chapter 13 hair skin and nails

largest organ system

skin

how many sqft does skin take up

20 sqft

skin protects the body from

environmental stesses

epidermis

outer highly differentiated layer

basal cell layer

forms new skin cells

outer horny cell layer is made up of

keratinized cells

dermis

inner supportive layer

connective tissue

collagen

elastic tissue

located in the dermis

beneath epidermis and dermis

subcutaneous layer of adipose tissue

subcutaneous layer stores

fat for energy, aids in cushioning/protection and provides increased mobility

Skin color is determined by

melanin, carotene, hemoglobin

melanin

brown pigment

carotene

yellow-orange pigment

red purple tones

underlying vascular bed

threads of keratin

hair shaft and bulb matrix

types of hair

lanugo, vellus, terminal

lanugo hair

also known as Vellus Hair, is the soft, white and downy hair found on the body; usually lacking a medulla

terminal hair

Long, coarse, pigmented hair found on the scalp, legs, arms, and bodies of males and females.

follicle

cyclical with active and resting phases

Sebaceous glands

secrete sebum (oil) into the hair follicles where the hair shafts pass through the dermis

sebum

secreted lipid substances through hair follicles

lubricate skin and form emulsion

sweat glands

eccrine and apocrine

eccrine glands

These glands produce sweat.

apocrine glands

produce a thick, milky secretion and open into the hair follicles

nails

hard plates of keratin on the dorsal edges of the fingers and toes

skin is

washable, waterproof and rugged producing protective and adaptive properties

functions of the skin

protection, prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vitamin D

lanugo

fine downy hair of newborn infant

vernix caseosa

Waxy or "cheesy" white substance found coating the skin of newborn humans

milia

Benign, keratin-filled cysts that can appear just under the epidermis and have no visible opening in newborns

children's skins and hair

epidermis thickens darkens and becomes lubricated

hair growth accelerates

adolescents hair skin and nails considerations

secretions from apocrine sweat glands increase

subcutaneous fat deposition increase

secondary sex characteristics

increase in metabolism in pregnant people leads to

increase secretion of sweat and sebaceous glands to dissipate heat

fat deposits are laid down as

maternal reserves for nursing a baby

in pregnancy expected skin color changes

due to increased hormone levels

In aging adults: elasticity

Loses elasticity; skin folds and sags

In aging adults: sweat and sebaceous glands

decrease in number and functions, leaving skin dry

Aging adults: Senile purpura

discoloration due to increasing capillary fragility

In aging adults: Skin breakdown due to multiple factors

cell replacement is slower and wound healing is delayed

In aging adults: hair matrix

Functioning melanocytes decrease, leading to gray fine hair

Genetic attributes of dark-skinned individuals afford protection against skin cancer due to ________.

melanin

increased likelihood of skin cancer in

whites than in black and Hispanic populations

succession of genetic mutations leading to

increased chromosome sensitivity to sun damage

most important environmental risk factor for skin cancer is exposure to

ultraviolet (UV) radiation both from sun and indoor tanning sourceschanges genetic makeup

increased risk for melanoma r/t increased number of

sunburns during ones lifetime

keloids

Nodules formed in wound healing due to excessive collagen, increased TGF-Beta activity

impact of measles

highly contagious pathogen

subjective data health history questions

Past history of skin disease, allergies, hives, psoriasis, or eczema?

Change in pigmentation or color, size, shape, tenderness?

Excessive dryness or moisture?

Pruritus or skin itching?

Excessive bruising?

Rash or lesions?

Medications: prescription and over-the-counter?

Hair loss?

Change in nails' shape, color, or brittleness?

Environmental or occupational hazards?

Self-care behaviors?

additional history questions for infants and children

Does child have any birthmarks?

Any change in skin color as a newborn? Does child have any rash or sores?

Does child have diaper rash?

Does child have any burns or bruises?

Has child been exposed to contagious or communicable disease?

Does child have habits such as nail biting or twisting hair?

