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143 Cards in this Set
- Front
- Back
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What are 8 functions of the skin?
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1. Protection
2. Prevent penetration [from pathogens] 3. Perception [from nerve endings] 4. Temperature regulation 5. Identification 6. Wound repair 7. Absorption and excretion 8. Synthesizes Vitamin D |
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What is the epidermis?
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the thin, outermost layer of skin
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What are the 2 components of the epidermis and what are they composed of?
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1. stratum corneum
(outermost or horny cell layer of dead keratinized cells) 2. stratum germinativum (inner or basal cell layer of live, proliferating cells) |
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What are 2 cell types that are found in the epidermis?
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1. keratinocytes
2. melanocytes |
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What is the dermis?
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the second layer of skin; a dense connective tissue layer that forms the bulk of the skin; consists of collagen, lymphatics, and blood vessels
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Does the number of melanocytes in a person's skin affect their skin color?
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no; the skin color depends on the concentrations of melanin (brown), carotene (yellow/orange), and underlying blood vessels (pinkish)
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What are the 3 types of sweat glands? And what do they produce?
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1. apocrine (milky, sticky secretions; bacteria live near these and cause smell)
2. eccrine: dilute saline solution 3. sebaceous (produce sebum) |
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At which age do you develop eccrine glands?
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2 months old
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Where are eccrine glands located?
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forehead, axillae, palms, soles
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When do apocrine glands become active?
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at puberty and times of excitement (sexual, emotional)
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What types of subjective data do you want to obtain while performing the history of your patient?
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1. Previous history of skin disease (allergies, hives, psoriasis, eczema)
2. Change in pigmentation 3. Change in mole (size, color, texture) 4. Excessive dryness or moisture 5. Pruritis 6. Excessive bruising 7. rash or lesion 8. medications 9. hair loss 10. change in nails 11. environmental or occupational hazards 12. self-care behaviors (sunscreen, vitamin D sun exposure) |
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If a patient answers yes to any of your subjective assessment questions, what should you do?
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PQRST
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What is a possible cause for dry skin?
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hypothyroidism
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What is a possible cause of excessive bruising?
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peripheral vascular disease
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What is the number one reason for the presentation of a rash?
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An allergic drug reaction
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What are possible causes for peeling?
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diabetes, PVD
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What physical manifestations occur when there is decreased circulation?
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thicker toenails, ulcers around the ankles
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When preparing to taking your patient's objective data, what should you assure?
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Be sure to take into account the external variables that may influence skin color
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When do you usually perform a skin assessment?
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Throughout the physical exam, while you are examining other parts of the body
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What should you always use if you encounter an open wound?
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Gloves
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What are 4 pieces of equipment that you need in order to assess the skin?
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1. Strong direct lighting
2. Small cm ruler 3. Penlight 4. Gloves |
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What types of equipment may you need for special procedures?
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1. Wood's light
2. Magnifying glass 3. Materials for lab tests: KOH, glass slide |
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What are 6 pieces of object information that you want to acquire during a skin assessment?
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1. color (pigmentation, widespread color change)
2. moisture 3. temperature 4. texture 5. mobility and turgor 6. any lesions |
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What types of variables affect skin color and are still considered normal? What are they caused by?
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1. temporary pallor: fear, exam room too cool
2. temporary erythema: embarrassment, exam room too hot |
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What are 5 types of widespread skin color change?
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1. pallor
2. erythema 3. cyanosis 4. jaundice 5. increased pigmentation |
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What is Raynaud's Phenomenon?
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A vasospastic condition in which a body part becomes white
May or may not be associated with a rheumatological disorder (CT disorder, RA) |
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What are some possibilities as to why a patient would appear washed-out?
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anemia? fear?
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Where are the signs of jaundice usually seen first?
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-in the eye + around the soft/hard palate
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What is the cause of jaundice?
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an increase in bilirubin in the blood
(usually from hepatitis, sickle cell disease, cirrhosis) |
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What is erythema?
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Intense redness from excess blood flow in small capillaries
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What are some causes of erythema?
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1. fever
2. embarrassment 3. localized infection 4. CO poisoning *port wine stains are a form of erythema |
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If you see a patient with erythema, how would the skin feel?
