The skin
what are the functions of the skin
Protects the body from environmental stresses like trauma, pathogens, dirt
adapts environmental influences like heat and cold
produces vitamin D [uses sunlight to convert cholesterol into vitamin D]
what are the 3 layers of the skin
epidermis--keratin makes it tough; avascular
dermis--mainly collagen.Blood vessels, nerves, sensory receptors, lymphatics lie in here; hair follicles, sabaceous glands, sweat glands
subcutaneous--adipose tissue, lobules of fat cells stored for energy, ins
what is vestigial
Refers to an organ or part--e.g hair, which is greatly reduced from the original ancestral form and is no longer functional or is of reduced or altered function.
Vestigial structures provide a clue to the evolutionary history of a species because they are
There are two types of hair
Vellus hair--fine [covers most part of the body]
terminal hair--thicker darker that grows on scalp, eyebrows, axillae pubic area, face, and chest in males
what muscle is controls/is attached to hair
arrector pili
what are sabaceous glands and its functions
produces oils which is secreted through the hair follicles. it lubricates the skin and hair.
Found everywhere except palms and sole
most abundant in scalp, forehead, face and chin
Name the two sweat glands and their functions
eccrine [dilute saline solution] sweat gland--opens directly onto the skin surface and produces sweat
aprocrine glands--produce thick milky secretion in the axillae, anogenital, nipples and naval area. This is vestigial in humans. They produce the musky b
what is Milia
sebum occluded skin follicles.
Milia are tiny while papules on the cheeks and forehead and across the nose and chin caused by sebum that occludes the opening of the follicles. Tell parents not to squeeze the lesions; milia resolve spontaneously within a f
Hair and nails are made up of
hairs are threads of keratin
nails are hard plates of keratin
what are some skin changes in pregnant women
Linea nigra--increased pigment in midline of the abdomen
chloasma--increase pigment in the face
striae gravidarum--stretch marks
vascular spiders--
what is linea nigra
a hyperpigmented line that begins at the sternal notch and extends down the abdomen through the umbilicus to the pubis
what is chloasma or melasma
known as the "mask of pregnancy," which is a butterfly-shaped pigmentation on the face or sun exposed areas during pregnancy.
what is striae gravidarum
Striae are jagged linear "stretch marks" of silver to pink color that appear during the second trimester on the abdomen, breasts, and sometimes thighs. They occur in one half of all pregnancies. They fade after delivery but do not disappear.
this also hap
what is vascular spiders
These lesions have tiny red centers with radiating branches and occur on the face, neck, upper chest, and arms. occurs more in whites
tattoos increase the risk of getting
Hepatitis C
what is seborrhea
oily
excessive discharge of sebum from the sebaceous glands causing white flakes--dandruff.
what is Xerosis
dry
what is alopecia
significant loss of hair.
A full hair equates with vitality in many culture.
what is pruritis and what causes it
intense itching; it is a symptom that occurs with:
1) dry skin
2) aging
3 ) drug reaction
4) allergy
5) obstructive jaundice
6) uremia--raised levels of BUN that are normally eliminated by the kidney.
7) lice
what is Hirsutism
excessive hair
what causes acne
CAUSE IS UNKNOWN
many myths surround the cause; it is not cause by poor diet, oily complexion or contagion.
with skin examination, where do you inspect first that is not too invasive/nonthreatening
the hands and fingernails
****what is intertrigfious areas
Areas with skin folds.
with inspection, separate the intertriginous areas such as under large breast, obese abdomen, and groin and inspect them thoroughly.
