Chapter Nine Hair, Skin, and Nails

Health Assessment

What represents the structural intactness and physiologic function of tissues and conditions that affect integrity?

Tissue Integrity

What influences tissue integrity?

• Motion

• Tactile Perception

• Perfusion

• Gas Exchange

• Elimination

• Nutrition

What is required for the maintenance of tissue integrity?

• Adequate Perfusion

• Adequate Nutrition

What does perfusion do?

Carry oxygenated blood and nutrients to tissues

What happens when perfusion is impaired?

Tissue injury or necrosis

What does a loss of tissue integrity result in?

Pain

What are the accessory structures of the skin?

• Hair

• Nails

• Sweat Glands

• Sebaceous Glands

What does the skin and accessory structures form?

Integumentary System

What are the functions of the skin?

• Protect body from microbial and foreign-substance invasion

• Protect internal body structures from minor physical trauma

• Retain body fluids and electrolytes

• Production of Vitamin D

• Excretion of sweat, urea, and lactic acid

• Expression of emotion

• Repair of its own surface wounds

What processes regulate body temperature?

• Radiation

• Conduction

• Convection

• Evaporation

What three layers make up the skin from superficial to deep?

1. Epidermis

2. Dermis

3. Hypodermis

Which layer of skin is the subcutaneous layer?

Hypodermis

Which layer of skin is the thin, outermost layer of the skin and is composed of stratified squamous epithelium?

Epidermis

What does the term avascular mean?

No direct blood supply

Which layer of skin is avascular?

Epidermis

What occurs in the deepest layer of the epidermis?

Active cell regeneration takes place

What does the process of keratinization do?

Causes the protein keratin to deposit which will cause the cells to become flat, hard, and waterproof

How often does the process of keratinization take place?

Approximately Thirty Days

What are the functions of melanin?

• Provides pigment for the skin and hair

• Serves as a shield against ultraviolet radiation

Which layer of skin comprises of highly vascular connective tissue?

Dermis

What regulates body temperature and blood pressure within the dermis?

Blood vessels dilating and constricting

What is the support structure for the dermis and epidermis?

Hypodermis

Which layer of skin is primarily composed of loose connective tissue and fat?

Hypodermis

What are the functions of fatty cells?

• Retain heat

• Provide a protective cushion

• Provide calories

What are to be considered appendages?

• Hair

• Nails

• Glands

Where are appendages formed?

Junction of the epidermis and the dermis

What forms hair?

Epidermal cells in the dermis

What is the structure of hair?

• Root

• Shaft

• Follicle

What supplies nourishment for growth at the base of a hair follicle?

Papilla

What are the epidermal cells converted to hard plates of keratin?

Nails

What makes up a nail?

• Free Edge

• Nail Plate

• Nail Root

What does the white, crescent-shaped area at the base of the nail represent?

New Nail Growth

What dos the term paronychium refer to?

Skin tissue adjacent to the nail

What glands regulate body temperature?

Eccrine Sweat Glands

How do eccrine sweat glands regulate body temperature?

Water secretion through the surface of the skin

What are the most numerous and widespread glands on the body?

Eccrine Sweat Glands

What primarily controls sweat glands?

Nervous System

Where would you find apocrine sweat glands?

• Axillae

• Nipples

• Areolae

• Anogenital Area

• Eyelids

• External Ears

When do apocrine sweat glands begin secretion?

Puberty

What does the decomposition of apocrine sweat glands produce?

Body Odor

What do sebaceous glands secrete?

Sebum

What does sebum do?

Keeps the skin and hair lubricated

The following is an example of which health history?

Ex. Do you have any chronic illnesses?

Present Health History

The following is an example of which health history?

Ex. Have you ever had problems with your skin such as skin disease, infections involving the skin or nails, or trauma involving the skin?

Past Health History

The following is an example of which health history?

Ex. Has anyone in your family ever had skin-related problems such as skin cancer or autoimmune-related disorders such as systemic lupus erythematosus?

Family Health History

The following is an example of which health history?

Ex. What do you do to keep your skin healthy?

Personal and Psychosocial Health History

What are commonly reported symptoms of skin disease?

• Pruritus

• Rashes

• Pain

• Lesions

• Changes in skin color and texture

• Wounds

• Changes in hair or nails

What mnemonic is used to assess a problem-based history?

OLDCARTS

What does the term pruritus refer to?

Itching

What factors could cause pruritus?

