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P.A. hair,skin,nails

Physical Assessment

Skin self regenerating protective covering, stratified with multiple layers
Epidermis most superficial layer of skin. Contains straum germativum and stratum corneum
Stratum Germativum Inner layer of epidermis. Contains layers of keratin and melanocytes. Forms new skin cells and gives skin color
Stratum Corneum Outer layer of epidermis. Contains dead keratin cells. Sloughs off layers,
Dermis inner connective tissue layer made up of collagen. contains nerves, sensory receptors, blood vessels, lymphatics, hair follicles, sebaceous glands, sweat glands
Subcutaneous Layer made up of adipose tissue. Insulation, energy, temp control, cushion
Hair : threads of keratin, shaft is visible, root is below surface embedded in follicle. Bulb matrix grows new cells, arrector pili give goosebumps.
sebaceous glands produce sebum which is secreted through hair follicles and prevents water loss
eccrine sweat glands control body temperature and are mature in 2 month old infant
apocrine sweat glands secrete during emotional/sexual stimulation. Combines with bacteria and smells.
Nails hard plates of keratin, pink from underlying nail bed of vascular epithelial cells
Functions of skin 1. Protects against invasion/trauma, 2. retard fluid loss, 3. regulate body temperature, 4. produce vitamin D, 5. regulate blood pressure, 6. repair surface wounds, 7. excrete sweat/urea/lactic acid, 8. express emotions, 9. sensory perception (nerves)
Skin in Infants skin smoother, less oily than adults, desquamation of stratum corneum, vernix caseosa at birth, subQ fat poorly developed, lanugo , eccrine glands function after 1 month, apocrine glands do not function
Vernix Caseosa cheesy substance on skin at birth
lanugo fine downy hair all over baby's body later replaced by vellus hair
Skin in adolescents apocrine glands activated, increased sebum production (causes acne), pubic and axillary hair, facial hair in boys
Skin in Pregnant Women increased blood flow to skin, increased sweat from sebaceous glands, fat deposits, stretch marks. Vascular spiders, increased pigmentation
Skin in older adults less gland activity, epidermis thins/flattens, permeability increased, loss of collagen/elastic fibers results in wrinkles, subQ tissue decreases, hollows deepen. Gray hair bc less melanocytes, less axillary and pubic hair bc less hormones, balding
History of Present Illness- skin ask about previous hx skin disease, changes in moles or color, excessive dryness/moisture, excessive bruising, travel hx, lesions, meds, hair loss, change in nails, exposures
Family Hx-skin current/past dermatologic diseases in family members, allergic diseases, familial hair loss/coloration patterns
personal and social hx personal care habits, nail care habits, exposure to hazards, recentstress, alcohol or drug use,self exams
Infant history- skin feeding hx, diaper hx, clothing, washing, rubbing head, temp of home
children history- skin eating habits, exposure to communicable disease, allergic disorders, pets or animal exposure, outdoor exposure, skin injury hx, unexplained injuries, chronic manipulation of hair, nail biting
pregnancy history- skin weeks of gestation/postpartum, hygeine, exposure to irritants, effect of pregnancy on skin
older adults hx- skin changes in sensation, generalized chronic hx, irritants, susceptibility to skin infection, delayed or interrupted healing response, frequent injuries, hx DM or PVD, hair loss
skin PE- inspection color, benign pigmented areas, color changes (pallor, erythema, cyanosis, jaundice), vascularity, bruising, lesions, hair, nails
skin PE- palpation temperature, moisture, texture, thickness, edema, mobility, turgor
discrete lesions distinct, individual lesions that remain separate (not running together) (ex. Skin tags, acne)
Confluent lesions lesions run together (ex. Hives)
grouped lesions clusters of lesions (ex. Vesicles of contact dermatitis)
target lesions resembles iris of an eye, concentric rings of color in lesions (erythema multiforme)
macule solely a color change, flat and circumscribed, <1 cm (ex freckles)
papule something you can feel, solid, elevated, circumscribed, <1 cm, caused by superficial thickening in epidermis (ex. Mole, wart, acne)
Nodule solid, hard or softened, elevated, >1 cm, may extend deeper into dermis than papule (ex. Fibroma, xanthoma)
wheal superficial, raised, transient, erythematous, slight irregular shape due to edema (ex. Mosquito bite)
vesicle elevated cavity containing free fluid, up to 1 cm, “blister”, clear serum flows (ex herpes zoster, chickenpox)
cyst encapsulated fluid-filled cavity in dermis or subQ layer, tensely elevating skin (ex. Sebateous)
scale compact, desiccated flakes of skin, shedding of dead excess keratin cells. Can be dry or greasy, silvery or white. (ex. Psoriasis, eczema, dry skin)
excoriation self inflicted abrasion; superficial, sometimes crusted. Scratches from intense scratching (ex. Insect bites, scabies, dermatitis, varicella)
Ulcer deeper depression extending into dermis, irregular shape, may bleed. Leaves scar when heals (ex. Stasis ulcer, pressure sore)
crust the thickened, dried out exudate left when vesicles/pustules burst or dry up. Color can be red/brown, honey, yellow depending on fluid ingredients. (ex. Impetigo. Scab after abrasion)
lichenification prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss/lichen
Pityriasis Rosea viral infection, self limiting, christmas tree pattern
Rosacea broken/swollen vessels under skin of the face. Exacerbated by the sun and alcohol
Tinea Corporis ringworm; scales on chest, abdomen, back of arms forming multiple circular lesions with clear centers
psoriasis scaly, erythematous patch with silvery scales on top.