what are some of the external variables that could lead to a misleading outcomes during an examination
1) fear or anger, cold room, cigarette smoking, prolonged elevation--> false pallor
2) embarrassment, hot room,--> false erythema
3) dependent position--> redness, warmth, distended veins
4) immobilized, prolonged inactivity-->pallor, coolness, nail bed p
The skills for skin examination are
Inspection --first
palpation
what is vitiligo
the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices [abnormal]
Danger signs: abnormal characteristics of pigmented lesions are summarized in the mnemonic ABCDE: what are they
1) Asymmetry [not regularly round or oval, two halves of lesion do not look the same]
2) Border irregularity [notching, scalloping, ragged edges, poorly defined margins]
3) Color variation [areas of brown, tan, black, blue, red, white, or combination]
4)
what is the "A" in the ABCDE rule stand for
Asymmetry
Some skin colors to note
pallor--white [vasoconstriction; the skin now takes on the color of the collagen--white]
erythema--red [vasodialation]
cyanosis--blue [decreased perfusion; tissues do not have enough oxygen]
jaundice--yellow [rising amount of bilirubin in blood]--this doe
checking skin temperature is best accomplished by using
the dorsal {back] surface of the hands
what is diaphoresis
profuse perspiration
where do you check for edema
imprint your thumb firmly against the ankle malleous or the tibia. If the pressure leaves a dent in the skin, pitting edema is present
How do you check the skin for mobility and turgor [elasticity]
Pinch up a large fold of skin on the anterior chest under the clavicle. Mobility is the skin's ease of rising, and turgor is its ability to return to place promptly when released. This reflects the elasticity of the skin
skin mobility is decreased with
edema
poor skin turgor is evident in
severe dehydration or extreme weight loss
what is cherry--senile--angiomas [NORMAL]
They are small--1 to 5 mm--, smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years. They normally increase in size and number with aging and are not
what is a primary lesion
lesion that develops on a previously unaltered skin
What is a secondary lesion
when a lesion changes over time or changes because of a factor such as scratching or infection, it is secondary. e.g.
crust
scale
fissure
erosion
ulcer
scare
keloid
describe a macule and a patch--primary skin lesion
solely a color change, flat and circumscribed
macule < 1cm eg petechiae
patch > 1cm eg mangolian spot, cafe au lait sport
describe a papule and a plaque--primary skin lesion
solid elevated and circumscribed
papule <1cm eg mole
plaque > 1cm eg psoriasis
describe nodules and tumor--primary skin lesion
solid, elevation, hard or soft, may extend deeper into the dermis
nodules > 1cm hard
tumor > 1 cm soft
describe vesicle and bulla--primary skin lesion
elevated cavity containing free clear fluid blister
vesicle <1cm
bulla > 1cm
what is a cyst--primary skin lesion
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin. Examples: sebaceous cyst, wen.
what is a pustule--primary skin lesion
Turbid fluid (pus) in the cavity. Circumscribed and elevated. Examples: impetigo, acne.
when measuring the size of a lesion, what should you use
A ruler, avoid using descriptions like quarter size or pea size
what is an annular or circular lesion
circular, begins in the center and spreads to periphery eg tinea corporis
what is a confluent lesion
lesions run together e.g., urticaria [hives]
what is a discrete lesion
distinct, individual lesions that remain separate [e.g.skin tags, acne].
what is a GYRATE or serpiginous lesion
twisted, coiled spiral, snakelike
what is a GROUPED lesion
GROUPED, clusters of lesions (e.g., vesicles of contact dermatitis).
what is a LINEAR lesion
LINEAR, a scratch, streak, line, or stripe.
what is a TARGET, or iris lesion
TARGET, or iris, resembles iris of eye, concentric rings of color in the lesions (e.g., erythema multiforme).
what is a ZOSTERIFORM lesion
ZOSTERIFORM, linear arrangement along a unilateral nerve route e.g. herpes zoster
what is a POLYCYCLIC lesion
POLYCYCLIC, annular lesions grow together e.g., lichen psoriasis
what is tinea corporis
ringworm of the body
Scales�hyperpigmented in whites, depigmented in dark- skinned persons�on chest, abdomen, back of arms forming multiple circular lesions with clear centers.
what is tinea pedis
Ringworm of the foot
"Athlete's foot," a fungal infection, first appears as small ves- icles between toes, sides of feet, and soles and then grows scaly and hard. Found in chronically warm, moist feet: children after gymnasium activities, athletes, aging
what is tinea capitis
Scalp ringworm
Rounded, patchy hair loss on scalp, leaving broken-off hairs, pustules, and scales on skin. Caused by fungal infection; lesions may fluoresce blue-green under Wood's light. Usually seen in children and farmers; highly contagious, may be tra
what is Tinea versicolor
Fine, scaling, round patches of pink, tan, or white that [hence the name] do not tan in sunlight, caused by a superficial fungal infection. Usual distribution is on neck, trunk, and upper arms
what is Tinea cruris
A fungal infection in the crural fold, not extending to scrotum, occurring in postpubertal males ["jock itch"] after sweating or wearing layers of occlusive clothing. It forms a red-brown half-moon shape with well-defined borders.
what is onychomycosis
fungal infection of the nail
what is pediculosis capitis
Head lice
the egg is called the nit
what is scabies
caused by the scabies mite, forming a linear or curved elevated burrow on the finger, web space of hands [interdigital] causing intense itch--pruritic contagion
know this difference ?????
