Hair, Skin, and Nails

derm/o

skin

sub

below

hypo

low, slow

hyper

fast, increased

adip/o

fat

lip/o

fat

cutane/o

skin

cyan/o

blue

erythem/o

red

hidr/o

sweat

ichthy/o

dry

kerat/o

hard tissue

melan/o

black

myc/o

fungus

squam/o

scale

therm/o

heat

xer/o

dry

pil/o

hair

trich/o

hair

onych/o

nail

cyte

cell

derma

skin

oma

tumor

phoresis

carrying, transmission

plasty

surgical repair

itis

inflammation of

Hair vellus

fine, short, soft hair “peach fuzz”

Hair terminal

thicker, longer hair

What are the 3 layers of the skin?

epidermis, dermis, and subcutaneous

Epidermis

outermost layer for protection

Dermis

contains blood vessels, nerves, glands, and hair follicles

Subcutaneous

contains fat and provides cushion, energy, and storage

What are the parts of the hair?

root, shaft, and follicle

Root

part of the hair below the skin

Shaft

part of the hair that extends above the skin

Follicle

structure of the skin where the hair grows

Eccrine glands

regulate body temperature through temperature

Apocrine glands

larger glands that are deeper in the skin AND activate at puberty to contribute to body odor

Sebaceous gland

produce sebum and helps keep the skin and hair lubricated and moisturized

Nails

epidermal cells converted to hard plates of keratin

Parts of the nail

free edge, nail body, and nail root

Skin physiology

Gives protection

Retains body fluids and electrolytes

Sensory perception

Body temperature and wound regulation

Absorption, excretion, and production

Skin Cancer Risk Factors

personal history of skin cancer, family history, older age, exposure to UV radiation, fair skin, blonde/red hair, blue or green eyes, moles

OLD CARTS

Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, Severity

Beginning 5

2 patient identifiers, hand hygiene, provide privacy - cover patient with a drape, temperature and comfort educate, and gain permission

What are the abnormal skin colors?

Cyanosis - blue due to inadequate oxygenation

Pallor - unhealthy pale maybe from anemia or illness

Jaundice - yellowing of the skin and sclera

Pigmented Nevi

A mole about 10-40 scattered throughout the body

Freckles

small, flat, hyperpigmented macule

Patch

area of darker skin pigmentation

Striae

Silver or pink stretch marks

Which part of the hand do you use to check temperature when palpating the skin?

dorsal (non palm side)

What is the expected angle of the nail base?

160 degrees

Beau’s Lines - abnormal nail finding

grooves or transverse depressions running across the nails, can be from trauma

Koilonychia or Spoon Nails - abnormal nail finding

deep depression, nails become concave

Clubbing - abnormal nail finding

increased curvature, >180 degrees @ nails base (chronic respiratory or cardiovascular disease)

What do you assess when looking at a lession?

location/distribution, color, shape, pattern, edges, depth, size, other things

ABCDE signs of melanoma

Asymmetry, Border, Color, Diameter, Evolving

Primary lesions

develop on previously unaltered skin

Primary lesion - macule

FRECKLES, flat circumscribed area, change in color of skin <1cm big

Primary lesion - patch

non-palpable irregular shaped macule >1cm

Primary lesion - papule

elevated firm & <1cm

Primary lesion - plaque

elevated, firm, and rough lesion >1cm

Primary lesion - nodule

elevated firm lesion deeper in dermis (1-2cm)

Primary lesion - tumor

elevated solid lesion deep in dermis (>2cm)

Primary lesion - wheal

elevated irregular shaped area in cutaneous edema

Primary lesion - urticaria

HIVES wheals that form an extensive reaction

Primary lesion - cyst

elevated encapsuled lesion, filled with liquid/semi-solid material

Primary lesion - bulla

vesicle >1cm

Primary lesion - pustule

elevated lesion filled with prulent fluid

Primary lesion - vesicle

elevated not in dermis filled with serous fluid

Secondary lesions

develop after a primary lesion OR as a result of changes to the original lesion

Secondary lesion - scar

fibrous tissue that replaces normal skin after an injury

Secondary lesion - keloid

elevated irregular scar that continues to grow

Secondary lesion - Striae

Stretch marks, thinning of epidermis from stretching

Secondary lesion - excoriation

loss of epidermis

Secondary lesion - scale

heaped up keratin, flaky skin

Secondary lesion - lichenification

rough, thickened epidermis

Secondary lesion - crust

dried drainage or blood

Secondary lesion - fissure

crack or break from the epidermis to dermis

Secondary lesions - erosion

loss of part of the epidermis

Secondary lesion - ulcer

loss of epidermis + dermis and concave

Pressure Ulcer Stage 1

redness and skin intact

Pressure Ulcer Stage 2

partial skin loss and dermis can be open

Pressure Ulcer Stage 3

full skin loss extending into subcutaneous tissue

Pressure Ulcer Stage 4

full tissue loss with exposed structures like bone, tendon, or muscle

Unstageable pressure injury

thickness skin loss and do NOT know depth bc covered

Deep tissue pressure injury

damage to underlying tissue from pressure, not open, and don’t know how deep

The tool that is used to help assess a patient’s risk of developing a pressure ulcer.

Braden Scale

Vascular lesions

changes related to blood vessels or bleeding under the skin

Vascular lesion - ecchymosis

bruising

Vascular lesion - Petechiae

tiny, flat, reddish-purple spots <0.5 mm

• small amounts of bleeding/hemorrhaging into skin

Vascular lesion - purpura

reddish-purple discoloration fo the skin >5cm (infection or bleeding disorder)

Vascular lesion - angioma

benign tumor consisting of small blood vessels

Vascular lesion - telangiectasia

dialation of small blood vessels

Vascular lesion - vascular spider

small, central red areas

What are some of the differences with cyanosis, ecchymosis, erythema, jaundice, and pallor with darker skin colors?

cyanosis = ashen-grey color

ecchymosis = deeper blueish-black tone

erythema = deeper brown/purple

jaundice = yellowish-green color

pallor = skin tone lighter than normal

What are some developmental considerations with infants and children?

jaundice due to increased bilirubin, nails thin and fragile, erythema toxicum (newborn rash), diaper rash, birthmarks, stock bites (red mark @ base of skull)

What are some developmental considerations with adolescents?

acne due to increase in sebaceous gland activity

What are some developmental considerations with aging skin?

dry skin, less elasticity, loss in subcutaneous tissue, facial hair in women, balding, increased capillary fragility, solar lentigines