Skin, Hair, Nails 11/25/2010

Epidermis- outer, thin but tough

 Keratin
 Melanocyte melanin (pigment)
 Avascular
 Continuously desquamataed
 Skin color sources
o Mainly from melanin
o Yellow orange tones of the pigment carotene
o Red purple tones in vascular bed
Dermis- inner
 Connective tissue- collagen- resist from tearing
 Elastic tissue- allows to stretch
 Nerves, sensory receptors, BV, and lymphatics
Subcutaneous layer- adipose tissue
 Fat cells
 Provides energy, insulation, cushioning
Appendages
 hair follicles
 vellus hair- covers most of the body
o terminal hair- grows on scalp and eyebrows, and pubic area
 sebaceous glands
o produce sebum that lubricate skin and hair and prevents
water loss
 sweat glands
o eccrine- sweat, open directly on to skin
o apocrine- produce think, milky secretion into hair follicles
 located on axillae, anogenital area, niples, and navel
 active in puberty
 responsible for body odor
 nail
o hard plates of keratin
FUNCTIONS OF THE SKIN
 Protection-
 Prevents penetration
 Perception
 Temperature regulation
 Identification
 Communication
 Wound repair
 Absorption and excretion
 Production of vitamin D
DEVELOPMENTAL CARE
 The Aging Adult
o Stratum corneum (epidermis’ outer layer) thins and flattens
o Loss of elastin, collagen, and fat
 Wrinkles
 Increase risk of shearing, tearing injuries
o Sweat and sebaceous glands decrease dry skin
 Greater risk for heat stroke
o Vascularity diminishes
 Minor trauma may produce dark red discolored areas or
senile purpura
o Factors risk
 Thin skin
 Decrease vascularity and nutrients
 Loss of cushioning
 Environmental trauma
 Social changes of aging
 Sedentary lifestyle
o # of functioning melanocytes decreases
 hair looks gray or white, thin and fine
o nails grow more slowly
o all these causes loss of self-esteem
CROSS CULTURAL CARE
 Melanin protects the skin against harmful agents
 Areas of skin affected by hormone: sexual skin areas—generally
darker
 Apocrine and eccrine sweat glands are important for fluid balance
and thermoregulations
 Skin conditions among blacks
o Keloids- scars that form at the site of a wound and grow
beyond
o Pigmentary disorders- dark or light spots (postinflammatory)
o Pseudofolliculities- razor bumps or ingrown hair
o Melasma- mask of pregnancy, patchy tan of the face
 Brittle and dry hair inadequate nutrition

Subjective Data
 Previous history of skin disease (allergies, gives, psoriasis eczema)
 Change in pigmentation
 Change in mole (size or color)
 Excessive dryness or moisture
 Pruritus
 Excessive bruising
 Rash or lesion
 Medications
 Hair loss
 Change in nails
 Environmental or occupational hazards
 Self-care behaviors
 Additional history for aging adult
o Changes of skin?
o Delay of wound healing?
o Pain?
Objective Data
 Equipments
o Use strong direct lighting
o Small centimter ruler
o Penlight
o Gloves
 Complete physical examination
 Regional examination
 Inspect and palpate the skin
o Color
 General pigmentation
 Freckles (ephelides) – small, flat,
 Mole (nevus)-proliferation of melanocytes
  Junctional nevus- macular only and occurs
in children and adolescents
 Compound nevi- in young adults, becomes
macular and popular
 Birthmarks- tan to brown color
 Vitiligo- complete absence of melanin
 Danger signs: abnormal characteristics of pigmented
lesions
 ABCDE
 Asymmetry
 Border irregularity
 Color variation
 Diameter greater than 6 mm
 Elevation and enlargement
 Widespread color change
 Pallor- due to vasoconstriction (SNS)
 It takes the color of collagen when oxygenated
blood are lost
 Erythema- intense redness from excess blood in
dilated capillaries
 expected with fever, local inflammation, or
emotional reaction
 occurs with polycythemia, venous stasis, CO
poisoning
 cyanosis- bluish mottled color that signifies
decreased perfusion
 indicated hypoxemia and occurs with shock,
heart failure, chronic bronchitis, and CHD
 jaundice- yellow color, indicating rising amounts
of bilirubins
 occurs with hepatitis, cirrhosis, sickle celll,
transfusion reaction
  Reliable sites are those with the least
pigmentation
 Under the tongue, buccal mucosa, palpebral
conjunctiva, and sclera
o Temperature
 Hypothermia
 hyperthermia
o Moisture
 Dehydration
 Mucous membranes look dry, and lips look
parched and cracked
 Diaphoresis- profused perspiration
o Texture
 Normal skin feels smooth and firm, with even surface
 Hyperthyroidism- skin feels smoother and softer
 Hypothyroidism- skin feels rough, dry and flaky
o Thickness
 Epidermis should be uniformly thin
 Callus is overgrowth of the epidermis
o Edema
 Fluid accumulating in the intercellular spaces
 Test by imprinting thumb, If pressure leaves a dent,
edema is present
 Graded on 4 point scale
 1- mild, 2- moderate, 3-deep, 4- very deeps
 o Mobility and turgor
 Mobility- ease of rising
 Turgor- ability to return to place
o Vascularity or Bruising
 Cherry senile angiomas- small, smooth, slightly raised,
bright red dots
 Ecchymosis- bruising
o Lesions
 Note:
 Color
 Elevation
 Pattern or shape
 Size
 Location
 Any exudate
INSPECT AND PALPATE THE HAIR
 Color
 Texture
 Distribution
 Lesions
o Seborrhea- dandruff
INSPECT AND PALPATE THE NAILS
 Shape and contour
o Jagged nails- nervous habits
o Dity nails- poor self care
o Clubbing-occurs with congenital chronic cyanotic heart
disease and with emphysema and chronic bronchitis
 Consistency
o Pits, groves, line- indicate nutrient deficiency
o Nail thick? Arterial insufficiency
o Spongy nail accompanies clubbing
 Color
o Translucent- normal (so pinkish)
o Brown linear streaks- sudden appearance may indicate
melanoma
o Splinter hemorrhages
o Transverse ridges
o Beau’s lines
o Lykonychia striata
o Cyanotic nail beds or sluggish color- consider CVD or
respiratory dysfunction

DEVELOPMENTAL CARE
 The Aging Adult
o Skin Color and Pigmentation
 Senile lentigines- liver spoint
  Keratoses- raised lesions, thickened area of
pigmentation that look crusted, scaly, and warty
 Seborrheic keratosis- dark, greasy, and stuck on
 They do not become cancerous
 Actinic (senile or solar) keratosis
 Red-tan scaly plaques that increase over
years
o Moisture-
 Xerosis (dry skin) is common
o Texture
 Acrochordons- skin tags
 Sebaceous hyperplasia- raised yellow papules with a
central depression
o Thickness
 Looks thin as parchment (evident over the dorsa of the
hands)
o Mobility and turgor
 Decreased (less elasticity)
o Hair
 Women may develop hairs on chin (unopposed
androgens)
 W-shaped hair loss for men
o Nails- nail growth decreases
11/25/2010
11/25/2010