Exam 2: Skin, Hair, and Nails

what are the 6 components of tissue integrity

motion, tactile perception, oxygenation, perfusion, elimination, nutrition

what should you ask the patient before starting the SHN health histroy exam

if they have noticed any changes in their skin, hair, or nails

why is a comprehensive SHN assessment necessary to be done when PT is admitted to hospital

to document if they had any skin lesions prior to being admitted

TRUE OR FALSE: you should perform inspection and palpation of the skin, hair, and nails simultaneously

true

what is color awareness

understanding and assessing the clients skin color (not the same as race or ethnicity) and possible variations of findings

what is color blindess

neglecting to consider the client’s skin color, can lead to incorrect assessments

what is an important factor you NEED in order to inspect SHN

natural light

what would the general color of the skin be described as

skin should be “even”

what are some exceptions where the skin is not “even” (what color are these places)

cheeks, upper chest and genitalia (more vascular—appear more reddish-purple tones)

what is albinism

lack of melanin

what is vitiligo

white patches on the skin due to an autoimmune disorder, melanocytes destroyed, not physically harmful

what is melasma

usually on face, known as “mask of pregnancy,” dark, blotchy, symmetrical brown or gray-brown patches on sun-exposed areas of the face like the cheeks, forehead, and upper lip

what is hemosederin staining

poor venous return from legs with back-up fluid and red blood cells from capillaries into interstitial tissues, a rusty, brownish-yellow to dark brown skin discoloration on the lower legs, ankles, or feet

what are striae

stretchmarks, common on pregnant or obese people, fade or appear more silverly colored over time

describe how cyanosis would look on light skin vs dark skin

white- grayish blue, dark- ashen gray

where should you look when assessing if someone with dark skin is cyanotic

at their mucus membranes

describe eccymosis (bruise) would look on light skin vs dark skin

white- dark red, purple, yellow, or green, dark- deeper bluish or black tone, may be difficult to see

since eccymosis (bruises) are hard to see on someone with darker skin how would you figure out if they had a bruise?

the area may be tender upon palpation

describe how erythema (redness) would look on light skin vs dark skin

white- areas of redness, dark- deeper brown or purple tone, may be difficult to see

what is an example of erythema (redness) that can tell you someone with dark skin has redness. Explain

cellulitis because it swells, gets tender, and feels warm

what is excoriation

an abrasion/scratch, loss of epidermis

describe pallor (paleness) on someone with light skin vs dark skin

light- whiter skin, dark- lighter, more yellowish brown, or ashen skin. Mor evident in conjunctiva (lower eyelid)

describe how petechiae (pinpoint bruises) would look on light skin vs dark skin

light- pinpoint reddish purple lesions, dark- difficult to see; may be seen in oral mucosa or sclera

where is cyanosis best seen

nail beds, earlobes, lips, mucous membranes, palms, and soles of feet

what is jaundice

yellowish color of skin and sclera due to excess bilirubin

what is petechiae caused by

broken capillaries

if you had 3 different patients come in with 1. petechiae, 2. a rash, or 3. urticaria/hives/wheals which patient would you see first and why?

the patient with urticaria/hives/wheals because it could be anaphylactic

urticaria/hives/wheals is best treated with what and is usually due to what?

antihistamine; allergy

if someone with darker skin had urticaria/hives/wheals how would you find it?

palpate because the wheals are raised

Describe the ABCDEF assessment for moles

A- asymmetrical (not round or oval), B-border (poorly defined or irregular), C- color (uneven, variegated), D- Diameter (greater than 6mm is concerning), E- Evolving (changing, getting bigger, darker, etc), F- feeling (itching, burning, tingling, etc)

when would the color of a mole be most concerning

if it had multiple colors

what are some primary prevention methods we can use to prevent skin cancers

sunscreen, long sleeve clothing, hats, etc

what is the most common type of skin cancer

Basal Cell Carcinoma

describe a basal cell carcinoma

nodular pigmented lesion with depressed center and rolled borders

what is the 2nd most common skin cancer

Squamous cell carcinoma

how should you palpate temperature of skin

directly on skin with the dorsal side of your hand bilaterally to comapre left and right

even though sometimes the fingers and toes may be slightly cooler than the arms, when is it more concerning?

if the limbs are different temps on either side

what is the normal moisture you should feel on skin

dry, but not excessively dry, minimal perspiration or oiliness

what is diaphoresis

excess moisture, sweat

when is diaphoresis abnormal

if it is present in the absence of strenuous activity

what is a possible cause of diaphoresis

hypoglycemia

where is the skin the thickest

palms of hands and soles of feet

where skin the thinnest

eyelids

where can decreased thickness of skin be seen

in hyperthyroidism, arterial insufficiency and aging

what is acanthosis nigricans

a condition that causes areas of dark, thick velvety skin to form in body folds and creases and typically affects the armpits, groin and neck. NOT DUE TO POOR HYGIENE

where should NOT assess for turgor in an older adult

forearm or dorsum of hand

what do you expect to see when assessing for a negative skin turgor test

skin should be elastic and should return immediately when released

what do you expect to see on the scalp

smooth with no evidence of flaking, scaling, redness, or open lesions

what is alopecia

patches of hair loss due to autoimmune disorders or anemic conditions

what is alopecia areata and who could it be found on

chronic inflammatory disease of hair follicles that could be found on men or women

