Nur 203 Ch 12 Iskin, Hair, Nails

Front 1

stratum germinativum

Back 1

prootective barrier forms new skin cells called keratin

Front 2

melanin

Back 2

gives brown tones to the skin and hair

Front 3

Vellus hair

Back 3

(fine faint hair) that covers most of the body except the palms and soles, the dorsa of the distal parts of the fingers, umbilicus, the glans penis and inside the labia

Front 4

terminal hair

Back 4

the darker thicker hair that grows on the scalp and eyebrows and after puberty on the axillae, pubic area, and the face and chest in the male

Front 5

Sebaceous gland

Back 5

produce sebum
oils and lubicates skin
not on palms and soles

Front 6

Eccrine sweat gland

Back 6

secreate sweat on skin surface

Front 7

Normal Nail Plate

Back 7

with fine longitudinal ridges that become prominent in aging

Front 8

Normal Lunula

Back 8

white opaque semilunar area at the proximal end of the nail

Front 9

cuticle

Back 9

cover and protect the nail matrix

Front 10

What is the function of the skin?

Back 10

protection
prevents penetration
perception
temperature regulation

Front 11

Skin produces which vitamin?

Back 11

ultraviolet light converts cholesterol into vitamin D

Front 12

Lanugo

Back 12

The fine downy hair of the new born.
In the first few months after birth, this is replaced by fine vellus hair.

Front 13

Terminal hair on infant

Back 13

soft, patchy loss at the temples and occiput

Front 14

Vernix caseosa

Back 14

thick, cheesy substance made up of sebum and shed epithelial cells.

Front 15

Linea nigra

Back 15

increased pigment of the abdomend on the pregnant female

Front 16

chloasma

Back 16

increased pigmend in the face of the pregnant female

Front 17

What happens to the skin of an aging adult?

Back 17

loses elasity, folds and sag, parchment thin, lax, dry and
stratum corneum thins and flattens,
loss of elastin, collagen, and subcutaneus fat and reduction in muscle tone.
Loss of collagen increases the risk for terring injuries.
Decreased sweat glands increases the risk of sun stroke.

Front 18

Senile purpura

Back 18

vascularity of the skin diminishes, while the vascular fragility increases, minor trasuma may produce dark red discolored areas

Front 19

How does the Striae gravidarum change in a pregnant female?

Back 19

connective tissue developes increasing fragility which develops in the skin of abdomen, breast, or thighs.

Front 20

eczema

Back 20

noncontagious inflammatory skin disease
Objective: redness, itching, outbreak of lessions that ay discharge and become encrusted and scaly

Front 21

Psoriasis

Back 21

noncontagious inflammatory skin disease
Objective: recurring reddish patches covered with silvery scales

Front 22

Generalized change in skin color suggest?

Back 22

pallor, jaundice, cyanosis

Front 23

seborrea

Back 23

oily

Front 24

xerosis

Back 24

dry

Front 25

Pruritus

Back 25

Most common of skin symptoms.
Occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice

Front 26

Alopeca

Back 26

significant hair loss

Front 27

Hirsutism

Back 27

Unusual Hair growth

Front 28

malignant melanoma

Back 28

happens in later years of life caused by one or more severe sunburns before 18 years of age

Front 29

The palms of the hands and soles of the feet have an extra epidermal layer called?

Back 29

Stratum lucidum

Front 30

What causes pallor?

Back 30

peripheral vasoconstriction
False: fear, anger

Front 31

What causes erythema?

Back 31

Flushing in face and neck
False: embarrassment

Front 32

What causes erythema?

Back 32

vasodilation
False: hot room

Front 33

How does cigarette smoking influence skin color?

Back 33

False pallor due to vasoconstriction

Front 34

What would cause false pallor, collness.

Back 34

Vasoconstriction sue to chilly room

Front 35

What would prolonged elevation cause?

Back 35

pallor, coolness duce to decreased arterial perfusion

Front 36

What would immobilizatiom or prolonged inactivity cause?

Back 36

pallor, coolness, nail beds pale, prolonged capillary filling time due to slowed circulation

Front 37

Where do dark skined people have areas of lighter pigmentation?

Back 37

palms, nail beds, and lips

Front 38

vitiligo

Back 38

complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices.

Front 39

ephelides

Back 39

(freckles) small, flat macules of brown melanin pigment that occur on sun exposed skin

Front 40

nevus

Back 40

(mole)- proliferation of melanocytes, tan to brown color, flat or raised. Acquired nevi are characterized by their symmetry, small sixe (6mm or less), smooth borders, and skingle uniform pigmentation.

