3ed Lecture SkinHair and Nails

8/10/2019 3ed Lecture SkinHair and Nails

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Skin, Hair& Nails

Prepared by: Jeffrey Esteron


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Skin:

has 2 layers-

outer(epidermis)

& innersupportive

dermis. Beneath

a third the

subcutaneouslayer of adipose

tissue.


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Epidermis:

a protective barrier, contain melanin,thin except on the surfaces exposedto friction, as palms &soles, its a

vascular, nourished by blood vesselsin the dermis below. Skin color isderived from three sources:

brown from melanin.s

yellow from carotene. red-purple from underlying vascular

bed.


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Dermis:

its the innersupportive layerconsist ofcollagen thatallows skin tostretch.

nerves, sensoryreceptors, bloodvessels,lymphatic.


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Subcutaneous layer:

adipose tissue(fat cells), for

temperature control& cushion

effect, also increased mobility


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v Epidermal appendages:

- hair- Sebaceous Glands

(sebum)- Sweat Glands(eccrine

produce sweat & apocrineproduce milky secretion into

hair follicles when have

emotional &sexual stimulation)-Nails.


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Nails

Posterior nail

fold &lateral

Nail plate & nailmatrix

Nail bed

lunula


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vFunctions of the Skin:

1- protection from

physical, chemical,

thermal & light

sources.

2-Prevent penetration of

microorganisms & loss

of water& electrolytes.

3-Perception: sensory

surface for touch, pain,

temperature

4-Temperature

regulation: through

sweat glands& heat

storage

5- Identification: facial

characteristics, color&

fingerprints.

6Communication:non

verbal communication

(facial expression,

body posture)

7- Wound repair: cell

replacement

8- Excretion of metabolic

waste

9-Production of vitamin

D(ultraviolet light

convert cholesterol

into vitamin D


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**Subjective Data:

1. previous hx of skin disease asallergies

2. change in color or pigmentation,

generalized change suggests

systemic illness(pallor-jaundice-

cyanosis).

3. change in mole: suggest

neoplasm. 4. Excessive dryness or moisture:

seborrhea-oily, xerosis- dry.


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5. purities: where &when itstart, occurs with dry skin,

aging, drug reactions, lice.Scratching may causeexcoriation of primary lesion

6. excessive bruising: where onthe body- how did happenhowlong you had it, possibility ofabuse or dizziness of

neurological or cardiovascularorigin.


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7. rash or lesion: onset- location-

where spread- quality- color-tender-warm- duration-anyone at

home or work with similar rash,

tried new food? identify primary

site.

8. medications: prescription &

over-the- counter, how long on

medication.drugs may increasesun light sensitivity as thiazides

diuretics


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9. hair loss: a gradual or sudden

onset? symmetrical? unusual hair

growth? Alopecia -Hirstuisim10. change in nails: shape-color

brittleness

11. Environmental or occupationalhazards: as dyes, chemicals,

radiation, sun exposure, insect

bitten, exposure to plants, animals?

may result a skin neoplasm peopleat risk: farmers-sailors- those over

40.


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12. self-care behaviors: cosmetics-

soap-chemicals usage.

Danger signs: ABCDE Asymmetry of lesion

Border

Color variation Diameter

elevation


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** Objective data:

Preparation:equipment needed; directlighting(natural daylight is ideal but not

always available)- ruler-penlight-gloves.

Comprehensive physical exam: skin

assessment is integrated throughout thecomplete exam, at the beginning assessing

hands &fingernails, to accustom him to

your touch. Inspect toes &its nails too.

The regional exam: remove his clothes,

stands back at first to get an overall

impression, to reveal distribution pattern.

inspect mucous membrane too.


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External variables influencing

skin color(projector)

-Emotionsas fear cause

vasoconstriction false pallor

-Environmentas hot room cause

vasodilatation false Erythema

- Physicalas prolonged elevation

cause decreased arterial perfusion

pallor whereas dependent positioncause venous pooling redness.


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** INSPECT PALPATE SKIN:

Color:normally consistent withgenetic background, examples;

a.Freckles__ small ,flat macules ofbrown melanin pigment that occur onsun exposed skin.

b.Mole__ a proliferation of

melanocytes , tan to brown color, flator raised

c.Birthmarks__ tan to brown in color.


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# Color change:note if it

transient or is due to pathology.

a.Pallor:when red-pink tones

from the oxygenated hgb in the

blood are lost, skin takescollagen color(white),causes:

stress-smoking

generalized pallor can be

observed in the mucous

membranes, lips , conjunctiva&

nailbeds.


