Skin , Hair & Nails, 330.Gsu.F.09
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Skin , Hair & Nails, 330.Gsu.F.09 Skin , Hair & Nails, 330.Gsu.F.09 Presentation Transcript

  • 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
      • A symmetry of a pigmented lesion
      • B order irregularity
      • C olor variation
      • D iameter greater than 6mm
      • E levation
      • E nlargement
  • 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