Unit exam 2 Flashcards
What is the largest organ of the body?
the skin
What are the two layers of the skin?
- Epidermis: outer highly differentiatd layer
- basal cell layer forms new skin cells
- outer horny cell layer of dead keratinized
cells
- Dermis: inner supportive layer
- connective tissue or collagen
- elastic tissue
** beneath these layers is a subcutaneous layer of adipose tissue
What are some functions of the skin?
- it is waterproof, protective, and adaptive
- protection from environment
- perception
- temp regulation
- identification
- communication
- wound repair
- absorption and excretion
- production of vitamin D
What is ichthyosis Vulgaris?
- is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin’s surface.
- tough skin
What are subjective data health history questions?
- past history of skin disease, allergies, hives, psoriasis, or eczema?
- change in pigmentation?
- excessive dryness or moisture?
- pruritus or skin itching?
- excessive bruising?
- rash or lesions?
- medications?
- hair loss?
- change in nails?
- self-care bxs?
- environmental or occupational hazards?
What are health history questions for adolescents?
skin problems such as pimples or blackheads?
What are health history questions for aging adults?
- what changes have you noticed in your skin in past few years?
- any delay in wound healing?
- any change in feet?
- falling?
- history of diabetes or peripheral vascular disease?
What is the complete physical exam?
- skin assessment integrated throughout exam
- separate areas with skinfold such as under large breasts, obese abdomen, and groin, and inspect them thoroughly
- always inspect feet, toenails, and between toes
How can you inspect and palpate the skin?
- Color
- General pigmentation, freckles, moles, birthmarks
- Widespread color change
- —Note color change over entire body skin, such as pallor (pale), erythema (red), cyanosis (blue), or jaundice (yellow)
- —Note if color change transient or due to pathology
- Temperature
- Use backs of hands to palpate person…why?
- 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
- Moisture
- Diaphoresis
- Dehydration
- Texture
- Thickness
- Edema
- Mobility and turgor
- Vascularity or bruising
- —Multiple bruises at different stages of healing and excessive bruises above knees or elbows should raise concern about physical abuse
- —Needle marks or tracks from intravenous injection of street drugs may be visible on antecubital fossae, forearms, or on any available vein
- Lesions: if any are present, note the following:
- Color
- Elevation
- Pattern or shape
- Size
- Location and distribution on body
- Any exudate: note color and odor
What are some color changes of the skin?
- Raynauds - a problem that causes decreased blood flow to the fingers; causes blue or white fingers
- Jaundice - yellow skin
- Cyanosis - a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
What are the stages of bruising?
bruise –> hemoglobin –> bilierdin –> biliruben –> healing
What is the bruise age by color?
Red - 0-2 days Blue, purple - 2-5 days green - 5-7 days yellow - 7-10 days brown - 10-14 days no further evidences of bruising 2-4 weeks
Types of wound exude: serous
clear, amber, thin, and watery
Types of wound exude: fibrinous
cloudy and thin, with strand of fibrin
Types of wound exude: serosanguineous
reddish, thin and watery
Types of wound exude: seropurulent
yellow or tan, cloudy and thick
Types of wound exude: purulent
opaque, milky; sometimes green
Types of wound exude: hemopurulent
reddish, milky and viscous
Types of wound exude: hemorrhagic
red and thick
What is ABCDE of skin assessment?
A: asymmetry B: border C: color D: diameter E: elevation and enlargement
What are some different shapes and configurations of lesions?
- Circular
- Confluent: joining or running together
- Discrete: made up of separated parts or characterized by lesions which do not become blended. In the same area but are not touching
- Grouped
- Linear
- Zosteriform: resembling herpes zoster
What is a macule?
- flat, distinct discolored areas less than 1 cm
What is a papule?
- Elevated, circumscribed and firm
- lesions, <1 cm in diameter
- Warts and drug related eruptions are papules
- Various colors including brown, red, pink, tan and bluish red
What is a nodule?
- <1 cm in diameter
- Similar to papules, but deeper
in dermis and feel firmer on
palpation - Fibromas and intradermal
nevi
What is a wheal?
