Skin for Health Assessment
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
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| show | Keloid formation, traction alopecia, pseudofolliculitis, folliculitis barbarae, and perineal follicularis
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| show | Findings indicating dehydration, cyanosis, or impaired skin integrity (acute lacerations).
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| show | Inspect the area/lesion first, then ask other questions.
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| show | Asymmetry, Border irregularity, Color, Diameter of more than 6mm, Evolution over time, Friend
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| The presence of what on the skin increases risk for melanoma? | show 🗑
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| What is phototoxicity? | show 🗑
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| What is photosensitivity? | show 🗑
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| What is photoallergy? | show 🗑
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| show | 1. Solid, tan, brown, black, or skin-colored.
2. Smaller than 6mm
3. Well-defined edges
4. Round or oval shape. Flat or dome-like surface
5. Emergence before 30 years of age.
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| show | Scabies
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| Localized pruritis is usually caused by what? | show 🗑
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| show | Medication and food allergies
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| show | Either Staph or Strep
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| What type of skin lesions are distinct and walled off, containing fluid or semi-solid material? Vary in size... | show 🗑
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| show | Pustule.
Ex: Pustular acne
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| show | Bulla.
Ex: Second-degree burns
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| show | Vesicle.
Ex: Herpes simplex, Chicken Pox
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| show | Macule.
Example: Freckles, stork bite.
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| What skin lesion is flat, circumscribed, discolored, >1 cm diamter? Example? | show 🗑
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| What skin lesion is raised, defined, any color, >1 cm diameter? Examples? | show 🗑
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| What skin lesion is solid, palpable, >1 cm diamter, often with some depth? Example? | show 🗑
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| What skin lesion is raised, flesh-colored, or red edematous papules or plaques, vary in size and shape? Example? | show 🗑
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| What skin lesion is raised, defined, any color, <1 cm diameter? Example? | show 🗑
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| show | linear break in skin surface, not related to trauma.
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| Excoriation? | show 🗑
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| Lichenification? | show 🗑
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| Polymorphous lesions? | show 🗑
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| Punctuate lesions? | show 🗑
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| Serpinigous Lesions? | show 🗑
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| Iris Lesions? | show 🗑
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| Annular Lesions? | show 🗑
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| Verrucaform Lesions? | show 🗑
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| show | Papilla-like for finger-like projections (similar to tongue papillae).
Ex: warts
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| Nummular/Discoid Lesions? | show 🗑
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| show | Central Depression.
Ex: Herpes Zoster
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| Zosteriform Lesions? | show 🗑
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| show | Single lesions in close proximity to larger lesion. "orbiting"
Ex: Cutaneous Candidiasis
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| show | With enlargement or multiplication, begin to coalesce for form larger lesion.
Ex: Urticaria
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| show | Primary= Type
Secondary= Shape, Size, Arrangement, and distribution, which further defines the underlying problem.
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| show | Primary= maculae, papules, nodules, tumors, polyps, wheals, blisters, cysts, pustules, abcesses.
Secondary= follow primary lesions (scar tissue, crusts from dried burns).
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| Patients with a Braden Score of ______ have a low risk of developing a pressure ulcer. | show 🗑
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| Patients with a Braden Score of _______have a moderate risk of developing a pressure ulcer. | show 🗑
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| Patients with a Braden Score of _______have a high risk of developing a pressure ulcer. | show 🗑
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| True or False? Patients with a total Braden score of 16 or less are considered to be at risk of developing pressure ulcers? | show 🗑
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| show | 1. Sensory Perception (ability to respond to pressure-related discomfort)
2. Moisture exposure of skin
3. Activity level
4. Mobility
5. Nutrition
6. Friction and Shear
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| Each leg is given what percentage in regards to the TBSA and burn classification? | show 🗑
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| Each arm is given what percentage in regards to the TBSA and burn classification? | show 🗑
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| show | Head: 9%
Anterior: 18%
Posterior: 18%
Pubic Area: 1%
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| show | General color
Texture
Moisture
Turgur
Temperature
*Focused inspection and palpation of rashes, lesions, or wounds.
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| What eight things do you assess a wound for? | show 🗑
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| show | 1. Superficial- (epidermal layers)
2.superficial-dermal (epidermis and pt of dermis)
3. dermal (epidermis and all of dermis)
4. full-thickness (all layers of skin and my extend to supportive fascia below)
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| When assessing a lesion, what do you identify? (6 things) | show 🗑
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| show | On the abdomen
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| An adult white patient visits your clinic for the first time. During assessment of the client's skin, the RN should assess for central cyanosis by observing the patient's? | show 🗑
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| show | A linear indentation on nailbed from slow or halted nail growth. Related to illness, physical trauma or poisoning.
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| The only layer of the skin that undergoes cell division is the: | show 🗑
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| What is Telangiectasis? | show 🗑
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| What is Onycholysis? | show 🗑
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| show | Full thickness tissue loss. SubQ fat may be visible but bone, tendon, or muscle is not not exposed
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| show | Partial thickness loss of dermis. Presents as shallow open ulcer with a red pink wound bed. NO SLOUGH!
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| show | INTACT SKIN! With nonblanchable redness of a localized area. Usually over bony prominence. Area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue.
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| Describe Suspected deep tissue injury | show 🗑
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| show | Full thickness tissue loss WITH exposed bone, tendon, or muscle. Slough or eschar may be present. Tunneling!
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| show | Full thickness tissue loss in which the base of the ulcer is covered by slough(yellow, tan, gray, green, or brown), eschar (tan, brown, or black) or both. True depth cannot be determined.
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| show | NO! As long as it is stable (dry, adherent, intact) it serves as the body's natural cover.
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| Neuropathic ulcers are commonly caused by what? | show 🗑
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| show | To determine grade of neuropathic ulcer. (caused by diabetes)
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| What 5 skin conditions in newborns are indications of greater risk for morbidity and mortality? | show 🗑
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| What is carotenemia caused by? Symptoms? | show 🗑
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| Physiologic vs Pathologic Jaundice? | show 🗑
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| show | Apply light pressure to skin to cause blanching. JAUNDICE DOES NOT BLANCHE!!! yellowish skin from OTHER causes will turn white.
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| What are 3 abnormal skin findings in pregnancy? | show 🗑
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| show | RECENT!!!
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| Clubbing of nails. Angle of nail is more than ______degrees. | show 🗑
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| In female patients, ovarian dysfunction may be characterized by??? | show 🗑
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| What part of your hand do you use to palpate for skin temperature? | show 🗑
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| show | Palmar surface of fingers and hands
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| How do you assess for vascularity? | show 🗑
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| show | tongue, lips, nail beds, and buccal mucosa.
Because they are less pigmented areas.
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| The healing process is divided into what 3 phases? | show 🗑
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| Why does skin tear easily in the older population? | show 🗑
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| How do the lesions progress in Varicella? | show 🗑
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| show | Measles, Rubella, Varicella
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| Headache often accompanies what two skin disorders? | show 🗑
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| What are the steps in the Self Skin Examination? | show 🗑
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| show | UVB= more likely to cause sunburn.
UVB= directly linked to skin cancer
UVA= Responsible for wrinkling and leathering of skin
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