nursing 344 - hair, skin + nails

epidermis

• outermost layer

• first line of defense

layers of the epidermis

• corneum: waterproof due to dead keratinocytes

• lucidum: thick skin only

• granulosum

• spinosum

• basale: melanocytes

dermis

• has nerve endings = nociceptive pain

• sebaceous glands = secretes sebum + makes hair and skin waterproof

arrector pili muscles

• eccrine: all over the skin, sweat for temp regulation

• apocrine: active after puberty, secrete milky sweat

stage 1 - pressure injury

• non-blanchable erythema of intact skin

• lightly pigmented

• color changes do not include purple/maroon

stage 2 - pressure injury

• partial loss of skin

• dermis is exposed

• fat not visible

stage 3 - pressure injury

• full-thickness loss of skin

• visible fat in ulcer

• granulation tissue, epibole, slough, eschar visible

stage 4 - pressure injury

• full thickness loss of skin + tissue

• exposed muscle, tendon, ligament, cartilage or bone in ulcer

• less painful than stage 3

unstageable

• obscured by slough or eschar

• cleaned → stage 3/4

maculae vs patch

• small, flat, non-palpable skin color change

• macule: <1cm (circumsized border)

• patch: >1cm (irregular border)

papule vs plaque

• elevated, palpable, solid mass

• papule: <0.5cm (warts)

• plaques: >0.5cm (psoriasis)

vesicle vs bulla

• circumscribed elevated, serous fluid filled mass

• vesicle: <0.5cm (varicella, poison ivy, 2nd degree burn)

• bulla: >0.5cm (contact dermatitis, large burn blister)

nodule vs tumor

• elevated, solid, palpable mass that extends deeper into dermis than a papule

• nodule: 0.5-2cm (circumscribed - keloid)

• tumor: >1-2cm (no sharp borders - larger than lipoma + carcinoma)

wheal

• elevated mass, transient borders

• serous fluid into dermis

• ex. urticaria (hive + insect bites)

pustule

• pus-filled vesicle or bulla

• ex. acne, impetigo, furuncles, carbuncles

cyst

• encapsulated fluid-filled located in subcutaneous tissue or dermis

• ex. sebaceous cyst and epidermoid cyst

erosion

• loss of superficial dermis

• canker sore

ulcer

• skin loss extending past epidermis

• necrotic tissue loss

• bleeding + scarring

scar (cicatrix)

skin mark left after healing of wound that represents replacement by ct

fissure

• linear crack in skin

• extends to dermis

• painful chapped lips

• athletes foot

vascular lesions

• petechiae

• purpura

• ecchymoses

• hematoma

petechiae

• small, red or purple spots

• caused by bleeding under the skin

purpura

• larger petechiae

• purple or reddish-purple discoloration

• due to bleeding under skin

ecchymoses

• round or irregular macular lesion

• larger than petechial lesion

• colors: black, yellow, green hues

hematoma

localized collection of blood creating elevated ecchymosis

cherry angioma

• papular + round

• red/purple found on trunk

• age-related

spider angioma

• red arteriole w/central body + radiating branches

• face, arms, neck, trunk

what diseases are associated with spider angioma?

• liver disease

• pregnancy

• vitamin b deficiency

telangiectasis

• bluish/red on leg and chest

• associated with increased venous pressure or aging

linear configuration

• straight line

• scratch

• streak

annual configuration

circular lesions

clustered configuration

lesions grouped together

discrete configuration

individual, distinct

nummular

coin-shaped lesions

confluent

small lesions running together to form one large lesion

longitudinal ridging - nails

parallel ridges running vertically

half and half nails

• ½ white and ½ pink

• chronic renal disease

pitting nails

psoriasis

koilonychia (cupping)

• spoon-shaped nails

• trauma to cuticles

• anemia, endocrine/cardiac disease

yellow nail syndrome

• grow slowly and curved

• aids + respiratory disease

paronychia nails

localized infection on nails

pallor

• low blood supply

• anemia - low hemoglobin

cyanosis

• high deoxygenated hemoglobin - hypoxia

• central cyanosis - cardiopulmonary issue

• peripheral cyanosis - localized (vasoconstriction)

jaundice

• high bilirubin

• malaria

• cirrhosis

• gall stones

erythema

• skin redness

• inflammation

• allergic reactions + trauma

acanthosis nigricans

• darkening of armpits

• insulin resistance from diabetes

• endocrine disorders (PCOS)

fungal infection colors

blue-green fluorescence

pruritus

• constant itchiness

• associated with liver disease, neuropathic disorders

increased moisture in skin vs decreased

• increased: hyperthyroidism

• decreased: hypothyroidism

clammy vs cold vs cool vs very warm skin

• clammy + cold: hypotension, shock

• only cold: raynaud hands

• cool: arterial disease

• very warm: febrile, hyperthyroidism

decreased turgor

• edema

• dehydration

patchy gray hair

nutritional deficiencies

malnutrition in black children

copper-red hair

hair leg loss

arterial insufficiency

raised lesions in scalp

• infection

• tumor growth

dry, dull hair

• hypothyroidism

• malnutrition

pustules surrounded by erythema

hair follicle infection

excessive generalized hair loss

• infection

• hormone disorders

• thyroid/liver disease

• drugs

• hepatic failure

patchy hair loss

• scalp infection

• dle/sle

hirsutism

• facial hair on females - adrenal hormone imbalance

• cushing disease

• PCOS

early clubbing

• 180 angle, spongy sensation

• vs late greater than 180

abcde’s of melanoma

• asymmetry

• borders

• color change

• diameter = greater than 6 mm

• evolutation