Chapter 14 Skin, Hair, and Nails

Pressure Ulcer Stage IV

-damage to the tendon, muscle, and bone -involves all three layers plus bone and other support tissue -the ulcer resembles a massive crater with hidden areas of damage in the adjunct tissue

Pressure Ulcer Stage III

-involves all 3 layers of skin -resembles a crater -hidden areas of damage may be extended through the sub-q tissue beyond the borders of the external lesion, but not through the underlying fascia

Risk factors for skin cancer

-male gender -chemical exposure -HPV -xerodrem pigmentosum -long term skin infection -alcohol intake; smoking -indadequate niacin in diet

Pressure Ulcer Stage II

-reddened area -loss of epidermis -skin is broken, and there is superficial skin loss involving the epidermis alone or also the dermis -the lesion resembles a vesicle, erosion, or blister

Pressure Ulcer Stage I

-skin unbroken, but appears red -no blanching when pressed -may feel warmer in area of breakdown

Secondary Skin Lesions

Arieses from a primary skin condition: erosion (canker sore) scar ulcer fissure

What race has lowest rates of skin cancer? Highest?

Asians; white Australians

Vascular Skin Lesions

Associated with bleeding, aging circulatory conditions, diabetes, pregnancy, and hepatic disease. petechia (round red macule 1-2 mm) ecchymosis (round/irregular macular lesions) hematoma cherry angioma (normally age related) spider angioma (liver disease, pregnancy, and vit B deficiency) Red arteriole lesion with a center body with radiating branches and is rare to have below the waist. telangiectasis - bluish or red lesion with varying shape and found on the legs and anterior chest. Does not blanch when pressure is applied.

ABCDE mnemonic to assess suspicious lesions

Asymmetry Border Color Diameter Elevation

Ensure adequate amount of which vitamin for risk reduction for skin cancer?

B3

A golden yellow pigment that is heavily keratinized and is found in subcutaneous fat is called what?

Carotene

A nurse observes the presence of hirsutism (facial hair) on a female client. The nurse should perform further assessment on this client for findings associated with which disease process?

Cushings

The inner layer of skin A well vascularized connective tissue layer containing collagen and elastic fibers, nerve endings, and lymph vessels.

Dermis

The terms "generalized," "exposed surfaces," "upper arm," and "skin folds" are used to describe which major characteristic of skin lesions?

Distribution

Eccrin vs Apocrine sweat glands

Eccrin- located over the entire skin Apocrine- concentrated in the axillae, perineum, and areolae of the breast

Layers of skin

Epidermis Dermis Subcutaneous layers

Pressure Ulcer - Unstageable

Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, brown) and/ or eschar in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined.

A nurse inspects a client's nails and notes the angle between the nail base and the skin is greater than 180 degrees. What additional data should the nurse collect from this client?

History of cigarette smoking

While assessing the nails of an adult client the nurse observes late clubbing. The nurse understands that she needs to further evaluate the client for signs and symptoms of

Hypoxia

A mother brings her child to the health care clinic and reports that her son has a four-day history of intense itching to his legs. On inspection of the child's legs, the nurse notes a honey-colored exudate coming from a vesicular rash bilaterally. The nurse recognizes this finding as what skin condition?

Impetigo

Deep purple, raised or flat lesions may indicate

Kaposi's sarcoma seen with AIDS patients

Ammonia odor from mouth

Kidney disease

Paronchia

Local infection of the tissue folds around the nail

There is a genetic component to which skin cancer?

Malignant Melanoma

Epidermis

Outer layer of skin Consists of dead, keratinized cells Composed of keratin Hair, nails, dental enamel

longitudinal ridging on nails

Parallel ridges running lengthwise. Seen in elderly and some young people with known etiology

Parents bring a child to the clinic and report a "rash" on her knee. On assessment, the nurse practitioner notes the area to be a reddish-pink lesion covered with silvery scales. What would the nurse practitioner chart?

Psoriasis

A nurse assesses a client for past history of nail problems. The nurse should ask questions about which of these conditions?

Psoriasis, fungal infections, trauma

A nurse in a dermatology clinic cares for an adolescent patient with multiple purulent, fluid-filled lesions on her face, shoulders, back, and chest. What is the most likely medical diagnosis for this patient?

Pustular acne

A middle-aged man comes in with multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful, and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should the nurse do?

Reassure him that there is nothing to worry about. These represent cherry angiomas, which are very common, benign lesions. Further follow up, such as laboratory work, skin biopsy, or even further questions, is not necessary at this time. It would be wise to ask the client to report any changes in any of his skin lesions, and that you would need to see him at that time.

The nurse assesses an older adult bedridden client in her home. While assessing the client's buttocks, the nurse observes that a small area of the skin is broken and resembles an erosion. The nurse should document the client's pressure ulcer as

Stage II pressure ulcer

Which layer of the skin contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles, and sweat glands?

Subcutaneous Tissue

The apocrine glands are dormant until puberty and are concentrated in the axillae, the perineum, and the

areola of the breast

While assessing an adult client's feet for fungal disease using a Wood light, the nurse documents the presence of a fungus when the fluorescence is

blue

melanin vs carotene coloring

brown vs yellow

Patchy hair loss

could be stress related

Acanthosis nigricans (AN), a linear streak-like pattern in dark skinned people suggests...

diabetes mellitus

The apocrine glands are stimulated by what?

emotional stress

yellow nail syndrome

grow slow and are curved may be seen in AIDS and resp syndromes

half and half nails

half white on the proximal half and pink on the distal half -seen with chronic renal disease

A patient with a zosteriform rash has a rash that

is distributed along a dermatome

pallor

lack of color

A nurse receives a report from the shift nurse that a client has new onset of peripheral cyanosis. The nurse recognizes that which of the following is the most likely underlying cause?

local vasoconstriction

Primary Skin Lesions

macule and patch (rubella) papule and plaque (warts) nodule and tumor vesicle and bulla wheal pustule cyst

While assessing an adult client, the nurse observes freckles on the client's face. The nurse should document the presence of

macules

Three types of skin cancer:

melanoma (deadliest) basal cell carcinoma squamous cell carcinoma

beau's line

recent infection

pustules with hair loss in patches

ring worm (Tina capitis)

A mother brings her 4-year-old daughter to the clinic and reports that the child has developed a rash that she is constantly scratching on her abdomen. On examination, the nurse finds that the rash is serpiginous. The nurse would know that the rash is most probably caused by

scabies

pitting on the nails

seen with psoriasis

Spoon shaped nails (koilonchia) Caused by...

spoon shaped that may be seen with trauma to cuticles or nail folds or iron deficiency anemia, endocrine or cardiac disease

The nurse is instructing a group of high school students about risk factors associated with various skin cancers. The nurse should instruct the group that

squamous cell carcinomas are most common on body sites with heavy sun exposure.

Connecting the skin to underlying structures is/are the

subcutaneous tissue

Loose connective tissue containing fat cells, blood vessels, nerves, and the remaining portion of sweat glands and hair follicles. Assists with heat regulation Contains the vascular pathways for -the supply of nutrients -the removal of waste products from the skin

subcutaneous tissue

vellus vs terminal hair

vellus- short, pale, and fine (present over most of the body) terminal- longer, generally darker, and coarser