Integumentary System Health Assessment Ch 12

Front 1

Epidermis

Back 1

outer visible layer, contains keratin-extremely tough, protective protein that can cause tissues to become hard

Front 2

Dermis

Back 2

second layer, made of proteins, mucopolysaccarides, thick gelatinous material; matrix for nerve tissue, blood vessels, hair follicles

Front 3

Subcutaneous layer

Back 3

third layer, adipose connective tissue

Front 4

Hair

Back 4

grows from follicles supplied by bl vessels in dermis

Front 5

Vellus

Back 5

short, pale, fine, located all over body except palms & soles

Front 6

Terminal hairs

Back 6

course, dark, on scalp, brows, legs, axillae, perineum; essential for warmth and protection

Front 7

Lunula

Back 7

proximal end of nail

Front 8

Capillary refill

Back 8

nailbed is pink b/c of this; should take less than 3 seconds

Front 9

Sweat glands

Back 9

eccrine- think "entire"; coiled tubules directly onto skin surface; mature in 2 month old infant
apocrine-thick, milky secretions into hair follicles, axillae, genitalia, areolae

Front 10

Sebaceous glands

Back 10

near hair follicles, secrete sebum, lubricate skin & hair, waterproof skin, more abundant on head

Front 11

Functions of Skin

Back 11

protection, prevent penetration, perception, temp regulation, identification, communication, wound repair, absorption, excretion, production of Vit D

Front 12

Resp. system

Back 12

if impaired, most evident in skin by cyanosis; central cyanosis= O2 sats less than 80%
Clubbing of nails-COPD, emphysema

Front 13

CV System

Back 13

if impaired, can lead to changes in skin color, and temp, resulting in lesions, ulcerations, necrosis.

Front 14

GI System

Back 14

if impaired, body can't excrete toxins properly so they'll accumulate on skin; bilirubin build up = jaundice
deficiencies of vitamins = xanthomas

Front 15

Urinary System

Back 15

if impaired, toxins also build up,
conc. of urea = uremic frost
increased fluid volume = edema in extremities

Front 16

Neurological system

Back 16

if impaired, decreased sensations more likely to experience trauma/injury
irritated nerves can produce pain, such as severe burning
pain after shingles = post-hepatic neuralgia

Front 17

Endocrine System

Back 17

if impaired, could be related to diabetes mellitus- immune, vascular, & neurological systems, foot ulcers;

Front 18

Hypothyroidism

Back 18

Endocrine system; dry, cool, puffy, nonpitting edema; hair dry, brittle, sparse

Front 19

Hyperthyroidism

Back 19

Endocrine; warmer, sweatier, smoother; nails thin/brittle; hair fine, silky, patchy hair loss

Front 20

Hypofunction of adrenal glands

Back 20

Endocrine; above kidneys; hyperpigmentation of skin (bronze) and alopecia; Addison's disease

Front 21

Lymphatic/Immune System

Back 21

if impaired, reflected as rashes or lesions; hypersensitivity, allergic changes, pruritus, dermatitis, psoriasis

Front 22

Infants

Back 22

hair follicles develop @ 3 months, midgestation skin covered c lanugo-fine downy hair, first few months after birth, replaced by fine vellus hair;
less subQ tissue, pink color at birth
sweat glands function at 1 month

Front 23

Vernix Caseosa

Back 23

thick cheesy substance made up of sebum & shed epithelial cells on newborn; "cradle cap"

Front 24

Physiological jaundice

Back 24

may occur 2-3 days after birth as a result of breakdown of excessive RBCs and immature liver function

Front 25

Pregnancy

Back 25

increased pigment in areolae & nipples, vulva, and sometimes midline of abd (linea nigra) or on the face (chloasma)

Front 26

Hyperestrogenemia

Back 26

common vascular spiders and palmar erythema during pregnancy

Front 27

Striae gravidarum

Back 27

CT increased fragility; noticeable on abd., breasts, thighs of pregant woman

Front 28

Mongolian spots

Back 28

common hyperpigmentation in black, Asian, American Indian, and Hispanic babies; gradually fade during 1st year

