physical assessment course

1,868 views
1,737 views

Published on

1 Comment
2 Likes
Statistics
Notes
No Downloads
Views
Total views
1,868
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
83
Comments
1
Likes
2
Embeds 0
No embeds

No notes for slide

physical assessment course

  1. 1. FunctionFunction 1. Preventing the passage of MO to skin & mucous membrane 2. Regulates the body temperature 3. Secretes sebum, an oily substance that softens and lubricate the hair and skin 4. Transmits sensation through nerve receptors 5. Produces and absorbs vitamin D in conjunction with ultraviolet rays from the sun. 6. F&E balance, absorption, excretion, immunity. 1. Preventing the passage of MO to skin & mucous membrane 2. Regulates the body temperature 3. Secretes sebum, an oily substance that softens and lubricate the hair and skin 4. Transmits sensation through nerve receptors 5. Produces and absorbs vitamin D in conjunction with ultraviolet rays from the sun. 6. F&E balance, absorption, excretion, immunity.
  2. 2. • Epidermis; the outer layer of skin is composed of four distinct layers: the stratum corneum, stratum lucidum, stratum granulosum, stratum germinativum. • The outermost layer consist of dead, keratinized cells that render the skin waterproof. • The epidermis, hair, nail, dental enamel, & horny tissues are composed of keratin. It is replaced every 3-4 weeks.
  3. 3. • The innermost layer of epidermis which called stratum germinativum is the only layer that undergoes cell division & contains melanin & keratin-forming cells. • Skin color depends on the amount of melanin & carotene" yellow pigment" contained in the skin & the volume of blood containing hemoglobin, the oxygen-binding pigment that circulates in the dermis.
  4. 4. • Dermis; the inner layer of skin. It is connected to the epidermis by means of papillae. • These papillae from the base of the visible friction ridges that provide the unique pattern of fingerprints with which we are familiar. • The dermis is a well-vascularized connective tissue layer containing collagen & elastic fiber, nerve endings, and lymph vessels. It is also the origin of hair follicles, sebaceous glands, and sweat glandssebaceous glands, and sweat glands. • Dermis; the inner layer of skin. It is connected to the epidermis by means of papillae. • These papillae from the base of the visible friction ridges that provide the unique pattern of fingerprints with which we are familiar. • The dermis is a well-vascularized connective tissue layer containing collagen & elastic fiber, nerve endings, and lymph vessels. It is also the origin of hair follicles, sebaceous glands, and sweat glandssebaceous glands, and sweat glands.
  5. 5. • Sebaceous Glands; develop from hair follicles and, therefore are present over most of the body, excluding the soles and palms. • They secrete an oily substance called sebum that lubricate hair and skin and reduces water loss through the skin; it is also fungicidal and bactericidal effects.
  6. 6. • Sweat Glands; two types; eccrine and apocrine. The eccrine glandseccrine glands are located over the entire skin surface & secrete an odorless, colorless fluid, the evaporation of which is vital to the regulation of body temperature. • The apocrine glandsThe apocrine glands are concentrated in the axillae, perineum, & areola of the breast & usually open through a hair follicle. • They secrete milky sweat. The interaction of sweat with the skin bacteria produces body odor.
  7. 7. • Subcutaneous Glands; merging with the dermis is the subcutaneous tissue, which is a loose connective containing fat cells, blood vessels , nerve, and the remaining portions of sweat glands and hair follicles. • The subcutaneous tissue assists with heat regulation & contains of vascular pathways for the supply of nutrients & removal of waste products from the skin.
  8. 8. • The Langerhans’ cells of the epidermisThe Langerhans’ cells of the epidermis, which bind antigen; the dermal dendrocytes of the dermis, which have phagocytic properties; & immune cells (T cells and mast cells), which are found in the dermis, contribute to the antigen-antibody responses affecting the skin.
