Copyright 2002, Delmar, A division of Thomson Learning Chapter 10 Skin, Hair, and Nails

Copyright 2002, Delmar, A division of Thomson Learning Competencies Describe the anatomy and physiology of the integumentary system. Explain the process of describing and classifying skin lesions. Identify common skin lesions and discuss possible etiologies. (continues)

Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify pathophysiological changes to hair and nails and discuss possible etiologies. State the warning signs of carcinoma in pigmented lesions. Describe methods used to assess integumentary changes in both light- and dark-skinned patients.

Copyright 2002, Delmar, A division of Thomson Learning Integumentary System Covers approximately 20 square feet in the average adult Thickness varying from 0.2 mm to 1.5 mm Layers  Epidermis  Dermis  Hypodermis (subcutaneous tissue)

Copyright 2002, Delmar, A division of Thomson Learning Glands of the Skin Sebaceous  Sebum-producing glands  Found everywhere in dermis except for the palmar and plantar surfaces Sweat  Apocrine  Eccrine

Copyright 2002, Delmar, A division of Thomson Learning Hair Distributed over the entire body surface, except palmar and plantar surfaces, lips, nipples, and glans penis Vellus Terminal hair Hair shaft is composed of  Cuticle, cortex, medulla Melanocytes

Copyright 2002, Delmar, A division of Thomson Learning Nails Matrix Nail plate Nail root Nail bed Periungual tissues Assess color of nail bed

Copyright 2002, Delmar, A division of Thomson Learning Functions of the Skin Serves as a protective barrier Temperature regulation Sensory organ—pain, touch, pressure, temperature Serves as an organ of excretion

Copyright 2002, Delmar, A division of Thomson Learning Functions of Hair and Nails Hair  Warmth  Protection  Sensation Nails  Protection to distal surface of digits

Copyright 2002, Delmar, A division of Thomson Learning Skin Cancer Risk Factors Ultraviolet light exposure Family history of skin cancer Second-degree burns before age 18 Acute sunburns Outdoor employment Melanocytic precursor lesion

Copyright 2002, Delmar, A division of Thomson Learning Skin Care Habits Use of lotions, perfumes, cosmetics, shaver, razor, sun protection Use of home remedies Frequency of bathing or showering Use of hats, visors, gloves, long sleeves or pants, sunscreens when exposed to the sun Length of time exposed to the sun

Copyright 2002, Delmar, A division of Thomson Learning Hair Care Habits Products used for hair care Use of chemicals on hair Changes in hair color or loss Use of a wig or hairpiece Use of a hair dryer, heated curlers, or curling iron

Copyright 2002, Delmar, A division of Thomson Learning Nail Care Habits Manicures or pedicures Type of nail care practiced Nail biting Nail splitting or discoloration

Copyright 2002, Delmar, A division of Thomson Learning General Assessment of Integumentary System Well-lit room Good visualization Explain assessment process to patient Provide warmth and privacy Head-to-toe assessment May be included in regional exam for acute illness

Copyright 2002, Delmar, A division of Thomson Learning Equipment Magnifying glass Good lighting, natural light preferred Penlight Clean gloves Small centimeter rule Microscope slide

Copyright 2002, Delmar, A division of Thomson Learning Inspection of the Skin Follow head-to-toe approach Supine position to inspect anterior surfaces Special attention to skin folds Side-lying position to inspect posterior surfaces

Copyright 2002, Delmar, A division of Thomson Learning Observe for Color  Cyanosis  Jaundice  Pallor  Redness  Dependent rubor (continues)

Copyright 2002, Delmar, A division of Thomson Learning Observe for Bleeding  Assess mucous membranes, previous venipuncture sites, or lesions  Petechiae  Purpura (continues)

Copyright 2002, Delmar, A division of Thomson Learning Observe for Ecchymosis  May be sign of physical abuse Vascularity  Spider angiomas  Venous stars  Cherry angiomas  Strawberry hemangiomas  Nevus flammeus  Necrosis (continues)