• Excessively dry or sensitive skin

• Allergic response (hives)

• Exposure to chemicals

• Infestation of scabies, lice, or insect bites

What diseases may cause pruritus?

• Biliary Cirrhosis

• Lymphoma

What does the term ecchymosis refer to?

Bruising

Clinical signs of a reddish tone with evidence of increased skin temperature secondary to inflammation indcates…

Erythema

Clinical signs of a yellowish color of skin, sclera of eyes, fingernails, palms of hand, and oral mucosa indicate…

Jaundice

What term relates to pale skin color that may appear white?

Pallor

What term refers to the small reddish-purple spots that apear on the mouth or the sclera of the eyes?

Petechiae

What can be visualized and felt with light palpation?

Rash

What can have frequent keloid development?

Scar

What is the clinical term for moles?

Nevi

What term refers to the small, flat, hyperpigmented macules that appear anywhere on the body?

Freckles

What term refers to an area of darker skin pigmentation that is usually brown or tan?

Patch

What is the clinical term for stretch marks?

Striae

What does the ABCDEF stand for when assessing a patient’s skin?

• Asymmetry

• Border

• Characteristics

• Diameter

• Evolving

• Feeling

What would be a concern diameter of the ABCDEF of assessing skin?

Six Millimeters

What terms would be used to describe the texture of skin?

• Smooth

• Soft

• Intact

• Even Surface

• Calluses (If Present)

What terms would be used to describe the temperature of skin?

• Hot

• Warm

• Cool

• Cold

What part of the hand should you use when assessing the temperature of a patient

Dorsal aspect of the hands

What terms would be used to describe the moisture of skin?

• Dry

• Oily

What term refers to assessing the mobility of skin by picking up and slightly pinching the skin on the forearm or under the clavicle before releasing…

Skin Turgor

What is the clinical term for excessive sweating?

Diaphoresis

What terms would be used to describe the nails when assessing?

• Length

• Smooth

• Rounded

• Ridges

• Firm

• Thick

• Brittle

• Thin

What is the expected angle of the nail base?

One-Hundred-Sixty Degrees

What occurs when the angle of the nail base exceeds one-hundred-eighty degrees?

Clubbing

What appears as white spots on the nail plate which is caused by minor trauma or manipulative of the cuticle?

Leukonychia

What does clubbing indicate?

Chronic respiratory or cardiovascular disease

How are lesions clasified?

1. Primary

2. Secondary

3. Vascular

What is the clinical term for acne?

Comedones

What are examples of primary lesions?

• Moles

• Freckles

• Patches

• Comedones

What is used to assist in assessing primary lesions?

Wood’s Lamp

What is an example of a secondary lesions?

Scar

What is an example of vascular lesions?

Ecchymosis

Which skin lesion is described as a flat, circumscribed area that is a change in the color of skin and is less than one centimeters in diameter?

Macule

Which skin lesion is described as elevated, firm, circumscribed area less than one centimeter in diameter?

Papule

Which skin lesion is described as a flat, nonpalpable, irregular-shaped macule more than one centimeter in diameter

Patch

Which skin lesion is described as elevated, firm, and rough lesion with flat top surface greater than one centimeter in diameter?

Plaque

Which skin lesion is associated with freckles?

Macule

Which skin lesion is associated with a wart?

Papule

Which skin lesion is associated with vitiligo?

Patch

Which skin lesion is associated with psoriasis?

Plaque

Which skin lesion is described as elevated, firm, circumscribed lesion deeper in dermis than a papule?

Nodule

Which skin lesion is associated with erythema?

Nodule

Which skin lesion is described as elevated and solid lesions which may or may not be clearly dermarcated and is deeper in the dermis?

Tumor

Which skin lesion is associated with neoplasms?

Tumor

Which skin lesion is described as a vesicle greater than one centimeter in diameter?

Bulla

Which skin lesion would a blister be an example of?

Bulla

Which skin lesion is described as elevated, superficial lesion, which is similar to a vesicle, but filled with purulent fluid?

Pustule

Which skin lesion would acne be an example of?

Pustule

Which skin lesion is described as a heaped-up keratinized cell?

Scale

Which skin lesion is described as an irregular-shaped, elevated, progressively enlarging scar that grows beyond the boundaries of the wound?

Keloid

Which skin lesion is described as thin-to-thick fibrous tissue that replaces normal skin following injury or laceration to the dermis?

Scar