  9. 9. Innervation and Blood SupplyInnervation and Blood Supply • The arterial vessels that nourish the skin form two plexuses (i.e., collection of blood vessels), one located between the papillary and reticular layers of the dermis and the other between the dermis and the subcutaneous tissue layer. • Capillary flow that arises from vessels in this plexus extends up and nourishes the overlaying epidermis by diffusion. • Blood leaves the skin by way of small veins that accompany the subcutaneous vessels. The lymphatic system of the skin, which aids in combating certain skin infections, also is limited to the dermis.
  10. 10. Lesions, Rashes, & Vascular Disorders • RashesRashes are temporary eruptions of the skin, such as those associated with childhood diseases, heat, diaper irritation, or drug-induced reactions. • LesionLesion refers to a traumatic or pathologic loss of normal tissue continuity, structure, or function. • Rashes & lesions may range in size from a fraction of a mm (e.g., the pinpoint spots of petechiae) to many cms (e.g., decubitus ulcer) • RashesRashes are temporary eruptions of the skin, such as those associated with childhood diseases, heat, diaper irritation, or drug-induced reactions. • LesionLesion refers to a traumatic or pathologic loss of normal tissue continuity, structure, or function. • Rashes & lesions may range in size from a fraction of a mm (e.g., the pinpoint spots of petechiae) to many cms (e.g., decubitus ulcer)
  11. 11. • Blister:Blister: a vesicle or fluid- filled papule. Blisters of mechanical origin form from the friction caused by repeated rubbing on a single area of the skin.
  12. 12. PruritusPruritus • Pruritus, or the sensation of itch, is a symptom common to many skin disorders. • Generalized itching in the absence of a primary skin disease may be symptomatic of other organ disorders, such as chronic renal disease, diabetes, or biliary disease. • Warmth, touch, & vibration also can act locally to trigger the itch phenomenon. • Pruritus, or the sensation of itch, is a symptom common to many skin disorders. • Generalized itching in the absence of a primary skin disease may be symptomatic of other organ disorders, such as chronic renal disease, diabetes, or biliary disease. • Warmth, touch, & vibration also can act locally to trigger the itch phenomenon.
  13. 13. Ultraviolet RaysUltraviolet Rays Sunburn • Sunburn is caused by excessive exposure of the epidermal & dermal layers of the skin to UV radiation, resulting in an erythematous inflammatory reaction. Sunburn ranges from mild to severe. • A mild sunburnA mild sunburn consists of various degrees of skin redness. • Severe sunburnSevere sunburn is inflammation, vesicle eruption, weakness, chills, fever, malaise, and pain Sunburn • Sunburn is caused by excessive exposure of the epidermal & dermal layers of the skin to UV radiation, resulting in an erythematous inflammatory reaction. Sunburn ranges from mild to severe. • A mild sunburnA mild sunburn consists of various degrees of skin redness. • Severe sunburnSevere sunburn is inflammation, vesicle eruption, weakness, chills, fever, malaise, and pain
  14. 14. Sunscreens & Other ProtectiveSunscreens & Other Protective MeasuresMeasures • The UV rays of sunlight or other sources can be either completely or partially blocked from the skin surface by sunscreens. • There are two primary types of sunscreens available on the market chemical (soluble) agents & physical (insoluble) agents. • Shielding the skin with protective clothing & hats or head coverings helps decrease ultraviolet radiation exposure. • The UV rays of sunlight or other sources can be either completely or partially blocked from the skin surface by sunscreens. • There are two primary types of sunscreens available on the market chemical (soluble) agents & physical (insoluble) agents. • Shielding the skin with protective clothing & hats or head coverings helps decrease ultraviolet radiation exposure.
  15. 15. Primary Disorders Of The SkinPrimary Disorders Of The Skin • Primary skin disorders are those originating in the skin. They include infectious processes, acne, allergic disorders & drug reactions, & arthropod infestations. • Although most of these disorders are not life threatening, they can affect the quality of life.
