Lec 4: Hair, Skin, and Nails

what is the skins/integument main functions

• homeostasis and regulation

• protection and movement

constitutive colour def

overall/usual colour without any changes

how does colour blindness affect general survey

affects assessment ability, difficult to see skin changes

type 1 skin type

• blue, green, grey eyes

• blonde

• white, pale, freckles

• always burns, never tans

type 2 skin type

• blue eyes

• red/blonde hair

• white, pale, beige tint

• usually burns sometimes tans

type 3 skin type

• brown eyes

• light brown hair

• white to light brown skin, olive

• burns sometimes, tans

type 4 skin type

• brown eyes

• medium brown hair

• light to moderate brown skin

• rarely burns, always tans

type 5 skin type

• brown eyes

• dark brown hair

• medium to dark brown skin

• rarely burns, tans more than average

type 6 skin type

• brown eyes

• black hair

• dark brown to black skin

• never burns

what do ask about when we do for health history of skin

• risk factors

• tell me about your concerns

• history of present illness (10 signs)

risk factors vs protective factors

• r=outdoors with no spf

• p=suncreen

modifiable vs non modifiable risk factors

• modifiable=use of sunscreen, take vitamin D

• non modifiable=albinism, genetics, skin colour

what do we do first then second when doing the physical exam

inspection then palpation

what do we look for during inspection

• colour

• sun exposed vs not exposed,

• assess mucus membranes, conjunctiva

• uniformity of colour

• hygiene

• lesions, rashes, erythema, swelling, discharge, odour

what conditions should we assess colour in

best to assess in natural or halogen lamp (not fluorescent) light

what do we look for/assess with palpation

• temp, use dorsal surface of hands

• moisture

• texture

• thickness

• turgor

what are the diff skin colours

• pallor (pale) is constitutive

• cyanosis

• jaundice can be local or constitutive (eyes or body)

• flushing

• erythema

• ecchymosis

• petechiae

flushing def

flushed pink cheeks (from heat)

Erythema def

swelling and redness (irritation)

• ex acne

Ecchymosis def

redness and bruising

Petechiae def

small red spots

what is a lesion

everything diff from constitutive colour

what do we inspect and palpate for lesions

• size

• shape

• colour

• texture

• exudate

• tenderness

• configuration

• location and distribution

• vascular

exudate def

goop/anything leaking out of lesion

Configuration def

how its layed out on body, random

how to check if lesion is vascular

check for pulsations and blanching

what are all the first 8 diff lesion types

• macules

• papules

• pustules

• plaques

• nodules

• vesicles

• bullae

• urticaria

macule

• freckles

• flat

papule

• raised

• any colour

• defined

pustules

• acne

• raised

• fluid filled

plaque

• raised

• defined

• any colour

nodule

• solid

• palpable

vesicles

• fluid filled

• chicken pox

bullae

• blister

• fluid filled

urticaria

what are the next 8 (2nd) types of lesions

• scale

• crust

• erosions

• ulcers

• petechiae

• purpura

• atrophy

• scars

• telangiectases

scale

• rapid turnover of epidermis

• psoriasis

crust

• dried secretions from primary lesion

erosions

• loss of epidermal layer

ulcers

• loss of skin extending into dermis or deeper

petechiae

• small macules/papules

• purple

purpura

atrophy

• thinning skin

scars

telangiectases

what are the diff colours lesions can come in

• red

• orange

• yellow

• violet (vascular lesions)

• shades of blue silver and gray

• black (melanocytic, eschar)

what should you note when describing Location and Distribution of a lesion

• single or multiple

• particular body parts

• random or patterned

• symmetric/asymmetric

• sun exposed or protected

what do the ABCDEs of Hyperpigmented Lesions (freckles) stand for

• asymmetry

• border

• colour

• diameter

• evolution

border for melanoma

• irregular

• ragged

colour for melanoma

are there diff colours

diameter for melanoma

• has it changed

• larger than pencil (6mm)

evolution for melanoma

has the mole changed in size, shape, color

• any bleeding, itchy

Pressure Injuries

1. pressure of bony prominences against surface

2. friction

3. shear

why are elderly more at risk for pressure ulcers

thinner skin

• drier the skin the higher the risk

skin turgor

used to measure hydration

what do we inspect for with hair

• quality

• distribution (gender, age, genetics)

• pattern of loss (smooth skin vs stubble)

• colour

• texture (has there been a change, dry/coarse or fine/silky)

• scalp

what is hair distribution impacted by

puberty=onset of pubic hair growth and increased hair on legs, face, chest (male sex)

how do we palpate hair

• light palpation

• scalp mobile and non-tender

what do we inspect for nails

• colour (pink to light brown)

• shape

what do we palpate for nails

capillary refill <3 secs

nail clubbing

sign of chronic hypoxia

what are some red flags for hair, skin, and nails

• pressure injury

  • braden scale for risk assessment

• acute dehydration

• cyanosis

• melanoma

• acute trauma and burns

spooning nails vs beau lines pic