skin, hair, nails

pallor

red/pink from Hgb in blood lost

uses connective tissue collagen → white appearance

cause:

• anemia

• shock

• arterial insufficiency

erythema

intense redness

excess blood dilates superficial capillaries

cause:

• fever

• inflammation

• emotion

• polycythemia

• carbon monoxide poison

cyanosis

decreased perfusion

tissue with increase level deoxygenated blood

cause:

• hypoxemia

• cardiac arrest

• hrt failure

• chronic bronchitis

jaundice

rising bilirubin in blood

cause:

• hepatitis

• cirrhosis

• sickle-cell

tinea capitis

scalp ringworm

round, patchy hair loss

leave scale on skin

pediculosis capitis

head lice

nits (eggs) visible in scalp, behind ear, nape of neck

constant itch

loss skin turgor

decreased elasticity

breakdown collagen, malnutrition, dehydration

skin fat loss

clubbing of nail

congenital cyanotic hrt disease

lung cancer

pulmonary disease

sebaceous glands

oil

sebum

eccrine gland

sweat

regulate temperature

apocrine gland

body odor

infant

lanugo → fine hair

vernix caseosa → cheese, protective coat

sebum → white bump, water producing milia

children

epidermis thickens, darken, lubricate

hair growth

adolescent

acne

secretion of apocrine sweat gland

subcutaneous fat deposit

secondary sex characteristic

pregnancy

increased metabolism, secretion sweat/sebaceous gland to dissipate

fat deposit laid down

striae

linea nigra

chloasma

vascular spider

older adults

elasticity loss

sweat/sebaceous glands → dry skin

senile purpura → discoloration

skin breakdown → slow replace, wound heal delay

hair matrix → melanocyte decreased, gray fine hair

clues of abuse

stories not matching

freq seek of injury cause

withdrawn, quiet, depression, anxious

companion refuse to leave pt side

objective instruction

outer skin surface first → underlying structure

separate intertriginous area, inspect thoroughly → skin folds

feet, toenail, between toes

secondary lesion

scale, crust

• dried exudate

• desquamation keratin

fissure, erosion

• linear crack

• no scar

ulcer, excoriation

• deep dermal loss → scar

• self-inflected

scar, atrophic

• lichenification

• keloid

• excess fibrous tissue

lesion shape

linear

circular/annular

clustered

dermatomal → shingle

confluent → lesion run together

discrete/grouped

gyrate → twisted

target/iris → concentric rings

polycyclic → annular lesion grow together

zosteriform → unilateral dermatome

ABCDEF skin assessment

Asymmetry

Border irregular

Color variation

Diameter > 6mm

Elevation or evolution

Funny looking

skin cancer basal cell

pearl

roll border

central ulceration

skin cancer squamous

scally

ulcerate

plaque/nodule

skin cancer melanoma

deadly

pigmented lesion with irregular border and color

health promotion

sunscreen

avoid tan beds

skin self-checks

hydration

hygiene

priority checks

first level

• airway

• breathing

• circulation

second level

• mental status

• acute pain

• infection risk

• abnormal loss

• elimination problem

third level

• lack knowledge

• mobility

• family coping

macule

flat

< 1cm

circumscribed color change

vesicle

elevated cavity

up to 1 cm

free fluid

wheal

superficial

raised

erythematous

annular

circular

spread to periphery

discrete

distinct

individual lesion

grouped

cluster lesion

skin

largest organ

protect from trauma, infection, environment

epidermis

outer layer

replaces every 4 weeks

cells: basal, horny

dermis

collagen

strength

connective tissue

subcutaneous

cushioning, insulation

adipose tissue

melanin

skin color

keratin

strength

hair

made of keratin

vellus → fine

terminal → thick

hair

normal → 160 degree

curved → 160 or less

early clubbing → 180

clubbing → heart/lung disease

culture and genetics

dark skin = increased melanin, decreased skin cancer risk

risk factor = UV exposure

subjective health hx

hx skin disease

change pigmentation

change mole size

excessive dry/moist skin

pruritus

excessive bruise

rash/lesion

medication

hair loss

change in nails

environment/occupational hazard

pt-centered care

subjective children hx

birthmark

change skin color

rash/sore

diaper rash

habit of nail bite, hair twist

step taken to protect child from sun exposure

adolescent subjective

skin issues → acne

aging adult subjective

changes of skin past few years

delay wound heal

change in feet

• toenail

• bunion

• shoes

bruise, trauma

hx diabetes or peripheral vascular disease

inspect, palpation color

dark skin → palm, soles, conjunctiva

widespread of color

general pigmentation:

• freckle

• mole

• birthmark

inspect, palpation temperature

back of hands

normal = warm, bilaterally, normal circulation

inspect, palpation moisture

diaphoresis → sweat

tenting → dehydration

inspect, palpation texture

smooth

firm

inspect, palpation thickness

callus formation

inspect, palpation edema

fluid accumulation interstitial space

1+

2+

3+

4+

inspect, palpation mobility, turgor

skin elasticity

inspect, palpation lesion

color

elevation

pattern, shape

size

location

inspect, palpation hair

color

texture

distribution

lesions in scalp

inspect, palpation nails

shape, contour

color

capillary refill

PRIORITY

signs of cancer

infection

poor circulation

pressure areas

vascular, purpuric lesion

hemangiomas → port wine stain, cavernous

telangiectasia → spider angioma, venous lake

purpura spectrum

• petechiae < 2mm

• purpura 2-10mm

• ecchymosis > 10mm

bruise evolution

• red/blue → blue-purple → green → yellow → brown