Which steps are taken to protect child from sun exposure?

additional health questions for adolescents

Skin problems such as pimples, blackheads

additional health history questions in aging adults

What changes have you noticed in your skin in past few years?

Any delay in wound healing?

Any other skin pain?Any change in feet: toenails, bunions, wearing shoes?

Have you had any falls?

History of diabetes or peripheral vascular disease?What do you do to care for your skin?

preparation

control external variables that impact change skin color

focus on being attentive to skin characteristics

equipment needed

Strong direct lighting, gloves, penlight, and small centimeter ruler

woods light

ultraviolet light used for diagnosing skin conditions

complete physical examination

Skin assessment integrated throughout examination

Scrutinize the outer skin surface first before you concentrate on underlying structures

Separate intertriginous areas (areas with skinfolds) such as under large breasts, obese abdomen, and groin, and inspect them thoroughly

These areas are dark, warm, and moist and provide perfect conditions for irritation or infection

Always inspect feet, toenails, and between toes

regional physical examination

-Individuals may seek health care for skin problems and assessment focused on skin alone.

-Assess skin as one entity; getting overall impression helps reveal distribution patterns.

color

general pigmentation, freckles, moles, birthmarks,

-widespread color change (pallor, erthrma, cyanosis, jaundice

temperature

use backs of hands to palpate person

skin should be warm, and temperature equal bilaterally

hands and feet might be slightly cooler in a cool environment.

moisture

diaphoresis, dehydration

texture

normal skin feels smooth and firm with even surface

thickness

observe for thickened areas (callus formation)

edema

assess for fluid accumulation in the interstitial space

mobility and turgor

assess skin elasticity

vascularity or bruising

Assess for presence of tattoos and/or variations

Lesions: if any are present, note the following:

ØColor

ØElevation

ØPattern or shape

ØSize

ØLocation and distribution on body

ØAny exudate: note color and odor

ØUse a Wood's light (ultraviolet light filtered through special glass) to detect fluorescing lesions.

hair color

due to melanin production

hair texture

Characteristics range from fine to thick to curly to straight and may be affected by use of hair care products

hair distribution

review gender patterns of hair distribution

hair lesions

Identification by looking at scalp and dividing hair into sections

shape and contour nails

Profile sign: view index finger at its profile and note angle of nail base; it should be about 160 degrees

nails consistency

observe for smooth, regular, not brittle or splitting, uniform nail thickness

nail color

Translucent nail plate to pink nail bed below

Note ethnic variations

nail capillary refill

Depress nail edge to blanch and then release, noting return of color; indicates status of peripheral circulation.

clubbing

ABCDEF skin assessment

A: asymmetry

B: border irregularity

C: color variations

D: diameter greater than 6 mm

E: elevation or evolution

F: funny looking—"ugly duckling" —different from others

infant skin color

Mongolian spot

Café-au-lait spot

Mongolian spot

Café-au-lait spot

infant skin color changes

Harlequin color change

Erythema toxicum

harlequin color change

Erythema toxicum

pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.

temporary cyanotic conditions in infants

acrocyanosis and cutis marmorata

acrocyanosis

Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

cutis mamorata

transient mottling in the trunk and extremities

in response to cooler room temperatures in babies

physiological jaundice in infants

carotenemia in infants

nevus simplex

"stork bite", pink red capillary on face or neck

aging skin color and presentations

solar lentigines (liver spots

keratoses - seborrheic or actinic

liver spots

keratoses

raised, thickened areas of pigmentation that look crusted, scaly, and warty

aging moisture

xerosis

aging skin texture

skin tags or acrochordons

sebaceous hyperplasia

aging skin thickness

Thin parchment as subcutaneous fat decreases Decreased mobility and turgor Decreased hair growth, nail growth, and brittle nails

annular or circular

begins in center and spreads to periphery

confluent

skin lesions that run together

discrete

Distinct, separate

grouped

clusters of lesions

gyrate

twisted, coiled spiral, snakelike

target or iris

resembles iris of eye, concentric rings of color in lesions