skin , hair & nails, 330.gsu.f.09
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Skin , Hair & Nails
Nursing 330
Governors State University
Shirley Comer
Skin Assessment- Inspection
Inspect– Wide Spread Color changes
Pallor Erythema Cyanosis Jaundice Pigmentation Changes Freckles Nevus (mole) Birthmarks
– Unusual Odors Hygiene, excessive sweating, urine, musty
Danger Signs ABCDE
Abnormal Characteristics of Pigmented lesions– Asymmetry of a pigmented lesion– Border irregularity– Color variation– Diameter greater than 6mm– Elevation– Enlargement
ABCD Pix
Skin Assessment – Palpation
Use back of hands Hypothermia or Hyperthermia Moisture
– Perspiration normal on face, hands, axilla and skin folds in response to anxiety
– Diaphoresis- perfuse perspiration r/t increased metabolic rate i.e. increased heart rate, pain or fever
Skin Assessment – Palpation cont
Texture- smooth and firm Thickness- thickened areas normal on hands
and feet Edema – Fluid accumulation in the intercellular
spaces– Pitting- finger leaves imprint in area.
Graded subjectively 0+ to 4+ Evident in dependant parts of body
Skin Assessment – Palpation cont
Vascular or Bruising-– Cherry (senile) angiomas- small, smooth, slightly raised, bright red
dots that commonly occur in all adults over 30. Not a significant finding
– Bruising- ask how occurred Multiple bruises at different stages of healing can be a sign of abuse Tattoos- ask about Symptoms of Hepatitis
Hygiene- note cleanliness- free of parasites Turgor- Pinch up a large fold of skin- should return to
normal position rapidly– Decreased in dehydration or extreme wt loss.– Tenting is when skin remains pinched up
Skin Lesions and Decubs
Nail Anatomy Pix
Nails- Inspection
– Capillary Refill- Blanching of nail bed lasts 1-2 seconds. Longer may indicate cardiovascular or respiratory disorder
– Shape and contour Clubbing-congenital or chronic CO2 retention Spooning-concave curves- Fe deficiency Jagged- chronic anxiety Transverse grooves-nutrient deficiency Longitudinal grooves- normal Nail adhered to bed- spongy bed accompanies clubbing Pitting often /c psoriasis Paronychis- swollen tender nail folds-fungal or bacterial infection
Clubbing image
Longitudinal and Transverse Nail Ridges - Photo
Hair Assessment - Inspection
Hair Assessment– Color– Texture– Distribution- male v. female alopecia– Lesions – Hygiene– Parasites
Palpation - Hair
Part hair to look at scalp (wear gloves)– Parasites– Hygiene– Scalp condition– Growth pattern– Alopecia– Lesions– Dandruff, seborrhea, psoriasis, eczema
Hair Loss- Male vs. Female
Commonly seen abnormalities - Petechiae
tiny hemorrhages Less than 2mm Round Purple, red, brown in color /s blanching Present /c thrombocytopenias, endocarditis, septicemia Found on mucus membranes, conjunctiva, abdomen,
buttocks, forearms
Purpura
Extensive patches of Petechiae and ecchymoses
Flat macular hemorrhage Seen /c thrombocytopenia, scurvy In elderly may result from minor trauma Hematoma -Elevated area of bleeding under
the skin
Petechae and Purpura Photo
Infant Assessment
General Pigmentation– Mongolian Spots-Blue, Black and Purple spots on
buttocks or sacrum- common if AA, Native American, Hispanic and Asia newborns.