Front 29

Cafe au lait spot

Back 29

large round patch of light-brown pigmentation usually present at birth

Front 30

Erythema toxicum neonatorum

Back 30

common rash during first 3-4 days of life; "flea bite", no tx needed

Front 31

Capillary hemangiomas

Back 31

"stork bite"

Front 32

hemangioma simplex

Back 32

strawberry marks, usually disappears by 5-7 years

Front 33

Milia

Back 33

tiny white papules on face; will resolve themselves

Front 34

Adolescents

Back 34

apocrine glands enlarge and function; axillary sweating can lead to body odor; sebaceous glands increase sebum = acne

Front 35

Pregnant Women

Back 35

increased blood flow to skin; peripheral vessels dilate to dissipate heat; "glow" = increased sweating

Front 36

Older adults

Back 36

skin atrophies; decreased elasticity, sebum, sweat, melanocyte function (gray hair, skin pales), age spots; women may develope facial hair b/c of loss of estrogen

Front 37

Actinic Keratoses

Back 37

elderly; red-tan scaly plaques that increase over the years and become raised and roughened

Front 38

Basal Cell carcinomas

Back 38

start as skin colored papule, translucent top;
then rounded pearly borders c central red ulcer;
slow but inexorable growth

Front 39

Seborrheic Keratoses

Back 39

elderly; thickened areas of pigmentation that look crusted, scaly, and warty; benign

Front 40

Senile Lentigines

Back 40

"liver spots", small, flat, brown macules

Front 41

Acrochordons

Back 41

skin tags, overgrowth of normal skin, stalk and polyplike

Front 42

Sebaceous hyperplasia

Back 42

raised yellow papules c central depression; more common in men over forehead, nose, cheeks

Front 43

Cultural Considerations

Back 43

African Americans-higher incidence of keloids, pseudofolliculitis & mongolian spots
Asians produce less sweat

Front 44

3 most common types of skin cancer

Back 44

1-basal cell-majority of cancers, sun, 90% head/neck, relatively tx
2-squamous cell carcinoma-66% on sun-exposed areas, respond well to tx
3-melanoma-less common but most deadly; sx present when it has metastasized to another organ

Front 45

Pruritus

Back 45

severe itching; localized or generalized? systemic etiology? psychological factors can influence perception; meds can affect

Front 46

Rashes

Back 46

local or generalized?
acute or chronic?
dermalogical or underlying systemic?

Front 47

Hair changes

Back 47

Alopecia-hair loss on scalp and body
-scarring-resulting from injury
-nonscarring-hormonal changes, meds, infectious or thyroid diseases
scalp grows 0.25 mm/day; 100 strands lost a day;

Front 48

Nail changes

Back 48

normal nail angle 160 degrees; watch for clubbing

Front 49

Hyperhydrosis

Back 49

excessive sweating

Front 50

Bronzing/Tanning color

Back 50

Addison's disease-adrenal glands

Front 51

Tan

Back 51

tinea versicolor-fungal infection

Front 52

yellow color

Back 52

liver disease, gallbladder disease, liver cancer

Front 53

dusky blue color

Back 53

arsenic poisoning, cyanosis, cold exposure, Raynaud's disease

Front 54

Pallor

Back 54

anemia, albinism

Front 55

Red

Back 55

polycythemia, rosacea

Front 56

Assessing lesions

Back 56

size in mm/cm, shape, color, texture, surface, exudate, tenderness/pain

Front 57

Primary lesions

Back 57

appear in response to change in in. or ex. environment of skin, non altered by trauma

Front 58

Secondary lesions

Back 58

changes in primary lesions; add to or take away from existing primary lesion

Front 59

Macule

Back 59

flat, nonpalpable < 1 cm
freckles or cherry angioma
primary

Front 60

Patch

Back 60

flat, nonpalpable > 1 cm
primary

Front 61

Papule

Back 61

raised but superficial, palpable < 1cm
psoriasis, mole, basal cell carcinoma
primary

Front 62

Plaque

Back 62

palpable, raised but superficial
> 1 cm
primary

Front 63

Wheal

Back 63

raised, superficial: allergic reaction
hives-transient lesion-comes and goes; primary

