary skin lesion
compact desiccated FLAKES of skin, dry or greasy, silvery or white from shedding of dead excess keratin cells. ex. laminated sheets psoriasis ( silver mica like) seborrheic dermatitis ( yellow greasy) eczema ( large, adherent, laminated) dry skin
Fissure
secondary skin lesion
linear crack with abrupt edges
extending into dermis, dry or moist
ex. chleilosis at corners of the mouth due to excess moisture
athletes foot
erosion
secondary skin lesion
scooped out but shallow depression
superficial lesion
epidermis is lost and the lesion is moist but there is no bleeding
heals without scar because erosion do not extending the dermis
ulcer
secondary skin lesion
deeper depression
extending into the dermis
irregularly shaped
it may bleed and leaves scar when heals
ex stasis ulcer, pressure sore, chancre
excoriation
secondary skin lesion
self inflicted abrasion superficial and sometimes crusted scratches from intense itching from insect bite scabies dermatitis
scar
secondary skin lesion
after a skin lesion is repaired, normal tissue is lost and replaced with connective tissue ( collagen)
A permanent fibrotic change.
ex. healed area of surgery or injury, acne
atrophic scar
secondary skin lesion
resulting skin level depressed with loss of tissue, thinning of the epidermis
ex. striae ( stretch marks)
Lichenification
secondary skin lesion
prolonged intense scratching eventually thickens the skin and produces tightly packed sets of papule
looks like the surface of moss ( leathery)
keloids
secondary skin lesion
hypertrophic scar
resulting skin level is elevated by excess scar tissue
invasive beyond the site of original injury
may increase long after healing occurs
looks smooth, rubbery, and claw like
higher in blacks
Pressure ulcers
appear on the skin over a bony prominence when circulation is impaired.
This occurs when a person is confined to bed or immobilized.
immobilization slows delivery of blood carrying oxygen and nutrients to the skin. It also slows venous drainage carrying metabolic wastes away from the skin.
Results in ISCHEMIA AND CELL DEATH.
common sites for pressure ulcers
back , heel, ischium, sacrum, elbow, scapula, vertebrae
or on the side ( ankle,knee, hip, rib, shoulder)
RISK factors for pressure ulcers
impaired mobility
thin fragile skin of aging
decreased sensory perception ( unable to respond to pain)
impaired level of consciousness ( unable to respond)
moisture from urine or stool incontinence
excessive perspiration or wound drainage
shearing injury ( being pulled down or across in bed)
poor nutrition
infection
Stage 1 pressure ulcer
Intact skin appears Red but UNBROKEN
localized redness in light skin blanches ( turns light with fingertip pressure)
dark skin appears darker but does NOT blanch
Stage II pressure ulcer
Partial thickness skin erosion with loss of epidermis or also the dermis
superficial ulcer looks shallow-like an abrasion or open blister with red-pink wound bed
Stage III pressure ulcer
Full thickness pressure ulcer extending into the subcutaneous tissue and resembles a CRATER
may see subcutaneous fat but NOT MUSCLE , BONE OR TENDON
checked weekly
Stage IV pressure ulcer
Full thickness pressure ulcer involves all skin layers and extends into supporting tissue.
checked weekly
exposes muscle, tendon, or bone, and may show SLOUGH ( stringy matter attached to wound bed) or ESCHAR ( black or brown necrotic tissue)
Basal cell carcinoma
malignant skin lesions
is the most common form of skin cancer
arise out of the basal layer
8-10 skin cancers are basal cell
tend to grow SLOWLY, very rarely metastasize but can s
most commonly appear as a pearly pink or white- dome shaped papule with prominent telangiectatic surface vessels that develop as the lesion enlarges
squamous cell carcinoma
malignant skin lesions
2/10 skin cancers are these
grows slightly more rapidly than basal cells
distant metastasis by occurs in about 5% of cases
firm smooth or hyperkaratotic papule or plaque-often with central ulceration..
melanoma
malignant
arises from preexisting nevi
cutaneous malignant melanoma 3/5 skin cancers
75% of all deaths from cancer
inspection of the hair: color
hair color comes from melanin production and may vary from pale blonde to total black. graying begins as early as 30s as result of genetic factors
inspection of hair: texture
scalp hair may be fine, or thick and look straight, curly, or kinky. it should look shiny
inspection of hair: distribution
tanner staging identifies gender patters of hair distribution
normal male/female patterns with puberty
fine villus hair covering the body
terminal hair-thick coarse pigmented.
inspection of hair: lesions
the scalp should be clean and free of any lesions or pest inhabitants. Many people normally have seborrhea ( dandruff) which is indicated by loose white flakes.
abnormal conditions of the hair
- seborrheic dermatitis ( cradle cap)
- tinea capititis ( scalp ringworm)
- toxic alopecia
- alopecia areata
- traumatic alopecia, traction alopecia
- trichotillomania
- head lice
- folliculitis
- hirsutism
- BOIL and abscess