Front 41

Junctional nevus

Back 41

macular only and occurs in children and adolescents. It progresses to the nivi in young adults that and macular and papular.

Front 42

Birth marks

Back 42

tan to brown

Front 43

What color is pallor?

Back 43

white

Front 44

What color is erythema?

Back 44

red

Front 45

What color is cyanosis?

Back 45

blue

Front 46

What are the inaccurate skin signs of dark-skinned people?

Back 46

amount of color pigment may mask color change

Front 47

What causes palor?

Back 47

high stress states that cause vasoconstriction

Other causes are cold, smooking, and edema.

Seen in the mucous membrane, lips, and nail beds.

Front 48

Where do you acess palor of anemia?

Back 48

palperbral conjunctva and nail beds

Front 49

What causes erythema?

Back 49

Intense redness of the skin

Expected with fever, local inflammation, or bludshing in cheecks, neck and upper chest

Front 50

Cyanosis

Back 50

tissues are not adequately perfused with oxygenated blod

Front 51

What causes cyanosis

Back 51

is asociated with decreased oxygenatio of the brain and changes in level of consciousness, respritory distress

Front 52

What does ashen gray color in dark skin or marked pallor in whites cccur with?

Back 52

anemia, shock, arterial insufficiency

Front 53

Jaundice

Back 53

yellow color, indicating rising amounts of bilirubin in the bood.
Found in hard and soft palate in the mouth and in sclera.

Exception: common yellow calluses on palms and soles are not jaundice

Front 54

How do you check skin temperture?

Back 54

Use backs (dorsa) of hands to palpate the person and chekc bilaterally

skin should be warm and equal bilateraly

Front 55

Hypothermia

Back 55

Coolness

Localized coolness is expected with immobilzed extremity.

Front 56

Hyperthermia

Back 56

increased metabolic rate such as fever.

Localized area feels hyperthermic with trauma, infection, or sunburn.

Front 57

Diaphoresis

Back 57

profuse perspiration

Front 58

Dehydratin

Back 58

Normal: membranes look smooth and moist
Abnormal: dehydration in the oral mucous membranes

Front 59

What is normal texture?

Back 59

Skin fells smooth and firm, with an even surface.

Front 60

Callus

Back 60

circumscribed overgrowth of epidermis and is an adaptation to excessive pressure fro the friction of work and weight bearing.

Front 61

What does jaundice occour with?

Back 61

hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.

Front 62

What accompanies jaundice?

Back 62

light or clay colored stools and dark golden urine often accompany jaundice in both light and dark skinned people.

Front 63

What abnormal finding occurs with hyperthermia?

Back 63

peripheral arterial insufficiency and Raynauds disease

Front 64

How is the skin effcted by hyperthyroidism?

Back 64

Hyperthyoidism has an increased metabolic rate, xausing warm, moist skin.

Front 65

How does hyperthyoidism effect the skin?

Back 65

skin feels smoother and softer, like velvet.

Front 66

How is the skin texture effected by hypothyroidism?

Back 66

skin feels rough, dry, flaky.

Front 67

Very thin, shiny skin (atrophic) occours with?

Back 67

arterial insufficiency

Front 68

Edema

Back 68

abnormal fluid accumulating in intercellular spaces

Front 69

How do you check for edema?

Back 69

imprint your thumbs firmly against the ankle malleolus or tibia.
Normaly the skin stays smooth. If your pressure leaves leaves a dent in the skin "pitting" edema is present.

Front 70

Explain the four point grad scale for Edema.

Back 70

1+ Mild pittling, slight indentation, no percepticle swelling of the legs

2+ Moderate pitting, indentation subsides rapidly

3+ Deep pitting, indentation remains for a short time, leg looks swollen

4+ Very deep pittling, indentation lasts a long time, leg is very swollen

Front 71

What is dependent edema?

Back 71

Edeam in the feet, ankles, and sacral areas. Skin looks puffy and tight.
You note a pig skin or Peau d' orange

Front 72

What is the cause of Unilateral Edema?

Back 72

consider a local or peripheral cause

Front 73

How do you test for mobility and turgor?

Back 73

Pinch up a large fold of skin on the anterior chest under the clavicle. Mobility is the skin rising and tugor is its ability to return to place promply.

Front 74

What happens to mobility when edema is present?

