assessing skin, hair, and nails

Question 1

Skin basics

Answer 1

epidermis outer, four layers. dermis inner

Question 2

Four layers of epidermis

Answer 2

stratum corneum, lucid, granulosum, germinativum

Question 3

Dermis contains

Answer 3

sebaceous glands - oily sebum waterproofs hair/skin. sweat glands - eccrine for sweat/thermoregulation all over. apocrine - puberty, milky sweat

Question 4

Types of hair

Answer 4

vellus - short fine all over. terminal - longer darker coarser (head, eyebrows)

Question 5

Nails

Answer 5

hard plates of keratin. cuticle, nail body, lunula

Question 6

cuticle

Answer 6

where nails grow

Question 7

nail body

Answer 7

extends over nail bed, pink b/c blood under nail bed

Question 8

Lunula

Answer 8

half moon at base of nail (nail matrix)

Question 9

Questions to ask about skin

Answer 9

dryness, oiliness, drainage, bruising, swelling, changes in skin color, pain/itching/tingling/numbness, aggravators, relieve symptoms, body odor/perspiration (too much?)

Question 10

Old people sweat _____ than young people

Answer 10

less

Question 11

Cultural considerations for sweat

Answer 11

asians/native Americans less. African americans/caucasians more

Question 12

What do you do with a health assessment and history?

Answer 12

cluster symptoms

Question 13

Hair condition

Answer 13

loss - could be normal (males), infections, stress, stress on the roots, chemo, meds

Question 14

Nail conditions

Answer 14

malnutrition (different conditions), local irritation (biting), infections (ex: fungal)

Question 15

Lifestyle and practices related to skin hair and nails

Answer 15

sunbathe/tanning booth, sunblock, self examination, immobility, extreme temps, body piercings, tattoos, daily routines (self care), prevent from living normal life?

Question 16

Looking at health history for skin hair and nails

Answer 16

severe sunburns as child, recent hospitalizations/surgeries, skin allergies, recent infections, pregnancy, self injury. family - cancer, allergies, keloids

Question 17

Equipment for physical exam

Answer 17

examination light, penlight, mirror, magnifying glass, centimeter ruler, gloves, wood light, gown, Braden scale, pressure ulcer scale for healing (PUSH)

Question 18

Skin inspection

Answer 18

general coloration - fair at highest risk, older = pale, amount of melanin culturally

Question 19

Abnormalities in skin color

Answer 19

pallor - pale, decreased blood supply. cyanosis - blue, oxygen deficiency (especially nail bed). jaundice - yellow (pale to pumpkin), mostly in sclera, oral mucosa, palms/soles. acanthuses nigricans - dark folds/creases

Question 20

Central vs peripheral cyanosis

Answer 20

central from cardiopulmonary problem, look in oral mucosa. peripheral may be local problem, vasoconstriction. oxygen/perfusion concern

Question 21

Inspect lesions

Answer 21

symmetry, border, shape, color, diameter, changes. use magnifying glass, centimeter ruler, wood light (suspected fungus)

Question 22

skin integrity

Answer 22

intactness, reddened areas, Braden scale, lesions

Question 23

Skin types

Answer 23

1 - always burns never tans (pale)
2 - usually burns sometimes tans (fair)
3 - may burn usually tans (darker skin)
4 - rarely burns always tans (Mediterranean)
5 - moderate constitutional pigmentation (Latin American/Middle Eastern)
6 - marked constitutional pigmentation (black)

Question 24

Skin palpation

Answer 24

texture, thickness, temp, moisture, mobility/edema, turgor

Question 25

texture

Answer 25

use palmar surface of three middle fingers

Question 26

temp

Answer 26

dorsal surface of hands

Question 27

moisture

Answer 27

older may be dryer

Question 28

mobility

Answer 28

less with edema

Question 29

turgor

Answer 29

two fingers to pinch skin over clavicle area

Question 30

inspect/palpate scalp

Answer 30

wear gloves/separate hair - cleanliness, dryness, oiliness, parasites, lesions. amount/distribution of hair

