hair, skin & nails health assessment
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