integumentary system  skin and glands  hair  nails

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  • Integumentary SystemSkin and Glands HairNails

  • HistoryIntegumentary SystemPrevious skin historyChanges in pigmentationMoles, any changesExcessive dryness or moistureItching (pruritus)Excessive bruisingRash or lesionsMedications Hair lossNail changes

  • Skin ColorGeneral pigmentation (skin tone)Vitiligo-absence of pigmentFrecklesSmall, flat macules, brownMoleProliferation of melanocytes, macular or papularTan to brownBirthmarksTan to brown in color

  • Widespread color changes

    Pallor (white)Unnatural paleness d/t constriction of cutaneous vesselsAnemia, Shock Erythema (redness)Excess blood in superficial capillaries d/t vasodilatationFever or localized inflammation

  • Cyanosis (blue)Decreased perfusionShock, heart failure, bronchitis, congenital ht dxJaundice (yellow)Excess bilirubin in the bloodCirrhosis, sickle-cell anemia, transfusion reactions

  • Temperature and MoistureTemperatureUse back of handHypothermiaCoolnessSurgery, immobilized extremity, shockHyperthermiaIncreased metabolic rateHyperthyroidism, fever, heavy exercise, trauma, infection, sunburn

  • MoistureDiaphoresis- excessive perspirationDehydration-dry, parched and cracked lips

  • Texture and ThicknessTextureCharacter of the skins surface. It is not normally uniform throughout. Elbow vs. cheekHyperthyroidism-velvetHypothyroidism-rough,dry, and flakyThicknessThin over bodyThick over palms & soles

  • Mobility & TurgorMobility = rise of skinTurgor = return of skin, the elasticity of skin. It may be diminished by edema or dehydration. The skin normally loses elasticity with ageElderly chestInfants abdomenAdult/teen - arms

  • Vascularity or BruisingVascularity or BruisingPetechiaeTiny purple or redspots d/t minute hemorrhages in the dermisCherry angiomasSmall, smooth, raised red dots on trunk in adults over 30Bruising (ecchymosis)Tattoos

  • Hair2 TypesTerminal HairLong, coarse, thick. Found on scalp, axilla and pubic areas.Vellus HairSmall, soft, tiny hairs. Covering entire body except hands, soles of feet and penisColorTextureDistributionCondition of scalp

  • Common Hair AbnormalitiesHirsutismMale pattern growth in women, especially the faceAlopecia - BaldingExcessively oily hairAssociated with androgen hormone stimulation

  • Dry brittle hairAssociated with aging and excessive use of shampoo, etcDry coarse discolored hairSuspect poor nutritionDecreased hair on the extremitiesArterial insufficiency

  • NailsShape & contourNormally transparent, smooth, convex with white tipsStrength/ThicknessCan be a nutritional indicatorColor determined by vascularity of nailbed Linear pigmentationPigment bands normal in dark skinned individualsLeukonychia striataMarkings from trauma, picking at cuticlesCapillary refillClubbing

  • Note if bite their nailsIf nails are dirty, cleanWell trimmed or groomed