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skin, hair & nails

skin largest organ, provides clues about general health, changes in the environment
relat to respiratory central & peripheral cyanosis
relat to digestive jaundice
relat to cardiovascular lesions, ulcerations, necrosis
relat to neurological sensation of touch, temp, pressure, vibration and pain
relat to urinary pruritis due to toxin buildup
age related skin changes: infant less subcutaneous tissue, skin appears pinkish
seborrheic dermatitis from infant sebum secretion (cradle cap?)
age related skin changes: adolescent apocrine glands become active, axillary sweating, body odor. Sebaceous glands start producing oil, acne predisposition
age related skin changes: older adult keratotic lesions, age spots = increased melanocytes graying hair = decrease in melanocytes
How do you check for color variations in Asians? Sclera, conjuntiva
subj history: changes in skin new moles, lesions; rashes, itching, dryness, pain, bleeding; fever, sore throat, SOB; recent environmental exposures; hair and nail changes
subj history: skin cancer risk fair skin, family history, exposure to sun, age
PA approach Head to toe, anterior, posterior, lateral. Assess by regions when examining cardio, resp and other systems
PA techniques Inspection and palpation
Primary lesion Initial alteration in the skin
When assessing color changes in dark-skinned people, check this oral mucosa membranes
Secondary lesion lesions resulting from changes in the primary lesion
Vitiligo patchy pallor
Inspection of skin (4) color, odor, lesions, signs of abuse
Inspection of nails (4) Color, length/cleanliness, ridges or pitting in nailbed, clubbing
clubbing > 180 degrees, vs normal at 160 degrees
Inspection of hair (3) color/quality/distribution, scalp conditions, infestations
what causes clubbing? poor circulation/resp, causes excess CO2. COPD, lung cancer*
Palpation of skin (4) Temperature, Moisture, Texture, Turgor
Palpate nail bed Capillary refill <3 seconds, texture
palpate scalp mobility, tenderness, masses, texture of hair
macule primary lesion; flat, distinct color area <1cm FRECKLE
patch primary lesion; large macule >1cm
papule primary lesion; solid, elevation of skin, no visible fluid <1cm
plaque primary lesion; broad, raised area on skin
nodule primary lesion: slightly elevated lesions, larger than papule but <2cm
purulent having pus
pustule primary lesion; small elevation containing purulent material
vesicle primary lesion; small fluid-filled blister
bulla primary lesion; fluid-filled blister >5mm diamter
wheal primary lesion; raised, pruritic
pruritic causing itching
secondary lesions scale, crust, erosion, ulcers, fissures
atrophy scarring
Descriptions of lesions surface relationship (raised, flat or depressed)
Descriptions of lesions blanching or pulsation of vascular lesions
Descriptions of lesions pattern, configuration and distribution
Descriptions of lesions size, shape, color, texture, exudate, tenderness
pattern configuration round/oval
pattern configuration discrete
pattern configuration grouped
pattern configuration confluent
pattern configuration linear
pattern configuration annular/circular
pattern configuration arciform
pattern configuration iris
pattern configuration reticular
pattern configuration gyrate
pattern configuration polycyclic
distribution diffuse
distribution scattered
distribution localized
distribution dermatome
distribution hairy areas
distribution extensor/flexor surfaces
distribution sun exposed areas
distribution interiginous (folds)
Purpuric Lesions Vascular lesion; ecchymosis; non-blanchable, variable size; caused by trauma
Purpuric Lesion vascular lesion;
Created by: kpieroni