  16. 16. Infectious Processes- Fungal Infections • Fungi are free-living, saprophytic, plantlike organisms, certain strains of which are considered part of the normal skin flora. • The superficial mycoses, more commonly known as tineatinea oror ringwormringworm, invade only the superficial keratinized tissue (skin, hair, and nails). • Deep fungal infections involve the epidermis, dermis, & subcutis. Infections that typically are superficial may exhibit deep involvement in immunosuppressed individuals. • Fungi are free-living, saprophytic, plantlike organisms, certain strains of which are considered part of the normal skin flora. • The superficial mycoses, more commonly known as tineatinea oror ringwormringworm, invade only the superficial keratinized tissue (skin, hair, and nails). • Deep fungal infections involve the epidermis, dermis, & subcutis. Infections that typically are superficial may exhibit deep involvement in immunosuppressed individuals.
  17. 17. •The fungi that cause superficial mycoses live on the dead keratinized cells of the epidermis. •They emit an enzyme that enables them to digest keratin, which results in superficial skin scaling, nail disintegration, or hair breakage, depending on the location of the infection.
  18. 18. •Deeper reactions involving vesicles, erythema, & infiltration are caused by the inflammation that results from exotoxins liberated by the fungus. •Tinea pedisTinea pedis (athlete’s foot, or ringworm of the feet) is a common dermatosis primarily affecting the spaces between the toes, the soles of the feet, or the sides of the feet.
  19. 19. •The lesions vary from a mildly scaling lesion to a painful, exudative, erosive, inflamed lesion with fissuring. Lesions often are accompanied by pruritus, pain, and foul odor. •Superficial fungal infections may be treated with topical or systemic antifungal agents. •Topical agentsTopical agents, both prescription and over-the-counter preparations, are commonly used in the treatment of tinea infections; however, outcome success often is limited because of the lengthy duration of treatment, poor compliance, & high rates of relapse at specific body sites.
  20. 20. Candidal Infections •Candidiasis (moniliasis) is a fungal infection caused by Candida albicans. This yeast-like fungus is a normal inhabitant of the GIT, mouth, & vagina. •Some persons are predisposed to candidal infections by conditions such as DM, antibiotic therapy, pregnancy, use of birth control pills, poor nutrition, & immuno- suppressive diseases. •Oral Candidiasis may be the first sign of infection with human immunodeficiency virus (HIV(.
  21. 21. AcneAcne •Acne is a disorder of the pilosebaceous unit (hair follicle & sebaceous gland). The hair follicle is a tubular invagination of the epidermis in which hair is produced. •The sebaceous glands empty into the hair follicle, & the pilosebaceous unit opens to the skin surface by means of a widely dilated opening called a pore
  22. 22. Atopic Eczema and Nummular EczemaAtopic Eczema and Nummular Eczema • Atopic eczema (atopic dermatitis) is occurs in two clinical forms: infantile & adult. • It is associated with a type I hypersensitivity reaction There is a family history of asthma, hay fever, or atopic dermatitis. The infantile formThe infantile form is characterized by vesicle formation, oozing, & crusting with excoriations years. • Adolescents & adultsAdolescents & adults usually have dry, leathery, & hyperpigmented or hypopigmented lesions located in the antecubital and popliteal areas. • Atopic eczema (atopic dermatitis) is occurs in two clinical forms: infantile & adult. • It is associated with a type I hypersensitivity reaction There is a family history of asthma, hay fever, or atopic dermatitis. The infantile formThe infantile form is characterized by vesicle formation, oozing, & crusting with excoriations years. • Adolescents & adultsAdolescents & adults usually have dry, leathery, & hyperpigmented or hypopigmented lesions located in the antecubital and popliteal areas.
  23. 23. • These may spread to the neck, hands, feet, eyelids, & behind the ears. Itching may be severe with both forms. Secondary infections are common. • Treatment of atopic eczema is designed to target the underlying abnormalities such as dryness, pruritus, superinfection, & inflammation.
