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TEST 2- CH 12 -Skin, Hair, and Nails
Terms in this set (75)
is the largest organ system
Covers 20 square feet of surface area in adults
Our skin is our body guard (it ___________ us)
Protects us from environmental stresses: trauma, pathogens, dirt
Allows us to adapts to other environmental influences: heat, cold
Functions of the skin includes:
Protection from environment
Absorption and excretion
Production of vitamin D
Health History Questions
Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation or color?
Change in mole (nevus) size, shape, color, tenderness?
Excessive dryness or moisture?
Pruritus or skin itching?
Rash or lesions?
Medications: prescription and over-the-counter?
Hair loss? Change in nails' shape, color, or brittleness?
Environmental or occupational hazards?
Additional history for infants and children
Does child have any birthmarks?
Any change in skin color as a newborn?
Does child have any rash, diaper rash, or sores?
Does child have any burns or bruises? If so, where? (Why should we care about this)
How did it happen?
Has child been exposed to any contagious skin conditions and or communicable diseases:
Scabies, impetigo, lice
Measles, chicken pox, scarlet fever?
Toxic plants: poison ivy?
Does child have any habits:
Nail-biting or twisting hair
What steps are taken to protect child from sun exposure?
Additional history for adolescents
Skin problems such as pimples, blackheads?
Additional history for aging adults
What changes have you noticed in your skin in last few years?
Any delay in wound healing?
Any change in feet: toenails; bunions, wearing shoes?
Falling: bruises, trauma?
History of diabetes or PVD?
Consciously attend to skin ____________________ (careful, tedious close examination)
Strong direct lighting, gloves, penlight, and small centimeter ruler
For special procedures...
Wood's light - ultraviolet lamp and magnifying glass (will highlight certain skin disorders and infections)
Materials for laboratory tests - potassium hydroxide (KOH) and glass slide
The Skin assessment is _____________ throughout examination (continued inspection) Examine when inspecting facial behaviors
Scrutinize the___________skin surface first before you concentrate on underlying structures
Separate skin (areas with skinfolds) such as under large breasts, obese abdomen, and groin and inspect them thoroughly. These areas are dark, warm, and moist and provide perfect conditions for ____________ or infection
Always inspect _______, toenails, and between toes (socks off!)
Stand back and Assess the skin as one entity; getting overall impression helps reveal ________________ patterns
With a rash, check all areas of body as you cannot rely on the history that rash is in only one location.
Patient can't always see everything, we need to help them by checking areas of the skin they can't ___________
Palpation - some skin changes have accompanying signs that can be felt
What are the skills used to assess a patient's skin?
Check the General pigmentation, freckles, moles, birthmarks
pale, red, blue, yellow
Widespread color change
Note color change over entire body skin, such as pallor (?), erythema (?), cyanosis (?), or jaundice (?)
not enough blood, normal
Skin is a good indication on how the heart is pumping. What does blue skin mean? What would flush, pinkish skin mean?
dorsa of hand
What part of the hand should be used to assess skin temperature?
bilaterally,. normal circulatory status
Skin should be warm, and temperature equal _______________; warmth suggests what?
an arterial block
If One leg is warm, and the other is cold, what could that be due to?
Hands and feet may be slightly cooler in a cool ___________________
extra RBCs in the blood
Erythema occurs with what?
hypoxemia, shock, cardiac arrest
Cyanosis indicates what condition?
hepatitis, sickle-cell disease
Jaundice occurs with what conditions?
This is generalized coolness of the skin due to possible immobilized extremity
This is increased metabolic rates such as fever or heavy exercise, causing skin to be really warm
This is profuse perspiration, accompanies an increased metabolic rate such as occurs in heavy activity or fever
This procedure is used on the skin and checks for dehydration by pinching a part of the skin and seeing if it snaps back to its original spot on the skin or stays up
Skin should feel smooth, firm and even
The epidermis is uniformly thin over most of the body, although thickened callus areas are normal on ________ and _________
This is fluid accumulating in the interstitial spaces.
How to check for edema...
Imprint your thumbs firmly for 3 to 4 seconds against the ankle malleolus or the tibia. Normal the skin stays smooth. If your pressure leaves a dent in the skin, edema is present.
Edema is graded on a four (4) point scale
4+--Very deep pitting
Grading scale is ___________; outcomes vary among different examiners
This is Bilateral edema that is generalized over the whole body due to heart or kidney failure
Inspect for any Needle marks or tracks from intravenous injection of street drugs may be visible on antecubital fossae, forearms, or on any available vein
Abuse & Trauma..