Back 74

mobility is decreased

Front 75

What are signs of poor tugor?

Back 75

severe dehydration or weight loos; the pinched skin recedes slowly or "tents" and stands by itself.

Front 76

Scleroderma

Back 76

"hard skin", a chronic connective tissue disorder associated with decreased moility.

Front 77

Cherry (senile agniomas)

Back 77

small (1-5mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults over 30.
Not Significant

Front 78

ecchymosis

Back 78

bursing, should be exspected with trauma of life
There are normally no venous dilations or varicosities.

Front 79

What bruises should raise concern about physical abuse?

Back 79

multiple burises at different stages of healing and excessive burises above knees or elbows should raise concern

Front 80

If there are tattoos on PT's body what do you do?

Back 80

document the presence of any tattoos
Advise the person tattos increase the risk of hepatitis C.

Front 81

How would you document a lesion?

Back 81

1. color
2. elevation
3. Pattern or shape
4. Size, in centimeters
5. location and distribution on body
6. any exudate (liquid)

Front 82

What is a primary lesion?

Back 82

lesion that devolops on previously unaltered skin

Front 83

What is a secondary lesion?

Back 83

a lesion that changes over time or changes becuase of scratching or infection.

Front 84

What can you do to identigy a macular rash in a dark skinned person?

Back 84

streching the area of skin between your thumb and index finger decreases(blances) the normal underlying red tones.
Red macules from dilated blood vessels with blanch mementarily, whereas those from extravasted blood (petechiae) does not.

Front 85

What do lesions with blue-green fluorescence indicate?

Back 85

fungal infection, such as tinea capitis (scalp ringworm)

Front 86

What causes graying hair?

Back 86

reduced melanin production in the follicles

Front 87

What is a sign of tinea capitis?

Back 87

Gray, scaly, well-defined areas with broken hairs

Front 88

Hirsutism

Back 88

excess body hair

Front 89

Seborrhea

Back 89

dandruff

Front 90

Profile Sign

Back 90

view the index finger at if profile and note the angle of the nail base, it should be 160 degrees
congenital chronic cyanotic heart disease, emphysema and chronic bronchitis.

Front 91

What would pits, transverse grooves, or lines indicate?

Back 91

nutrient deficiecy or acute illness.

Front 92

A spongy nail base accompanies what?

Back 92

clubbing

Front 93

Brown linear streaks are abnormal in light skinned people and may indicate what?

Back 93

melanoma

Front 94

Capillary refill

Back 94

indicates the status of the peripheral circulation.
A sluggish color return takes longer than 1 or 2 seconds.

Front 95

What do you consider when their are cyanotic nail beds or sluggish corlor return

Back 95

cardiovasuclar or respiratory dysfuncion

Front 96

Senile lentigines

Back 96

commonly called liver spots are are small, flat, brown macules due to extensive sun exposure. They appear on the forearms and dorsa of the hands. Not malignant and require no treatment.

Front 97

Keratosis

Back 97

raided, thickened areas of pigmentationthat loook crusted, scaly, and warty.

Front 98

senile keratosis

Back 98

red tan scaly plaques that increase over the years to become raised and roughened. May have a silvery white scale adherent to the plaque. PREMALIGANT - squamous cell carcinoma

Front 99

Acrochordons

Back 99

skin tags on eyelids, cheecks, and neck, axillae, trunk

Front 100

Sebaceous hyperplasia

Back 100

raised yellow papules with a central depression

Front 101

How does the skin change in elders?

Back 101

thin as archment, tugor is decreased, skin tents
Fungal infection are common

Front 102

alopecia

Back 102

balding

Front 103

Vitilgo

Back 103

patchy depigmentation from destruction of melanocytes

Front 104

Pallor: anemia difference in light and dark skin.

Back 104

due to decreased hematocrit and (shock) decreased perfusion, vasoconstriction

Light skin: generalized pallor

Dark skin: Brown skin appears yellow brown, dull; black skin appears ashen gray, check areas with less pigmentation, such as conjunctivae, mucous membranes

Front 105

How does pallor due to local arterial insufficiency differ with skin color?

Back 105

Light skin: marked localized pallor: lower extremities, especially when elevated

Dark skin: ashen gray, dull, coll to palpitation

Front 106

How does pallor due to albinism: total absence of pigment melanin thoughout the integument

Back 106

light skin: whitish pink

Dark skin: tan, cream, white

Front 107

How does pallor due to Vitiligo, patchy depigmentation from destruction of melanocytes change with skin color?

