N 295 lecture 3 skin student copy

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N 295 lecture 3 skin student copy

  1. 1. Integumentary System: Assessing the SKIN Spring 2012
  2. 2. Functions of the Skin <ul><li>Protects Against Trauma </li></ul><ul><li>Protects Against Ultraviolet Radiation </li></ul><ul><li>Support Structure </li></ul><ul><li>Maintains Body Temperature </li></ul>Spring 2012
  3. 3. Functions of Skin <ul><li>Involved with Absorption and Excretion </li></ul><ul><li>Involved with Immunity </li></ul><ul><li>Synthesizes Vitamin D </li></ul><ul><li>Helps Maintain Fluid Balance </li></ul><ul><li>Provides Sensation with the External Environment </li></ul>Spring 2012
  4. 4. Structures of Skin <ul><li>Epidermis </li></ul><ul><li>Dermis </li></ul><ul><li>Subcutaneous Tissue </li></ul><ul><li>Epidermal Appendages: </li></ul><ul><ul><li>Hair </li></ul></ul><ul><ul><li>Nails </li></ul></ul><ul><ul><li>Sebaceous Glands </li></ul></ul>Spring 2012
  5. 5. Risk Factors <ul><li>. . . . . . </li></ul><ul><li>. . . . . . </li></ul><ul><li>. . . . . . </li></ul><ul><li>. . . . . </li></ul><ul><li>. . . . . </li></ul>Spring 2012
  6. 6. SECONDARY SKIN LESIONS <ul><li>Crust * </li></ul><ul><li>Scale </li></ul><ul><li>Fissure </li></ul><ul><li>Erosion </li></ul><ul><li>Ulcer </li></ul><ul><li>Scar </li></ul><ul><li>Excoriation </li></ul><ul><li>Keloid </li></ul><ul><li>Lichenification </li></ul>Spring 2012
  7. 7. Descriptions of Lesions * <ul><li>Size </li></ul><ul><li>Shape </li></ul><ul><li>Color </li></ul><ul><li>Texture </li></ul><ul><li>Surface relationship </li></ul><ul><li>Exudate </li></ul><ul><li>Tenderness or pain </li></ul>Spring 2012
  8. 8. Skin Assessment: <ul><li>Approach </li></ul><ul><li>Inspection </li></ul><ul><li>Palpation </li></ul>Spring 2012
  9. 9. Examination <ul><li>General Inspection : </li></ul><ul><ul><li>General pigmentation </li></ul></ul><ul><ul><li>Texture </li></ul></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Moisture </li></ul></ul><ul><ul><li>Mobility </li></ul></ul><ul><ul><li>Turgor </li></ul></ul><ul><ul><li>Vascularity or bruising </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Lesions or discoloration </li></ul></ul>Spring 2012
  10. 10. Adult <ul><ul><li>Normal Variations: </li></ul></ul><ul><ul><ul><li>Striae </li></ul></ul></ul><ul><ul><ul><li>Vitiligo </li></ul></ul></ul><ul><ul><ul><li>Moles </li></ul></ul></ul><ul><ul><ul><li>Freckles </li></ul></ul></ul><ul><ul><ul><li>Birthmarks </li></ul></ul></ul>Spring 2012
  11. 11. Warning Signs of Cancer <ul><li>A = Asymmetry </li></ul><ul><li>B = Boarder irregular </li></ul><ul><li>C = Color variation </li></ul><ul><li>D = Diameter >6mm </li></ul><ul><li>E = Elevation & Enlargement </li></ul>Spring 2012
  12. 12. Abnormal Skin Findings <ul><li>Central Cyanosis </li></ul><ul><li>Peripheral Cyanosis </li></ul><ul><li>Pallor: </li></ul><ul><li>decreased Hgb-, </li></ul><ul><li>decreased perfusion </li></ul><ul><li>Also on conjunctiva and mucus membranes </li></ul>Spring 2012