  24. 24. • It involves allergen control, basic skin care, & medications. Because dry skin & pruritus often exacerbate the condition, hydration of the skin is essential to treating atopic dermitis. • Mild or healing lesions may be treated with lotions containing a mild antipruritic agent. • Treatment is palliative. Frequent bathing, foods rich in iodides and bromides, reduced stress, & increased the environmental humidity. • Topical corticosteroids, coal tar preparations, & UV light treatments are prescribed as necessary. • It involves allergen control, basic skin care, & medications. Because dry skin & pruritus often exacerbate the condition, hydration of the skin is essential to treating atopic dermitis. • Mild or healing lesions may be treated with lotions containing a mild antipruritic agent. • Treatment is palliative. Frequent bathing, foods rich in iodides and bromides, reduced stress, & increased the environmental humidity. • Topical corticosteroids, coal tar preparations, & UV light treatments are prescribed as necessary.
  25. 25. Urticaria • Urticaria, or hives, is characterized by edematous plaques, called wheals, that are accompanied by intense itching. Wheals typically appear as raised pink or red areas surrounded by a paler halo. • Histamine, released from mast cells, is the most common mediator of urticaria. It causes hyper- permeability of the microvessels of the skin and surrounding tissue, allowing fluid to leak into the tissues, causing edema and wheal formation.
  26. 26. A variety of immunologic, nonimmunologic, physical, and chemical stimuli can cause urticaria. The most common causes of acute urticaria are foods or drinks, medications, or exposure to pollens or chemicals. Food is the most common cause of acute urticaria in children. Physical urticarias constitute another form of chronic urticaria. Physical urticarias are intermittent, usually last less than 2 hours, are produced by appropriate stimuli, have distinctive appearances and locations, and are seen most frequently in young adults.
  27. 27. • Other types of physical urticaria are cholinergic (i.e., exercise-induced), cold, delayed pressure, solar (i.e., sunlight), aquagenic (i.e., water), vibratory, & external (localized heat-induced). • Appropriate challenge tests (e.g., application of an ice cube to the skin to initiate development of cold urticaria) are used to differentiate physical urticaria from chronic urticaria due to other causes.
  28. 28. •Subjective History Data (what the patient tells you( • Collect data about current ""These information obtainedThese information obtained symptoms provides clues to theprovides clues to the client’sclient’s • Client's past and family history • Life style and health practices overall level of functioning in relation to skin, nail, & hair
  29. 29. Interview ApproachInterview Approach • Ask questions in a straightforward manner. • Keep in mind that a nonjudgmental and sensitive approach is needed if the client has abnormalities • Explore symptoms from the client with a symptom analysis. Use COLDSPA as a guide. • Ask questions in a straightforward manner. • Keep in mind that a nonjudgmental and sensitive approach is needed if the client has abnormalities • Explore symptoms from the client with a symptom analysis. Use COLDSPA as a guide.
  30. 30. • CHARACTER: Describe the sign or symptom. How does it feel, look, sound, smell, and so forth? • ONSET: When did it begin? • LOCATION: Where is it? Does it radiate? • DURATION: How long does it last? Does it recur? • SEVERITY: How bad is it? • PATTERN: What makes it better: What makes it worse? • ASSOCIATED FACTORS: What other symptoms occur with it?
  31. 31. History of current symptoms • Because of differences in education, languagedifferences in education, language, or cultural background, some clients may provide vague or confusing answers. • Be sure to state questions clearly and use words that the client can understand; avoid medical jargonavoid medical jargon. • Changes in sensation may indicate vascular orvascular or neurologic problemsneurologic problems such as DM or arterial occlusive disease. Sensation problems may put the client at risk for developing pressure ulcers. • Because of differences in education, languagedifferences in education, language, or cultural background, some clients may provide vague or confusing answers. • Be sure to state questions clearly and use words that the client can understand; avoid medical jargonavoid medical jargon. • Changes in sensation may indicate vascular orvascular or neurologic problemsneurologic problems such as DM or arterial occlusive disease. Sensation problems may put the client at risk for developing pressure ulcers.
