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    Chapter 12: Skin, Hair, and Nails

    Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

    Skin, Hair, and Nails

    Chapter 12

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    Chapter 12: Skin, Hair, and Nails

    Structure and FunctionSubjective DataHealth History Questions

    Objective DataThe Physical ExamAbnormal Findings

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    Chapter 12: Skin, Hair, and Nails

    Structure of Skin

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    Chapter 12: Skin, Hair, and Nails

    Structure of Nails

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    Chapter 12: Skin, Hair, and Nails

    Function of the Skin

    ProtectionPrevents penetrationPerception

    Temperature regulation

    IdentificationCommunicationWound repairAbsorption and excretion

    Production of vitamin D

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    Chapter 12: Skin, Hair, and Nails

    Subjective DataHealth HistoryQuestions

    Previous history of skin disease(allergies, hives, psoriasis, or eczema)

    Change in moleChange in pigmentation (size or colour)Excessive dryness or moisturePruritus

    Excessive bruising

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    Chapter 12: Skin, Hair, and Nails

    Subjective DataHealth historyquestions(cont.)

    Rash or lesionMedicationsHair lossChange in nailsEnvironmental or occupational

    hazardsSelf-care behaviours

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThe

    Physical ExamPreparationExternal variables that influence skin colourEquipment needed

    Strong direct lightingSmall centimetre rulerPenlightGloves

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.) SkinInspect and palpate

    ColourGeneral pigmentationWidespread colour change

    PallorErythemaCyanosis

    Jaundice

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.) SkinInspect and palpate (cont.)

    TemperatureHypothermiaHyperthermia

    MoistureDiaphoresis

    Dehydration

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.)

    SkinInspect and palpate (cont.) Texture ThicknessEdemaMobility and turgorVascularity or bruising

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    Chapter 12: Skin, Hair, and Nails

    Objective Data The Physical Exam(cont.)

    SkinInspect and palpate (cont.)Lesions

    ColourElevationPattern or shapeSize

    Location and distribution on bodyExudate

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.)

    HairInspect and palpateColour

    TextureDistributionLesions

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.)NailsInspect and palpate

    Shape and contourProfile sign

    ConsistencyColour

    Capillary refill

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    Chapter 12: Skin, Hair, and Nails

    Objective DataThePhysical Exam(cont.)Promoting health and self-care

    Teach skin self-examination, using theABCDE rule

    AasymmetryBborderCcolour

    DdiameterEelevation and enlargement

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    Chapter 12: Skin, Hair, and Nails

    Abnormal Findings

    Common Shapes andConfigurations of LesionsAnnular or circularConfluentDiscreteGrouped

    Target or irisLinearPolycyclic

    Zosteriform

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    Chapter 12: Skin, Hair, and Nails

    Annular or Circular

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    Ch 12 Ski H i d N il

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    Chapter 12: Skin, Hair, and Nails

    Confluent

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    Ch 12 Ski H i d N il

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    Chapter 12: Skin, Hair, and Nails

    Discrete

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    Ch t 12 Ski H i d N il

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    Chapter 12: Skin, Hair, and Nails

    Grouped

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    Ch t 12 Ski H i d N il

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    Chapter 12: Skin, Hair, and Nails

    Target

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Linear

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Polycyclic

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Zosteriform

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Abnormal FindingsPrimary and Secondary SkinLesionsPrimary skin lesions

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    Urticaria (hives) Vesicle Cyst Bulla Pustule

    Macule Papule Patch Plaque Nodule Wheal Tumour

    Excoriation Scar Atrophic scar Lichenification Keloid

    Secondary skin lesions Crust Scale Fissure Erosion Ulcer

    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Macule

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Papule

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    Chapter 12: Skin Hair and Nails

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    Chapter 12: Skin, Hair, and Nails

    Nodule

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    Chapter 12: Skin, Hair, and Nails

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    Chapter 12: Skin, Hair, and Nails

    Wheal

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    Chapter 12: Skin, Hair, and Nails

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    Chapter 12: Skin, Hair, and Nails

    Vesicle

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    Chapter 12: Skin, Hair, and Nails

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    p , ,

    Cyst

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    p , ,

    Pustule

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    Chapter 12: Skin, Hair, and Nails

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    p , ,

    Crust

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    Chapter 12: Skin, Hair, and Nails

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    p

    Scale

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    Fissure

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    Erosion

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    Ulcer

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    Excoriation

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    Scar

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    Atrophic Scar

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    Lichenification

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    Keloid

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    Abnormal FindingsVascular LesionsHemangiomas

    Port-wine stain(nevus flammeus)Strawberry mark(immature hemangioma)Cavernous hemangioma(mature)

    TelangiectasesSpider or star angioma

    Venous lake

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    Purpuric lesionsPetechiaePurpura

    Lesions caused bytrauma or abusePattern injuryHematomaEcchymosis (bruise)

    Chapter 12: Skin, Hair, and Nails

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    Lesions caused by traumaor abuse: Pattern injury

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    Chapter 12: Skin, Hair, and Nails

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    Lesions caused by traumaor abuse: Hematoma

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    Chapter 12: Skin, Hair, and Nails

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    Lesions caused by traumaor abuse: Ecchymosis

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    Chapter 12: Skin, Hair, and Nails

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    Canadian Cancer Society Risk Factors

    Prolonged exposure to UV rays, individualsmost at riskUnder age 18Fair skinned

    History of skin cancerHave freckles or molesHave a family history orUsing medications that increase sensitivity to

    UV rays.

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    Chapter 12: Skin, Hair, and Nails

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    The lesions in theillustrationare best described as?A. GroupedB. ZosteriformC. PolycyclicD. Linear