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45 terms

Assessment: Hair, Skin, & Nails

Quiz 1: Ch. 9-11, focus on HSN D'Amico & Barberito, Health & Physical Assessment 2/e
Inspection of Skin
PI-OO-II (P-I-N-G-O: Bingo dog song ending, dogs inspect skin)

1. Position (sitting, exam gown)
2. Instruct (will be looking carefully at skin)
3. Observe (cleanliness, perspiration, sheen, smell)
4. Observe (skin tone)
5. Inspect (pigmentation)
6. Inspect (superficial arteries & veins)
Palpation of Skin
I'D APPP IPP ("I'd tap it")
Tempt Me To Thank Ellie's Little Sister

1. Instruct
2. Determine (skin temp)
3. Assess (moisture)
4. Palpate (texture)
5. Palpate (thickness)
6. Palpate (elasticity)
7. Inspect & Palpate (lesions)
8. Palpate (sensitivity)
Inspection of Hair & Scalp
I Oc Oc At ODist IL

1. Instruct
2. Observe (cleanliness)
3. Observe (color)
4. Assess (texture)
5. Observe (distribution)
6. Inspect (lesions)
Assessment of Nails
In A Hyper Insect's Pink Underwear, A Caterpillar Insists Playing a Sax & Cello, Putting Thousands of Regulars to Bed; It's a Party, Cutie!

1. Instruct
2. Assess (hygiene)
3. Inspect (even, pink undertone)
4. Assess (color)
5. Inspect & Palpate (shape & contour) 160
6. Palpate (thickness, regularity, attachment to bed)
7. Inspect & Palpate (cuticles)
Spoon nail
Assessment of Nails
6. Inspect & Palpate (shape & contour)
-Nail angle < 160 degrees
Normal nail
Assessment of Nails
6. Inspect & Palpate (shape & contour)
-Slightly convex.
-Nail angle ~160 degrees
Assessment of Nails
6. Inspect & Palpate (shape & contour)
-Convex and wide.
-Nail > 160 degrees
Splinter Hemorrhage
Assessment of Nails
6. Inspect & Palpate (shape & contour)
-Reddish brown spots in nail.
-Cause: Trauma or endocarditis (infection in heart)
Assessment of Nails
6. Inspect & Palpate (shape & contour)
-Nail plate loosens from distal nail and proceeds to proximal portion.
Skin Inspection: Cleanliness (abnormal findings)
Urea & ammonia salts found on skin --> kidney disorder
Skin Inspection: Skin Tone (abnormal findings)
1. Cynosis or pallor --> low plasma oxygen (at risk for altered tissue perfusion)
2. Pallor --> anemia
Skin Inspection: Pigmentation (abnormal findings)
Vitiligo: patchy, depigmented areas over face, neck, hands, feed, and body folds
Skin Palpation: Moisture (abnormal findings)
1. Diaphoresis: profuse sweating (e.g. from hyperthyroidism, or impending myocardial infarction)
2. Pruritis: itching r/t dr skin
Skin Palpation: Texture (abnormal findings)
1. Excessively smooth and velvety: Hyperthyroidism
- thin, shiny skin --> impaired circulation
2. Excessively dry: Hypothyroidism
- rough, scaly skin
Skin Palpation: Temperature (abnormal findings)
HIGHER T caused by:
1. Metabolic disorders, such as HYPERTHYROIDISM
2. After vigorous activity
3. External environment is warm

LOWER T caused by:
1. Metabolic disorders, such as HYPOTHYROIDISM
2. External environment is cool
Skin Palpation: Elasticity (abnormal findings)
1. "Tent": Skin turgor decreased (pinch @ clavicle)
Caused by: Dehydration or losing a lot of weight
2. Increased skin turgor: scleroderma "hard skin" (scarred underlying connective tissue)
3. Edema: decrease in skin mobility caused by accumulation of fluid in intercellular spaces
Increased accumulation of fluid in a dependent part that is caused by an accumulation of fluid in the intercellular spaces

Four-point scale for grading edema:
+1: 2 mm
+2: 4 mm
+3: 6 mm
+4: 8 mm
Skin Palpation: Lesions (abnormal findings)
1. Ecchymosis: bruising (periumbilical & flank)
2. Cullen's sign: in periumbilical area --> bleeding in abdomen
3. Grey Turner's sign: in flank area --> bleeding in peritoneum
4. Pancreatitis: in flank area --> bleeding in peritoneum