herpes zoster shingles. Small grouped vesciles on route of cutaneous sensory nerve, then pustules, then crusts
basal cell carcinoma starts as skin colored papule with a pearly translucent top and overlying telangiectasia (broken vessel). Develops rounded, pearly borders with central red ulcer.
malignant melanoma usually dark/brown. Have irregular shape, multiple colors, irregular borders, may scale, flake, ooze.
squamous cell carcinoma erythematous scaly patch with sharp margins, 1 cm or more. Develops central ulcer and surrounding erythema. Goes down to squamous layer
Kaposi's sarcoma occurs in end stage AIDs patients
hemangioma caused by benign proliferation of blood vessels in the dermis
port wine stain (nevus flammeus) large, flat, macular patch covering the scalp or face, frequently along the distribution of CN V. dark red, bluish, purplish. Consists of mature capillaries
strawberry mark (immature hemangiomas) raised, bright red are with well defined border about 2-3 cm in diameter. doesnt blanch with pressure. Consists of immature capillaries. Present at birth or develops in first few months. Usually disappears by 5-7 yrs
cavernous hemangioma (mature) reddish, blue irregularly shaped, solid and spongy mass of blood vessels. May be present at brith, may enlarge in first 10-15 months, will not involute spontaneously
telangiectases caused by vascular dilation; permanently enlarged and dilated blood vessels that are visible on the skin surface
spider/star angioma fiery red, star shaped marking with a solid circular center. Capillary radiations extend from central arterial body, With pressure, note a central pulsating body and blanching of extended legs. seen in liver failure.
venous lake blue-purple dilation of venules and capillaries in star shaped, linear, or flaring pattern. Pressure causes them to empty or disappear
purpuric lesions caused by blood flowing out of breaks in the vessels. Red blood cells and blood pigments are deposited in tissues.
petechiae tiny punctuate hemorrhages, 1-3 mm, round and discrete, dark red, purple, or brown. Caused by bleeding from superficial capillaries. May indicate abnormal clotting factor.
purpura confluent and extensive patch of petechiae and ecchymoses >3 mm flat, red to purple, macular hemorrhage. Seen in generalized disorders such as thrombocytopenia and scurvy. (vascular bleeding)
pattern injury bruise or wound whose shape suggests the instrument or weapon that caused it
hematoma bruise you can feel, elevates the skin, seen as swelling
ecchymosis mechanical injury that results in hemorrhage into tissues. Bruise.
alopecia areata sudden appearance of a sharply circumscribed, round or balding patch, usually with smooth, soft, hairless skin underneath.
traumatic/traction alopecia linear or oval patch or hair loss along hair line, a part or scattered. Caused by trauma from hair roller, tight brainding, tight ponytail, and barrettes.
paronychia red, swollen, tender inflammation of the nail folds.
scabies intensely pruritic contagion caused by scabies mite
onycholysis slow, persistent fungal infection of fingernails and toenails. Changes color (green), texture, thickness, crumbling, breaking, loosening of nail plate
subungual hematoma collection of blood underneath toenail or fingernail. Caused by injury
leukonychia punctuate white discoloration of the nail due to an injury
habit-tic deformity depression down middle of nail or multiple horizontal ridges, caused by continuous picking of cuticle by another finger of the same hand. Causes injury to nail base and nail matrix
Curvature should be 160 degrees
koilonychia spoon nails. Causedby iron deficiency anemia
beau lines transverse furrow or groove. Occurs with any trauma that temporarily impairs nail formation, such as acute illness, toxic reaction, or local trauma.
white banding white lines across nail caused by low albumin
pitting pitting and crumbling of nails with distal detachment due to psoriasis
periungual growths warts or digital mucous cysts
atopic dermatitis (eczema) erythematous papules and vesicles with weeping, oozing, and crusts. Paroxysmal and sever pruritus. Family hx of allergies
intertrigo (candidiasis) Candidiasis fungus infects superficial layers. Sclading red, moist patches with sharply demarcated border, some loose scales. Usually in genital area extending along inguinal and gluteal folds. Aggravated by urine, feces, heat and moisture.
Impetigo moist, thin-roofed vesicles with thin erythematous base. Rupture to form thick, honey colored crusts. Contagious bacterial infection.
stasis dermatitis edema of lower extremities, skin starts to break down, ulcerations form
actinic keratosis small, rough, raised area found on skin that has been in the sun for a long time. May develop into squamous cell carcinoma
seborrheic keratosis benign, looks like dirt
lentigo liver spots, age spots,sun exposure
Created by: alexadianna