Ch 14 Assessing Skin, Hair, And Nails

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Skin

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The largest organ of the body it is a physical barrier that protects the underlying tissues and organs for microorganisms physical trauma ultraviolet radiation and dehydration it plays a vital role in temperature maintenance fluid and electrolyte balance absorption excretion sensation immunity and vitamin D synthesis the skin also provides individuals identity to a person's appearance

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The skin is composed of three layers the

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Epidermal, dermal, and subcutaneous tissue. The sexy thing is tissue which contains varying amounts of fat connects the skin to the

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The epidermis is

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The outer layer of skin, is composed of four distinct layers the stratum corneum, stratum lucidum stratum granulosum and stratum germinativum. The outer most layer consists of dead, keratinized cells that rendered the skin waterproof. The epidermal layer is almost completely replaced every 3 to 4 weeks. The innermost layer of the epidermis stratum lucidum is the only layer that undergo cell division and contains melanin brown pigment and keratin and forming self

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Dermis

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The inner layer of skin. Dermal papillae connect the dermis to the epidermis they are visible in the hands and feet and create the unique pattern of friction ridges commonly known as fingerprints. The dermis is a well vascularized connective tissue layer containing collagen and elastic fibers nerve endings and lymph vessels is also the origin of the sweat glands and hair follicles

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Sebaceous glands

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Attached to hair follicles and therefore are present over most of the body excluding the soles and Palms they create an oily substance called sebum that waterproofs the hair and skin

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Sweat glands

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There are two types of sweat glands eccrine and apocrine glands glands are located over the entire skin. Their primary function is secretion of sweat in thermoregulation which is accomplished by evaporation of sweat from the skin surface the apocrine glands are associated with hair follicles in the axilla perineum and areola of the breast apocrine glands are small and non-functional until puberty at which time they are activated and secrete a Milky sweat interaction of sweat with skin and women apocrine secretions with the menstrual cycle

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Subcutaneous tissue

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Lies Beneath the dermis a loose connective tissue containing fat cells blood vessels nerves in the remaining portion of sweat glands and hair follicles the subcutaneous tissue that stores fat as an energy Reserve provides insulation to conserve internal body heat serves as it question to protect bones and internal organs and contains vascular Pathways for the supply of nutrients and removal of waste products to and from the skin

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Hair

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Consists of layers of keratinized cells found over much of the body except for the lips nipples soles of feet Palms of the hands labia minora and penis hair develops within is sheet of epidermal cells called the hair follicle hair growth occurs at the base of the follicle where cells in the hair bolt are nourished by dermal blood vessels

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The two general types of hair are

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Vellus share which is peach fuzz is short tell fine and present over much of the body and terminal hair to particularly scalp and eye brows is longer generally darker and coarser than vellus Hair. Puberty initiates the growth of additional terminal hair and both sexes on the axilla perineum and legs hair color varies and is determined by the type of amount of pigment melanin in the pheomelonen production. Nasal hair auditory canal hair eyelashes and eyebrows filter dust and other Airborne debris

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Nails

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Located on the distal phalanges of fingers and toes are hard transparent plates of keratinized epidermal cells that grow from the cuticle the nail body extends over the entire nail bed and has a pet change as a result of blood vessels underneath the Leonora is a crescent-shaped area located at the base of the nail it is the visible aspect of the nail Matrix did not protect the distal end of the fingers and toes enhanced precise movement of the digits and allow for an extended Precision grip

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Symptoms that may be related to pathologic skin conditions includes

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Swelling bruises welts or Burns May indicate accident trauma or abuse if these injuries cannot be explained or do not match the symptoms or the clients explanation seems unbelievable or vague physical abuse should be suspected dry probiotic skin stretch marks skin tag dark patches and skin infections are common in obese client

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A change in the appearance of bleeding of any skin lesion especially a mole indicate

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Cancer

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Asymmetry irregular borders color variations diameter greater than 1/4 or 6 cm in evolving or changing over time or characteristics of

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Cancerous lesion

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Changes in Sensational temperatures of the skin May indicate

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Vascular neurology problems such as Pro for neuropathy related to diabetes mellitus or arterial occlusive disease. Decreased sensation may put the client at risk for developing pressure ulcers impaired skin integrity and skin infections

