202SkinHairNails

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Anonymous
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8229
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202SkinHairNails
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2010-02-26 13:51:59
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202: Skin, Hair, & Nails
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  1. *Epidermis
    -Outer layer, avascular (no BV, doesn't bleed)
  2. *Dermis
    -hair, nails
    • -Inner layer, contains nerves, sensory receptors, BV, lymphatics
    • -Hair: VELLUS (fine, soft, non pigmented; covers body except palms, soles, umbilicus, glans penis, inside labia), TERMINAL (course, thick, pigmented; scalp, eyebrows, eyelashes, axillae, pubic, face&chest in males)
    • -Nails
  3. *Dermis
    -Eccrine gland
    Produces sweat/perspiration (saline), matures at 2mos
  4. *Dermis
    -Apocrine glands
    • -Opens into hair follicles
    • -Activated during puberty
    • -Secrete fluid in response to stimuli & heat
    • -Decomposition of apocrine sweat produces BO (action of bacteria in fluid)
    • -Located in axillae, nipples, areolae, anogenital area, eyelids & external ears
    • -Secretion dec w/ aging (more prone to overheating)
  5. *Dermis
    -Sebaceous glands
    • -Secretes sebum which lubricates skin & nails
    • -Concentrated in scalp & face (absent on palms & soles)
    • -Some conditions in adult and child are r/t overproduction of sebum (cradle cap, acne, seborrheic dermatitis)
  6. Subcutaneous Tissue
    • -Adipose or hypodermis
    • -Layer below the skin
  7. Skin Functions
    • -Protect: against bacteria, fluid/electrolyte loss
    • -Sensory perception: pain, touch, temp, pressure
    • -Thermoregulation: due to sweat & fat insulation
    • -Replaces cell in surface wounds (aides in wound repair)
    • -Absorption&Excretion: metabolic wastes-sweat, lactic acid, urea
    • -Renal failure-->uremic frost: kidneys can't excrete waste, urea seeps out through skin
    • -Vit D production: compounds are converted into Vit D when UV light comes into contact w/ skin surface
  8. Subjective Data
    • -Previous hx of skin dz, change in pigmentation
    • -Change in mole size, color, shape
    • -Xerosis (dryness), Seborrhea (oily skin), prutitis (common w/ age d/t xerosis, chronic illness)
    • -Excessive bruising (abuse, clotting disorder, falls), rash, lesions
    • -Medications: may cause skin eruptions, pruritis, photosensitivity (sunburn)
    • -Alopecia (diffused, patchy, total hair loss), hirsutism (excess facial hair d/t inc androgen prod by adrenal glands)
    • -Nail change, sun exposure, self care behaviors (sunscreen, soaps, cosmetics)
  9. *Objective data
    -Inspect & Palpation
    • *Integrate skin assessment during phys exam
    • -Assess sun exposed areas (inc cancer risk), intertriginous areas for fungus (skin folds), feet (primarily in diabetics)
    • -Identify body piercing and skin condition (for inflamm, infection)
    • -Describe skin color: pinkish tan, fair (light); light to dark brown; olive
  10. *Objective data
    -Localized color change
    • -Vitiligo: absence of melanin pigment in patchy areas (more common in dark skinned)
    • -Freckles: ephelides, small, flat, brown macules
    • -Pigmented nevi: (moles) inspect for changes
    • -Birthmarks: inspect for changes
  11. *Diffused color changes
    -Pallor
    • *white or lighter coloration; ashen gray w/ brown/black skin
    • -Anxiety/fear (vasoconstriction 2° to SNS stimulation)
    • -Cold/Cigarette smoking (peripheral vasoconstriction)
    • -Shock (shunting blood from periphery to mjr organs)
    • -Arterial insufficiency/anemia (dec blood supply to PV system)
  12. *Diffused color changes
    -Erythema
    • *Red, flushed appearance
    • -Hyperemia: excess blood of superficial capillaries r/t fever, local inflamm, inc emotions (blushing)
    • -Polycythemia (accumulation of RBC)
    • -Venous stasis: venous system doesn't drain back to heart erythema
    • -Carbon monoxide poisoning
  13. *Diffused color changes
    -Cyanosis
    • *Bluish, gray due to dec perfusion of tissues (tissue hypoxia)
    • -Central Cyanosis: (very late sign of hypoxia) 5mg unoxygenated hgb 2° to cardio-pulmonary problems
    • -may not be seen in anemia, may not be enough unoxygenated hgb to show color changes (if hgb = 10, then 1/2 must be oxygenated before cyanosis is seen--may die of hypoxia first)
    • -Peripheral Cyanosis: 2° d/t vasoconstriction (exposure to cold)
  14. *Diffused color changes
    -Jaundice
    • *Yellow, icteric, rising amts of bilirubin in blood (byproduct of RBC breakdown)
    • -1st seen in junction b/t hard & soft palate & in sclera
    • -Clay colored stools, dark yellow urine (bilirubin normally excreted thru GI tract; in biliary obstruction, bilirubin absorbed then excreted in urine)
    • -Later seen in skin (if can't break down, absorbed into skin; bili light (UV) helps breakdown)
  15. *Objective data
    -Skin temp
    • -Hypothermia: due to dec circulation; generalized, localized (peripheral arterial insufficiency)
    • -Hyperthermia (heat); generalized (inc metabolic rate-hyperthyroidism, fever, heavy exercise), localized (inflamm, infection)