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when touching with the back of the hand, the skin should feel warm
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What causes cyanosis?
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decreased perfusion of blood flow to the area .:. lack of oxygenated blood
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What are some causes of cyanosis?
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1. shock
2. heart failure 3. chronic lung disease 4. polycytemia vera (may be benign, not necessarying a decrease in oxygenated blood; an abnormal increase in RBC number) *a possible manifestation of cyanosis is thickened nails |
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What are mongolian spots?
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hyperpigmentation that usually occurs on the bottom and may fade in the first year of life
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What is the ethic distribution for mongolian spots?
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African American: 90%
Asians: 80% Native Americans Hispanics Caucasians: 9% |
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What are 2 types of acne?
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1. comedonal: noninflammatory lesions (blackheads, whiteheads) may have some lesions with pus
2. pustular (may be associated with rosacia and possibly age and distribution) |
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Increased pigmentation is a possible precursor of which disease?
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diabetes;
it is associated with insulin resistance in heavyset kids |
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What are 4 changes in skin that occur in older adults?
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1. more wrinkling
2. senile purpura 3. dry skin (xerosis) 4. senile lentigines |
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What is senile purpura?
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easy brusing in older people; little breaks in the skin
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What is senile lentigines?
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-"liver spots" they are small, flat brown vacuoles
-they are a cluster of melanocytes but they are NOT related to the liver -usually benign |
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What causes senile lentigines?
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sun exposure
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What is diaphoresis?
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profuse perspiration from increasing the metabolic rate (MI, exercise)
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How should you assess edema?
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on a scale of 1+ to 4+, you would assign a level based on the amount of excess fluid below subQ
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Where should you check for signs of dehydration?
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oral mucosa
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What is skin turgor?
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The skin's ability to go back into place
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What is skin mobility?
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The skin's ease of rising
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What might a cast on a person's foot cause?
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localized hypothermia
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What is a lesions diagnosis based upon? (2)
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1. distribution of lesions
2. morphology and configuration of lesions |
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What are 3 ways that lesions could be distributed and located?
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1. localized
2. universal 3. symmetrical |
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What are 5 things that you should determine about a lesion?
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1. is it primary or secondary?
2. color (red, violet, brown) 3. sharpness of edge (well- vs ill-defined) 4. surface contour (dome, pendunculated[sticking up], spire-like) 5. geometric shape or configuration |
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What are 12 primary skin leasions?
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1. macule
2. patch 3. papule 4. plaque 5. nodule 6. tumor 7. wheal 8. urticaria 9. vesicle 10. bulla 11. pustule 12. cyst |
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What is a macule?
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Macule:
A circumscribed, flat, nonpalpable change in skin color |
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How large is a macule?
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Up to 1 cm
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Give 6 examples of macules.
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Macules:
1. Freckles 2. fat nevi 3. hypopigmentation 4. petechiae (little red dots) 5. measles (several macules clustered together) 6. scarlet fever |
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What is a patch?
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A macule larger than 1 cm
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What are 5 examples of a patch?
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1. senile lentigo (liver spots)
2. mongolian spot 3. vitiligo (MJ) 4. cafe au lait spot (hypopigmented) 5. measles rash |
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What is a papule?
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A papule is a palpable, elevated, circumscribed, solid mass
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What causes a papule?
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superficial thickening in the epidermis
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How large are papules?
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Up to 0.5 cm
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Give 4 examples of papules.
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1. elevated nevus (mole)
2. lichen planus 3. wart 5. molluscum |
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What is a plaque?
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A flat, elevated surface that is often formed by coalescence of papules
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How large is a plaque?
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Larger than 0.5 cm
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What are 4 examples of plaques?
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1. psoriasis
2. lichen planus 3. xanthoma 4. xanthelasma |
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What is xanthelasma?
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Plaque on top of the eyelid
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What is a nodule?
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A solid, elevated, firm or soft mass
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What is the size of a nodule?
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less than 1-2 cm
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How does a nodule compare to a papule?
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A nodule may be firmer and extend deeper into the dermis
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Give 2 examples of nodules.
