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