Front 64

Nodule

Back 64

palpable, solid & into dermis; lipoma "fatty tumor" < 2 cm; primary

Front 65

Tumor

Back 65

palpable, into dermis; > 2 cm
primary

Front 66

Cyst

Back 66

fluid filled, encapsulated nodule
primary lesion

Front 67

Vesicle

Back 67

palpable, fluid filled; < 1 cm; primary
e.g. blister, herpes simplex, 2nd & 3rd degree burns

Front 68

Bulla

Back 68

palpable, fluid-filled; > 1 cm; primary

Front 69

Pustule

Back 69

palpable, "pus filled", purulent matter, primary lesion; e.g. acne, folliculitis, impetigo

Front 70

Lichenification

Back 70

secondary; thickening & scaling (contact dermititis)

Front 71

Scales

Back 71

shedding, dead skin cells (psoriasis) secondary

Front 72

Crust

Back 72

secondary; dried exudates (herpes)

Front 73

Scar

Back 73

secondary; replacement of tissue (surgery)

Front 74

Keloid

Back 74

Secondary; hypertrophic scarring (after tattoos, surgery)

Front 75

Excoriation

Back 75

secondary; not beyond superficial: abrasion (scabies)

Front 76

Erosion

Back 76

secondary; loss of superficial (candidiasis erosion (yeast) or impetigo)

Front 77

Fissure

Back 77

secondary; linear breaks in skin (hand dermatitis or athlete's foot)

Front 78

Ulcer

Back 78

secondary; irregular loss, may be necrotic (DUs, stasis ulcer)

Front 79

Atrophy

Back 79

secondary; thinning of skin c/ transparent appearance (aging, arterial insufficiency, topical corticosteroids)

Front 80

Round/oval pattern

Back 80

like a coin (eczema)

Front 81

Discrete pattern

Back 81

separate & apart (moles or molluscum)

Front 82

grouped pattern

Back 82

clustered (herpes)

Front 83

confluent pattern

Back 83

run together (rubella or hives-uticaria)

Front 84

Linear pattern

Back 84

line (poison ivy)

Front 85

annular/circular pattern

Back 85

ring-shaped, ringworm

Front 86

arciform pattern

Back 86

arcs (syphilis)

Front 87

Iris pattern

Back 87

bull's eye (Lyme's disease)

Front 88

Gyrate pattern

Back 88

twisted, coiled spiral

Front 89

Polycycclic pattern

Back 89

annular lesions grow together (lichen planus, psoriasis)

Front 90

Zosteriform

Back 90

linear arrangement along nerve route (herpes zoster)

Front 91

Nevus Flammeus

Back 91

port wine stain, large, flat macular patch on head, dark red/bluish; secondary

Front 92

Spider/Star angioma

Back 92

bl vessels dilated on skin, star shaped, solid circular center; secondary

Front 93

Tinea capitis

Back 93

secondary; fungal infection of head

Front 94

Extensor/Flexor surfaces distribution

Back 94

elbows, knees, neck, ankles

Front 95

Dermatome

Back 95

area of skin supplied by single pair of dorsal roots

Front 96

Intertriginous areas

Back 96

folds of skin; fingers/toes, buttocks (diaper rash)

Front 97

ABCDE

Back 97

Asymmetry
Border irregularity
Color Variations
Diameter > 0.5 cm
Elevated/Enlargement

Front 98

Palpation of skin

Back 98

skin temperature, moisture, texture, turgor (look for tenting = dehydration)

Front 99

Koilonychia

Back 99

spooning of the nails, severe iron deficiency-anemia

Front 100

Lovibond's angle

Back 100

loss of normal angle of nail, "clubbing", from COPD, congenital heart, emphysema

Front 101

Onycholysis

Back 101

fungal infection of nails

Front 102

Paronychia

Back 102

red, infection of nail/cuticle

Front 103

subungual hematoma

Back 103

collection of blood under nail

Front 104

Hirsutism

Back 104

woman c male facial hair patterns

Front 105

Nursing Dx

Back 105

Health seeking behaviors r/t fear of skin cancer
Impaired skin integrity
Fear r/t family history of skin cancer