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


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

  1. 1. Skin , Hair & Nails Nursing 330 Governors State University Shirley Comer
  2. 2. Skin Assessment- Inspection <ul><li>Inspect </li></ul><ul><ul><li>Wide Spread Color changes </li></ul></ul><ul><ul><ul><li>Pallor </li></ul></ul></ul><ul><ul><ul><li>Erythema </li></ul></ul></ul><ul><ul><ul><li>Cyanosis </li></ul></ul></ul><ul><ul><ul><li>Jaundice </li></ul></ul></ul><ul><ul><ul><li>Pigmentation Changes </li></ul></ul></ul><ul><ul><ul><li>Freckles </li></ul></ul></ul><ul><ul><ul><li>Nevus (mole) </li></ul></ul></ul><ul><ul><ul><li>Birthmarks </li></ul></ul></ul><ul><ul><li>Unusual Odors </li></ul></ul><ul><ul><ul><li>Hygiene, excessive sweating, urine, musty </li></ul></ul></ul>
  3. 3. Danger Signs ABCDE <ul><li>Abnormal Characteristics of Pigmented lesions </li></ul><ul><ul><li>A symmetry of a pigmented lesion </li></ul></ul><ul><ul><li>B order irregularity </li></ul></ul><ul><ul><li>C olor variation </li></ul></ul><ul><ul><li>D iameter greater than 6mm </li></ul></ul><ul><ul><li>E levation </li></ul></ul><ul><ul><li>E nlargement </li></ul></ul>
  4. 4. ABCD Pix
  5. 5. Skin Assessment – Palpation <ul><li>Use back of hands </li></ul><ul><li>Hypothermia or Hyperthermia </li></ul><ul><li>Moisture </li></ul><ul><ul><li>Perspiration normal on face, hands, axilla and skin folds in response to anxiety </li></ul></ul><ul><ul><li>Diaphoresis - perfuse perspiration r/t increased metabolic rate i.e. increased heart rate, pain or fever </li></ul></ul>
  6. 6. Skin Assessment – Palpation cont <ul><li>Texture - smooth and firm </li></ul><ul><li>Thickness - thickened areas normal on hands and feet </li></ul><ul><li>Edema – Fluid accumulation in the intercellular spaces </li></ul><ul><ul><li>Pitting- finger leaves imprint in area. </li></ul></ul><ul><ul><ul><li>Graded subjectively 0+ to 4+ </li></ul></ul></ul><ul><ul><ul><li>Evident in dependant parts of body </li></ul></ul></ul>
  7. 7. Skin Assessment – Palpation cont <ul><li>Vascular or Bruising- </li></ul><ul><ul><li>Cherry (senile) angiomas - small, smooth, slightly raised, bright red dots that commonly occur in all adults over 30. Not a significant finding </li></ul></ul><ul><ul><li>Bruising- ask how occurred </li></ul></ul><ul><ul><ul><li>Multiple bruises at different stages of healing can be a sign of abuse </li></ul></ul></ul><ul><ul><ul><li>Tattoos - ask about Symptoms of Hepatitis </li></ul></ul></ul><ul><li>Hygiene- note cleanliness- free of parasites </li></ul><ul><li>Turgor- Pinch up a large fold of skin- should return to normal position rapidly </li></ul><ul><ul><li>Decreased in dehydration or extreme wt loss. </li></ul></ul><ul><ul><li>Tenting is when skin remains pinched up </li></ul></ul>
  8. 8. Skin Lesions and Decubs
  9. 9. Nail Anatomy Pix
  10. 10. Nails- Inspection <ul><ul><li>Capillary Refill - Blanching of nail bed lasts 1-2 seconds. Longer may indicate cardiovascular or respiratory disorder </li></ul></ul><ul><ul><li>Shape and contour </li></ul></ul><ul><ul><ul><li>Clubbing-congenital or chronic CO2 retention </li></ul></ul></ul><ul><ul><ul><li>Spooning-concave curves- Fe deficiency </li></ul></ul></ul><ul><ul><ul><li>Jagged- chronic anxiety </li></ul></ul></ul><ul><ul><ul><li>Transverse grooves-nutrient deficiency </li></ul></ul></ul><ul><ul><ul><li>Longitudinal grooves- normal </li></ul></ul></ul><ul><ul><ul><li>Nail adhered to bed- spongy bed accompanies clubbing </li></ul></ul></ul><ul><ul><ul><li>Pitting often /c psoriasis </li></ul></ul></ul><ul><ul><ul><li>Paronychis- swollen tender nail folds-fungal or bacterial infection </li></ul></ul></ul>
  11. 11. Clubbing image
  12. 12. Longitudinal and Transverse Nail Ridges - Photo
  13. 13. Hair Assessment - Inspection <ul><li>Hair Assessment </li></ul><ul><ul><li>Color </li></ul></ul><ul><ul><li>Texture </li></ul></ul><ul><ul><li>Distribution- male v. female alopecia </li></ul></ul><ul><ul><li>Lesions </li></ul></ul><ul><ul><li>Hygiene </li></ul></ul><ul><ul><li>Parasites </li></ul></ul>
