Module 2: Skin & Hair/Head & Neck Disorders

Objectives:

Hair, Skin, and Nails

  • Identify normal and age-related variations in the skin, hair, and nails, and recognize common abnormalities across the lifespan

  • Describe how the skin reflects overall health, including its roles in signaling systemic disease and chronic conditions

  • Differentiate abnormal skin lesions and understand risk factors and prevention strategies for pressure injuries/ulcers

  • Explain the risk factors, characteristics, differences, and early detection techniques for the three most common types of skin cancer

  • Apply health promotion and risk reduction strategies to maintain healthy skin, hair, and nails across the lifespan

Head and Neck Disorders

  • Identify risk factors, signs, and symptoms of traumatic brain injuries and explain their clinical implications

  • Differentiate between the major types of headaches based on characteristics, causes, and treatments

  • Compare hypothyroidism and the major types of headaches based on characteristics, causes, and treatments

  • Explain the pathophysiology, diagnosis, and management of malignant multiple myeloma

Head and Neck Disorders

Structure and Function of the Head:

  • Cranium encases and protects brain and brainstem

  • Consists of 22 cranial and facial bone

  • Movements of these bones allows for facial expressions, eating, speech, and head movement

  • Information processing center

  • Aids in sensory functions

Headaches:

  • Can be benign or a warning sign of serious conditions

    • EX: brain tumor or subarachnoid hemorrhage

  • 3 Types:

    • Tension

    • Cluster

    • Migraine

Assessment of Headaches:

  • Medical and social history

  • Neurological exam

  • Headache impact test (HIT-6)

  • Headache diary

  • CT scan

  • MRI

  • EEG

Tension Headaches:

  • Occurring periodically due to stress

  • The pain is dull, aching, with gradual onset and present as a pressure or bandlike sensation in the head

  • Pain is often bifrontal or occipitofrontal

  • Often associated with muscular tightness in the neck, shoulders, and occipital area

  • Vital signs and neurological examination are normal

  • Non Opioid medications provide relief

Cluster Headaches

  • A neurovascular disorder characterizes by sever, unilateral, periorbital pain

    • involves the activation of the hypothalamus and the trigeminal nerve

  • Commonly occurs in early morning hours or sleep

  • Pain is described as sharp, stabbing, and unilateral with radiation to the cheek, jaw, occipital region, or neck

  • Hallmark signs:

    • tearing of the eyes

    • conjunctival injection

    • rhinorrhea

    • eyelid edema

    • ptosis

  • Triggers:

    • alcohol

    • tobacco

    • stress

    • allergy

    • weather changes

  • Vital signs and neurological examinations are normal

  • non opioid medications give relief

Migraine Headaches

  • Etiology: genetic, environmental, and neurological factors

    • 75% of the sufferers being women

  • Abnormal nerve activity causes changes in cerebral perfusion, causing recurrent headaches

  • Low serotonin levels lead to constriction/dilation of blood vessels

  • Without treatment, a migraine headache can last 4-72 hours

  • Unilateral, vascular throbbing headache

    • Associated symptom of nausea, vomiting, and sensitivity to light and sound

  • Often preceded by an aura, a visual or sensory experience that occurs before the headache

  • Commonly precipitated by stress, hormones, smoking, weather changes, food additives, caffeine, alcohol, or excessive fatigue

  • Treatment of migraine is focused on alleviating pain:

    • Acute headache

    • Preventative treatment

Traumatic Brain Injury

  • Injury to the brain that causes temporary short-term or long-ter problems with brain function

    • Extend and location of the injury determines level of disability

  • Etiology

    • Accidents involving automobile, motorcycles, bicycles

    • Falling

    • Excessive alcohol ingestion

    • Abuse of infants and elderly being cared for by caregivers

  • Symptoms:

    • Headaches and fatigue

    • Blurred vision

    • Vomiting

    • Confusion

    • Memory problems

    • Loss of consciousness

    • Seizures

    • Changes in speech

  • Treatment:

    • Varies based on extent of injury

Lymphatic Tissue of the Neck

  • Function is to transport lymph, fluid containing WBCs throughout the body

  • Lymph Nodes serve as the center for proliferation and response of immune cells

  • 100s of them go throughout the body

  • Lymphnodes filter out the debris that has been collected through the use of macrophages