  13. 13. Examination <ul><li>Palpate skin for temp, moisture, mobility and turgor </li></ul><ul><li>Hair Distribution </li></ul><ul><li>Nail </li></ul><ul><ul><li>Thickening or hypertrophy </li></ul></ul><ul><ul><li>Thinning or Brittleness </li></ul></ul><ul><ul><li>Spoon Shaped </li></ul></ul><ul><ul><li>Pitting of Nail </li></ul></ul><ul><ul><li>Pigmented Bands </li></ul></ul><ul><ul><li>Splinter Hemorrhages </li></ul></ul>Spring 2012
  14. 14. Vascular Lesions: <ul><li>Petechiae </li></ul><ul><li>Ecchymosis </li></ul><ul><li>Purpura </li></ul><ul><li>Hematoma </li></ul><ul><li>Venous Star </li></ul><ul><li>Telangiectasis </li></ul><ul><li>Spider Angioma </li></ul><ul><li>Erythema </li></ul>Spring 2012
  15. 15. Pitting Edema * <ul><li>1+ < 0.25 inch (4.32mm) depression </li></ul><ul><li>2+ 0.25 - 0.5 inch (12.7mm) </li></ul><ul><li>3+ 0.5 - 0.75 inch (19 mm) </li></ul><ul><li>4+ 0.75 - 1 inch or more (25 mm) </li></ul>Spring 2012
  16. 16. Pitting Edema * <ul><li>1+ < 0.08 inch (2mm) depression __________ </li></ul><ul><li>2+ 0.16 inch (4mm) ___________ </li></ul><ul><li>3+ 0.24 inch (6 mm) </li></ul><ul><li>4+ >0.32 inch (8 mm) </li></ul>Spring 2012
  17. 17. Aging Adult Health History <ul><li>Increased Risk of Damage </li></ul><ul><li>Delayed Wound Healing </li></ul><ul><li>Pruritis </li></ul><ul><li>Skin Turgor </li></ul><ul><li>Lentigo (macule) </li></ul><ul><li>Cutaneous Tags </li></ul><ul><li>Cherry Angioma (red papule) </li></ul><ul><li>Seborrheic keratoses / Actinic keratoses </li></ul>Spring 2012
  18. 18. Older Adult <ul><li>Approach: </li></ul><ul><li>Skin atrophies </li></ul><ul><li>Increase amount of pigmentation esp. in sun exposed areas </li></ul><ul><li>Isolated areas of hypo pigmentation </li></ul><ul><li>Skin becomes drier and flattens, often becoming paper like </li></ul><ul><li>Elasticity decreases and wrinkles develop </li></ul>Spring 2012
  19. 19. Older Adult <ul><li>Decreased melanocyte function causes gray hair and pale skin </li></ul><ul><li>Decreased axillary, pubic & scalp hair </li></ul><ul><li>Women: facial hair </li></ul><ul><li>Men: nasal hair </li></ul><ul><li>Nails grow more slowly, become thicker & more brittle, yellowish </li></ul>Spring 2012
  20. 20. Older Adult <ul><li>Temp/ moisture , mobility </li></ul><ul><ul><li>Increased dryness (xerosis) </li></ul></ul><ul><ul><li>Thinning of the skin </li></ul></ul><ul><ul><li>Hanging skin </li></ul></ul><ul><li>Hair: </li></ul><ul><ul><li>Graying, thin texture </li></ul></ul><ul><ul><li>Symmetric balding may occur in men </li></ul></ul><ul><li>Facial & Body hair </li></ul><ul><ul><li>Men increased coarseness </li></ul></ul><ul><li>Nail </li></ul><ul><ul><li>Thickening, increases brittleness, deformity </li></ul></ul>Spring 2012
  21. 21. Cultural Considerations <ul><li>The oral mucosa is best for assessing color changes in dark-skinned persons </li></ul><ul><li>Assessing the sclera for jaundice, rather than the skin in Asians </li></ul>Spring 2012
  22. 22. Health Promotion <ul><li>Immunizations </li></ul><ul><li>Sun Exposure & Protection </li></ul><ul><li>Skin Cancer </li></ul><ul><li>Teach client: </li></ul><ul><ul><li>skin self assessment </li></ul></ul><ul><ul><li>Toenail trimming </li></ul></ul><ul><ul><li>Ingrown toenail care </li></ul></ul>Spring 2012

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