Copyright 2002, Delmar, A division of Thomson Learning (continues) Observe for Moisture  Xerosis  Diaphoresis Temperature  Hypothermia  Hyperthermia Texture  Smooth  Rough

Copyright 2002, Delmar, A division of Thomson Learning Observe for Tenderness  Localized  Generalized Turgor  Decreased may be associated with dehydration (continues)

Copyright 2002, Delmar, A division of Thomson Learning Observe for Edema  Note the presence of fluid accumulation in the intercellular spaces  Assess dependent areas  Use 4-point scale to rate severity of edema  Assess symmetry

Copyright 2002, Delmar, A division of Thomson Learning Types of Edema Pitting Nonpitting Angioedema Dependent Inflammatory Noninflammatory Lymphedema

Copyright 2002, Delmar, A division of Thomson Learning Observe for Lesions  Document anatomic location  Assess arrangement or grouping: localized, regionalized, or generalized  Note the morphology  Note if any exudate present

Copyright 2002, Delmar, A division of Thomson Learning Mnemonic for Evaluating Lesion A (asymmetrical) B (borders) C (color) D (diameter) E (elevation)

Copyright 2002, Delmar, A division of Thomson Learning Types of Lesions Nonpalpable  Macule  Patch Palpable  Papule  Plaque  Nodules  Tumor  Wheal (continues)

Copyright 2002, Delmar, A division of Thomson Learning Types of Lesions A fluid-filled cavity  Vesicle  Bullae  Pustule  Cyst (continues)

Copyright 2002, Delmar, A division of Thomson Learning Types of Lesions Above the skin surface  Scales  Crust  Lichenification  Atrophy (continues)

Copyright 2002, Delmar, A division of Thomson Learning Types of Lesions Below the skin surface  Erosion  Fissure  Ulcer  Scar  Keloid  Excoriation

Copyright 2002, Delmar, A division of Thomson Learning Stages of Pressure Ulcers Stage 1  Skin is reddened, but intact Stage 2  Epidermal and dermal layers are injured Stage 3  Subcutaneous tissues are injured Stage 4  Muscle and perhaps bone are injured

Copyright 2002, Delmar, A division of Thomson Learning Identifying Burns First-degree  Epidermis is injured or destroyed  Skin is red, dry, painful Second-degree  Epidermis and upper layers of dermis are injured  Skin is red, blistery, painful  Partial thickness (continues)

Copyright 2002, Delmar, A division of Thomson Learning Identifying Burns Third-degree  Epidermis, dermis are destroyed, subcutaneous tissue injured  Hair follicles, sweat glands, and nerve endings are destroyed  Skin is white, red, black, tan, or brown  Painless  Partial thickness (continues)

Copyright 2002, Delmar, A division of Thomson Learning Identifying Burns Fourth-degree  Epidermis, dermis are destroyed  Subcutaneous, muscle, and bone may be injured  Hair follicles, sweat glands, and nerve endings destroyed  Skin is white, red, black, tan, or brown  Full thickness

Copyright 2002, Delmar, A division of Thomson Learning Wound Evaluation Location Color Drainage Odor Size Depth Measure the borders Draw a picture to depict wound

Copyright 2002, Delmar, A division of Thomson Learning Inspection of Hair Color Distribution  Alopecia  Hirsutism Scalp lesions Palpate texture

Copyright 2002, Delmar, A division of Thomson Learning Inspection of Nails Color Shape and configuration Nail angles Palpate texture

Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Skin changes  Wrinkles  Loss of subcutaneous fat  Diminished elasticity  Lentigo  Keratosis Hair changes  Gray  Loss (continues)

Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Nail changes  Thicken  Yellow  Overcurvature

Copyright 2002, Delmar, A division of Thomson Learning Safety Tips for the Elderly Identify environmental hazards and minimize risk Interventions to decrease risk for thermal injuries Interventions to maintain skin integrity and prevent damage