  32. 32. • Uncontrolled body odor or excessive orUncontrolled body odor or excessive or insufficient perspirationinsufficient perspiration may indicate an abnormally with the sweat glands or an endocrine problems such as hypothyroidism or hyperthyroidism. • Poor hygiene practicesPoor hygiene practices may account for body odor, and health education may be indicated. Perspiration decreases with aging because sweat glands activity decreases.
  33. 33. Examples of suggested questions Are you experiencing any current skin problems such as rashes, lesions, dryness…etc? Describe any birth marks or moles you now have? Have you noticed any change in your ability to feel pain, pressure, light touch, or temperature changes? Do you have trouble controlling body odor? How much do you perspire?
  34. 34. • Past HistoryPast History • Current problems may be recurrence of previous ones. • Various types of allergens can precipitate a variety of skin eruption • Some skin rashes or lesions may be related to viruses or bacteria. • Family HistoryFamily History • Acne, and atopic dermatitis tend to be familiar • A genetic component is associated with skin cancer.
  35. 35. Previous problems with the skin, nail, and hair including any treatment or surgery and its effectiveness? •Allergic skin reactions to food, medication, plants, or other environmental substances? Previous history of skin diseases Excessive dryness Change in pigmentation Change in mole size or color Excessive bruising Rash or lesion Pruritis Medications Hair loss Change in nails Environmental hazards Self-care behaviors
  36. 36. Lifestyle and Health Practices • Sun exposure can cause premature aging of skin and increase risk of cancer. • Older, disabled, or immobile clients who spend long periods of time in one position are at risk for pressure ulcer. • Extreme temperature affects the blood supply to the skin, and can damage the skin layers. • Regular habits provide information on hygiene and life style. The products used may be also being a cause of abnormality. Improper nail-cutting technique can lead to ingrown nails or infection.
  37. 37. • Decreased flexibility and mobilityDecreased flexibility and mobility may impair the ability of some elderly clients to maintain proper hygiene practices, such as nail cutting, bathing, and hair care • A balanced dietA balanced diet is necessary for healthy skin, hair, and nails. Adequate fluid intake is required to maintain skin elasticity. • Skin, hair, or nail problems, especially if visible, may impair the client's ability to interact comfortablyclient's ability to interact comfortably with others because of embarrassment or rejection by others. • StressStress can cause or exacerbate skin abnormalities • If clients do not how to inspect the skin, teach them how to recognize suspicious lesions early.
  38. 38. • Objective Data (what we see, smell, hear & feel)Objective Data (what we see, smell, hear & feel) • Color-freckles, moles, birthmarks. Color changes (erythema, pallor, cyanosis, jaundice). • Temperature. Moisture. Texture. Thickness. Edema • Turgor. Bruising. Lesions (note color, elevation, pattern, size, location, and any exudate)
  39. 39. • Assessment of the skinAssessment of the skin, involves inspection and palpation. The entire surface may be assessed at one time or as each aspect of the body is assessed. • The nurse may need to use the olfactory sense to detect unusual skin odors; these are usually most evident in the skin folds or in the axillae. • Pungent body odor is frequently related to poor hygiene, hyperthyroidosis” excessive perspiration”.
  40. 40. • The skin first assessed for color. Look for localized areas of bruising, cyanosis, pallor, & erythema. Check for uniformity of color & hypopigmentation or hyperpigmentation areas. • Place exposed to the sun may show a darker pigmentation than other areas. Remember that color changes may look different in dark- skinned people.
