Copyright 2002, Delmar, A division of Thomson Learning Chapter 10 Skin, Hair, and Nails.

Copyright 2002, Delmar, A division of Thomson Learning

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.

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


Integumentary System Covers approximately 20 square

feet in the average adult Thickness varying from 0.2 mm

to 1.5 mm Layers

Epidermis Dermis Hypodermis (subcutaneous tissue)


Glands of the Skin Sebaceous

Sebum-producing glands Found everywhere in dermis except

for the palmar and plantar surfaces Sweat

Apocrine Eccrine


Hair Distributed over the entire body

surface, except palmar and plantar surfaces, lips, nipples, and glans penis

Vellus Terminal hair Hair shaft is composed of

Cuticle, cortex, medulla Melanocytes


Nails Matrix Nail plate Nail root Nail bed Periungual tissues Assess 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 Hair

Warmth Protection Sensation

Nails Protection to distal surface of digits


Skin Cancer Risk Factors Ultraviolet light exposure Family history of skin cancer Second-degree burns before age 18 Acute sunburns Outdoor employment Melanocytic precursor lesion


Skin Care Habits Use of lotions, perfumes, cosmetics,

shaver, razor, sun protection Use of home remedies Frequency of bathing or showering Use of hats, visors, gloves, long

sleeves or pants, sunscreens when exposed to the sun

Length of time exposed to the sun


Hair Care Habits Products used for hair care Use of chemicals on hair Changes in hair color or loss Use of a wig or hairpiece Use of a hair dryer, heated curlers,

or curling iron


Nail Care Habits Manicures or pedicures Type of nail care practiced Nail biting Nail splitting or discoloration


General Assessment of Integumentary System Well-lit room Good visualization Explain assessment process to

patient Provide warmth and privacy Head-to-toe assessment May be included in regional exam

for acute illness


Equipment Magnifying glass Good lighting, natural light

preferred Penlight Clean gloves Small centimeter rule Microscope slide


Inspection of the Skin Follow head-to-toe approach Supine position to inspect anterior

surfaces Special attention to skin folds Side-lying position to inspect

posterior surfaces


Observe for Color

Cyanosis Jaundice Pallor Redness Dependent rubor

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Observe for Bleeding

Assess mucous membranes, previous venipuncture sites, or lesions

Petechiae Purpura

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Observe for Ecchymosis

May be sign of physical abuse Vascularity

Spider angiomas Venous stars Cherry angiomas Strawberry hemangiomas Nevus flammeus Necrosis

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Observe for Moisture

Xerosis Diaphoresis

Temperature Hypothermia Hyperthermia

Texture Smooth Rough


Observe for Tenderness

Localized Generalized

Turgor Decreased may be associated with

dehydration

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Observe for Edema

Note the presence of fluid accumulation in the intercellular spaces

Assess dependent areas Use 4-point scale to rate severity of

edema Assess symmetry


Types of Edema Pitting Nonpitting Angioedema Dependent Inflammatory Noninflammatory Lymphedema


Observe for Lesions

Document anatomic location Assess arrangement or grouping:

localized, regionalized, or generalized

Note the morphology Note if any exudate present


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


Types of Lesions Nonpalpable

Macule Patch

Palpable Papule Plaque Nodules Tumor Wheal

(continues)


Types of Lesions A fluid-filled cavity

Vesicle Bullae Pustule Cyst

(continues)


Types of Lesions Above the skin surface

Scales Crust Lichenification Atrophy

(continues)


Types of Lesions Below the skin surface

Erosion Fissure Ulcer Scar Keloid Excoriation


Stages of Pressure Ulcers Stage 1

Skin is reddened, but intact

Stage 2 Epidermal and dermal layers are injured

Stage 3 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

Second-degree Epidermis and upper layers of dermis

are injured Skin is red, blistery, painful Partial thickness

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Identifying Burns Third-degree

Epidermis, dermis are destroyed, subcutaneous tissue injured

Hair follicles, sweat glands, and nerve endings are destroyed

Skin is white, red, black, tan, or brown Painless Partial thickness

(continues)


Identifying Burns Fourth-degree

Epidermis, dermis are destroyed Subcutaneous, muscle, and bone may

be injured Hair follicles, sweat glands, and nerve

endings destroyed Skin is white, red, black, tan, or brown Full thickness


Wound Evaluation Location Color Drainage Odor Size Depth Measure the borders Draw a picture to depict wound


Inspection of Hair Color Distribution

Alopecia Hirsutism

Scalp lesions Palpate texture


Inspection of Nails Color Shape and configuration Nail angles Palpate texture


Gerontological Variations Skin changes

Wrinkles Loss of subcutaneous fat Diminished elasticity Lentigo Keratosis

Hair changes Gray Loss

(continues)


Gerontological Variations Nail changes

Thicken Yellow Overcurvature


Safety Tips for the Elderly Identify environmental hazards

and minimize risk Interventions to decrease risk for

thermal injuries Interventions to maintain skin

integrity and prevent damage

Copyright 2002, Delmar, A division of Thomson Learning Chapter 10 Skin, Hair, and Nails.

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Transcript of Copyright 2002, Delmar, A division of Thomson Learning Chapter 10 Skin, Hair, and Nails.