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1. fibroma
2. intradermal nevi (mole going into the dermis) |
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What is a tumor?
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A solid elevated firm or soft mass that extends deep into the dermis
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What is the size of a tumor?
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larger than 1-2 cms
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Give 2 examples of tumors.
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1. lipoma (common, not malignant)
2. hemangioma |
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What is a wheal?
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A superficial, raised, erythematous, TRANSIENT lesion with somewhat irregular borders due to localized edema
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Where is fluid held in a wheal?
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Diffusely in the tissues
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What are 2 examples of a wheal?
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1. mosquito bite
2. allergic reaction (ie to drugs) |
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What is urticaria?
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Wheals coalescing to form an extensive reaction
ex: hives, poison ivy-->very pruritic |
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What is a vesicle?
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A circumscribed, superficial, elevated cavity that contains free fluid
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What is the size of a vesicle?
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up to 1 cm in size
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Give 3 examples of vesicles
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1. herpes simplex
2. chicken pox 3. contact dermatitis 4. poison ivy 5. poison oak |
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What is a bullae?
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A larger vesicle that is usually single chambered and superficial in the epidermis;
it is thin walled, so it ruptures easily |
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What is the size of a bullae?
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larger than 1 cm
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Give 4 examples of a bullae.
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1. friction blister
2. pemphigus 3. burn 4. contact dermatitis 5. herpes zoster (shingles) |
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What is a cyst?
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an encapsulated fluid or pus-filled cavity in dermis or subcutaneous layer
this causes a tense elevation of the skin |
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How large is a cyst?
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Larger than 1 cm
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Name 2 types of cysts.
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1. sebaceous cyst
2. old sebaceous cells *an infectious process, the cyst must be broken to treat |
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What is a pustule?
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A circumscribed, superficial, elevated cavity that contains turbid fluid (pus)
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How large is a pustule?
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up to 1 cm
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Give 2 examples of pustules.
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1. impetigo
2. acne |
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What is the usual cause of a secondary lesion?
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when there is a primary lesion underneath
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What is a crust?
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thickened, dried residue
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What causes a crust?
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burst vesicles, pustules or blood
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What color is a crust?
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red-brown, honey-colored, or yellow DEPENDING ON THE FLUID'S ORIGIN
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Give examples of a crust.
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1. eczema
2. impetigo 3. crust phase of herpes simplex |
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What is Tinea Pedis?
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Athlete's foot.
-compact desiccated flakes of skin -dry or greasy -silvery or white -from shedding of dead excess keratin cells -visible exfoliation of the DERMIS |
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What are fissures?
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-A linear crack with abrupt edges
-extends into the DERMIS -may be dry or moist |
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Give examples of fissures.
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1. cheilosis
2. athlete's foot 3. anal fissure 4. renal failure (generalized in arms and legs) |
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What is erosion?
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A superficial, circumscribed, loss of epidermis.
Leaves a scooped-out, but shallow depression -moist but NO bleeding |
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Why does erosion heal without a scar?
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erosion does not extend into the dermis
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Give 2 examples of erosion.
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1. stage 2 pressure sore
2. burn |
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What is an ulcer?
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-A circumscribed depression that EXTENDS INTO THE DERMIS (.:. scars)
-irregular shape -MAY bleed |
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What are 3 types of ulcers?
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1. stasis ulcer (ppl with poor blood supply get ulcers around the ankle)
2. pressure sore 3. chancre |
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Why is it important to teach diabetics to check their feet daily?
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For ulcers; diabetes effects little vessels and causes you to lose feeling in your feet; you might get ulcers around the ankle
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What is excoriation?
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A superficial scratch mark
*may be a self-inflicted abraision secondary to intense itching |
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Give examples of excoriation.
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1. scratch from foreign body
2. insect bites 3. scabies 4. dermatitis 5. varicella |
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What is a scar?
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After open reduction of a fracture, a scar is the replacement of destroyed normal tissue by FIBROUS CT
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Are scars permanent?
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yes, their degree depends on how oxygenated and severe the wound was
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What is atrophy?