  41. 41. • PallorPallor is the result of inadequate circulation blood or hemoglobin and subsequent reduction in tissue oxygenation. It may be difficult to determine in clients with dark skin. • It is usually characterized by the absence of underlying red tones in the skin and may be most readily seen in the buccal mucosa. • CyanosisCyanosis; a bluish tinge is the most evident in the nail beds, lips, & buccal mucosa. In dark-skinned clients, close observation of the conjunctiva & palms & soles may show evident of cyanosis.
  42. 42. • JaundiceJaundice may first be evident in the sclera of the eyes & then in the mucous membranes & the skin. • EdemaEdema is the presence of excess interstitial fluid. An area of edema appears swollen, shiny, & taut & tends to blanch the skin color, or, if accompanied by inflammation, may redden the skin. • Generalized edema is most often an indication of impaired venous circulation and in some cases reflects cardiac dysfunction or vein
  43. 43. • If possible and the client agrees, take a digital or instant photograph or significant skin lesions for the client record. Include a measuring guide” ruler or tape” in the picture to demonstrate lesion size. • Hemoglobin, which circulates in the red cells and carries most of the oxygen of the blood, exists in two forms. OxyhemoglobinOxyhemoglobin, a bright red pigment, predominates in the arteries and capillaries.
  44. 44. • An increase in blood flow through the arteries to the capillaries of the skin causes a reddening of the skin, while the opposite change usually produces pallor. • The skin of light-colored persons is normally redder on the palms, soles, face, neck, and upper chest. • As blood passes through the capillary bed, some of the oxyhemoglobin loses its oxygen to the tissues & changes to deoxyhemoglobin—a darker & environment.
  45. 45. • Skin color is affected not only by pigments but also by the scattering of light as it is reflected back through the turbid superficial layers of the skin or vessel walls. • Skin of light-skinned look paler and more opaq Comedones (blackheads) often appear on the cheeks or around the eyes. Where skin has been exposed to the sun it looks
  46. 46. • Weather beatenWeather beaten: thickened, yellowed, & deeply furrowed. Skin on the backs of the hands & forearms appears thin, fragile, loose, & transparent, and may show whitish, depigmented patches known as pseudoscars. • Well demarcatedWell demarcated, vividly purple macules or patches, termed actinic purpura, may also appear in the same areas, fading after several weeks.
  47. 47. • These purpuric spots come from blood that has leaked through poorly supported capillaries and has spread within the dermis. • Dry skin (asteatosis)—a common problem is especially on the legs, where a network of shallow fissures often creates a mosaic of small polygons.
  48. 48. • Some common benign lesions often accompany aging: cherry angiomas which often appear early in adulthood, seborrheic keratoses, and, in sun-exposed areas, actinic lentigines or “liver spots” and actinic keratoses . • Elderly people may also develop two common skin cancers: basal cell carcinoma & squamous cell carcinoma.
  49. 49. Ulcer: deep, irregularity area of skin loss extending into the dermis or subcutaneous tissue. May be bleeds, may leave scar.
  50. 50. • Scar: flat, irregular area of connective tissue lest after a lesion or wound has healed. New scars may be red, older scars may be silvery or white.
  51. 51. • Pustule: vesicle or bulla filled with pus such as in impetigo.
  52. 52. • Cyst: A 1-cm or larger, elevated, encapsulated, fluid-filled or semisolid mass arising from the subcutaneous tissue or dermis. • Papule;Papule; Circumscribed, solid elevation of skin. Papules are less than 1 cm such as acne and warts
  53. 53. • TurgorTurgor: inspect & palpate the skin’s texture, noting its thickness & mobility. It should look smooth & be intact. • Rough, dry skin is common in hypothyroidism, and excessive keratinization. Skin that isn’t intact may indicate local irritation or trauma. • Palpation will also help you evaluate the patient’s state of hydration. Dehydration and edema cause poor skin turgor. • Overhydration causes the skin to appear edematous and spongy. Localized edema can also result from trauma or systemic disease.
