Exam 1: Skin, Hair, Nails

What is the purpose of the skin, hair, and nails? (10)

1. protection against penetration

2. perception

3. fluid balance

4. temp. regulation

5. identification

6. communication

7. wound repair

8. absorption

9. excretion

10. vitamin D production

Identify all 11 structures.

1. epidermis

2. dermis

3. subcutaneous layer

4. sensory receptors

5. sebaceous gland

6. sweat gland

7. artery

8. vein

9. nerve

10. hair follicle

11. arrector pili muscle

What is the difference between sebaceous glands and sweat glands (and 2 types of sweat glands)?

sebaceous glands: secrete sebum (oily) for lubrication through hair follicles

sweat glands: secrete sweat for temp. regulation (eccrine: sweat; apocrine: thick milk)

Identify whether this data is subjective (S) or objective (O).

1. edema

2. skin disease history

3. mobility/turgor

4. pigmentation changes

5. mole changes

6. moisture

7. shape/contour of nails

8. xerosis

9. seborrhea

10. temperature

11. excessive bruising

12. nail consistency

13. rash

14. vascularity/bruising

15. lesions

16. nail color

17. medications

18. lesions of scalp

19. skin color

20. alopecia

21. nail changes

22. environmental/occupational hazards

23. self-care

24. texture

25. thickness

26. capillary refill

27. pruritus

1. O

2. S

3. O

4. S

5. S

6. O

7. O

8. S

9. S

10. O

11. S

12. O

13. S

14. S

15. O

16. O

17. S

18. O

19. O

20. S

21. S

22. S

23. S

24. O

25. O

26. O

27. S

Pallor

pale

Keratin

tough, fibrous protein that forms new skin cells

Melanin

pigment that gives brown tones to skin/hair; protects skin from UV rays

T or F: melanocytes are in interspersed along the epidermis.

T

What is the difference between the epidermis, dermis, and subcutaneous layer?

e: outer, highly differentiated, stratified, inner basal cell layer, avascular

d: inner, supportive, collagen (CT), elasticity, vascular, nerves, sensory receptors, lymphatics, hair, glands

s: inner-most; adipose (fat) tissue, energy storage, temp. control, protection, mobility (loose)

1. What is hair made up of?

2. types? (2)

3. What are the parts?

1. keratin

2. types:

   1. vellus: fine, covers body (not palms/soles)

   2. terminal: dark, thick that grows on scalp, eyebrows, axillae, pubic area, face/chest in M

3. parts:

   1. shaft: visible above skin

   2. root: bellow surface

   3. bulb matrix: new cells produced in expanded area of root

Erythema

red

Cyanosis

blue

Jaundice

yellow

Uremia

green/frosty

When assessing skin color, you should include these 5 things…

1. general pigmentation

2. freckles

3. moles

4. birthmarks

5. widespread change

Why do you use back of hands to palpate skin for temperature?

thinner skin on dorsa of hand

Palpate

examine by touch

Skin should be warm and equal bilaterally because warmth suggests…

normal circulatory status

Hypothermia

body heat is lost faster than produced, using up body’s stored energy and lowering body’s temp.

This is an example of what condition?

hypothermia

Hyperthermia

abnormally high body temp.

This color is an example of…

pallor

This color is an example of…

erythema

This color is an example of…

cyanosis

This color is an example of…

jaundice

This color is an example of…

uremia

Xerosis

excessive dryness of skin

Seborrhea

excessive oil of skin

Alopecia

hair loss

Pruritus

itchiness

What are 5 external factors of skin color?

1. emotions

2. environment

3. disease processes

4. physical

5. nutritional status

Diaphoresis

sweating

The nurse is assessing a patient who has been admitted for liver failure. What finding would the nurse expect?​

1. Cyanosis​

2. Flushing​

3. Rubor​

4. Jaundice

4

If there is a presence of edema, document on a scale of to ____

0; 4+

What is normal mobility? Turgor?

mobile; <1 second

Edema

accumulation of fluid in interstitial spaces (extracellular), causing swelling

Compare pitting and dependent edema.

pitting: when you depress on swelled skin, it leaves an indentation that remains

dependent: specific to parts that gravity pulls the blood down (extremities)

When is edema considered normal?

pregnancy

The production of ______ impacts hair color.

melanin

How do you identify lesions of the scalp?

divide hair into sections

Normal nails are angled at _____ degrees. Curved nails are angled at ____ degrees. Clubbing of the nails occurs when the profile angle is ___ degrees.

