What is the dermis?
thin layer, containing collagen, elastic tissue
Sebaceous gland?
hair follicle, on all body besides palms/sole
eccrine sweat glands?
over skin, normal sweat
apocrine sweat glands?
hair follicles/ perineum
Melanoma:
greatest risk is intermittent sun exposure
Basal Cell Carcinoma:
moderate exposure (trunk/lower legs)
Squamous cell carcinoma:
on body sites most common to heavy sun exposure
What increases the risk for skin cancer?
sun exposure, fair skin, males (>50), HPV, etoh, inadequate niacin in diet.
Pt teaching for protecting against skin cancer:
hates, long sleeves, avoid sun burns, annual cancer screenings
assessing for suspicious skin lesion and warning signs
Asymmetry
Border
Color
Diameter: 1/8-1/4 inch
Elevated
warning signs: bleeding, tender to touch, itching, grows
what type of lighting is best to use when assessing
natural light
pallor
loss of color, cold skin (amenia)
Erythema
skin redness/warmth, on dark skin palpate for warmth
Cyanosis
O2 deficiency, white/blue tinged. dark skin appears blue/dull
Jaundice
yellow skin bc hepatic dysfunction (fix is UV light). normal in newborn 3-4th day of life
Acanthosis Nigrican
linear streak like pattern in dark skin people, suggests DM. roughening of skin on back of neck
Braden Scale:
sensory perception, moisture, activity, mobility, nutrition, friction/shear. 1 is a problem, 3 having no problem
primary vs secondary
...
linear lesion
straight line, scratch
annular
circular lesions
clustered
lesions grouped together- herpes
discrete
individual and distinct ones
confluent- smaller lesions run together to form larger lesionsMacule
freckle. <1 cm
Patch
Vitiligo. >1 cm
Papules
wart. <.5 cm
Plaque
psoriasis. >.5 cm.
Nodule
elevated palpable,
Vesicle/ Bulla
Elevated mass; contains serous fluid (chicken pox)
Wheal
elevated mass with irregular borders (uticaria). hives
pustule
pus filled vesicle (acne)
cyst
encapsulated fluid filled/semisolid in SQ tissue or dermis
Secondary skin lesion:
...
erosion:
scratch mark
ulcer
skin lost past epidermis
scar/fissure
linear crack, chapped lips/athletes foot
purpuric lesion:
cause by blood flowing out of breaks in the vessels. difficult to see in dark skinned people.
petechia
round red or purple macule 1-2 mm; associated. don't blanch. can be caused my meds
purpura
confluent and extensive patch of petechia and ecchymoses. >3 mm. flat, red to purple, macular hemorrhage.
ecchymosis
round or irregular macular lesions seen with trauma. black eye
hematoma:
localized collection of blood- associated with trauma
cherry angioma:
papular and round
spider angioma:
red arteriole lesion of face, arm, neck. (associated with liver dz, pregnancy, vitamin b deficiency)
how to test for turgor
use 2 finger to pinch over clavical
how to test for edema
use thumb to check for swelling or accumulation of fluid
pitting in nails is seen in ______
psoriasis
koilonychia
(spoon shaped nails) seen with trauma, iron deficiency enema, endocrine and cardiac dz's
clubbing of nails
heart failure, because constantly cyanotic
paronychia
local infection
linea nigra
brownish blackish pigment midline abdomen
striae gravidarum
prego stretch marks
chloasma:
pigment in face
spider nevi
lesions with tiny red centers on face, neck, upper chest and arms
in prego, hair and nails ________, but it _______
grow, but its softer and thinner
in prego, pale skin suggests _______
anemia
normal skil color for newborns
pale white with pink, yellow, brown, olive tone, black
normal in newborns:
acrocyanosis (bluish coloring in hands), physiologic jaundice, milia (tiny white bumps on face), erythema toxicum, cafe au lait (brown spots), benign hemangiomas- strawberry marks (red skin marks), mottling when chilled
abnormal findings in newborns:
yellow skin- jaundice in utero. or jaundice within 24 hours of birth means hemolytic dz.
blue skin- cyanosis
pallor- anemia
redness- fever, irritation
6 or more cafe au last can mean neurofibromatosis
tuffs of hair over spine in new borns can mean:
spina bifida
blue nailneds in newborns can mean
cyanosis
mongolian spots
bluish pigmented areas on sacral areas of asians, african americans, and mexican american infants
rubeola
rubella
chickenpox
scaly lesions means
fungal infection
normal variation in adult:
skin tags, skin lesions, more pale bc decreased melanin, dryer bc decreased sebum, wrinkled skin, hair is dryer/thinner. nails are thicker, yellow and brittle.
abnormal findings in adults:
herpes zoster (painful rash), petechiae (platelet deficiency), bruises, purpura, torn skin, patchy, assymetic hair loss.
normal IV site
skin is intact, without redness, swelling, phebitis
report an IV site:
report pain, any redness, sweeping, appearance of vein, cool skin