  14. 14. Palpation - Hair <ul><li>Part hair to look at scalp (wear gloves) </li></ul><ul><ul><li>Parasites </li></ul></ul><ul><ul><li>Hygiene </li></ul></ul><ul><ul><li>Scalp condition </li></ul></ul><ul><ul><li>Growth pattern </li></ul></ul><ul><ul><li>Alopecia </li></ul></ul><ul><ul><li>Lesions </li></ul></ul><ul><ul><li>Dandruff, seborrhea, psoriasis, eczema </li></ul></ul>
  15. 15. Hair Loss- Male vs. Female
  16. 16. Commonly seen abnormalities - Petechiae <ul><li>tiny hemorrhages </li></ul><ul><li>Less than 2mm </li></ul><ul><li>Round </li></ul><ul><li>Purple, red, brown in color </li></ul><ul><li>/s blanching </li></ul><ul><li>Present /c thrombocytopenias, endocarditis, septicemia </li></ul><ul><li>Found on mucus membranes, conjunctiva, abdomen, buttocks, forearms </li></ul>
  17. 17. Purpura <ul><li>Extensive patches of Petechiae and ecchymoses </li></ul><ul><li>Flat macular hemorrhage </li></ul><ul><li>Seen /c thrombocytopenia, scurvy </li></ul><ul><li>In elderly may result from minor trauma </li></ul><ul><li>Hematoma - Elevated area of bleeding under the skin </li></ul>
  18. 18. Petechae and Purpura Photo
  19. 19. Infant Assessment <ul><li>General Pigmentation </li></ul><ul><ul><li>Mongolian Spots -Blue, Black and Purple spots on buttocks or sacrum- common if AA, Native American, Hispanic and Asia newborns. </li></ul></ul><ul><ul><li>Bruising - Common following injuries from rapid, traumatic, or breech births </li></ul></ul><ul><ul><li>Congenital birth marks- Port wine stains, angiomas, Strawberry mark, Cavernous Hemangioma </li></ul></ul>
  20. 20. Common Birthmarks – Port Wine Stain, Hemangioma, Strawberry mark, café au late spot, mongolian spot
  21. 21. Age specific - children <ul><li>Petechiae and Hematoma may be present on face r/t prolonged violent crying or coughing </li></ul><ul><li>Abuse patterns </li></ul><ul><ul><li>Multiple bruises in various stages of healing </li></ul></ul><ul><ul><li>Injuries to parts of body covered /c clothing </li></ul></ul><ul><ul><li>Marks suggestive of instrument use- belt, cigarette, pinching, biting </li></ul></ul>
  22. 22. Age specific- children Cont <ul><li>Common findings </li></ul><ul><ul><li>Diaper Dermatitis- red moist diffuse macular </li></ul></ul><ul><ul><li>Candidiasis(yeast)- fiery red moist patches with clear borders </li></ul></ul><ul><ul><li>Impetigo- Red vesicles rupture to form honey colored crust- Contagious bacterial infection </li></ul></ul><ul><ul><li>Chickenpox (Varicella)- small vesicles evolving to pustules on trunk spreading to face, and limbs </li></ul></ul><ul><ul><li>Ringworm- fungal infection produces scales and can cause permanent hair loss </li></ul></ul><ul><ul><li>Measles (Rubeola)- red macular/papular rash behind ears and spreads to body </li></ul></ul><ul><ul><li>German Measles (Rubella)- Paler lesions than rubeola </li></ul></ul>
  23. 23. Common Childhood findings
  24. 24. Common Findings- Tinea forms, athlete’s foot, ringworm and Jock itch
  25. 25. Common Findings – Rubella, cradle cap, uticaria
  26. 26. Age Specific Children cont <ul><li>Atopic Dermatitis (eczema) </li></ul><ul><ul><li>red papules and vesicles /c weeping, oozing and crusts </li></ul></ul><ul><ul><li>Scalp, forehead, cheeks, forearms, elbows and back of knees </li></ul></ul><ul><ul><li>Family hx of allergies </li></ul></ul><ul><li>Seborrheic Dermatitis (Cradle Cap) </li></ul><ul><ul><li>Greasy yellow-pink lesions on scalp and forehead </li></ul></ul><ul><ul><li>No family hx of allergies </li></ul></ul>
  27. 27. Common Childhood Lesions- Contact dermatitis, Candidiasis, Atopic dermatitis
  28. 28. Age Specific Assessment <ul><li>Adolescent- increase in sebaceous gland r/t increased acne and oily skin </li></ul><ul><li>Pregnant Woman </li></ul><ul><ul><li>Striae - Stretch marks. Initially pink then silver </li></ul></ul><ul><ul><li>Linea Nigra- Brownish black line abdominal midline </li></ul></ul><ul><ul><li>Chloasma - Irregular brown patches on face- aslo /c oral contraceptives-disappears /p pregnancy ends </li></ul></ul><ul><ul><li>Vascular Spider Veins- Capillaries on skin surface break </li></ul></ul>