- Vary in size and shape
- Elevated, irregular, and relatively
transient - Mosquito bite causes wheal
- Hives are multiple wheals that usually cause severe itching from some sort of hypersensitive reaction.
***TB test elevation bubble
What is a vesicle?
- Circumscribed; <1 cm in diameter
- Elevated and filled with serous fluid.
- Blisters and varicella lesions are examples
What is a bullae?
- vesicles >1 cm
– Rupture easily because of their
thin walls
– Large blisters from 2nd degree
burns may be classified as bullae
What is a cyst?
- Nodules filled with liquid or semisolid material
- Can be expressed
- Example – sebaceous cyst
What is a pustule?
- similar to vesicles
- filled with purulent rather than serious fluid
- acne and impetigo cause pustules
What are patches?
- Differ from macules
- Irregular shape
- > 1 cm in diameter
- Port-wine marks are examples (Sam’s birth mark on his leg)
- Vitiligo – otherwise normal skin with non-pigmented white patches
What are plaques?
- Elevated like papules but >1 cm
- Firm and rough
- Often formed by coalesced papules (psoriasis)
What is a tumor?
- Larger than nodules, >1 cm on surface
- Deeper in dermis than nodules
- May or may not be demarcated, firm, or malignant
What are some examples of a break in the continuity of skin surface?
Fissures Erosions Ulcers Excoriations Scars Atrophic scars Lichenifications - skin has become hardened and leathery, usually from chronic irritation. Keloids - raised type of scar, usually after an injury that has healed. Grow much larger than original injury that caused the scar.
What are some examples of debris on the skin surface?
CRUST
- Dried collection of blood, pus, serum
- Slightly elevated
- Vary in size and color
- May also be called a scab
SCALES
- Dry buildup of dead skin cells
- Often flakes off surface of skin
- Irregular and variable in size
- Fungal infections, psoriasis, eczema
What is a fissure?
- Linear breaks in the skin extending from epidermis to dermis
- Small, deep and red
- Tinea pedis (athlete’s foot) produces fissures
What is erosion?
- Resemble excoriations
- Depressed area is moist and glistening
- Follow vesicular rupture (varicella)
What is excoriation?
- Loss of epidermis, leaving exposed dermis
- May be linear or be hollowed out
- Example - abrasions
What is a scar?
- Collagenous tissues that permanently
replace injured dermis - Vary in size and color
- Progressively enlarging scars growing beyond original boundaries are called keloids
What is a keloid?
- caused by excess deposition of collagen in a healing wound
- are benign tumors, and the tendency to develop keloids is inherited
- African Americans are more susceptible.
What is lichenification?
- Thickening of epidermis
- Caused by chronic rubbing and scratching
- Chronic dermatitis/callous
What is an ulcer?
- Concave, exudative
- Deep erosions that involve dermis and may involve below
- Variable in size
What is atrophy?
- thinning of skin
- translucent and paper like
- striae (stretch marks)
What are different vascular lesions?
- Hemangiomas
- port-wine stain
- strawberry mark
- cavernous hemangioma
- Telangiectases
- spider or star angioma
- venous lake
- Purpuric lesions
- petechiae
- purpura
- Lesions caused by trauma or abuse
- pattern injury
- hematoma
- contusion (bruise)
- Ecchymosis – bleeding into skin, not traumatic, > 1 cm
- Hematoma – same, but raised
- Petechiae – tiny hemorrhages from capillaries
- Purpura – confluence of petechiae and ecchymosis
- Mechanical injury – blunt force trauma causes hemorrhage into tissues.
What are things that can exacerbate a Pressure ulcer?
Moisture Impaired mobility thin skin Decreased sensation(neuropathy, paraplegic, post stroke, spinal cord damage, MS) Impaired loc/comprehension Incontinence Wound drainage Shearing injury Poor nutrition Infection Low albumin level Compromised blood flow (PAD, shock, venous insufficiency) Skin color…hard to see changes In skin Bony prominences Age
What is the stage 1 of a pressure ulcer?