Back 107

Light skin: patchy milky white spots, oftern symetrical bilaterally

Dark skin: same

Front 108

How does cyanosis, increased amount of unoxygenated hemoglobin differ with skin color?

Back 108

Light skin: dusky blue

Dark skin: dark but dull, lifeless, only severe cyanosis is apparent in skin - check conjunctivae, oral mucosa, nail beds.

Front 109

What causes central and periphearal cyanosis and what is a sign?

Back 109

Central - chronic heart and lung disease cause arterial desaturation

Peripheal - exposure to cold, anxiety, nail bed dusky

Front 110

Erythema caused by hyperemia, te increased blood flow through engorged arterioles, such as in inflammation, fever, alcohol intake, blushing differs in skin color how?

Back 110

light skin: red bright pink

Dark skin: purplish tinge, but difficult to see, palpate for increased warmth with inflammation, taut skin and hardening of deep tissues

Front 111

Erythema caused by polycythemia, increased red blood cells, capillary stasis differs in skin color how?

Back 111

Light skin: bright cherry red in face and upper torso

Dark skin: well concealed by pigment check for redness of lips

Front 112

Erythema cuased by carbon monoxide poisoning differs in skin color how?

Back 112

Light skin: bright cherry red in face and upper torso

Dark skin: cherry red color i nail beds, lips, and oral mucosa

Front 113

Erythema caused by venous stasis, decreased blood flow from area, engorged venules differs in skin color how?

Back 113

Light skin: dusky rubor of dependent extremities, a prelude to necrosis with presure sore

Light skin: easily masked, use palpaiton for warmth or edema

Front 114

Jaundice caused by increased serum bilirubin, over 2 to 3 mg/100 ml due to liver inflammation or hemolytic disease, such as after severe burns, some infections differs in skin color how?

Back 114

light skin: yellow in sclera, hard palate, mucous membrane, then over skin

Dark skin: check sclera for yellow near limbus; do not mistake normal yellowish fatty deposits in the periphery under the eyelids for jaundice - Jaundice best noted in junction of hard and soft alate and also palms

Front 115

Jaundice caused by carotenemia, increased serum carotene form ingesiton of large amounts of carotene rich foods such as after severe burns, some infections difer in skin color how?

Back 115

Light skin: yellow orange in forehead, palms and soles, nasolabial folds, but no yellowing in sclera or mucous membranes

Dark skin: yellow orange tinge in palms and soles

Front 116

Jaundice caused by uremia, renal failure cuses retained uro chrome pigments in the blood

Back 116

Orange green or gray overlying pallor of anemia; may alos have ecchymoses and purpura

Dark skin: easily masked; rely on laboratory and clinical findings

Front 117

Brown Tan caused by Addison's disease, cortisol deficiency stimulates increased melanin production

Back 117

Light skin: bronzed appearance,an "external tan" most apparent around nipples, perineum, genitalia, and pressure points (inner thighs, buttocks, elbow, axillae)

Dark skin: Easily masked; rely on lab and clinical findings

Front 118

Brown-Tan cuased by Cafe au lait spost, due to increased malanin pigment in basal cell layer differs in skin color how?

Back 118

Light skin: tan to light borwn, irregularyly shaped, oval patch with well defined borders

Front 119

Annular lesion

Back 119

circular, begins in center and spreads to periphery.

Front 120

confluent lesion

Back 120

lesions run together
eg. urticaria(hives)

Front 121

discrete

Back 121

distinct, individual lesions that remain separate

Front 122

grouped

Back 122

cluster of lesions

Front 123

target

Back 123

or iris, resembles iris of cye concentric rings of color in the sesions

Front 124

Polycyclic

Back 124

annular lesions grow togeter

Front 125

gyrate

Back 125

twisted, coiled spiral, snakelike

Front 126

linear

Back 126

scratch, streak, like, or stripe

Front 127

zosteriform

Back 127

linear arrangement along a nerve roupe
eg. herpes zoster

Front 128

Macule

Back 128

soley a color change, flat and circumscribed, less than 1 cm. Ex freckles, flat nevi, hypopigmentation, petehiae, measles, scarlet fever
primary Lesion

Front 129

patch

Back 129

macules that are larger than 1 cm. ex. mongolian spot, vitiligo, cafe au lait spot, chloasma, measles rash
primary lesion

Front 130

Nodule

Back 130

solid, elevated, hard or soft, larger than 1 cm.
May be deeper than papule
primary lesion