  • When pathogens invade the body, lymphnodes become enlarged. This is called lymphadenopathy

Multiple Myeloma

  • Cancer of the lymphatic system

  • Arises from B-lymphocytes that are neoplastic and invade the bone marrow

  • Pathophysiology

    • Proliferation of malignant plasma in the bone marrow and osteolytic bone lesions throughout the skeletal system

      • Overproduction of the monoclonal antibody

      • Disrupts normal antibody production

      • Weakens immune system

  • Incurable

  • More common in men; African Americans

  • Risk factors: exposure to chemicals, agent orange, radiation, genetic factors

  • Clinical manifestations:

    • Severe bone pain

    • Pathologic fractures

    • Hypercalcemia (high blood calcium levels)

    • Anemia

    • Recurrent infections

    • Weight loss

    • fatigue

    • Renal insufficiency

  • Diagnostic

    • Bone marrow biopsy

    • X-rays

    • CBC

    • Urine - Bence Jones Proteins

  • Management:

    • Steroids

    • Chemotherapy

    • Stem cell transplant

  • Complications

    • Fractures

    • Leads to bone destruction, bone marrow failure, renal failure, and neurological complications

Thyroid disorders

  • Butterfly shaped gland on front of the neck

  • Functions of the thyroid: metabolism, growth and development of the human body

  • In response to thyroid stimulating hormone, produces:

    • T3- triiodothyronine

    • T4- thyroxine

  • Assessment and Diagnostic:

    • Palpate thyroid gland

    • T3/T4/TSH levels

Hyperthyroidism

  • Sudden weight loss, without changes in appetite

  • Tachycardia, irregular heartbeat, or palpitations

  • Nervousness, anxiety, and irritability

  • Tremors in hands or feet

  • Sweating

  • Changes in bowel patterns, more frequent bowel movements

  • Fatigue, insomnia, muscle weakness

Hypothyroidism

  • Increased sensitivity to cold

  • Unintentional weight gain

  • Pale, dry skin

  • Thin, brittle hair or nails

  • Constipation

  • Depression

  • Fatigue

  • Weakness

Hair, Skin, an Nail Disorders

Nails can inform about systemic disorders → hypoxia, endocarditis, infection, circulation issues, etc

Hair can also reflect metabolic changes → hair needs blood supply and adequate diet to grow

  • Associated with sebaceous glands which release oil

  • Arrector pili - muscles that contract to “goosebump” as part of thermoregulation

Sweat glands:

  • Eccrine - orginate in the dermis and open to the skin surface

    • Transport sweat to the outer skin surface to regulate body temperature

  • Apocrine - located deep in the dermis, open through a hair follicle

    • Found in the axilla and groin

    • Secrete oily substances that mixes with bacteria → body odor

Diagnostic Tools to Assess the Integumentary System:

  • Skin scraping - good for fungal infections

  • Patch testing

  • Biopsy

  • Wood’s UV light - illuminated areas with bacteria

Common Changes Associated with Aging

  • Skin:

    • Pale

    • Skin lesions (age spots among other things)

    • Dry

    • Loses turgor 

  • Hair → thinner

  • Nails → thickened, yellow, and brittle

    • Caused by decreased blood flow to the hands

  • Subcutaneous (adipose) tissue decrease with age

Skin Lesions:

  • Primary - developed as a result of a disease process

    • Macule and Patch

    • Papule and plaque

    • Nodule and tumor

    • Vesicle and bulla

    • Wheal

    • Pustule - filled with dead neutrophils

    • Cyst

  • Secondary - evolved from primary; may be from scratching, improper care, etc. 

    • Erosion

    • Ulcer

    • Scar

    • Fissure

Disorders to know:

  • Skin:

    • Albinism

    • Melasma

    • Cellulitis

    • Pressure Ulcers

    • Psoriasis

    • Skin cancers

    • Shingles

    • Vitiligo

  • Hair:

    • Pattern Baldness

    • Alopecia

  • Nails:

    • Paronychia

    • Onychomycosis

    • Ingrown Nails