when giving her health history, patient states she was diagnosed with Vitiligo a year and a half ago. What do you expect to see when you assess her skin
Patchy, milky white spots ! Vitiligo is an acquired condition in which the complete absence of melanin pigment results in patchy areas of white or light skin on the face, neck, hands, feet, and body folds and around orificies.
Senile lentigines are
small brown macules that are clusters of melanocytes that appear after extensive sun exposure.
Toxic alopecia
which accompanies severe illness or chemotherapy, is a patchy, asymmetric balding.
Monilial Infection
which has a predilection for the intertriginous areas, which are warm, dark, and moist- is characterized by scalding red, moist patches with clearly demarcated borders.
You are conducting an in-service for nurses and students assigned to a medical floor at the local hospital on age-related changes in the skin. Which information would you include?
The loss of collagen increases the risk of shearing, tearing injuries, thinning and flattening of the stratum corneum increases absorption of chemicals, diminished vascularity and increased vascular fragility lead to senile purpura, increased sweat gland
carotenemia
produces a yellow-orange skin coloration in light-skinned individuals that is most easily seen on the forehead, chin, tip of the nose and nasolabial folds, palms, and soles, behind the ears, and over the knuckles. It does not cause yellowing of the sclera
a 65 year old complaining of "skin spots" . what types of normal- age - related hyperpigmented "spots" would you expect to see
seborrheic keratoses and lentigines
Acrochordons are
skin tags
comedones are
acne lesions
which skin assessment finding would you consider to likely be a precancerous keratotic lesion?
a raised, rough plaque of red-tan pigmentation with a silver-white scale
keratoses
are lesions that are raised, thickened areas of pigmentation that look crusted, scaly, and warty.
seborrheic keratosis look
dark, greasy and stuck on.
lichenification
is a raised, thickened, dry area of decreased pigmentation with a tightly packed set of papules; it is caused by prolonged intense scratching adn looks like the surface of moss ( or lichen)
cutis marmorata
is a transient mottling in the trunk and extremities in response to cooler room temperatures. It forms a reticulated red or blue pattern over the skin, persistent cutis marmorata can occur with Down's
Red- Blue is the color of fresh
bruises
When assessing a pt. skin , which findings alerts you to the potential for hepatitis c infect?
Tattoos
Keloids
are hypertrophic scars
spoon nails occur when a concavity in the fingernail itself gives itself an apperance
of a spoon shape to the entire nail. This can occur from iron deficeincy, trauma, severe illness, or exposure to certain solvents.
telangiectasia
is a permanently enlarged and dilated blood vessels visible on the skin surface
when teaching a group of middle schoolers about hygiene, you plant to include info on the apocrine glands. which info might you choose to include
apocrine glands are mainly located in the axillae, anogenital area, nipples, and navel, they produce a thick, milky secretion and open into the hair follicles, they become active during puberty and decrease functioning in aging adults, they secrete with e
Eccrine, not apocrine glands
are sweat glands produce sweat that, through evaporation, helps regulate body temp
Clubbing of nails
is indicative of COPD
circumoral cyanosis
bluish tint around the lips
psoriasis
sharply defined pitting and crumbling of teh nails with distal detachment occurs often
equipment needed to assess the skin and appendages includes:
ruler, penlight, filtered ultraviolet light, KOH, magnifier, and gloves. strong direct lighting, preferably natural is also needed
what are essential components of a pt history for dermatology disorders?
previous history of skin disorders, symptom analysis (or HPI) of current problems, Allergies, Self-care behaviors, Occupation and hobbies, prescribed and over the counter medications, and herb and substance abuse
55 year old complaining of spots in her nails, you note red-brown linear streaks ( embolic lesions) that you recognize as splinter hemorrhages
can occur with bacterial endocarditis
clubbing of the nails occurs with
bronchial tumor
onycholysis
fungal infect. of the nails characterized by color change, thickness, and crumbing.
sharply defined pitting and crumbling of the nails with distal detachment often occurs with
psoriasis
54- year old pt with furuncles on the back of his neck, what is the nature of this reoccuring problem
suppurative, inflammatory skin lesions resulting from an infected hair follicle
pustule
has turbid fluid (pus) in the cavity and is circumscribed and elevated.
a fissure
is a linear crack with abrupt edges, extends into the dermis, and can be dry or moist.
acne is caused by
increase in sebaceous gland activity, which leads to increased oiliness ( this increased activity can present as mild or severe and usually appears on teh face and sometimes on the chest, back and shoulders.
milder acne form presents as
open comedones (blackheads) or closed comedones (white heads)
severe acne includes
papules, pustules,and nodules
document a circular shaped lesion as
annular
confluent lesions
run together i.e. urticaria ( hives).
Zosteriform refers
a linear lesion that runs along a nerve route ( herpes zoster)
Term used when describing sloughing of necrotic inflammatory tissue that causes a deep depression in the skin extending into the dermis
ulceration
gangrene
refers to the death of body tissue due to lack of blood flow or a bacterial infect.