– Bruising- Common following injuries from rapid, traumatic, or breech births
– Congenital birth marks- Port wine stains, angiomas, Strawberry mark, Cavernous Hemangioma
Common Birthmarks – Port Wine Stain, Hemangioma, Strawberry mark, café au late
spot, mongolian spot
Age specific - children
Petechiae and Hematoma may be present on face r/t prolonged violent crying or coughing
Abuse patterns– Multiple bruises in various stages of healing– Injuries to parts of body covered /c clothing– Marks suggestive of instrument use- belt, cigarette,
pinching, biting
Age specific- children Cont
Common findings– Diaper Dermatitis- red moist diffuse macular– Candidiasis(yeast)- fiery red moist patches with clear borders– Impetigo- Red vesicles rupture to form honey colored crust-
Contagious bacterial infection– Chickenpox (Varicella)- small vesicles evolving to pustules on
trunk spreading to face, and limbs– Ringworm- fungal infection produces scales and can cause
permanent hair loss– Measles (Rubeola)- red macular/papular rash behind ears and
spreads to body– German Measles (Rubella)- Paler lesions than rubeola
Common Childhood findings
Common Findings- Tinea forms, athlete’s foot, ringworm and Jock itch
Common Findings – Rubella, cradle cap, uticaria
Age Specific Children cont
Atopic Dermatitis (eczema) – red papules and vesicles /c weeping, oozing and
crusts– Scalp, forehead, cheeks, forearms, elbows and
back of knees– Family hx of allergies
Seborrheic Dermatitis (Cradle Cap)– Greasy yellow-pink lesions on scalp and forehead– No family hx of allergies
Common Childhood Lesions- Contact dermatitis, Candidiasis, Atopic dermatitis
Age Specific Assessment
Adolescent- increase in sebaceous gland r/t increased acne and oily skin
Pregnant Woman– Striae- Stretch marks. Initially pink then silver– Linea Nigra- Brownish black line abdominal midline– Chloasma- Irregular brown patches on face- aslo /c
oral contraceptives-disappears /p pregnancy ends– Vascular Spider Veins- Capillaries on skin surface
break
Pregnancy – Cholasma, striae, spider veins, linea nigra
Age Specific- Older Adult
Senile Lentigines- Liver Spots- small flat brown macules-r/t sun exposure Venous stars and angiomas Dry Skin- increases in elderly Acrochordons- Skin Tags- overgrowth of normal skin Skin thins- /c decreased sebaceous gland activity and SQ fat Less Elasticity- Tents more Alopecia- genetic- male pattern baldness Hair Greys- r/t decreased melanocyte function Hair Thins- Growth decreases, amount decreases in axilla in pubic areas.
– Women- may develop facial hair /p menopause r/t decreased estrogen
– Men- grow bristly hairs in ears, nose and eyebrows
Common Findings – Senile Lentigines, Skin Tags, Seboratic Keratosis
Age Specific – Older Adult cont
Nails– Growth decreases– Longitudinal ridges– Brittle– Yellowing– Toenails thickened and misshapen r/t chronic PVD
Malignancies
Basal Cell carcinoma- – Most common form of Skin cancer– starts as skin colored papule– Develops pearly borders with red center– Slow growing
Squamous Cell Carcinoma-– Red scaly patch /c sharp margins– 1 cm or more– Develops central ulcer /c surrounding redness– Less common but grows rapidly
Malignancies of AIDS
Epidemic Kaposi’s Sarcoma– 3 stages
Multiple pink patches Lesions develop into raised papules, oval and vary in color Advances are widely disseminated involving skin, mucus
membranes, and visceral organs
Malignancies cont
Malignant Myeloma-– ½ of lesions are pre existing nevi– Brown, tan, black. Red, or purple– Irregular borders
– May scale, flake or ooze– Metastasizes quicker than other forms
Skin Cancer – Basal Cell, Squamous Cell, Kaposi’s, Malignant Myeloma
Other Common Lesions
Folliculitis- superficial infection of hair follicle r/t shaving Psoriasis- Scaly red patches /c silvery scales Herpes Simplex- Cold sore- vesicle then pustule which
erupts Herpes Zoster- Shingles- small groped vesicles then
pustules then crust- develops along nerve path Contact dermititis- Local reaction to irritant- redness
followed by swelling, wheals or uticaria. Allergic drug reaction- red macular rash, generalized.
May proceed to uticaria
Common Findings – Follicuilitis, Herpes Simplex, Cherry angioma, Shingles, MRSA
Common Findings- Fungal infection, ingrown toenail, changes with age
Lyme Disease, Eczema, Rosacea, Vitiligo
Practice Exam Question
Your neighbor calls you to ask your opinion about a sore that won’t heal on his nose. He states it started out as a small red spot and is now about ½ inch irregular red and brown patch. What would you suggest he do?
A. Suggest he see a doctor about the lesion B. suggest he apply an hydrocortisone cream C. Suggest he wait a month and see how it looks D. Suggest he use a good moisturizer
Rationale
A is the correct answer because the lesion description sounds like a malignancy
B and D are incorrect as these products are not appropriate treatments
C. is incorrect as malignancies can grow quickly