*Physical abuse should be assessed
Primary Lesions
Initial lesion of a disease on previously unaltered skin
Secondary Lesions
Skin condition or changes to the skin that occurs following a primary lesion (e.g. scratching, abrasion, infection)
Skin Palpation: Sensitivity (abnormal findings)
Track marks: potential substance abuse; injection of drugs into veins or other parts of the body
Melanoma Assessment
B=Border Irregularity
C=Color Variegation
D=Diameter greater than 6 mm
E=Evolving changes (size, shape, symptoms, surfaces, shades of color)
Hair Inspection: Cleanliness (abnormal findings)
1. Lesions may occur on scalp (cancerous). Use ABDCE method.
2. Excessive dandruff (dead, scaly flakes of epidermal cells)--> psoriasis or soborrheic dermatitis

vs. head lice (pediculosis capitis) - nits
Hair Inspection: Color (abnormal findings)
Graying in patches: nutritional deficiency (commonly protein or copper)
Hair Inspection: Texture (abnormal findings)
Dull, dry, brittle, coarse: hypothyroidism, nutritional deficiencies
Hair Inspection: Distribution (abnormal findings)
1. Excessive hair loss (women): imbalance in adrenal hormones
2. Widespread hair loss: illness, infection, metabolic disorders, nutritional deficiencies, chemotherapy
3. Alopecia areta: patchy hair loss-->infection
Hair Inspection: Lesions (abnormal findings)
1. Gray, scaly patches: Fungal infection (E.g. ringworm) --> Use Wood's lamp (UV) to fluoresce infection
2. Pediculosis capitis: head lice - nits, scratching. Check scalp for excoriation from scratching
Nail Assessment: Hygiene (abnormal findings)
Self-care deficit or r/t employment
Nail Assessment: Even, pink undertones (abnormal findings)
1. Colorless: peripheral arteriosclerosis or anemia
2. Yellow: jaundice
3. Dark red: Polycythemia (pathologic increase in production of RBC)
Nail Assessment: Capillary refill (abnormal findings)
Blue nailbeds, sluggish color return: CV or Resp. disorders
Nail Assessment: Shape & Contour (abnormal findings)
1. Clubbing: hypoxia or impaired peripheral tissue perfusion over time (cirrhosis, smoking, colitis, thyroid disease) >160
2. Spoon nail: Iron deficiency, concave <160
Nail Assessment: Thickness, regularity, attachment to bed (abnormal findings)
1. Onycholysis: sparation of nail plate from bed (trauma, infection, skin lesions)
2. Thick nails: circulatory disorders
Nail Assessment: Cuticles (abnormal findings)
Paronychia: infection of cuticle caused by untreated hangnails
Macule (lesion)
flat, nonpalpable change, < 1 cm, circumscribed border
Patch (lesion)
flat, nonpalpable change, > 1 cm, may have irregular border
EX: Mongolian spots, port-wine stains, vitiligo, chloasma
Papule (lesion)
Elevated, solid palpable masses with circumscribed border.
< 0.5 cm
EX: moles, warts
Plaque (lesion)
-Elevated, solid palpable masses with circumscribed border.
-Groups of papules that form lesions > 0.5 cm
EX: psoriasis
Nodule (lesion)
-Elevated, solid, hard or soft palpable masses extending deeper into the dermis that a papule.
-Circumscribed borders, 0.5 - 2 cm
EX: small lipoma, squamous cell carcinoma
Tumor (lesion)
-Elevated, solid, hard or soft palpable masses extending deeper into the dermis that a papule.
-May have irregular borders, > 2 cm
EX: large lipoma, carcinoma
Vesicle (lesion)
-Elevated, fluid-filled, round or oval shaped, palpable masses with thin, translucent walls and cicrumscribed borders.
Vesicles < 0.5 cm
EX: herpes simplex/zoster, early chicken pox, small burn blisters, poison ivy
Bulla (lesion)
-Elevated, fluid-filled, round or oval shaped, palpable masses with thin, translucent walls and cicrumscribed borders.
Bullae > 0.5 cm
EX: contact dermatitis, friction blisters, large burn blisters
Wheal (lesion)
Elevated, often reddish area with irregular border caused by diffuse fluid in tissues
EX: insect bites and hives (extensive)
Pustule (lesion)
Elevated, pus-filled vesicle or bulla with circumscribed border. Size varies.
EX: acne, impetigo, carbuncles (large boils)
Cyst (lesion)
Elevated, encapsulated, fluid-filled or semisolid mass orig. in subcutaneous tissue or dermis.
Usually 1 cm or larger
EX: sebaceous cysts, epidermoid cysts
Seborrheic dermatitis
"Cradle cap" common in infants. It appears as eczema of yellow-white greasy scales on scalp and forehead.