psoriasis--extensor
eczema--flexor
what is mongolian spot NORMAL
mongolian spot is a common variation of hyperpigmentation in Black, Asian, American Indian, and Hispanic newborns It is a blue- black to purple macular area at the sacrum or buttocks but sometimes on the abdomen, thighs, shoulders, or arms.
what is cafe au lait spot NORMAL
The caf� au lait spot is a large round or oval patch of light brown pigmentation [hence, the name "coffee with milk"], which is usually present at birth
what is acrochordons or skin tags NORMAL
A cutaneous skin tag is a common skin growth that form a stalk and are polyp-like. They occur frequently on eyelids, cheeks and neck, and axillae and trunk. It is usually harmless. normal variant in adults
what is Senile Lentigines NORMAL
Senile Lentigines. Commonly called liver spots, these are small, flat, brown macules. These circumscribed areas are clusters of melanocytes that appear after extensive sun exposure. They appear on the forearms and dorsa of the hands. They are not malignan
what is Basal cell carcinoma
skin colored papule with a translucent top. looks like a large open pore with a central yellowing. Pearly boarders with central red ulcer. it is the most common kind of skin cancer; slow but inexorable[unstoppable] growth
what is squamous cell carcinoma
erythematous scaly patch with sharp margins, 1cm or more. develops central ulcer and surrounding erythema. less common than BCC but grows rapidly.
what are the risk factors for pressure sores [bed sores] [pressure ulcer] decubiti
1.) nutrition
2.) comorbid diseases [two chronic diseases in a patient e.g. diabetes and paralyzes]
3.) immobility
4.) inactivity
5.) moisture
6.) pressure
7.) shearing
stages of decubiti
stage 1-- intact skin appears red but unbroken. localized redness; will not blanch
stage 2--partial thickness skin erosion with loss of epidermis or also the dermis. superficial ulcer; looks like abrasion or open blister
stage 3--full thickness pressure u
if you see exudate present record
amount
odor
color
consistency
COCA
how long should you wait for a capillary refill be sure of peripheral circulation
<2 seconds
what is the normal angle between base and nail
approx 160 degrees
at what angle is it clubbing of the nails
180 degree
what is the Beau's line and what causes it
a depression across the nail that extends down to the nail bed. causes include
1.) trauma
2.) illness
3.) toxic reaction
4) malnutrition
what is leukonychia and what are the causes
white spots or milk spots on the nail
causes include trauma, hereditary, heart disease, renal failure
what is melanonychia and what causes it
Melanonychia is a black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in black patients, as a result of trauma, chronic myelogenous leukemia, sickle cell anemia, polycythemia
what is koilonychia and the causes
Koilonychia, also known as spoon nails, is a nail disease that can be a sign of low iron. it could be hereditary.
what is clubbing and what are the possible causes
inner edge of nail elevated; nail bed angle is greater than 180 degrees
Diseases that disrupt normal pulmonary circulation (chronic lung inflammation, bronchial tumors, heart defects, COPD, cystic fibrosis, CHF, hypoxia, chronic anemia
symptoms of lupus include
Pain or swelling in joints
Muscle pain
Red rashes, most often on the face******
Chest pain when taking a deep breath
Hair loss********
Pale or purple fingers or toes********
Sensitivity to the sun
Swelling in legs or around eyes
Mouth ulcers**********
Swo
Nevus is the medical term for
mole
To access for early jaundice, you assess
the sclera and hard palate
An area of thin, shiny skin with decreased visibility of normal skin markings is called
atrophy
a risk factor for melanoma is
skin that freckles or burns before tanning
Herpers zoster--shingles forms what kind of lesion
pustular, umbilicated leision
what is Petechiae
Petechiae are tiny punctuate hemorrhages that are 1 to 3 mm, round and discrete, and dark red, purple, or brown caused by bleeding from superficial capillaries.
what is purpura
Purpura is a flat, macular, red to purple hemorrhage that is a confluent and extensive patch of petechiae and ecchymoses greater than 3 mm
what is andecchymosis
An ecchymosis is petechiae that are greater than 3 mm.
Do newborns sweat?
No Newborn infants do not sweat and use compensatory mechanisms to control body temperature.
Component of nail examination includes
contour, consistency, and color.
To determine if a dark skinned patient is pale, the nurse should assess the color of the:
To detect pallor in a dark skinned individual, the nurse should assess an area with the least pigmentation, such as the conjunctivae or mucous membranes.
know about KOH
...
what is Languo
Lanugo: fine downy hair of the newborn infant.
fine vellus hair in first few months