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