what is hirsutism

unwanted hair growth in women with an increase of hair on face, body, and pubic area

what are causes of hirutism

hormonal changes or polycystic ovarian syndrom (PCOS)

what is pediculosis

head lice, nits

what is seborrheic dermatitis

dandruff, in infants called cradle cap, more common in lighter skin people, treat with antifungal dandruff shampoo

what is melanonychia (expected variation)

pigmented longitudinal lines on nails

what is Beau’s lines (abnormal)

transverse groove across the nail caused by trauma

what is koilonychia (abnormal)

sppon nails, caused by anemia

what is leukonychia (abnormal)

white spots on nails caused by trauma

what is clubbing

angle at nailbed is grater than or equal to 180 degrees, associated with chronic hypoxia

what is paronychia (abnormal)

acute or chronic infection of cuticle (infected hangnail)

what is onychomycosis (abnormal)

fungal infection of the nails, usually toenails

what is an ingrown toenail

lateral grows into skin usually on the big toe

________ have thinner more permeable skin than older children and adults

newborns

newborn and young infants have ______ _______ ___ and a large body surface area which can lead to ______ ______

decreased subcutaneous fat; thermoregulation problems

what do skin colors depend on

amount of fat present

what is acrocyanosis

dusky/cyanotic lips, nailbeds, and feet immediately after birth and siappears once infant is warmed

when does jaundice appear in ½ of all newborns life

between 2nd-5th day of life and disappears in 1-2 weeks

what is cogenital dermal melanocytosis (mongolian blue spot)

increased mealnocytes should fade and dissapear, flat and non painful

what is cafe au lait spots

flat, pigmented birthmarks

what is nevus simplex or stork bited

common vascular birthmark, usually disappears by 5 years of age

what is nevus flammeus (abnormal)

port wine stain, usually on face along 5th cranial nerve, does nor disappear, often start pinkish and become red/purple. treatment: laser but not always effective

what is infantile hemangioma (abnormal)

strawberry hemangioma, usually disappear by 5 years of age

what is cavernous hemangioma (abnoraml)

reddish-blue mass of blood vessels, could affect eyesight or breathing, treatment:surgery

what is milia

sometimes called milk spots, small papules on cheeks, nose, chin, and forehead. disappear by third week of life

what is Erythema toxicum neonatorum

baby acne, common rash that lasts a few days that goes away on its own. can appear anywhere but palms of hands and soles of feet

describe newborn hair

fine and soft, lanugo (silky body hair) that may be found anywhere, but scalp, ears, shoulder, and back are most common

what is cradle cap (expected)

also called infantile seborrheic dermatitis, crusty, oily scales on scalp, may also be on ears, nose, or groin, disappears over time

what fluid is in vesicles

serous fluid

what fluid is in pustules

purulent fluid

are vesicles or pustules considered acne

pustules

describe adolescent skin changes

skin texture becomes more adult like, increased perspiration, acne peaks at about 16 years

describe older adult skin changes

skin becomes parchment like in appearance, skin hangs loosely due to loss of adipose tissue and elasticity

what is seborrheic keratoses (SK)

noncancerous benign growth looks as if it is glued on the skin

what is Dermatosis papulosa nigra (DPN)

not really moles, a variant of SK

What is solar lentigo

also known as sun spots or liver spots, flat patches

what are acrochordon

skin tags, fleshy, benign lesions

why is it important to assess and document bruises on PTs

you need to obtain data to rule-out abuse and note that they had the bruises prior to coming in

when are bruises more concerning

if there are multiple bruises at different stages

who are more at risk for bruises

people who are dependent on others (children or older adults)

when else can bruises alert the nurse if there is abuse

if the bruises are in unexpected places or patterns (eg. forearms, middle belly, upper thighs, etc)

what clients are at higher risk for skin tears

older adults due to thinner, more fragile skin or people who have thinner skin due to long term use of certain meds such as cortisone

what is a way we can prevent skin tears

protective sleeves on arms or legs

what are main spots that are at risk for pressure ulcers

bony prominences that PTs lay on a lot in supine such as: coccyx, heels, elbows, shoulders

what is blanching

assess for perfusion to skin, press on skin with one finger and skin turns white then color returns rapidly when finger raised from the skin

how do we assess Stage 1 pressure injury with blanching

if pressing on reddened skin area does NOT cause blanching (or whitening)

describe a stage 1 pressure injury

non blanchable redness, skin is intact

describe a stage 2 pressure injury

just the skin is taken off, very shallow open ulcer, pink wound, no slough or bruising

describe stage 3 pressure injury

full thickness loss of skin, subcutaneous fat may be visible, no bone, tendon, or muscle exposed, slough may be present, wound may have undermining and tunneling

describe stage 4 pressure ulcer

full thickness gone, bone, tendon, or muscle are exposed, slough or eschar may be present in wound bed

what is kennedy terminal ulcer

appears suddenly, progresses rapidly, usually refers to sacral ulcers, associated with terminally ill patients