skin and nails

Excretion is linked to body odor, particularly in the following areas:
- Axilla (underarms)
- Anogenital areas
Sweat glands are populous on the palms and soles, lacking sebaceous glands.

Nails are composed of hard keratin.
- Components of nails:
- Lumbula: The white half-moon shape at the base of the nail.
- Cuticle: Located at the nail's base, acting as a protective gasket.

Older adults experience the following changes in their skin:
- Loss of elastin and collagen
- Reduction in subcutaneous fat leading to sagging skin
Skin turgor: a measure of skin elasticity.
- Tested by pulling up the skin and observing if it snaps back.
- Quick snap-back indicates hydration.
- Failure to return indicates potential dehydration, particularly in older adults.
- Ideal area for testing skin turgor: under the clavicle, as the skin on the back of the hand may already be sagging.

When assessing head coverings in patients who choose to wear them, it's vital to:
- Ask for permission before removal.
- Document that the patient declined for cultural or religious reasons.

Hair texture varies by ethnicity:
- African American hair tends to be coarse.
- Asian hair is typically silky and smooth.

Cupping is an ancient therapy practiced in Asia, the Middle East, and Egypt, aiming to alleviate pain, inflammation, and promote relaxation.
It has gained popularity in the U.S., with practitioners using heated glass domes on the skin.
Example: Olympic swimmer Michael Phelps used cupping for shoulder discomfort.

Signs of dehydration include:
- Cracked lips
- Dry mucous membranes
- Significant weight loss and weakness in elderly patients may necessitate emergency care.
Nurses should observe skin turgor during assessments.

Cyanosis: a blue tint to the skin indicating decreased oxygenation.
Immediate action is required: administer oxygen, even without a physician's order, as it can be a life-threatening condition.

Look for signs of impaired skin integrity, such as:
- Chemical or thermal burns
- Pressure ulcers
- Abrasions
- Rashes
Encourage patients to provide subjective data on skin history during health assessments.

Systematic review includes asking patients about:
- Skin itching, rashes, or sores
- Personal history of sunburn or chemical burns
- Skin care regimen (e.g., sunscreen usage, beauty treatments)

For infants and children, inquire about:
- Birthmarks and changes in skin color
- History of physiological jaundice or infections and their treatments (e.g., exposure to toxic plants).

Regular assessments for older adults should include inquiries about noticeable skin changes, speed of wound healing, particularly for diabetics, and any new bumps or lesions.

Cultural sensitivity is essential, e.g., some Arabic women may require a chaperone during assessment.
Ensure patient comfort and privacy during skin examinations, using warm rooms and appropriate tools (e.g., a ruler, good lighting).

Inspect skin for:
- Color, temperature, distribution
- Lesions, pigmentation
- Signs of bruising or abuse:
- Look for needle marks, tattoos, which must be documented.

Assess nails for shape, color, and contour:
- Clubbing of nails: indicative of heart and lung diseases, often found in cystic fibrosis and heavy smokers.
- Measure capillary refill time (should be < 3 seconds) and observe for cyanosis in nail beds.

Use dorsal hand for temperature assessment.
- Skin should be evenly warm.
- Check for edema, distinguishing between generalized and localized swelling:
- Pitting edema: leaves an impression when pressed.

Assess bruises (also known as ecchymosis):
- Fresh bruises undergo color changes through stages.

Common conditions in children:
- Diaper rash, candidiasis (yeast infection), impetigo
- Eczema, measles, and chickenpox.
Document various skin lesions and their implications in adults:
- Basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and Kaposi's sarcoma (associated with AIDS).

Discuss any skills and assessments in laboratory settings that will be practiced in forthcoming sessions starting at 1:10 PM.