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Pruritus may be seen with

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Dry skin drug reactions allergies life Kenya insect bites uremia obstructive jaundice abnormal sensation of tingling or prickling for burning or referred to as first Asia period numbness darling of sensation of pain temperature and touch to the field maybe soon and diabetic peripheral neuropathy

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Hyperhidrosis

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I'll control body odor or excessive or insufficient perspiration excessive perspiration May indicate an abnormality of the sweat gland or an endocrine problems such as hypothyroidism or hyperthyroidism

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Perspiration decreases with age and because sweat gland activity decreases in older adults

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Patchy hair loss

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accompanying infection stress hairstyle that puts stress on hair roots and some types of chemotherapy also common with malabsorption syndromes malnutrition and anorexia nervosa and bulimia also common after gastric bypass surgery I lost is coming in aging the rate of hair growth slows and hair strands we can't become thinner some hair follicles stop producing hair

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Bacterial infections make calls on the nails

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Green black or brown nail discoloration yellow thick crumbling nails are seen and fungal infections yeast infection cause a white color in separation of the nail plate from the nail bed it takes 6 months to totally replace a fingernail in 12 months to totally replace a toenail

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Some skin rashes or lesions may be related to

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Viruses or bacteria

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Skin viruses such as chickenpox and measles can be

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Highly contagious ask me in a topic dermatitis tend to be familiar from allergies may be identified from family history

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Excessive or unprotected exposure to ultraviolet radiation can cause

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Premature aging of skiing and increase the risk of Skin Cancer Care can also be damaged by too much sun

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Psoriasis is associated with

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Cigarette smoking alcohol consumption

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Risk factors for MRSA includes

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Participating in contact Sports sharing personal items such as towels are razors suppression of the immune system functions cancer or chemotherapy HIV residing in unsanitary or crowded living conditions like dorms or military barracks working in the healthcare industry receiving antibiotics within the past 3 months 6 months young or Advanced age men having sex with men and hemodialysis

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Risk factors for skin cancer

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Sun exposure especially intermittent pattern with sunburn Non Solo source of UV are tanning booths medical therapy such as puva and ionization radiation family or personal history and genetic susceptibility especially for malignant melanoma mold especially HEB collisions pigmentation irregularities albinism is burn scars fair skin light hair light eyes age risk increases with increasing age actinic keratosis male gender for non melanoma cancer Specialists white men over 50 chemical exposure a Scenic tour Cole Paterson some oils for non melanoma cancer human papillomavirus so don't take me into some long time skin inflammation or injury acne that will not resolve inadequate my actions and diet Bowen disease scaly or thickening patch depressed and system

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How to examine your own skin

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Examining head and face using one or both mirrors use a blow dryer to inspect scalp check including nails and full length mirror examine elbows arms and underarms focus on neck chest torso women check under breast with back to mirror use hand mirror to instant back of neck shoulders upper arms back buttocks legs sitting down check legs and feet including soles heels and nails used hand mirror to examine genitals

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Risk assessment for pressure ulcer

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So long pressure to body especially bony prominences decreased absent perception or sensation decreased absent Mobility increased moisture increase decrease nutrition friction or shearing forces fragile tissues and skin due to age vascular incompetence diabetes mellitus or body with excessive or underweight

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To prevent pressure ulcers for bed or chair bound clients you should

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Salesforce Edition every 15 minutes or 2 hours that music positioning schedule use pressure mattress for chair cushion use lifting devices as directed to this year for patient lifts for family if necessary use the positioning with pillows for wedges to avoid bony prominence contact with surface and to maintain body alignment avoid doing the type devices for those who are bed-bound avoid elevating head of bed Beyond 30 degrees except for brief.

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Equipment and accessories for a second skin hair and nails

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Examination light penlight mirror for clients self-examination of skin magnifying glass centimeter ruler gloves good light examination gown or drapes grading scale for pickets impression service pressure ulcer scale for healing tool to measure pressure ulcer healing

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Pallor

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Loss of color is skin an arterial insufficiency increased blood supply in anemia Pallid tones vary from Pell to ashen without underlining pink

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Cyanosis

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Make calls with white skin to appear blue tanged specially in the Perioral nail bed and conjunctival areas dark skin the appear blue dull and lifeless in the same areas

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The older clients can become spell to to decrease melanin production and decreased dermal vascularity

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Jaundice

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Characterized by yellow skin tones ranging from pale to Pumpkin particularly of the sclera oral mucosa palms and Soles

