skin , hair & nails, 330.gsu.f.09

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  • 1. Skin , Hair & Nails Nursing 330 Governors State University Shirley Comer
  • 2. Skin Assessment- Inspection
    • Inspect
      • Wide Spread Color changes
        • Pallor
        • Erythema
        • Cyanosis
        • Jaundice
        • Pigmentation Changes
        • Freckles
        • Nevus (mole)
        • Birthmarks
      • Unusual Odors
        • Hygiene, excessive sweating, urine, musty
  • 3. Danger Signs ABCDE
    • Abnormal Characteristics of Pigmented lesions
      • A symmetry of a pigmented lesion
      • B order irregularity
      • C olor variation
      • D iameter greater than 6mm
      • E levation
      • E nlargement
  • 4. ABCD Pix
  • 5. Skin Assessment Palpation
    • Use back of hands
    • Hypothermia or Hyperthermia
    • Moisture
      • Perspiration normal on face, hands, axilla and skin folds in response to anxiety
      • Diaphoresis - perfuse perspiration r/t increased metabolic rate i.e. increased heart rate, pain or fever
  • 6. Skin Assessment Palpation cont
    • Texture - smooth and firm
    • Thickness - thickened areas normal on hands and feet
    • Edema Fluid accumulation in the intercellular spaces
      • Pitting- finger leaves imprint in area.
        • Graded subjectively 0+ to 4+
        • Evident in dependant parts of body
  • 7. Skin Assessment Palpation cont
    • Vascular or Bruising-
      • Cherry (senile) angiomas - small, smooth, slightly raised, bright red dots that commonly occur in all adults over 30. Not a significant finding
      • Bruising- ask how occurred
        • Multiple bruises at different stages of healing can be a sign of abuse
        • Tattoos - ask about Symptoms of Hepatitis
    • Hygiene- note cleanliness- free of parasites
    • Turgor- Pinch up a large fold of skin- should return to normal position rapidly
      • Decreased in dehydration or extreme wt loss.
      • Tenting is when skin remains pinched up
  • 8. Skin Lesions and Decubs
  • 9. Nail Anatomy Pix
  • 10. Nails- Inspection
      • Capillary Refill - Blanching of nail bed lasts 1-2 seconds. Longer may indicate cardiovascular or respiratory disorder
      • Shape and contour
        • Clubbing-congenital or chronic CO2 retention
        • Spooning-concave curves- Fe deficiency
        • Jagged- chronic anxiety
        • Transverse grooves-nutrient deficiency
        • Longitudinal grooves- normal
        • Nail adhered to bed- spongy bed accompanies clubbing
        • Pitting often /c psoriasis
        • Paronychis- swollen tender nail folds-fungal or bacterial infection
  • 11. Clubbing image
  • 12. Longitudinal and Transverse Nail Ridges - Photo
  • 13. Hair Assessment - Inspection
    • Hair Assessment
      • Color
      • Texture
      • Distribution- male v. female alopecia
      • Lesions
      • Hygiene
      • Parasites
  • 14. Palpation - Hair
    • Part hair to look at scalp (wear gloves)
      • Parasites
      • Hygiene
      • Scalp condition
      • Growth pattern
      • Alopecia
      • Lesions
      • Dandruff, seborrhea, psoriasis, eczema
  • 15. Hair Loss- Male vs. Female
  • 16. Commonly seen abnormalities - Petechiae
    • tiny hemorrhages
    • Less than 2mm
    • Round
    • Purple, red, brown in color
    • /s blanching
    • Present /c thrombocytopenias, endocarditis, septicemia
    • Found on mucus membranes, conjunctiva, abdomen, buttocks, forearms
  • 17. Purpura
    • Extensive patches of Petechiae and ecchymoses
    • Flat macular hemorrhage
    • Seen /c thrombocytopenia, scurvy
    • In elderly may result from minor trauma
    • Hematoma - Elevated area of bleeding under the skin
  • 18. Petechae and Purpura Photo
  • 19. Infant Assessment
    • General Pigmentation
      • Mongolian Spots -Blue, Black and Purple spots on buttocks or sacrum- common if AA, Native American, Hispanic and Asia newborns.
      • Bruising - Common following injuries from rapid, traumatic, or breech births
      • Congenital birth marks- Port wine stains, angiomas, Strawberry mark, Cavernous Hemangioma
  • 20. Common Birthmarks Port Wine Stain, Hemangioma, Strawberry mark, caf au late spot, mongolian spot
  • 21. Age specific - children
    • Petechiae and Hematoma may be present on face r/t prolonged violent crying or coughing
    • Abuse patterns
      • Multiple bruises in various stages of healing
      • Injuries to parts of body covered /c clothing
      • Marks suggestive of instrument use- belt, cigarette, pinching, biting
  • 22. Age specific- children Cont
    • Common findings
      • Diaper Dermatitis- red moist diffuse macular
      • Candidiasis(yeast)- fiery red moist patches with clear borders
      • Impetigo- Red vesicles rupture to form honey colored crust- Contagious bacterial infection
      • Chickenpox (Varicella)- small vesicles evolving to pustules on trunk spreading to face, and limbs
      • Ringworm- fungal infection produces scales and can cause permanent hair loss
      • Measles (Rubeola)- red macular/papular rash behind ears and spreads to body
      • German Measles (Rubella)- Paler lesions than rubeola
  • 23. Common Childhood findings
  • 24. Common Findings- Tinea forms, athletes foot, ringworm and Jock itch
  • 25. Common Findings Rubella, cradle cap, uticaria
  • 26. Age Specific Children cont
    • Atopic Dermatitis (eczema)
      • red papules and vesicles /c weeping, oozing and crusts
      • Scalp, forehead, cheeks, forearms, elbows and back of knees
      • Family hx of allergie