Front 131

Tumor

Back 131

larger than a few centimeters in diameter, firm or soft, deeper into dermis, may be benign or maligant
ex. lipoma, hemangioma
primary lesion

Front 132

papule

Back 132

something you can feel ie, solid, elevated, circumscribed, less than 1 cm diameter, due to superficial thikening in the epidermis. ex. elvated nevus (mole), lichen planus, molluscum, wart (verruca)
Primary lesion

Front 133

plaque

Back 133

papules coalesce to form surface elevation wider than 1 cm. A plateeaulike, disk-shaped lesion. ex. psoriasis, lichen planus
primary lesion

Front 134

wheal

Back 134

superficail, raised, transient, and erythematous, slightly iregular shape due to edema (fluid held diffusely in the tissures) ex. mosquito bite, allergic reacton, dermographism
primary lesion

Front 135

Urticaria (hives)

Back 135

wheals coalesce to form extensive reaciton, intensely pruritic
primary lesion

Front 136

cyst

Back 136

encapsulated fluid filled cavity in dermis or subcutanous layer, tensely elevatong skin ex. sebaceus cyst, wen
primary lesion

Front 137

Vesicle

Back 137

elevated cavity containing free fluid, up to 1cm. Clear serum flows if wall is ruptured. ex. herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatis
primary lesion

Front 138

Bulla

Back 138

larger than 1 cm diameter, usually single chambered (unilocular), superficial in epidermis, it is thin walled, so it ruptures easily examples: fricktion blister, pemphigus, burns, contact dermatitis.
primary lesion

Front 139

pustule

Back 139

turbid fluid (pus) in the cavity. Circumscribed and elevated. ex. impetigo, acne.
primary lesion

Front 140

crust

Back 140

thickened, dried out exudate left when vesicles/pustules burst or dry up. ex. impetigo

Front 141

Fissure

Back 141

linear crack with abrupt edges, entends into dermis, dry or moist
ex. cheilosis - at corners of mouth due to excess moiture, athlete foot.

Front 142

scale

Back 142

compact, edsiccated flakes of skin, dry or greasy, silvery or white, from shedding to dead excess keratin cells. ex. scarlet fever, psoriiasis

Front 143

erosion

Back 143

scooped out but shallow depression. Superficial, epidermis lost, moish but no bleeding, heals without scar because erosion does not extend into dermis.

Front 144

ulcer

Back 144

deeper depresson extenidng into dermis, irreguar shape may bleed, leaves scar when heals. Examples, stasis ulcer pressure sore, chancre.

Front 145

Scar

Back 145

after a skin lesion is repaired, normal tissue is lost and replaced whith connective tissue (collagen). This is a permanent fibrotic change.

Front 146

Lichenification

Back 146

prolonged intense scratching eventually thickens the skin and produces packed sets of papules, lookes lakes surface or moss or lichen

Front 147

excoriation

Back 147

self inflicted abrasion, superficial, sometimes crusted scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella.

Front 148

Atrophic scar

Back 148

resulting skin level depressed with loss of tissue, a thinning of the epidermis ex. striae

Front 149

Keloid

Back 149

a hypertrophic scar. excess scar tissue. May increase long after healing occurs. Higher insidence amoung blacks.

Front 150

excoriation

Back 150

self inflicted abrasion, superficial, sometimes crusted, scratches from intense itching. ex. insect bites, scabies, dermatitis, varicella

Front 151

Atrophic scar

Back 151

resulting skin level depressed with loss of tissue, a thining of the epidermis. ex striae

Front 152

apocrine sweat gland

Back 152

thick, milky secretion and into the hair follicles, axillae, anogenital area, nipples, and navel and are vestigial in humans. they become active during puberty, and secretion occurs with emotional and sexual stimulation.

Front 153

Stawberry hemangioma

Back 153

raised bright red area wit ell defined borders about 2-3cm in diameter.
Does not blanch
Disapears by 5-7
requires no treatment

Front 154

Nevus Flammeus (pork-wine-stain)

Back 154

large, flat macular patch covering the sclap or face, frequently along CN V.
Dark red, bluish or purplish and intensifies with crying, exertion or exposure to heat or cold.

Front 155

Cavernous hemangioma (mature)

Back 155

reddish - bue, irregualry shaped, solid and spongy mass of blood vessels.
Benign

Front 156

Spider or star angioma

Back 156

fiery, star shaped marking with a solid circular center. Capillary radiations extend from the central arterial boudy.