hair, skin & nails health assessment

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the skin plays a vital role in the temperature maintenance, fluid and electrolyte balance, and synthesis of vitamin

D

the nurse is assessing an African american clients skin, after the assessment the nurse should instruct the client that A/A are more susceptible to

chronic discoid lumpus erthmatosus

nevus

congenital pigmented area on the skin, for exmple, mole or birthmark

hair follicles, sebaceous glands and sweat glands originate from the

dermis

annular

describes a lesion that forms a ring around a clear center of normal skin

an adult male client visits the clinic and tells the nurse that he believes he has athletes foot, the nurse observes that the client has linear cracks in the skin on both feet--should document presence of

fissures

female client complains that her skin feels "dry"--> the nurse should instruct the client that skin elasticity is related to adequate

fluid intake

a 20 year old who has sudden generalized hair loss, has not received radiation or chemo-->nurse should further assess for signs and symptoms of

hypothyroidism

papule

solid, elevated, circumscribed, superficial lesion; 1 cm or less in diameter

the nurse is instructing a group of high schoolers about the 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 exposure to the sun

petechiae

tiny, flat, purple or red spots on the surface of the skin resulting from minute hemorrhage

to assess clients skin turgor

use 2 fingers to pinch the skin under the clavicle

short, pale and fine hair that is present over much of the body is termed

vellus

a clients skin color depends on the melanin and carotene contained in the skin, and the clients

volume of blood circulating in the dermis

the only layer of skin that undergoes cell division is the

innermost layer of the epidermis

the nails, located on the distal phalanges of the fingers and toes, are composed of

keratinized epidermal cells

while assessing an adult client, the nurse observes freckles on the clients face, the nurse should document presence of

macules

during assessment of the clients skin, nurse should assess for central cyanosis by observing the clients

oral mucosa

squamous cell carcinoma is associated with

overall amount of sun exposure

pressure ulcer of older adult bedridden client in her home with small area of skin broken and resembling erosion

stage 2 pressure ulcer

connecting the skin to underlying structures is/are the

subcutaneous tissue

an adult male client visits the outpatient center and tells the nurse that he has been experiencing patchy hair loss, the nurse should further assess for

symptoms of stress

a client visits the clinic for a routine physical examination, the nurse prepares to assess the clients skin & asks if there is any family history of skin cancer because

there is a genetic component with skin cancer, especially basal cell carcinoma

lichenification

thickening of the skin characterized by accentuated skin markings

nurse is preparing to examine the skin of an adult client with a diagnosis of herpes simplex--the nurse plans to measure the clients symptomatic lesions and measure the size of the clients

vesicles

dark skinned client who has been transported by ambulance: when nurse observes that the clients skin also appears pale, blue-tinged lips and oral mucosa, the nurse should document the presence of

a great degree of cyanosis

an AA female client visits the clinic and tells the nurse she had her ears pierced several weeks ago, and an elevated, irregular, reddened mass has now developed at the ear lobe-->document

a keloid

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

aerola of the breast

bulla

an elevated, circumscribed, fluid-filled lesion; greater than 1 cm in diameter

to assess for anemia in dark-skinned clients, the nurse should observe the client's skin for a color that appears

ashen

assessing the skin of older adult client: she has small yellowish brown patches on her hands, the nurse should instruct the client that these are

caused by aging of the skin in older patients

induration

hardening of the skin, usually caused by edema

urticaria

hives, pruritic wheals, often transient and allergic in origin

keloid

hypertrophic scar tissue, prevalent in nonwhite races

while assessing the nails of an older adult the nurse observes early clubbing, should further evaluate signs and symptoms of

hypoxia

nurse documents the presence of fungus when florescence is

blue

wheal

elevated, solid, transient lesion; often irregularly shaped, an edematous

a primary function of hair in the nose and eyelashes is to serve as

filter for dust

if a female client enters a clinic for the first time with many bruises around her head and neck the "result of an accident", you may be able to suspect that they are experiencing

domestic abuse

assessing elevated, palpable and solid mass with a circumscribed border that measures 1 cm is a

plaque

while assessing the nails of an adult client, they observe beau lines & should ask client if she has had

recent illness

a client diagnosed with discoid systemic lupus erthematosus continues to swim in the sunglight 3x a week, she has accepted her patchy air loss and wears a wing on ocassion, a priority for nursing diagnosis would be

risk for ineffective health assessment related to deficient knowledge of effects of sunlight on skin lesions

dark-skinned client visits because "he hasnt been feeling well", to assess skin for jaundice, the nurse should inspect the clients

sclera


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