  54. 54. • MoistureMoisture:: It should be relatively dry, with amount of perspiration. • Skin fold areas should also be fairly dry. • Overly dry skin will look red, and flaky. • Overly moist skin can be caused by anxiety, obesity, or an environment that’s too warm.
  55. 55. • Skin TemperatureSkin Temperature: palpate the skin for temperature, which can range from cool to warm. Warm skin suggests normal circulation. • Make sure to distinguish between generalized & localized coolness and warmth. • Localized skin coolness can result from vasoconstriction associated with cold environments or impaired arterial circulation to limb. • General coolness can result from such conditions as a shock or hypothyroidism.
  56. 56. • Localized warmth can occur in an area of infection, inflammation, or burn. Generalized warmth occurs with fever or systemic diseases. • Skin integritySkin integrity: especially carefully in pressure point areas” sacrum, hips, elbows”. If any skin breakdown is noted, use a scale to document the degree of skin breakdown
  57. 57. • Hair consists of layers of keratinized cells found over much of the body except for the lips, nipples, soles of the feet, palms of the hands, labia minora, and penis. • Hair growth occurs at the base of the follicle, where cells in the hair bulb are nourished by dermal blood vessels. • There are two general types of hair vellus & terminal. Vellus hair is short, pale, & fine and present over much of the body. The terminal hair "particularly scalp & eyebrows" is longer, generally darker, & coarser than the vellus hair.
  58. 58. • Inspecting the hair, considering development changes and ethnicity differences, and determining the individual’s practices and the factors influencing them. • Normal hair is resilient & evenly distributed. In people with severe protein deficiency” Kwashiorkor”, the hair color is faded and appears reddish or bleached, and the texture is coarse & dry. • Some therapies cause alopecia” hair loss and some disease conditions affect the coarseness of hair. • Color • Texture • Distribution • Lesions
  59. 59. Nail • The nail, located on the distal phalanges of fingers & toes, are hard, transparent plates of keratinized epidermal cells that grow from a root underneath the skin fold “cuticle”. • The nail body extends over the entire nailbed & has a pink tinge as a result of the rich blood supply underneath. • At the base of the nail is the lunula, a paler, crescent- shaped area. The nails protect the distal ends of the fingers & toes
  60. 60. • Nails are inspected for nail plate shape, angle between the nail & the nail beds, nail texture, nail bed color, & the intactness of the tissues around the nails. • The nail plate is normally colorless and a convex curve. The angle between the nail and the nail bed is normally 160 degrees. • One nail abnormality is the spoon shape, in which the nail curves upward from the nail bed. KoilonychiasKoilonychias, in clients with IDAIDA
  61. 61. • ClubbingClubbing “the angle between the nail & the nail bed is 180 degrees or greater caused by a long-term lack of oxygen. • Nail textureNail texture is normally smooth. Excessively thick nails can appear in the elderly, in the presence of poor circulation, or in relation to a chronic fungal infection. Excessively thin nails or the presence of grooves can reflect prolonged iron deficiency anemiairon deficiency anemia. • The nail bed is highly vascular, a characteristic that accounts for its pink color in white people. A bluish or purplish tint to the nail bed may reflect cyanosis, and pallor may reflect poor arterial circulation.
