Chapter 13. Skin, Hair, and Nails

What is the body's largest organ system?

The skin.

How many layers does the skin have?

The skin has two layers: the epidermis and the dermis.

What is the outer highly differentiated layer of the skin?

The epidermis.

What is the inner supportive layer of the skin?

The dermis.

What is located beneath the epidermis and dermis?

A subcutaneous layer of adipose tissue.

How does skin elasticity change in aging adults?

The skin loses elasticity, causing it to fold and sag.

Why does aging skin tend to be drier?

Sweat and sebaceous glands decrease in number and function, reducing moisture.

• difficulty regulating body temperature

What is senile purpura?

Discoloration of the skin due to increasing capillary fragility.

• AKA capillary burst more easily

Why is skin breakdown more common in aging adults?

Multiple factors contribute, including slower cell replacement and delayed wound healing.

Why does hair turn gray and become finer with age?

Functioning melanocytes decrease in the hair matrix, leading to gray, fine hair.

How does melanin affect skin cancer risk?

Melanin provides protection against skin cancer, which benefits dark-skinned individuals.

Which population has the highest likelihood of developing skin cancer?

White individuals have a higher likelihood of developing skin cancer than other populations.

• paler skin = more at risk for skin cancer

What is the most important environmental risk factor for skin cancer?

Exposure to ultraviolet (UV) radiation from the sun and tanning sources.

How is melanoma risk related to sun exposure?

An increased number of sunburns over a lifetime raises the risk of melanoma.

What general health history question might be asked about recent skin issues?

"Have you had any skin problems recently?"

Other subjective questions to ask

• Hair loss?

• Change in nails’
  shape, color, or
  brittleness?

• Environmental or
  occupational
  hazards?

• Self-care behaviors?

• History of diabetes
  or peripheral
  vascular disease?

How should skin assessment be conducted during an exam?

Skin assessment should be integrated throughout the exam.

Why is it important to separate skin folds during a skin assessment?

To check for hidden skin issues such as rashes, infections, or pressure sores.

What areas should always be inspected during a skin assessment?

The feet, toenails, and between the toes.

How should skin be assessed if one area has a problem?

The entire skin should be assessed as a single entity, not just the affected area.

What should be inspected regarding skin color?

General pigmentation, freckles, moles, birthmarks, and any widespread color changes.

What types of widespread color changes should be noted during a skin inspection?

Pallor (pale), erythema (red), cyanosis (blue), or jaundice (yellow).

How should the cause of a color change be assessed?

Determine if the color change is transient or due to pathology.

How should skin temperature be assessed?

Use the backs of your hands to palpate the skin.

What is the normal temperature pattern of skin?

The skin should be warm, and the temperature should be equal bilaterally.

What temperature variation might be normal in certain areas?

Hands and feet may be slightly cooler in a cool environment.

What should be assessed regarding skin moisture?

Diaphoresis (sweating) and dehydration.

What are signs of diaphoresis and dehydration in the skin?

Diaphoresis refers to excessive sweating, and dehydration results in dry skin.

What should be observed regarding skin texture?

The texture of the skin should be noted for any roughness, smoothness, or other abnormalities.

What should be assessed regarding skin thickness?

The skin thickness should be noted, as changes can indicate certain health conditions.

What does the presence of edema in the skin indicate?

Edema refers to swelling due to fluid retention and should be assessed for its severity and cause.

How is skin mobility and turgor assessed?

By gently pinching the skin to see how quickly it returns to its normal position.

What does abnormal vascularity or bruising in the skin suggest?

It may suggest circulatory issues, trauma, or physical abuse.

What should raise concern about physical abuse during skin inspection?

Multiple bruises at different stages of healing and excessive bruises above the knees or elbows.

Where might needle marks or tracks from intravenous drug use be visible?

In the antecubital fossae, forearms, or any available vein.

What should be noted about any lesions present on the skin?

The color, elevation, pattern or shape, size, location and distribution, and any exudate.

What affects the color of hair?

Hair color is due to melanin production.

What factors should be assessed regarding hair texture?

Hair texture can range from fine to thick, curly to straight, and may be affected by hair care products.

What should be assessed regarding hair distribution?

Assess whether hair is evenly distributed across the scalp and body.

What should be noted regarding lesions on the hair?

Inspect for any lesions or abnormalities on the scalp or hair.

What is the purpose of identifying hair characteristics?

Identification helps assess overall hair health and potential conditions that may affect the hair.

What should be assessed regarding the shape and contour of nails?

The profile sign should be noted by viewing the index finger at its profile and checking the angle of the nail base, which should be about 160 degrees.

How should the consistency of nails be assessed?

Check for smoothness and firmness of the nails, noting any abnormalities.

What should be observed about the color of nails?

The nail plate should be translucent, showing a pink nail bed beneath it.

How is capillary refill assessed in nails?

Depress the nail edge to blanch it for at least 5 seconds, then release and note how quickly color returns. This indicates peripheral circulation.

What is the ABCDEF rule used for in skin assessment?

The ABCDEF rule is used to teach skin self-examination to detect suspicious lesions.

What does the "A" in the ABCDEF rule stand for?

A stands for asymmetry, meaning one half of the lesion doesn't match the other half.

What does the "B" in the ABCDEF rule stand for?

B stands for border irregularity, meaning the edges of the lesion are uneven or blurred.

What does the "C" in the ABCDEF rule stand for?

C stands for color variations, meaning the lesion has different colors or shades.

What does the "D" in the ABCDEF rule stand for?

D stands for diameter greater than 6mm (1/2 cm), meaning the lesion is larger than the size of a pencil eraser.

What does the "E" in the ABCDEF rule stand for?

E stands for elevation and evolution, meaning the lesion is raised and has changed over time.

What does the "F" in the ABCDEF rule stand for?

F stands for "funny looking," meaning the lesion appears unusual or atypical.

What should be inspected in the skin, hair, and nails?

Color and pigmentation, texture and distribution, shape, contour, and consistency.

What should be palpated in the skin, hair, and nails?

Temperature and texture, edema, mobility, and turgor.

What should be noted during skin inspection regarding lesions?

Presence, shape, configuration, and distribution of lesions.

What should be taught during skin, hair, and nails assessment?

Teach self-examination to help detect changes in skin, hair, and nails.

What health promotion should be emphasized during skin, hair, and nails assessment?

Encourage self-care, skin protection, and awareness of changes to prevent and detect conditions early.