Skin, Hair, & Nails Flashcards
functions of the skin
- protection
- prevents penetration
- perception
- temperature regulation
- identification
- communication
- wound repair
- absorption and excretion
- production of vitamin D
changes in the aging adult
- losing elasticity
- sweat and sebaceous glands decreasing, skin becomes dry
- decreased thermoregulation
- vascular fragility increase
- minor injury causes senile purpura (easy, benign bruising
- sun exposure and cigarette smoking cause wrinkling
- loss of subcutaneous can increase skin breakdown
- graying due to loss of melanocytes
- hair loss, nail changes, women get whiskers
- self-esteem
common skin variations
- freckles
- vitiligo
- striae
- seborrheic keratosis (a warty or crusty pigmented lesion)
- scar
- mole
- cutaneous tage
- cutaneous horn
- cherry angiomas
common skin conditions found in African Americans
- Keloids
- Post inflammatory hypo or hyperpigmentation
- Pseudofollicultis-razor bumps or ingrown hair
- Melasma-”mask of pregnancy”
common variations of pigmentation
- freckles
- moles
moles
clumps of melanocytes, tan to brown
-6mm or less, symmetrical, smooth borders, single uniform pigmentation
junctional moles
-macular, only in children/adolescents
compound
-macular and papular (adolescent to adult)
why is it important to ask about medications when assessing skin
- some can cause photosensitivity reaction if the skin is exposed to UV light
- some may experience allergic reaction to specific drugs, creams, or ointments
why is it important to ask about nail changes when assessing nails
can be a sign of systemic disorders such as malnutrition or local irritation
signs of bacterial infection in nails
green, black, or brown nail
signs of fungal infection in nails
yellow, thick, crumbling
yeast infection
white, separation of nail plate from nail bed
why is changing in sensation of skin important
- may indicate vascular or neurologic problems such as peripheral neuropathy related to DM or arterial occlusive disease
- can put patient at risk for developing pressure ulcers, impaired skin integrity, and skin infections
why is hair loss an important thing to assess
-it can be a sign of infection, stress, hypothyroidism, malabsorption syndromes, malnutrition, anorexia nervosa, and bulimia
how to assess irregular nevi
-ABCDE A: asymmetry B: border irregularity C: color variation D: Diameter E: elevation or evolution -rapid changes, itching, burning, bleeding -ugly duckling- does it look weird compared to other nevi
risk factors for melanoma
- uv radiation
- indoor tanning
- white people 20 times more likely than African Americans, 5 times more likely in Hispanics
types of skin color changes
- pallor
- erythema
- cyanosis
- jaundice
pallor
- white
- oxygenated hemoglobin in blood are lost-ANEMIA
- arterial insufficiency
- shock (with shock-rapid pulse rate, oliguria, apprehension, and restlessness).
- also caused from vasoconstriction from cold and smoking.
erythema
- red
- hyperemia in dilated capillaries.
- Fever, local inflammation
- emotional reactions (blushing)
cyanosis
- blue
- decreased perfusion or deoxygenated blood
- best seen in lips, nose, cheeks, oral mucosa
- occurs in shock, cardiac arrest, heart failure, chronic bronchitis, congenital heart disease
jaundice
- yellow
- Hemolytic disease of newborn
- hepatitis
- cirrhosis
- sickle-cell disease
- transfusion reactions. (caused by a rise in bilirubin in the body, clay colored stools and dark urine as well)
acanthosis nigricans
- discoloration in body folds or creases
- think diabetes
how to assess for temperature
- use the back of hands, checking bilaterally
- skin should be warm and equal bilaterally and suggest normal circulation
hypothermia
- generalized coolness, local coolness can be expected with immobility or case
- can occur in shock, cardiac arrest, arterial insufficiency, Raynaud disease
hyperthermia
- increased metabolic rate such as in fever or heavy exercise
- can be found with trauma, infection, or sunburn
- can occur in hypothyroidism
moisture
-occurs naturally on face, hands, axillae, and skin folds
diaphoresis
- sweating
- due to high metabolic rate as in heavy activity, fever, warm environment, or anxiety
- seen in thyrotoxicosis (thyroid storm), heart attack, anxiety, or pain
where is dehydration assessed and what are the signs
- assessed in oral mucosa and skin turgor