Question 31

Inspect/palpate nails

Answer 31

grooming/cleanliness, color/markings, shape. assess texture/cap refill - <2

Question 32

Normal skin variations

Answer 32

freckles, vitiligo (depigmentation), striae (stretch marks), scars, moles, cutaneous horn (ears), cutaneous tag, seborrheic keratosis, cherry angiomas

Question 33

Skin lesion configuration

Answer 33

linear, annular, clustered, discrete, nummular, confluent

Question 34

linear

Answer 34

straight line like a scratch

Question 35

annular

Answer 35

circular lesions

Question 36

clustered

Answer 36

lesions grouped together

Question 37

discrete

Answer 37

individual and distinct lesions

Question 38

nummular

Answer 38

coin shaped lesions

Question 39

confluent

Answer 39

smaller lesions run together to form a larger lesion

Question 40

pressure ulcers

Answer 40

Stage 1, stage 2, stage 3, unstageable

Question 41

Stage 1 pressure ulcer

Answer 41

intact skin, nonblanchable redness

Question 42

Stage 2 pressure ulcer

Answer 42

partial thickness loss of dermis, shallow red/pink wound bed, no slough

Question 43

Stage 3 pressure ulcer

Answer 43

full thickness tissue loss, may see fat but not bone/tendon/muscle

Question 44

Stage 4 pressure ulcer

Answer 44

full thickness tissue loss w/ exposed bone/tendon/muscle, often includes tunneling or undermining

Question 45

Unstageable

Answer 45

full thickness tissue loss but base covered w/ slough/eschar, can't see

Question 46

Primary lesions

Answer 46

solid - papule, plaque, nodule, not solid - vesicle, bulla, pustule, wheal, cyst

Question 47

Vascular lesions (abnormalities)

Answer 47

petechia, ecchymosis, hematoma, spider angioma

Question 48

Papule

Answer 48

circumscribed elevated, palpable, solid mass. <0.5cm

Question 49

nodule

Answer 49

elevated solid palpable mass that extends deeper into dermis, 0.5-2cm

Question 50

plaque

Answer 50

>0.5cm, coalesced papules w/ flat top

Question 51

Vesicle

Answer 51

circumscribed elevated palpable mass containing serous fluid, <0.5cm

Question 52

bulla

Answer 52

circumscribed elevated palpable mass containing serous fluid >0.5cm

Question 53

pustule

Answer 53

pus filled vesicle or bulla

Question 54

wheal

Answer 54

elevated mass w/ transient borders, often irregular. serous fluid in dermis (not free fluid in cavity)

Question 55

cyst

Answer 55

encapsulated fluid filled mass in subcutaneous tissue or dermis

Question 56

petechia

Answer 56

pinpoint skin hemorrhage (1-2mm), secondary to blood extravasation, red/purple macule

Question 57

ecchymosis

Answer 57

bruise - secondary to blood extravasation, larger than petechia

Question 58

hematoma

Answer 58

localized collection of blood, creates elevated ecchymosis

Question 59

Spider angioma

Answer 59

red arteriole lesion, central body w/ radiating branches, rarely below waist. compression of center completely blanches

Question 60

ABCDE

Answer 60

asymmetry, border, color variations, diameter >6mm, evolution - changes over time

Question 61

abnormalities in color variations

Answer 61

Pallor, cyanosis, jaundice, acanthosis nigricans

Question 62

pallor

Answer 62

pale to ashen without underlying pink. Due to decreased blood supply (arterial insufficiency)

Question 63

cyanosis

Answer 63

blue-tinged. mostly in the pectoral, nail bed, and conjunctival areas. Light skin blue color noted and dark skin blue, dull, and lifeless. Oxygen deficiency

Question 64

jaundice

Answer 64

yellow skin tones ranging from pale to pumpkin. They are primarily seen in the sclera, oral mucosa, palms, and soles.

Question 65

acanthosis nigricans

Answer 65

velvety darkening of the skin in body folds and creases. especially the neck, groin, and axilla.

Question 66

Central cyanosis

Answer 66

results from cardiopulmonary problems. Look for central cyanosis in the oral mucosa.

Question 67

peripheral cyanosis

Answer 67

local problem. Vasoconstriction.

Question 68

So a skin color variation indicates an oxygenation and perfusion concern?

Answer 68

Yes..... the body is connected