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Acanthosis nigricans

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Is velvety darkening of skin and body folds and creases especially the neck groin and axilla suggest diabetes mellitus in dark skin people

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Erythema

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Skin redness and warmth is seen and inflammation allergic reactions or trauma erythema in the dark skin client may be difficult to see however the affected skin feels swollen and warmer than the surrounding skin

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Rough flaky dry skin is seen as

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Hyperthyroidism the older clients can they still dryer then the youngest clients can be to sebum production decreases with age

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Very thin skin may be seen in

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clients with arterial insufficiency sore steroid therapy

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Cold skin May the company

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Shop for hypertension cool skin May Company arterial disease very warm skin indicate a fever say of hyperthyroidism

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Decreased turgor is seen in

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Dehydration recoil of skin occurs in less than 2 seconds suggest moderate dehydration more than 2 seconds to get severe dehydration and More Than 3 seconds is described as tentin

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The older clients skin loses its turgor because of a decrease and elasticity and collagen fibers sagging or wrinkled skin appears in the facial breast and scrotal areas

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Excessive generalized hair loss may occur with

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Infection nutritional deficiencies hormonal disorders thyroid or liver disease drug toxicity hepatic and renal failure it may also result from chemotherapy or radiation therapy

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Hirsitism

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Facial hair on female is a characteristic of Cushing disease and polycystic ovary syndrome results from imbalance of the adrenals hormones or it may be side effects of steroids

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Early clubbing and late clubbing

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Early clubbing 180 degree angle with spongy sensation and lick clubbing greater than 180 degrees angle can occur from hypoxia do nails come case may be present with iron deficiency anemia thickening of the nails may be caused by decreased circulation

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Onycholysis

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Detachment of nail plate from nail bed is sing and infections or trauma

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Vitiligo

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Depigmentation of the skin

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Striae

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Stretch marks

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Capillary refill greater than 2 seconds indicate

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Respiratory or cardiovascular disease that cause hypoxia

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Necrotic tissue eschar

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4 black brown or tan tissue that adheres firmly to the one bed or ulcer edges and maybe either firmer or softer than surrounding skin

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Slough

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3 yellow or white tissue that adheres to the ulcer that in strings or big clumps or is mucinous

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Granulation tissue

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2 pink for beefy red tissue with a shiny moist granular appearance

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Epithelial tissue

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1 so superficial ulcers new pink or shiny tissue that grows in from the edges or as Islands on the ulcer surface

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Close resurface skin

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0 the world is completely covered with epithelium in the skin

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Stage 1 ulcer

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Intact skin with non blanchable redness of a localized area usually over a bony prominence darker pigmented skin may not have visible clenching its color made from the surrounding area the area may be painful firm sauced warmer or coolers as compared with adjacent tissue

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Stage 2 ulcer

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Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink moon bed without sloth

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Stage 3 pressure ulcer

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Full thickness tissue loss subcutaneous fat may be visible butt bone tendon or muscle is not exposed. The bridge of the nose ear and malleolus do not have subcutaneous tissue

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Stage 4 pressure ulcer

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Full thickness tissue loss with exposed bone tendon or muscle sloth eschar maybe present on some part of the wound bed often includes undermining and tunneling

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Unstageable ulcer

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Thickness tissue loss in which the base of the ulcer is covered by sloth yellow skin grey green or brown and or escar tan brown or black in the wound bed until enough slough and or escar is removed her exposed to base

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Macule

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Small slots non-potable skin color change maybe brown white tan purple red are less than one centimeter

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Vesicle

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Circumscribed elevated palpable Mass containing serous fluid vesicles are less than 0.5 centimeters

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Wheal

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Elevated math with translucent folders that is often irregular

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Pustule

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Pus filled vesicle or bulla include acne impetigo furuncles and carbuncles

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Cyst

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Capsulated fluid-filled or semi-solid mass that is located in the subcutaneous tissue or dermis

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Erosion

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Loss of superficial epidermis that does not extend to the dermis

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Fissure

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Linear crack in the skin that may extend to the dermis and maybe painful

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Petechiae

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Round red or purple natural that is 1 to 2 millimeter in size City secondary to blood extravasation and associated with bleeding Tendencies or emboli to the skin

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Ecchymosis

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Sound or irregular macular lesion that is larger than petechial lesions the color varies and changes black yellow and green hues

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Hematoma

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A localized collection of a blood creating an elevated after meiosis it is associated with trauma