NRSE210 Exam #2 part 1

Epidermis locations and regrowth general information

• outer layer, avascular, thin and tough

• replaced every 4 weeks

• mostly thin except in places with high friction (palms and soles of feet)

Dermis general information

• inner supportive layer, consists mostly of connective tissue and collagen

• tough and elastic, allows for stretching, resist tearing

Dermis makeup

nerves, sensory receptors, blood vessels, lymphatics, hair follicles, sabacous glands, sweat glands 

Subcutaneous layer makeup 

• Fat (adipose tissue)

Subcutaneous layer function

energy storage, insulation, cushioning, aids mobility of skin over underlying structures

Hair information

• comes out of follicles

• growth cycle is active and resting phase

• 2 types: vellus and terminal hair

Vellus hair

fine, faint, covers most of the body

• arms, face, legs

Terminal hair

Darker, thicker

• on scalp, evebrows, axillae, pubic area, face and chest of men

Sabaceous glands (produces and secretion site)

• sebum

• hair follicle

sebum functions

lubricates skin and hair, prevents water loss, antibacterial properties

Distribution of sebaceous glands

• everywhere but palms and soles of feel

• abundant on scalp, forehead, face, chin

two sweat gland types

eccrine and apocrine

Eccrine sweat gland (description, function)

• coiled tubules that open directly to the surface

• produce sweat (water and salt) and important for temperature regulation

Apocrine sweat gland (description, function, body odor cause)

• open into hair follicles

• located in axillae, nipples, anogenital area. produce thick oily secretion (becomes active at puberty

• cause by bacterial action on secretion

Nails (parts and description)

lunula and cuticle

• hard plates of keratin

Lunula

white, crescent- shaped area at nail base where new keratin cells form

Cuticle

protects nail matrix by covering and sealing space between nail plate and skin

Function of skin (8)

protection, perception, temperature regulation, identification, communication, wound repair, absorption/ secretion, production of vitamin D

Subjective data: previous history of the skin

• allergies, hives, psoriasis, eczema

• changes in mole

• dryness or moisture

• pruritus or excessive bruising, rash/lesion

• medications

• hair loss, change in nails, self care

• enviorment/ job hazards

pruritus

sensation of itching on the skin

Equipment for skin objective data collection

good lighting, small centimeter ruler, penlight, gloves

vitiligo 

absence of melanin; autoimmune destruction of pigment (patches with no melanin, genetic)

skin danger signs ABCDE

• Asymmetry (both sides look similar)

• Border irregularity (fuzzy, blending edges)

• Color variation (uniform vs dark)

• Diameter (< 6mm is likely benign)

• Elevation/ evolution changes

Pallor

color pigmentation changes

• paleness, stress, anxiety, fear

• blood vessels constrict

• seen with anemia

Erythema

color pigmentation changes

• redness

• dilated superficial capillaries

• local inflammation

• blushing, warmth 

cyanosis

bluish color; decreased perfusion and oxygenation

jaundice

yellow color due to increased bilirubin; visible in sclera and mucous membrane

checking mobility and turgor

pinch skin to check elasticity; should return to normal quickly

• tending = dehydration

Lesions: observe for 6 factors

• color

• elevation

• patter/ shape

• measurement (size)

• location

• distribution

Hair (inspection and palpate details)

distribution, texture, excess hair growth

• separate hair into sections to examination scalp

Nail shape

• normal 160 degrees

• clubbing 180 degrees

• curved nail 160 degrees or less (no concern)

capillary refill

depress nail edge, color should return in 2 seconds or less 

Skin lesions: annular

circular, begins at center and spreads to the periphery (ex. ringworm)

Skin lesions: confluent

lesions that run together (ex. hives)

Skin lesions: discrete

distinct, individual lesions that remain separate (ex. acne, skin tags)

Skin lesions: grouped

clusters of lesions (ex. vesicles of contact dermatitis)

Skin lesions: gyrate

twisted, coiled, spiral, or snake line (ex. ringworm)

Skin lesions: target (or Iris)

resembles the Iris of an eye, concentric rings of color in the lesion (ex. erythema multiforme)

Skin lesions: linear

scratch, streak, line

Skin lesions: polycyclic 

annular lesions that grow together, run in groups (ex. psoriasis)

Skin lesions: zosteriform

linear arrangement along a unilateral nerve route (ex. shingles, herpes)

Skin lesions: macule

• primary skin lesion

• flat, circumscribed, < 1 cm (ex. freckles)

Skin lesions: papule

• primary skin lesion

• elevated, firm <1 cm (ex. wart)

• solid, no fluid

Skin lesions: patch

• primary skin lesion

• flat, > 1cm (ex. vitiligo)

• macule > 1 cm

Skin lesions: plaque

• primary skin lesion

• papules grouped to form a surface elevation >1 cm

Skin lesions: nodule

• primary skin lesion

• solid, elevated > 1 cm (ex. psoriasis)

Skin lesions: wheal

• primary skin lesion

• superficial, raised, transient, irregular shape, red (ex. mosquito bite)

Skin lesions: tumor

• primary skin lesion

• 1g, solid grwoth, > 102 cm

• benign/ malignant

Skin lesions: Urticaria (hives)

grouped wheals

• primary skin lesion

• very pruritic (itchy)

Skin lesions: vesicle

• primary skin lesion

• elevated cavity containing clear fluid < 1 cm (ex. blister)