- mucous membranes are dry, skin turgor tents, lips are parched, dry, crack skin
assessing texture
- should be smooth, firm, even
- in hyperthyroidism skin feels soft like velvet
- in hypothyroidism skin feels dry, rough, flaky
assessing thickness
- should be uniformly thin over most of the body
- have callus areas on palms and soles
- in arterial insufficiency skin is very thin and shiny
assessing mobility and turgor
- pinch skin fold on the anterior chest under the clavicle
- mobility: skin should rise easily (decreased with edema)
- turgor: skin ability return to place
- slow turgor with dehydration and severe weight loss
cherry anginomas
- normal findings especially after 30
- red and small
- increase in size and frequency with age
petechia
-round red or purple macule that is 1-2 mm in size
hematoma
-localized collection of blood
spider anginoma
- red arteriole lesion with radiating branches
- seen in liver disease, pregnancy, vitamin B deficiency
bruising
- contusion
- should be consistent with type of trauma
- normally no venous dilations or varicosities
stages of bruising
- red to blue- immediately or within first 24 hours
- blue to purple
- blue to green
- yellow
- brown to disappearing
assessing lesions
- color
- elevation: flat, raise, or pedunculated
- pattern or shape: angular, grouped, confluent, linear
- size: measure in centimeters
- location and distribution on body- generalized to any certain area
- exudate: note color or odor
- palpate and gently scrape any scaling or bleeding
- primary or secondary
circular lesions
- begins in the center and spreads to periphery
- tinea corporis (ringworm)
confluent lesion
- run together
- urticaria (hives)
discrete lesion
- distinct lesions that remain separate
- skin tags, acne
linear lesion
-scratch, streak, line, or stripe
zosteriform lesion
- linear arrangement along a unilateral nerve route
- herpes zoster
grouped lesions
- clusters
- vesicles or contact dermatitis
primary lesions
- macule
- papule
- patch
- plaque
- nodule
- wheal
- tumor
- urticaria
- cyst
- pustule
macule
- less than 1 cm, flat
- freckles
papules
- less than 1 cm, raised
- mole or wart
patch
- larger than 1 cm
- vitiligo, cafe au lait spot, mongolian spot
plaque
- wider than 1 cm
- coalesce to form elevation
- psoriasis
nodule
- less than 1 cm
- solid, elevated, hard or soft, may extend deeper into the dermis
- fibroma
wheal
- superficial, raised, transient, erythematous, irregular shaped from edema
- insect bite, allergic reaction
tumor
- larger than a few cm in diameter
- firm or soft, benign or malignant
- lipoma
urticaria
- lots of wheals together
- intensely pruritic
cyst
- encapsulated fluid-filled cavity in dermis or subcutaneous layer
- sebaceous cyst
pustule
- turbid fluid fill
- circumscribed and elevated
- pimple or impetigo
secondary skin lesions
- crust
- scale
- fissure
- erosion
- ulcer
- excoriation
- scar
- lichenification
crust
- dried exudate, color depends on fluid
- impetigo, scab
scale
-compact desiccated flakes of skin, dry or greasy, silvery or white
fissure
- linear crack, abrupt edges, extends into dermis, dry or moist
- cheilosis, athlete’s foot
erosion
-scooped out shallow depression, epidermis loss, moist but no bleeding, no scar formation
ulcer
- deeper depression, extends into dermis and beyond, may bleed, leaves scar
- pressure ulcer
exoriation
- can be self inflicted from intense itching
- insect bites, scabies, varicella
scar
- post repair of lesion-permanent fibrotic change after healing
- surgery, injury, acne
lichenification
-thickened skin from prolonged scratching
nail abnormalities
- thickened nails (may indicate poor circulation)
- koilonychia (spoon shaped nails)
- pitting (psoriasis)
- yellow nail syndrome (respiratory/AIDS)
- paronychia (infection around nail bed)
mongolian spots
- blue to black to purple macular area at sacrum, buttocks, sometimes abdomen, thighs, shoulder or arms
- usually subside within 1 year
- common in Black, Asian, American Indian, and Hispanic newborns
cafe au lait spot
- large round oval spot of light brown pigmentation
- present at birth
- normal variant
braden scale scoring
- determines pressure sore risk
- 19-23 no risk
- 15-18—preventative interventions needed
- 13-14—Moderate risk
- 10-12—High risk
- 6-9—very high risk
pressure injury risk areas
- head
- ear
- shoulder
- elbow
- hip
- sacrum
- buttocks
- knee (inner and outer side)
- heel