160; <160; 180

Capillary refill

when you depress edge of nail and then release

T or F: people with darker skin have a higher amount of melanocytes.

F

What produces melanin?

melanocytes

What 4 things can affect melanin production?

1. sun exposure

2. keratin

3. underlying vascular bed

4. genetics

Lesion

area of skin that has suffered damage

Name 2 medications that affect the skin.

1. Accutane

2. birth control

What is the first step of assessment?

skin inspection

Mobility

pinching (tempting) skin

Turgor

how fast skin goes down once let it out of the pinch

If you are _____________, turgor is slower.

dehydrated

Which part of the nail do you look at when determining color?

nail bed

What is the symbol for with? without?

c with line over; s with line over

What 7 things do you document for lesions of the skin?

1. color

2. quantity

3. elevation (macular/piacular)

4. pattern/shape (grouped/scattered; distinctness)

5. size (cm)

6. location and distribution

7. exudate (color; odor)

Exudate

fluid that leaks out; drainage

Macular

flat

Piacular

raised

What are the 9 shapes/configurations of lesions?

1. annular

2. confluent

3. discrete

4. grouped

5. gyrate

6. target

7. linear

8. polycyclic

9. zosteriform

Annular

circular

Linear

scratch, streak, line, stripe

What lesion shape/configuration is this? What condition can cause this?

linear; Blaschko’s lines

What lesion shape/configuration is this? What condition can cause this?

annular; tinea corporis: ringworm

Confluent

run/grown together

What lesion shape/configuration is this? What condition can cause this?

confluent; urticaria: hives

Discrete

separate, individual

What lesion shape/configuration is this? What condition can cause this?

discrete; acne

Grouped

clustered together

What lesion shape/configuration is this? What condition can cause this?

grouped; dermatitis

Gyrate

twisted, coiled spiral, snakelike

What lesion shape/configuration is this? What condition can cause this?

gyrate; erythema gyratum repens

Target

iris/bullseye/concentric rings

What lesion shape/configuration is this? What condition can cause this?

target; erythema multiforme

Polycyclic

annular lesions that link together like a Venn-diagram

What lesion shape/configuration is this? What condition can cause this?

polycyclic; psoriasis

zosteriform

linear arrangement along a nerve​

What lesion shape/configuration is this? What condition can cause this?

zosteriform; herpes zoster: shingles

What are the 12 primary lesion types?

1. papules

2. patches

3. plaques

4. nodules

5. wheals

6. urticaria

7. vesicles

8. cysts

9. bullas

10. pustules

11. macules

12. tumors

Tumors

benign/malignant; deep in dermis; > few cm.

What type of skin lesion is this? Give an example.

tumors; lipoma

Bullas

unilocular (1 cavity); superficial; thin walls (easily rupture); > 1 cm

What type of skin lesion is this? Give an example.

bullas; friction blister

Urticaria

hives: wheals unite to form extensive reaction, itching

What type of skin lesion is this? Give an example

urticaria; hives

What type of skin lesion is this? Give an example.

vesicle; herpes zoster (shingles)

Vesicles

elevated, fluid, <1 cm

Papules

superficial thickening of epidermis <1 cm, so elevated

What type of skin lesion is this? Give an example.

papule; nevus: mole

Macules

color change <1 cm

What type of skin lesion is this? Give an example.

macule; freckles

Patches

macules >1 cm

What type of skin lesion is this? Give an example.

patch; vitiligo

Plaque

united papules >1 cm (plateau)

What type of skin lesion is this? Give an example.

plaque; psoriasis

Nodule

solid, elevated, hard/soft; > 1cm

What type of skin lesion is this? Give an example.

nodule; intradermal nevi

Wheal

superficial, raised, short-term, erythematous, irregular shape from edema

What type of skin lesion is this? Give an example.

wheal; mosquito bite

Cysts

encapsulated fluid-filled balloon in dermis/subcutaneous layer, so elevated skin

What type of skin lesion is this? Give an example.

cyst; sebaceous cyst

Pustules

elevated and filled with pus