  16. *Objective data
    -Moisture
    • -Perspiration (normal sweating)
    • -Diaphoresis (perfuse sweating)
    • -Dehydration (dry skin & mucus membranes, thirst-late sign of dehydration)
  17. *Objective data
    -Texture, thickness, edema, turgor, hygeine
    • -Texture
    • -Thickness (callouses on hands/feet, arterial insufficiency-thin, shiny on hairless part)
    • -Edema
    • -Turgor: How quickly skin snaps back when pinched
    • -pinch skin on ant. chest below clavicle or forearm
    • -poor turgor: tenting (skin doesn't snap back--sign of dehydration); don't test hands in elderly--false +
    • -Hygeine: clean & free of odor
  18. *Objective data
    -Vascularity
    • -Cherry angiomas: tiny blood blister (bright red, papular lesion, 1-5mm; on trunk, upper chect, extremities; inc w/ age)
    • -Telangiectases: dilated superficial BV
    • -SPIDER ANGIOMA: central arterial (fiery red) w/ capillary radiations; blanches w/ pressure; on face, neck, arms, upper trunk--usually not below waist; assoc w/ liver dz (can't break down hormone) d/t dec metabolism of hormones resulting in estrogen excess
    • -VENOUS STAR: bluish spider angioma; non blanching w/ pressure; primarily located on legs; assoc w/ varicose veins
  19. *Objective data
    -Petechiae
    • -1-3 mm, deep red, rounded
    • -Results from superficial capillary bleeding
    • -Caused by bacteremia (sepsis), bleeding disorders (thrombosytopenia--dec in platelets)
  20. *Objective data
    -Purpura
    • -Extensive confluent patch of petechiae
    • -Reddish, purple, irregular (senile purpura r/t thinning skin)
  21. *Objective data
    -Ecchymyosis
    -Hematoma
    -Pattern Injuries
    • E-larger patch of capillary bleeding
    • -r/t trauma, bleeding disorders or liver dysfunction
    • -Purple/purple-blue fading to green, yellow, brown over time
    • H: subcutaneous nodule (raised bruise)
    • PI: suspect abuse (scalding, belt strap/buckle, cig burns)
  22. *Characteristics of Lesions
    • -Color
    • -Elevation: flat, raised, pedunculated (stalk--skin tag)
    • -Configuration: shape or pattern
    • -Size: metric--mm, cm
    • -Number
    • -Location (body part) & distribution (localized vs. generalized)
    • -Discharge or exudate (color, odor)
  23. *Primary Lesions
    -Flat Lesions
    • -Macule: flat, circumscribed, discolored, <1cm (freckles, flat nevi, petechia)
    • -Patch: flat, irregular, >1cm (vitiligo)
  24. *Primary Lesions
    -Raised Lesions
    • -Papule: solid, elevated, circumscribed, <1cm (raised nevus, wart-verruca)
    • -Plaques: coalesced papules, >1cm (psoriasis); individual papules run together into larger mass
    • -Nodule: solid, elevated, 1-2cm (lipoma = fatty growth)
    • -Tumor: larger than a few cm, firm or soft (lipoma)
    • -Wheal: superficial, raised, erythematous, irregular (allergic rxn, PPD, mosquito bite); causes interstitial edema
    • -Urticaria: hives; wheels coalesce to form extensive rxn; intensely pruritic
  25. *Primary Lesions
    -Fluid Filled (raised)
    • -Vesicle: elevated cavity w/ clear fluid, <1cm (herpes simples, varicella, herpes zoster, contact dermatitis-poison ivy)
    • -Bulla: elevated cavity w/ fluid, >1cm (blister, burns)
    • -Pusutule: contains pus; filled w/ leukocytes, not necessarily infected (acne)
    • -Cyst: encapsulated fluid filled cavity in dermis or sub-q (sebaceous cyst). If deep hard to ID if nodule or tumor (solid/raised, not fluid)
    • -never cancerous
  26. *Secondary lesions (1-4)
    • -Crust: thickened, dried exudate (dried serum/blood/pus) on top of 1° lesion (scab)
    • -rupture of herpes vesicle--> crust w/ erythematous base
    • -impetigo: staph & strep
    • -Scale: compact flakes of skin (psoriasis-white, silvery), seborrheic dermatitis (yellow-greasy), seborrhea (dandruff)
    • -Fissure: linear crack (cheilosis-corners of mouth), callused heels, tinea pedis (athletes foot b/t toes)
    • -Erosion: shallow depression, moist, no bleeding (underneath vesicular ruptures--if chicken pox rupture)
  27. *Secondary Lesion (5-8)
    • -Ulcer: deep depression into dermis; leaves scar (stasis ulcer, pressure sore)
    • -Excoriation: superficial abrasion (dermatitis); inflamm of skin-red, open sore
    • -Scar: CT replacing normal tissue. Atrophic-depressed scar (stretch marks-striae), hypertrophic-excess scar tissue 2° to inc collagen formation (keloid)
    • -Lichenification: thickening of skin (eczema-atopic dermatitis), chronic sun exposure
  28. *Configurations of Lesions (1-5)
    • -Annular: ring, clear center (tinea corporus-ring worm, pityriasis rosea)
    • -Semiannular: 1/2 ring--moon shape
    • -Discrete: isolated
    • -Confluent: lesions run together (urticaria-appear as one)
    • -Grouped: clusters of lesions (appear stuck together, individual lesions can still be identified)
  29. *Configurations of Lesions (6-10)
    • -Gyrate: coiled spiral, snakelike
    • -Iris: target appearance (has colored center unlike annular)
    • -Linear: scratch
    • -Web like/lace pattern: mottled appearance (hot bath for long time-skin gets blotchy
    • -Zosteriform: linear along a nerve route (shingles-herpes zoster)
  30. Infectious Etiology

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