  29. 29. Pregnancy – Cholasma, striae, spider veins, linea nigra
  30. 30. Age Specific- Older Adult <ul><li>Senile Lentigines - Liver Spots- small flat brown macules-r/t sun exposure </li></ul><ul><li>Venous stars and angiomas </li></ul><ul><li>Dry Skin- increases in elderly </li></ul><ul><li>Acrochordons - Skin Tags- overgrowth of normal skin </li></ul><ul><li>Skin thins- /c decreased sebaceous gland activity and SQ fat </li></ul><ul><li>Less Elasticity - Tents more </li></ul><ul><li>Alopecia- genetic- male pattern baldness </li></ul><ul><li>Hair Greys- r/t decreased melanocyte function </li></ul><ul><li>Hair Thins - Growth decreases, amount decreases in axilla in pubic areas. </li></ul><ul><ul><li>Women - may develop facial hair /p menopause r/t decreased estrogen </li></ul></ul><ul><ul><li>Men - grow bristly hairs in ears, nose and eyebrows </li></ul></ul>
  31. 31. Common Findings – Senile Lentigines, Skin Tags, Seboratic Keratosis
  32. 32. Age Specific – Older Adult cont <ul><li>Nails </li></ul><ul><ul><li>Growth decreases </li></ul></ul><ul><ul><li>Longitudinal ridges </li></ul></ul><ul><ul><li>Brittle </li></ul></ul><ul><ul><li>Yellowing </li></ul></ul><ul><ul><li>Toenails thickened and misshapen r/t chronic PVD </li></ul></ul>
  33. 33. Malignancies <ul><li>Basal Cell carcinoma- </li></ul><ul><ul><li>Most common form of Skin cancer </li></ul></ul><ul><ul><li>starts as skin colored papule </li></ul></ul><ul><ul><li>Develops pearly borders with red center </li></ul></ul><ul><ul><li>Slow growing </li></ul></ul><ul><li>Squamous Cell Carcinoma- </li></ul><ul><ul><li>Red scaly patch /c sharp margins </li></ul></ul><ul><ul><li>1 cm or more </li></ul></ul><ul><ul><li>Develops central ulcer /c surrounding redness </li></ul></ul><ul><ul><li>Less common but grows rapidly </li></ul></ul>
  34. 34. Malignancies of AIDS <ul><li>Epidemic Kaposi’s Sarcoma </li></ul><ul><ul><li>3 stages </li></ul></ul><ul><ul><ul><li>Multiple pink patches </li></ul></ul></ul><ul><ul><ul><li>Lesions develop into raised papules, oval and vary in color </li></ul></ul></ul><ul><ul><ul><li>Advances are widely disseminated involving skin, mucus membranes, and visceral organs </li></ul></ul></ul>
  35. 35. Malignancies cont <ul><li>Malignant Myeloma- </li></ul><ul><ul><li>½ of lesions are pre existing nevi </li></ul></ul><ul><ul><li>Brown, tan, black. Red, or purple </li></ul></ul><ul><ul><li>Irregular borders </li></ul></ul><ul><ul><li>May scale, flake or ooze </li></ul></ul><ul><ul><li>Metastasizes quicker than other forms </li></ul></ul>
  36. 36. Skin Cancer – Basal Cell, Squamous Cell, Kaposi’s, Malignant Myeloma
  37. 37. Other Common Lesions <ul><li>Folliculitis - superficial infection of hair follicle r/t shaving </li></ul><ul><li>Psoriasis- Scaly red patches /c silvery scales </li></ul><ul><li>Herpes Simplex - Cold sore- vesicle then pustule which erupts </li></ul><ul><li>Herpes Zoster - Shingles- small groped vesicles then pustules then crust- develops along nerve path </li></ul><ul><li>Contact dermititis - Local reaction to irritant- redness followed by swelling, wheals or uticaria. </li></ul><ul><li>Allergic drug reaction - red macular rash, generalized. May proceed to uticaria </li></ul>
  38. 38. Common Findings – Follicuilitis, Herpes Simplex, Cherry angioma, Shingles, MRSA
  39. 39. Common Findings- Fungal infection, ingrown toenail, changes with age
  40. 40. Lyme Disease, Eczema, Rosacea, Vitiligo
  41. 41. Practice Exam Question <ul><li>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? </li></ul><ul><li>A. Suggest he see a doctor about the lesion </li></ul><ul><li>B. suggest he apply an hydrocortisone cream </li></ul><ul><li>C. Suggest he wait a month and see how it looks </li></ul><ul><li>D. Suggest he use a good moisturizer </li></ul>
  42. 42. Rationale <ul><li>A is the correct answer because the lesion description sounds like a malignancy </li></ul><ul><li>B and D are incorrect as these products are not appropriate treatments </li></ul><ul><li>C. is incorrect as malignancies can grow quickly </li></ul>