Lecture 4: Skin, Hair, and Nails Flashcards
(52 cards)
Layers of Skin + Function
- Epidermis
- Thin, tough - Dermis
- Connective tissue (collagen)
- Elastic tissue
3 Subcutaneous layer
- Adipose layer: store fat (energy), temperature, protection (cushion)
Function Of the Skin
- Protection
- Prevents penetration
- Perception (sensory)
- Temperature regulation
- Identification
- Communication
- Wound repair
- Absorption and excretion
- Production of vitamin D
Developmental Considerations: Infant and children
- Newborn
- Lanugo, vernix caseosa; skin thin and more permeable, greater risk for fluid loss, ineffective temperature regulation - At puberty
- Increased sweat gland secretions, more active sebaceous glands, evidence of secondary sex characteristics in skin
Developmental Considerations: Pregnant Women
- Connective tissue becomes fragile
- Striae (stretch marks)
Developmental Considerations: Older adults
- Slow atrophy of skin structures
- Loss of elasticity, collagen, subcutaneous fat
- Thinning skin
- Decreased sweat and sebaceous glands
- Greater risk for heat stroke
- Increased risk for skin disease
- Change in hair distribution
- Psychological impact of visible aging
Health History
- Previous history of skin disease (allergies, hives, psoriasis, or eczema)
- Change in pigmentation
- Change in mole (size or colour)
- Excessive dryness or moisture
- Pruritus – itchiness
- Excessive bruising
- Rash or lesion
- Medications
- Hair loss
- Change in nails
- Environmental or occupational hazards
- Self care behaviours
Additional Heath History Q’s: Infants and children
- Birthmarks
- Skin colour changes: jaundice, cyanosis
- Allergic rash
- Diaper rash
- Burn or bruises
- Exposure to contagious skin conditions
- Sun protection
Additional Heath History Q’s: Adolescents
- Skin problems
Additional Heath History Q’s: Older adults
- Skin changes
- Delay in wound healing
- Skin pain
- Foot/nail changes
- Falling
- Diabetes or cardiovascular disease
- Skin care
Subjective Data (OPQRSTU)
O: Onset
- When did it start? When did you first notice it?
P: Provocative or Palliative
- What brings it on? What were you doing when you first noticed it? What makes it better? What makes it worse?
Q: Quality or quantity
- How does it look, feel? How intense/severe is it?
R: Region or Radiation
- Where is it? Does it spread anywhere?
S: Severity Scale
- How bad is it (on scale of 1-10)? Is it getting worse, better, staying the same?
T: Timing
- Onset - Exactly when did it first occur?
- Duration - How long did it last?
- Frequency - How often does it occur?
U: Understand Patient’s Perception
- What do you think it means?
Inspect and Palpate: Skin
- Colour
- General pigmentation: Presence of freckles, moles, birthmarks
- Widespread colour change: Pallor, erythema, cyanosis, jaundice - Temperature: hypothermia/hyperthermia
- Moisture - diaphoresis/dehydration
- Texture
- Thickness
- Edema
- Mobility and turgor
- Vascularity or bruising
Lesions
- Colour
- Elevation
- Pattern or shape
- Size
- Location and distribution on body
- Exudate
What is the Braden Scale
- For predicting pressure sore risk
(an area of skin over a bony prominence and the circulation becomes compromised
Inspect and Palpate: Hair
- Colour
- Texture
- Distribution
- Lesions
Inspect and Palpate: Nails
- Shape and Contour: Profile sign; index finger, angle of nail base, firm to palpation
- Consistency; smooth and regular vs. brittle or splitting
- Colour: Capillary refill; even pink nail bed, capillary refill
ABCDE Rule
A - Asymmetry
B - Border – irregularity
C - Colour – varied
D - Diameter – greater than 6mm
E - Elevation and enlargement, or evolving changes such as change in size, shape, symptoms (itching, tenderness), surface (bleeding) and shades of colour
Developmental Considerations: Older Adult
- Senile lentigines (liver spots)
- Keratoses: seborrheic
- Skin tags
- Sebaceous hyperplasia
- Thin, parchment-like skin
- Skin “tents” by itself
- Decreased hair growth; changs in thickness, colour
- Thickened, brittle, or yellow nails
Abnormal Findings
Common shapes and configurations of lesions:
- Annular or circular
- Confluent
- Discrete
- Grouped
- Gyrate
- Target or iris
- Linear
- Polycyclic
- Zosteriform
Primary Skin Lesions
- Macule, papule, patch, plaque, nodule, wheal, tumour, urticaria (hives), vesicle, cyst, bulla, or pustule
Secondary Skin Lesions
- Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, or keloid
Annular or Circular Lesions
Appear as circular or ovoid macules or patches with an erythematous periphery and central clearing
Confluent Lesions
Lesions that arise due to spatially separate sources of structural damage in the brain, usually separated in time, occur near each other and create a larger connected region of lesion tissue
Confluent Lesions
Lesions that arise due to spatially separate sources of structural damage in the brain, usually separated in time, occur near each other and create a larger connected region of lesion tissue
Discrete Lesions
Are distinctly separate from each other with identifiable borders