- Pressure Injury: Non-blanchable erythema of intact skin
- Intact skin
- localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin.
- Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
What is the stage 2 of a pressure ulcer?
- Partial thickness skin loss with exposed dermis
- wound bed is viable, pink or red, moist, and may also present as an
- intact or ruptured serum-filled blister.
- Superficial
- Abrasion, blister, shallow crater
What is the stage 3 of a pressure ulcer?
- Full thickness skin loss
- adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges are often present
- Damage or necrosis of subcutaneous tissue
- Slough and/or eschar may be visible
- Presents as deep crater with or without undermining and tunneling of adjacent tissues
- Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed.
- If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury
What is the stage 4 of a pressure ulcer?
- Full thickness skin loss and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer
E- xtensive destruction, tissue necrosis or damage to muscle, bone or supporting structures - Slough and/or eschar may be visible.
- Undermining and sinus tracts possible
What is tunneling?
narrow opening or passageway that can extend in an direction through soft tissue and result in dead space with potential of abscess formation. Also known as a sinus tract.
What is undermining?
the destruction of the underlying tissue surround some or all of the wound margins. May extend in one or many directions underneath the wound edge
What is Senile purpura?
Discoloration due to increasing capillary fragility
What do you inspect and palpate for nails?
- shape and contour
- consistency
- color
- capillary refill
What is paronychia?
- Inflammation of the skin around the nail
- Characterized by swelling, sometimes redness and tenderness
Acute – usually bacterial
Chronic – usually fungal
What is a splinter hemorrhage?
- Red or brown linear streaks parallel to the long axis of the nail
- Have been associated with sub-bacterial endocarditis or minor trauma
How can you inspect and palpate the skull?
- Note general size and shape
- Assess shape: place fingers in person’s hair and palpate scalp
- Skull normally feels symmetric and smooth
- There is no tenderness to palpation
- Palpate temporomandibular joint as the person opens the mouth, and note normally smooth movement with no limitation or tenderness
How can you inspect the face?
- Note facial expression and appropriateness to behavior or reported mood
- Facial structures always should be symmetric
- Note symmetry of eyebrows, palpebral fissures, nasolabial folds, and sides of mouth
- Note any abnormal facial structures (coarse facial features, exophthalmos, changes in skin color or pigmentation), or abnormal swellings
- Note any involuntary movements (tics) in facial muscles; normally none occur
What is the thyroid gland?
- an important endocrine gland straddles trachea in middle of the neck
- The gland has two lobes, connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
- Synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
How can you inspect and palpate the neck?
- Symmetry
- Range of motion
- Lymph nodes
- Trachea
- Thyroid gland
- Posterior approach
- Anterior approach
- Auscultate thyroid for bruit, if enlarged
What is the lymphatic system?
- an extensive vessel system, is major part of immune system, which detects and eliminates foreign substances from body
- Vessels allow flow of clear, watery fluid from tissue spaces into circulation
- Nodes are small, oval clusters of lymphatic tissue that filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation
- Greatest supply is in head and neck
You should be familiar with direction of drainage patterns of lymph nodes
Flexion
chin to chest
norm about 45 degrees
Extension
chin to ceiling (55 degrees)
Rotation
chin to shoulder (70 degrees)
Lateral
ear to shoulder (40 degrees)
What are some abnormal facial appearances?
- Parkinson syndrome
- Cushing syndrome
- Graves’ disease
- Hyperthyroidism
- Myxedema (hypothyroidism)
- Bell’s palsy
- Brain attack or cerebrovascular accident
- Cachectic appearance
- Scleroderma
What is graves disease?
Autoimmune disease that causes hyperthyroidism (Active thyroid)
What is goiter?
abnormal enlargement of thyroid gland
What is bells palsy?
Caused by trauma to 7th cranial nerve. ½ face is paralyzed or weakened.
What is cachexia?
Means bad condition. Physical wasting with loss of muscle and mass due to disease. Advanced cancer, AIDS, severe heart failure.
