Chapter 10 Skin, Hair, and Nails

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)

Competencies Identify pathophysiological changes to hair and nails and discuss possible etiologies. State the warning signs of carcinoma in pigmented lesions. (continues)

Competencies Describe methods used to examine integumentary changes in both light- and dark-skinned patients.

Integumentary System Covers approximately 20 square feet on the average adult Thickness varies from 0.2 mm to 1.5 mm (continues)

Integumentary System Layers Epidermis Dermis Hypodermis (subcutaneous tissue)

Glands of the Skin Sebaceous Sweat Sebum-producing glands Found everywhere in dermis except for the palmar and plantar surfaces Sweat Apocrine glands Eccrine glands

Hair Distributed over the entire body surface except palmar and plantar surfaces, lips, nipples, and glans penis Vellus Terminal hair (continues)

Hair Hair shaft is composed of the cuticle, cortex, and medulla Melanocytes

Nails Matrix Nail plate Nail root Nail bed Periungual tissues Lunula Examine color of nail bed

Functions of the Skin Serves as a protective barrier Temperature regulation Sensory organ—pain, touch, pressure, temperature Serves as an organ of excretion

Functions of Hair and Nails Warmth Protection Sensation Nails Protection to distal surface of digits

Melanoma Risk Factors Ultraviolet light exposure Family history of skin cancer Severe sunburns as a teenager or child Fair-skinned people with light-colored eyes and hair (continues)

Melanoma Risk Factors > 50 moles Dysplastic nevi Age > 65 years old

Basal and Squamous Cell Cancer Risk Factors Ultraviolet light exposure Fair-skinned people with light-colored hair and eyes Chemical exposure Radiation therapy Personal history of skin cancer Smoking

Skin Care Habits Ask the patient questions to determine use of skin care products hair removal products home remedies to treat skin irritations a tanning bed sun protection (continues)

Skin Care Habits Ask the patient questions to determine frequency of bathing or showering previous reaction to jewelry (metal)

Hair Care Habits Ask the patient questions to determine use of hair care products chemicals on hair wig or hairpiece hair dryer, heated curlers, or curling iron Ask if patient has experienced changes to hair (color, texture, or loss)

Nail Care Habits Ask the patient questions to determine type of nail care practiced, including manicures or pedicures nail biting nail splitting or discoloration

General Examination of Integumentary System Well-lit room Good visualization Explain examination process to patient Provide warmth and privacy Cephalocaudal examination

Equipment Magnifying glass Good lighting, natural light preferred Penlight (continues)

Equipment Clean gloves Microscope slide Small centimeter ruler

Inspection of the Skin Cephalocaudal approach Anterior and lateral aspects of skin Dorsal and palmar surfaces of skin (continues)

Inspection of the Skin Color Cyanosis Jaundice Carotenemia Pallor Redness Dependent rubor (continues)

Inspection of the Skin Bleeding Ecchymosis Assess mucous membranes, previous venipuncture sites, or lesions Petechiae Purpura Ecchymosis May be sign of physical abuse (continues)

Inspection of the Skin Vascularity Spider angioma Venous star Cherry angioma Strawberry hemangioma Nevus flammeus Necrosis (continues)

Inspection of the Skin Lesions Document anatomic location Assess arrangement or grouping: localized, regionalized, or generalized Note if any exudate present Note the morphology

Mnemonic for Evaluating Lesion A (asymmetrical) B (borders) C (color) D (diameter) E (elevation)

Types of Lesions Nonpalpable Macule Patch (continues)

Types of Lesions Palpable Papule Plaque Nodule Tumor Wheal (continues)

Types of Lesions Fluid-filled cavity Vesicle Bullae Pustule Cyst (continues)

Types of Lesions Above the skin surface Scales Lichenification Crust Atrophy (continues)

Types of Lesions Below the skin surface Erosion Fissure Ulcer Scar Keloid Excoriation

Wound Evaluation Location Color Drainage Odor Size Depth (continues)

Wound Evaluation Measure the borders Draw a picture to depict wound

Stages of Pressure Ulcers Skin is reddened but intact Stage 2 Epidermal and dermal layers are injured (continues)

Stages of Pressure Ulcers Subcutaneous tissues are injured Stage 4 Muscle and perhaps bone are injured

Identifying Burns First-degree Epidermis is injured or destroyed Skin is red, dry, painful (continues)

Identifying Burns Second-degree Epidermis and upper layers of dermis are destroyed Skin is red, blistery, painful Also called partial-thickness burn (continues)

Identifying Burns Third-degree Epidermis and dermis are destroyed, subcutaneous tissue is injured Hair follicles, sweat glands, and nerve endings are destroyed Skin is white, red, black, tan, or brown Also called full-thickness burn (continues)

Identifying Burns Fourth-degree Epidermis, dermis are destroyed Subcutaneous tissue, muscle, and bone may be injured Hair follicles, sweat glands, and nerve endings are destroyed Skin is white, red, black, tan, or brown

Palpation of the Skin Moisture Temperature Xerosis Diaphoresis Hypothermia Hyperthermia (continues)

Palpation of the Skin Tenderness Should be nontender Tenderness can be localized or generalized (continues)

Palpation of the Skin Texture Turgor Smooth Rough Decrease may be associated with dehydration (continues)

Palpation of the Skin Edema Note the presence of fluid accumulation in the intercellular spaces Assess dependent areas Use 4-point scale to rate severity Assess symmetry

Types of Edema Pitting Nonpitting Angioedema Dependent Inflammatory Noninflammatory Lymphedema

Inspection of Hair Color Distribution Scalp lesions Palpate texture Alopecia Hirsutism Scalp lesions Palpate texture

Inspection of Nails Color Shape and configuration Palpate texture Nail angles Palpate texture