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Chapter 26

Chapter 26. Assessment of the Skin, Hair, and Nails. Mrs. M. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011. Anatomy and Physiology Review. Structure of the skin Subcutaneous fat Dermis Epidermis Hair Nails Glands. Anatomy of the Skin. Anatomy of the Nail. Functions of the Skin .

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Chapter 26

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  1. Chapter 26 Assessment of the Skin, Hair, and Nails Mrs. M. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011

  2. Anatomy and Physiology Review • Structure of the skin • Subcutaneous fat • Dermis • Epidermis • Hair • Nails • Glands

  3. Anatomy of the Skin

  4. Anatomy of the Nail

  5. Functions of the Skin • Protection • Homeostasis • Temperature regulation • Sensory organ • Vitamin synthesis • Psychosocial

  6. Assessment of the Skin • Demographic data • Socioeconomic status • Drug use • Allergies • Nutrition status • Family and genetic risk • Current health problems

  7. Skin Assessment • Color • Lesions, primary and secondary • Assess each lesion for: • A—asymmetry of shape • B—border irregularity • C—color variation within one lesion • D—diameter >6 mm

  8. Inspect Skin • Look for signs of: • Edema • Moisture • Vascular changes

  9. Inspect Skin: Petechiae

  10. Integrity of Skin • Skin tears • Cleanliness • Tattoos and piercings

  11. Palpation • Palpation confirms the size of the lesions and determines whether they are flat or slightly raised: • Macular—flat rash • Papular—raised rash • Skin temperature—assessed with the back of the hand • Turgor—the amount of skin elasticity

  12. Hair Assessment • Inspect and palpate the hair for cleanliness, distribution, quantity, and quality. • Dandruff is an accumulation of patchy or diffuse white or gray scales that appear on the surface of the scalp. • Hirsutism is excessive growth of body hair, which is one manifestation of hormonal imbalance.

  13. Nail Assessment • Dystrophic (defective nutrition or metabolism) nails • Color of nail plate • Nail shape changes • Nail thickness, consistency, lesions • Acute and chronic paronychia (infection of the nail)

  14. Nail Disorders Iron deficiency can cause spoon shape nails

  15. Skin Assessment Methods for Patients with Darker Skin • Assess for: • Pallor: mouth/gums • Cyanosis: mouth/gums • Inflammation • Jaundice • Skin bleeding

  16. Diagnostic Assessment • Cultures for fungal infections • Cultures for bacterial infections—unroofing • Cultures for viral infections • Skin biopsies: • Punch biopsy • Shave biopsy • Excisional biopsy

  17. Skin Biopsy • Excisional biopsy—complete lesion removed with margin of normal skin down to adipose tissue. • Incisional biopsy—cross-section wedge of tissue through center of lesion. • Shave biopsy—horizontal shave of the skin lesion with only superficial portion of dermis. • Punch biopsy—for sampling possible cancers, tumors, and inflammatory skin conditions.

  18. Wood’s Light Examination Ultraviolet/black light used and certain infections will change color

  19. NCLEX TIME

  20. Question 1 According to the American Cancer Society, which race has the highest incidence of melanoma? • Asians • African Americans • Whites • Hispanics

  21. Question 2 Evaporation of the water contained in the sweat from eccrinesweat glands can cause the body to lose how much fluid in a single day? • 500 mL • 1 to 2 L • 5 to 7 L • 10 to 12 L

  22. Question 3 Spoon-shaped nails are a possible outcome of which condition? • Lung cancer or hypoxia • Iron deficiency or diabetes • Emphysema or chronic obstructive pulmonary disease • Severe malnutrition or psoriasis

  23. Question 4 In dark-skinned patients, jaundice is best checked for in which area? • Skin over palms and soles • Conjunctivae • Sclera nearest the corners of the eye • Oral mucosa, especially the hard palate membranes

  24. Question 5 True or False: Untreated dandruff can cause hair loss. • True • False

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