Chapter 11- skin, nails, and hair

Melanoma

ABCDEF asymmetry border irregularity color, uneven diameter >6mm evolved or changed feelling(itch, tingle, sting)

Onycholysis

Separation of the nail plate from the nail bed in fungal infections or after trauma.

Lesion characteristics

Size Shape, location Color Texture Elevation / depression Pedunculation (skin tags) Exudate

Petichiae

Small purple discoloration; 1-3 mm diameter; non blanch

nail clubbing

The nail appears more convex and wide. The nail angle is greater than 160 degrees. 160 is considered normal. It occurs in chronic respiratory and cardiac conditions in which oxygenation is compromised (emphysema, COPD). chronic hypoxia

longitudinal ridging

The presence of tiny raised lines or ridges that run up and down the length of the nail due to aging, nail injury, or trauma

hemangioma

a benign tumor made up of newly formed blood vessels present at birth, resolves by age 9

vascular lesions

ecchymosis (bruising)

telangiectasia (spider angioma)

irregular red lines caused by dilation of blood vessels

nevus flammeus

port wine stain

Pitting nails

seen with psoriasis

Nail Assessment

shape and contour, consistency, color, capillary refill angle nail base=160 degrees

integumentary system

skin, hair, nails, glands provides information about a pts health status it can indicate fuctioning of: thermoregulatory, endocrine, respiratory, cardiovascular, gastrointestinal, neurologic, urinary, immune system findings also reflect the pts: hydration, nutrition, and emotional status and help point you in the direction of other systems or organs that may be indicated.

Beau lines

transverse depression in nail bed due to systemic disorders

Kilonychia

(Spoon nail) Anemia or congenital

edema scale

0 = none observed +1 = minimal (<2mm) +2 = depression 4mm +3 = depression 6mm +4 = depressions >8mm

Coining

A practice among Southeast Asians in which a coin or other object is rubbed across the skin in a specific manner to treat various health concerns. results in bruising and abrasions

cherry angioma

a small, round, bright red blood vessel tumor on the skin, often on the trunk of the elderly

dysplastic nevi

atypical moles that can develop into skin cancer more than 50 normal moles may increase risk for melanoma most common on the" face shoulder upper arms men-back women-legs most likely related to sun exposure

urgent assessment of skin findings

dehydration , cyanosis, impaired skin integrity(lacerations, burns, tissue injury) may require immediate evaluation and interventions with fluids and oxygen suspicious lesions may indicate cancer rash and fever=infection

skin

epidermis-outermost layer of skin has 5 layers, first line of defense against pathogents dermis- second layer or skin has 2 layers, supports epidermis, contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles, sweat glands subcutaneous-fat, loose connective tissue, function is to provide insulation, caloric reserve, cushioning, contributes to skin mobility

UV exposure

exposure between 10-4 has the greatest intensity of UV waves normally takes 10 min for skin to redden SPF 30 protects the skin for redding for 30 x10 min=300 minutes apply 15-30 before exposure must be applied every 2 hours after swimming or sweating for max effect pts should use lip balms wear sunglasses with 99% UV protection

lesion documentation

location, shape, color, pattern, edges, flat/raised, size

older adults

loose elastin, collagen, and subcutaneous fat, resulting in thinner skin effects of these changes include include decreased resilence, sagging, and wrinkling of skin structures decreased turgor- a measure of skin elasticity, decreases as a result of thinning of the dermis and reduced elastin production. hydration status can also affect skin turgor decreased melanin;hair follicle atrophy nail growth slows nails thin, increased brittleness

Yellow nails

lung disorders and lymphedema

Rashes

mascular lesions can be ecchymosis(bruise), pressure point changes or tinea veriscolor papular-acne , warts, nevi, insect bites, early varicella less than 1cm pustular- acne, furuncles, carbuncles,any size vesicular-herpes simplex, varicella, impetigo less than 1 cm plaque-psoriasis, lichen simplex, more than 1cm

Cupping

placing a heated cup on the skin to create a slight suction

hair

protects various body areas from debris and invasion, provides insulation, enables the conduit of sensory stimulation to the nervous system.

common integumentary symptoms

pruritus-itching rash(multiple lesions) single lesion or would

purpura

red-purple skin lesion due to blood in tissues from breaks in blood vessels,non blanchabe

clinical significance of skin integumentary

the integumentary system is a window to other body systems/ changes in skin, hair, or nails may be the first clue to other health problems

subjective data collection

when assessing general skin condition in pts without an identified concern, gather information about general health, including nutritonal status, which may identify any potential causes for skin disorders. risk factors identifies areas of concern and provides direction for pt education.excessive UV radiation is the most important focus area for the integumentary systembc sun exposure has been shown to cause cancers, particulary melanoma self skin examination- helps at risk pts identify potentially problematic lesions through the detection of moles.