  62. 62. • The tissue surrounding the nails is normally intact epidermis. ParonychiaParonychia is an inflammation of the tissues surrounding a nail” often referred to as an ingrown nail” • Shape and Contour • Consistency • Color • Capillary refill
  63. 63. Abnormal Nail Conditions • Koilonychia (spoon nails) • Beau’s line (transverse groove) • Oncholysis (fungus) • Late clubbing (seen with COPD)
  64. 64. Koilonychia (Spoon NailsKoilonychia (Spoon Nails((
  65. 65. Clubbing of NailsClubbing of Nails
  66. 66. Onycholysis (fungusOnycholysis (fungus((
  67. 67. Risk FactorsRisk Factors 1) Sun exposure, in intermittent pattern with sunburn 2) Medical therapies such as radiation 3) Family history and genetic susceptibility 4) Moles, especially atypical lesions 5) Pigmentation irregularities “albinism, burn scars” 6) Immunosuppression 7) Age, risk increases with increase age 8) Male gender 9) Chemical exposure 10) Long-term skin inflammation or injury
  68. 68. Treatments used to skin cancerTreatments used to skin cancer • A common operationoperation simply cuts out the affected area under local anaesthetic. • CryosurgeryCryosurgery is used on smaller cancers, in which liquid nitrogen is applied to the tumor to freeze it and kill the cells, which simply shrivel & drop off once warmed up. • Heat from a lasera laser is sometimes used to burn away the tumor. Precisely targeted radiotherapyradiotherapy is occasionally pointed at the cancer, as is chemotherapy in the form of a cream.
  69. 69. • Photodynamic therapyPhotodynamic therapy" - which uses a cream to sensitize the tumor - then exposes it to high intensities of light to destroy it. • Chemotherapy or biological treatmentChemotherapy or biological treatment such as interferon may be given to attempt to eradicate skin cancer cells in other parts of the body used in the case of melanoma, if there is a suspicion that the cancer may have spread beyond the skin layer,.
  70. 70. Reduction of riskReduction of risk • Reducing exposure to ultraviolet (UV) radiation, especially in early years • Avoiding sunburns • Avoiding sun exposure during the day (usually from 10 AM to 3 PM), when the sun is highest in the sky • Wearing protective clothing (long sleeves and hats) when outdoors
  71. 71. • Using a broad-spectrum sunscreen that blocks both UVA and UVB radiation • Use SPF sun block of at least 50 • Reapply sun block Q 2 hours & after swimming • Examine the skin for suspect lesions. If there is anything unusual, seek professional advice as son as possible
  72. 72. Age Related Changes of the Integumentary SystemAge Related Changes of the Integumentary System • The older person’s skin is wrinkled and has a loss of resiliency. The skin becomes thinner, drier, less elastic, and more fragile as SC fat diminishes. • The elastin fibers are replaced with collagen fibers, and sebaceous and sweat gland activity decreases. • Capillary blood flow also decreases which slows wound healing. Fingernails usually thicken, become ridged and brittle, and grow more slowly
  73. 73. EQUIPMENT AND SUPPLIES • Examination light • Penlight • Mirror for client’s self-examination of skin • Magnifying glass • Centimeter ruler • Gloves • Wood’s light • Examination gown or drape
  74. 74. KEY ASSESSMENT POINTSKEY ASSESSMENT POINTS • Inspect skin color, temperature, moisture, texture • Check skin integrity • Be alert for skin lesions • Evaluate hair condition; loss or unusual growth • Note nailbed condition and capillary refill
  75. 75. ‫الكرب‬ ‫دعاء‬‫الكرب‬ ‫دعاء‬ •‫الكريم‬ ‫الحليم‬ ‫ا‬ ‫إل‬ ‫إله‬ ‫ل‬‫الكريم‬ ‫الحليم‬ ‫ا‬ ‫إل‬ ‫إله‬ ‫ل‬ •‫العظيم‬ ‫العلي‬ ‫ا‬ ‫إل‬ ‫إله‬ ‫ل‬‫العظيم‬ ‫العلي‬ ‫ا‬ ‫إل‬ ‫إله‬ ‫ل‬ •‫ورب‬ ‫السماوات‬ ‫رب‬ ‫سبحان‬‫ورب‬ ‫السماوات‬ ‫رب‬ ‫سبحان‬ ‫العظيم‬ ‫العرش‬‫العظيم‬ ‫العرش‬ •‫العالمين‬ ‫رب‬ ‫لله‬ ‫الحمد‬‫العالمين‬ ‫رب‬ ‫لله‬ ‫الحمد‬

×