Dermonecrosis literally means
death of skin and can be induced by the venom of certain spiders
maceration
is the softening and breaking down of the skin as a result of prolonged exposure to moisture
which direction would you give a pt. in preparation for checking the profile sign
hold your index finger straight out so I can look at it from the side. The profile sign is done to assess for clubbing of the fingers, which occurs in congenital cyanotic heart disease and neoplastic pulmonary diseases
normally the angel of the nail base is 160 degrees or less
in early clubbing, the angle straightens out to 180 degrees and the nail bed feels spongy on palpation. to check the profile sign, the index finger is viewed from the side and the angle of the nail base is noted
41 year-old gentleman who presents with a complaint of skin problems. on examination, you note single-chambered , superficial lesions containing free fluid greater than 1 cm in diameter. How would you refer to this finding in your documentation
Bullae
Red, swollen, hard, tender, pus-filled lesion caused by acute localized bacterial ( usually straphloccoal) infection that usually occur on the back of the neck, the buttocks, and occasionaly the wrists or ankles
furuncles
vesicles
elevated cavities containing free fluid, up to 1 cm, they are also known as blisters. Clear serum flows of the wall is ruptured
wheals
are superficial, raised, transient, erythematous lesions that are slightly irregular in shape as a result of edema
when assessing a pt. with very dark brown skin, where would you look for petechiae?
buccal mucosa, in persons with dark skin petechiae ( round , discrete, tiny punctate hemorrhages ) cannot be seen on the skin, so mucous membranes or conjunctivae must be inspected. In persons with lighter shade of brown, petechiae are best visualized in
staging pressure ulcers depends on
ulcer depth
skin is intact but reddened and nonblanching in
stage 1 pressure ulcer
erosion of the epidermis and sometimes the dermis
stage II pressure ulcer
a full-thickness ulcer extending into the subcutaenous tissue and looks like a crater
stage III pressure ulcer
ulcer involves all skin layers and extends into supporting tissues, exposing muscle, tendon, or bone
Stage IV pressure ulcer
Which term would you use when referring to a scooped-out , shallow depression in the skin
Erosion
a deeper depression extending into the dermis, is irregular in shape, may bleed, and leaves a scar when it heals
ulcer
a self-inflicted abrasion that is superficial and sometimes crusted
excoriation
fissure
linear crack with abrupt edges, extends into the dermis, and can be dry or moist
which problem are you assessing when you look for the "ugly duckling" sign?
malignant melanoma
the examiner looks for a lesion that stands out as different when comparing with a neighboring nevi
which factor is the basis for staging pressure ulcers
depth of ulcer
on a skin assessment of a patient, you find elevated cavities containing free fluid that are less than 1 cm in diameter scattered over the right lower cheek. How would you identify these lesions in your documentation
Vesicles
single-chambered, superficial lesions containing free fluid greater than 1 cm in diameter are called
bullae
pustules are
circumscribed , elevated cavities filled with pus
Mr. shea a 51- year old pt. who presents with complaints of a skin lesion. On examination, you note a linear skin lesion that runs along a nerve route. which term would you use when documenting this finding
Zosteriform
dermatome
is a circumscribed skin area that is supplied mainly from one spinal cord segment though a particular spinal nerve
shingles refers to small
grouped vesicles that emerge along the route of a cutaneous sensory nerve, and evolve into pustules, and then crusts.
which skin lesion requires monitoring or removal because of its potential for developing into a squamous cell carcinoma
actinic keratosis, they are red-tan scaly plaques that eventually become raised and roughened . They are directly related to sun exposure and are premalignant, with the potential to develop into squamous cell carcinoma
keratoses
raised, thickened areas of pigmentation that look crusted, scaly, and warty
seborrheic keratoses
look dark, greasy, and stuck on and occur primarily on the trunk.
ephelides
are freckles or small, flat macules of brown melanin pigment
a cherry angioma
a smooth, slightly raised, bright red dot commonly found on the trunk in adults over the age 30
what is an example of a primary lesion
Hives. Primary lesion are those that develop on previously unaltered skin. an ex. of a primary lesion is hives (urticaria). when a lesion changes over time or changes because of factors such as infection or scratching, it is a secondary lesion. Erosions,
Tugor
is the ability of the skin to return to place after being pinched up and released
when taking a health history and the pt. complains of prurtitus. what is a common cause of this symptom
drug reactions, can lead to pruritus or itching
excessive bruising can occur in response to traumatic event or a coagulation abnormality. It is associated with
erythema, not pruritus
hyperpigmentation is related to
color changes
a flat macular hemorrhage is called
purpura,
purpura is a flat, macular , red-to-purple hemorrhage that is a confluent and extensive patch of petechiae and ecchymoses greater than 3mm
an ecchymosis is a hemorrhage greater than
3mm
are tiny punctate hemorrhages that are 1-3 mm round and discrete; and dark red, purple, or brown caused by bleeding from superficial capillaries
Petechiae
Vascular lesions caused by a
benign proliferation of blood vessels in the dermis
There are 2 types of sweat glands:
Eccrine glands and apocrine glands
Evaporation of sweat reduces
body temp.
apocrine glands produce a
thick, milky secretion and open into the hair follicles, they are located in mainly the axillae, anogenital area , nipples, and naval