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-Depressed skin level resulting from loss of tissue
-A thinning of the EPIDERMIS with loss of normal skin furrows, resulting in shiny, translucent skin |
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What are examples of atrophy?
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1. striae
2. senile skin 3. arterial insufficiency 4. stretch marks |
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What is lichenification?
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thickening and roughening of the skin usually as a result of INTENSE SCRATCHING
results from a tightly packed set of PAPULES causes increased visibility of the superficial skin markings |
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Give examples of lichenification
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1. long standing eczema
2. atopic dermatitis |
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What is a keloid scar?
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A hypertrophic scar
the resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of original injury |
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9 common shapes/configurations of lesions are..
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1. annular (circular)
2. confluent 3. discrete 4. grouped 5. gyrate 6. target 7. linear 8. polycyclic 9. zosteriform |
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Give 3 types of vascular lesions.
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1. petechiae
2. purpura 3. ecchymosis 4. cherry angioma 5. spider angioma 6. telangiectasia 7. nevus flammeus (port wine stain) |
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What is petechiae?
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RED, pin-sized macules of the blood in the skin
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What is purpura?
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A larger macule or papule of blood in the skin
Such blood-filled lesions DO NOT BLANCH |
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What is ecchymosis?
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Larger extravasations of blood into the skin
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What is cherry angioma?
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AKA Campbell de Morgan spots
-small bright red papules -BENIGN angiomas common on the TRUNKS of the middle-aged and elderly -Start showing up around 28 -Older you get, the more you get! |
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What is spider angioma?
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Stellate telangiectases that look like spiders with legs radiating from a central, often palpable feeding vessel
-to confirm dx: press on center with slide and the lesion will disappear |
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What should you check if a patient has many spider angiomas on his trunk?
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liver function
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When might spider angiomas be normal?
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in faces of children or during pregnancy
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What is telangiectasia?
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refers to permanently dilated and visible vessels in the skin
may appear linear, punctuate or stellate crimson-purple markings |
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What might cause telangiectasia?
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Nifedipine (drug in the ICU)
Roseacia |
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What is nevus flammeus?
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port wine stain
-present at birth -caused by dilated DERMAL capillaries -pale, pink, to purple macules -mostly on FACE and TRUNK |
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Skin warning signs: ABCDE
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A: asymmetry
B: border C: color D: diameter E: elevation/enlargement |
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What is an exception to elevation in the skin warning signs?
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Melanoma in situ may be flat
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What is perhaps the most important sign of malignant melanoma?
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Enlargement
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How should you assess elevation?
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assess surface distortion by side-lighting
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What is the most common malignancy?
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basal cell carcinoma
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Describe basal cell carcinoma.
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-locally invasive and destructive
-slow growing -rare metastasizing -almost translucent, dome-shaped papule with overlying tangiectasias |
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Which type of lesions have the potential to become malignant (become squamous cell carcinoma)?
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actinic keratosis
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Where is squamous cell carcinoma usually found?
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head, neck, hands
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What should you inspect and palpate on the hair?
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-color
-texture -distribution -lesions |
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What should you inspect and palpate on the nails?
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-shape and contour (profile signs)
-consistency -color |
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What is vellus hair?
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all of the body except head, genitals
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What are 2 types of hair?
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1. vellus
2. terminal |
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What causes hair to turn white?
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melanin is replaced by air bubbles in the air shaft
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What is alopecia areata?
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non-scarring hair loss, typically of rapid onset in sharply defined, usually round or oval area
-the loss may be diffuse or patchy or band-like at the margins of the scalp -most likely an immunological phenomenon |
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What are 2 possible causes of hirutism?
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1. heritage
2. polycystic ovarian syndrome |
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What happens to your nails as you get older?
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Your nails thicken, become ridged, and split
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What is a normal nail angle?
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160 degrees
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What is clubbing?
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Flattening of nail from lack of oxygen
(cancer in lungs, lungs disease) |
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How should you check for capillary refill?
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pinkness should return in 1-3 seconds after pressing
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What is paronychia?
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acute, BACTERIAL infection of the proximal and lateral nail fold
-rapid onset of pain and swelling -pus accumulates behind the cuticle -chronic, irritant exposure |