Skin lesions: bulla

• primary skin lesion

• >1cm, elevated, easily ruptured (ex. thin blister)

Skin lesions: cyst

• primary skin lesion

• encapsulated, fluid filled, elevating the skin

Skin lesions: pustule

• primary skin lesion

pus- filled cavity (ex. acne)

Skin lesions: crust

• secondary skin lesion

• thickened, dried up

• ex. scab

Skin lesions: scale

• secondary skin lesion

• compact, desiccated flakes of skin

• ex. psoriasis

Skin lesions: fissure

• secondary skin lesion

• linear crack with abrupt edges

• ex. athletes foot

Skin lesions: erosion

• secondary skin lesion

• scooped out, shallow depression

• moist, no bleeding, heals without scar

Skin lesions: ulcer 

• secondary skin lesion 

• deep depression into dermis, irregular shape, may bleed

• leaves scar

Skin lesions: exoriation

• secondary skin lesion

• self inflicted abrasion, superficial, sometimes crusted

• ex. scratching

Skin lesions: scar

• secondary skin lesion

• normal tissue replaced with connective tissue after surgery 

Skin lesions: lichenification

• secondary skin lesion

• thickened skin from prolonged scratching

Skin lesions: keloid 

• secondary skin lesion

• hypertrophic scar, excess scar tissue beyond wound edges

primary skin lesion definition

happen on their own and can evolve into secondary

secondary skin lesion definition

result of underlying primary lesions or external factors

how do pressure ulcers happen, where do they happen, and who's at risk for them?

• caused by localized ischemia from unrelieved pressure, tissue compression (causing decrease blood flow)

• often occur on bony prominences

• immobile or bed bound patients, elderly, malnourished

stages of pressure ulcers

stage 1: non blanchable erythema of intact skin (epidermis)

stage 2: partial thickness skin loss, shallow ulcer with pink wound or blister (dermis)

stage 3: full thickness loss of skin, into subcutaneous fat (hypodermis)

stage 4: full thickness skin loss, exposed bone, tendon, or muscle

cranial bones

frontal, parietal, occipital, temporal

Facial bones

14 total, articulate at surface

mandible

only movable facial bone

mastoid process

boney prominence behind the ear, part of the temporal bone

cervical vertebrae (job)

support the head (C1- C7)

C7

vertebra prominence, palpable landmark on base of the neck

Cranial nerve VII

control facial muscles

salivary glands: parotid

in the cheeks, in front of the ear

salivary glands: submandibular 

beneath mandible at angle of jaw 

salivary glands: sublingual

floor of the mouth under the tongue, smallest, no palpable

Temporal artery

side of the forehead

• palpable, smaller than other arteries

Major muscles in the neck

sternomastoid, trapezius

Trapezius (location and function)

• back of the head to shoulders, occipital bone to scapular and clavicles

• Function: turning head, moving shoulders, extending head

Sternomastoid (location and function)

sternum to mastoid (behind ear)

• head rotation and flexion

neck triangle: antierior triangle (location)

in front of sternomastoid (RED)

neck triangle: posterior triangle (location)

behind sternomastoid, bordered by trapezius and clavicle 

thyroid gland (makeup, location, function)

• endocrine gland with two lobes connected by thin isthmus

• straddles trachea

• stimulates rate of cellular metabolism; affects weight

cricoid cartilage (location)

1 cm above isthmus; upper trachea ring

thyroid cartilage (location)

above cricoid

• Forms Adams apple in men

lymph nodes order (1-5)

1) preauricular

2) post auricular

3) occipital

4) submental

5) submandibular

lymph nodes (6-10)

6) jugulodigastric

7) superficial cervical

8) deep cervical

9) posterior cervical

10) supraclavicular

subjective data for head/ neck

• headaches

• past injury to head or surgery

• dizziness

• neck pain

• lumps/swelling

Objective data: head and neck

• skull- inspect and palpate (normal cephalic, smooth symmetrical)

• Temporal artery: palpate

• TMJ: palpate both sides of jaw and ask patient to open and close

• Face: symmetrical, facial expressions

CN VII test

smile, puff up cheeks, raise eyebrows

CN XI test

shoulder shrug and head turn against resistance

Tension headache (origin, pain, triggers, Tx)

• musculoskeletal origin

• gradual onset, bilateral, mild- moderate pain

• Triggers: stress, fatigue, dehydration

• Tx: rest, massage, tylenol

Migraine (origin, pain, triggers, Tx)

• vascular/ nerve origin, genetic, more common in women

• moderate- sever, throbbing, unilateral/bilateral

• Trigger: hormones, food, sleep, weather, N/V

• Tx: rest in a dark, quiet room, meds, NSAIDs

NSAID

Non-Steroidal Anti-Inflammatory Drugs.

• reduce pain, inflammation, and fever -

• Examples of NSAIDs include ibuprofen, naproxen, and aspirin.

Tx

treatment

Cluster headache (origin, pain, triggers, Tx)

• around/ behind the eye, temporal

• unilateral, severe, more common in men

• Triggers: strong smells, alcohol

• Tx: oxygen therapy, calcium channel blockers

simple diffuse goiter 

thyroid enlargement, iodine deficiency 

pilar cyst (wen)

benign scalp, cyst, shiny, smooth

parotid gland enlargement

mumps, duct inflection/ blockage, unilateral swelling

grave’s disease (definition, effects)

hyperthyroidism

• increase metabolic rate, goiter, bulging eyes, weight loss, tachycardia, anxiety