______ ages groups can be abused, try not to think of abuse as only being among children. It is more common than we think
Little man on your shoulder "something does not look right here...." If a thought comes to mind that the person may be abused, use that thought.
Mechanism of injury (does the injury make sense?)
Lesions: if any are present note:
Pattern or shape
Size, use a ruler to measure or relate to common object (better)
Location and distribution on body
Any exudate (leakage of a wound): note color and odor
Use a Wood's light (ultraviolet light filtered through special glass) to detect fluorescing lesions
When a lesion develops on previously unaltered skin, it is knwon as ______________. However, when a lesion changes over time or changes because of scratching or infection, it is known as _____________
Photographing a wound, lesion or skin abnormality is becoming an accepted practice. Can be merged directly into an EMR (patients chart). Must be done with utmost professionalism and concern for privacy!
Inspect and palpate hair
Distribution - balding? When did it start, family history?
Alopecia - sudden hair loss, starts as a patch or in one focused area
Lice - more common than you think - not related to socioeconomic status
Hair color comes from melanin production and may vary from blonde to black
Graying begins as early as the ______s because of reduced melanin production in the follicles
Scalp hair may be fine or thick and may look straight curly or kinky. It should look shiny
The nail surface is normally slightly curved or flat, and the posterior and lateral nail folds are smooth and rounded. Nail edges are smooth, rounded, and clean, suggesting adequate self-care.
Profile Sign of nails...
View the index finger at its profile and note the angle of the nail base; it should be about _______ degreees. The nail base is firm to palpation
Clubbing of nails occurs wtih congenital cyanotic heart disease, ______ cancer (from smoking)* and pulmonary disease
Normal nail angle: 160 degrees
Curved nail: 160 degrees or less
Early clubbing: 180 degrees
Smokers will experience this. The angle of the nail base will be 180 degrees or greater.
The surface of the nail is smooth and regular, not brittle or _____________
The color of the nail is translucent. The nail plate is a window to even, pink nail bed ____________
Depress nail edge to blanch and then release, noting return of color; indicates status of peripheral circulation
Color return is normally instant
Sluggish color return takes longer than 1 or 2 seconds
This assessing what aspect of the nail?
Teach skin self-examination using __________ rule to detect suspicious lesions
A - asymmetry
B - border
C - color
D - diameter
E - elevation and enlargement
Deer tick (carries the bacteria that causes lyme disease)
Flu like symptoms (fever)
Can have serious sequelae and lingering health effects
Very pronounced rash (can also be tricky)
Reactivation of chicken pox VIRUS (Varicella Zoster)
Virus lives within our nervous system in a dormant start until activated
Appears in bands
Poor immune system
PAINFUL red rash
-- (Caused by a benign proliferation of blood vessels in the dermis)
Port-wine stain (nevus flammeus)
Strawberry mark (immature hemangioma)
Cavernous hemangioma (mature)
--- (Caused by vascular dilation; permanently enlarged and dilated blood vessels that are visible on the skin surface)
Spider or star angioma
--- (Caused by blood flowing out of breaks in the vessels. Red blood cells and blood pigments are deposited in the tissues (extravascular). Difficult to see in dark-skinned people)
Primary skin lesions...Table 12-4
Solely a color change, flat and circumscribed, of less than 1 cm.
Macules that are larger than 1 cm.
café au lait spot
Something you can feel (i.e., solid, elevated, circumscribed, less than 1 cm diameter)
caused by superficial thickening in epidermis.
Elevated nevus (mole)
Papules coalesce to form surface elevation wider than 1 cm.
A plateaulike, disk-shaped lesion
Solid, elevated, hard or soft, larger than 1 cm
May extend deeper into dermis than papule
Larger than a few centimeters in diameter
firm or soft, deeper into dermis
may be benign or malignant, although "tumor" implies "cancer" to most people. Examples:
Superficial, raised, transient, and erythematous
Slightly irregular shape from edema (fluid held diffusely in the tissues)
Wheals coalesce to form extensive reaction
Elevated cavity containing free fluid, up to 1 cm; a "blister."
Clear serum flows if wall is ruptured
Early varicella (chickenpox)
Herpes zoster (shingles)
Larger than 1 cm diameter; usually single chambered (unilocular)
superficial in epidermis; thin walled and ruptures easily
Encapsulated fluid-filled cavity in dermis or subcutaneous layer
Tensely elevates skin
Turbid fluid (pus) in the cavity
Circumscribed and elevated
Examples of secondary lesions...
Common shapes and configurations of lesions...
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