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B. Jaundice:

a yellow color indicating rising

amounts of bilirubin in the blood,

first noted in the hard & softpalate in the mouth & sclera.


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C. Cyanosis:

a bluish color,

the tissues are

not adequatelyperfused with

oxygenated

blood.
http://images.google.jo/imgres?imgurl=http://www.lf2.cuni.cz/Projekty/interna/foto/014/pic00011.jpg&imgrefurl=http://www.lf2.cuni.cz/Projekty/interna/zof/avysetreni/ahlavakrk.htm&h=432&w=398&sz=88&hl=en&start=3&tbnid=ELTgI7a-kb_UlM:&tbnh=123&tbnw=113&prev=/images%3Fq%3Dcyanosis%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DG


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D.Erythema:

intense redness

due to excess

blood(hyperemia) in

the detailedsuperficial

capillaries,

expected with

fever , localinflammation or

emotional

reactions.
http://images.google.jo/imgres?imgurl=http://www.medicouncilalcol.demon.co.uk/handbook/images/palmar_erythema.jpg&imgrefurl=http://www.medicouncilalcol.demon.co.uk/handbook/images/palmar_erythema.htm&h=213&w=320&sz=36&hl=en&start=2&tbnid=h43srE_61bvyYM:&tbnh=75&tbnw=113&prev=/images%3Fq%3Derythema%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN


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Skin assessment:cont

Temperature:use the backs(dorsa) of

your hands bilaterally, should be warm .

- hypothermia hyperthermia

Moisture:moist appears normally on the

face, hands, axilla& skinfolds in response

to activity, a warm environment or anxiety.

Diaphoresisas in heavy activity or fever.

Dehydrationin oral mucous membranes.

Texture:smooth& firmwith an even

surface.


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Thickness:epidermis is uniformly

thin. A callus is a circumscribed

overgrowth of epidermis & is anadaptation to excessive pressure

from the friction of work .

Edema:fluid accumulating in theintercellular spaces, imprint your

thumbs firmly against the ankle

malleous or tibia. normally the skin

surface stays smooth. If yourpressure leaves a dent in the skin,

pitting edema is present, graded on

4 points scale:


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Edema:

+ 1: mild pitting

+2 moderate

+3 deep +4 very deep
http://images.google.jo/imgres?imgurl=http://medstat.med.utah.edu/kw/human_reprod/mml/hrob_99502.jpg&imgrefurl=http://medstat.med.utah.edu/kw/human_reprod/seminars/seminar3A.html&h=274&w=350&sz=17&hl=en&start=13&tbnid=_4vRKrSmgFAZVM:&tbnh=90&tbnw=116&prev=/images%3Fq%3Dedema%2Bmore:tests_diagnosis%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN%26cx%3Ddisease_for_patients


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Mobility & Turgor:pinch up a large

fold of skin on the anterior chest

under the clavicle, mobility is theskins ease of rising & turgor is its

ability to return to place promptly

when released, this reflects the

elasticity of skin. Vacularity or Bruising:angiomas ,

smooth, slightly raised bright red

dots that commonly appear on the

trunk in all adults over 30.


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Lesions:

note the; color-elevation-shape-

size- location& distribution-any

exudates.


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** INSPECT & PALPATE THE

HAIR:

- color

- texture

- distribution -lesions

**
http://images.google.jo/imgres?imgurl=http://www.4girls.gov/body/hair.jpg&imgrefurl=http://www.4girls.gov/body/hygiene_hair.htm&h=300&w=200&sz=7&hl=en&start=4&tbnid=gHU4SFwN4_wEzM:&tbnh=111&tbnw=74&prev=/images%3Fq%3Dhair%2Bcare%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN


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**INSPECT & PALPATE THENAILS:

shape & contour:

normally slightly

curved or flat,edge are

smooth,

rounded& clean


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Nails assessment:

a. the profile sign:index finger note

the angle of the nail base, it should

be about 160 degrees, curved nailswith a convex profile

B. consistency:surface is smooth &

regular, not brittle or splitting, firmly

adhere to the nail bed.


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C. Color:even, pink nail bedunderneath. All people normally

may have white hairline linearmarkings from trauma orpicking at the cuticle.

d. Capillary refill:depress nailedge to blanch then releasenoting return of color, return isinstant, or at least within a few

seconds in a cold environment,indicates the status of theperipheral circulation.


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***skin lesions:

** Primary &secondary lesions

page 176-185

3ed Lecture SkinHair and Nails

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