n 295 lecture 3 skin student copy
TRANSCRIPT
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Integumentary System: Assessing the
SKIN
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Functions of the Skin
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1. Protects Against Trauma2. Protects Against Ultraviolet
Radiation3. Support Structure4. Maintains Body Temperature
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Functions of Skin
5. Involved with Absorption and Excretion6. Involved with Immunity7. Synthesizes Vitamin D8. Helps Maintain Fluid Balance9. Provides Sensation with the External
Environment
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Structures of Skin
1. Epidermis2. Dermis3. Subcutaneous Tissue4. Epidermal Appendages:
– Hair– Nails– Sebaceous Glands
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Risk Factors
• . . . . . .• . . . . . .• . . . . . .• . . . . . • . . . . .
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SECONDARY SKIN LESIONS1. Crust *2. Scale3. Fissure4. Erosion5. Ulcer6. Scar 7. Excoriation8. Keloid9. Lichenification
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Descriptions of Lesions *
• Size• Shape• Color• Texture• Surface relationship• Exudate• Tenderness or pain
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Skin Assessment:
• Approach
• Inspection
• Palpation
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Examination
• General Inspection :– General pigmentation– Texture– Temperature– Moisture– Mobility– Turgor– Vascularity or bruising– Edema– Lesions or discoloration
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Adult
–Normal Variations:• Striae• Vitiligo• Moles• Freckles • Birthmarks
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Warning Signs of Cancer
• A = Asymmetry• B = Boarder irregular• C = Color variation• D = Diameter >6mm• E = Elevation & Enlargement
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Abnormal Skin Findings
• Central Cyanosis
• Peripheral Cyanosis
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• Pallor:
• decreased Hgb-, decreased perfusion• Also on conjunctiva
and mucus membranes
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Examination
• Palpate skin for temp, moisture, mobility and turgor
• Hair Distribution• Nail
– Thickening or hypertrophy– Thinning or Brittleness– Spoon Shaped– Pitting of Nail– Pigmented Bands– Splinter Hemorrhages
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Vascular Lesions:
1. Petechiae2. Ecchymosis3. Purpura4. Hematoma5. Venous Star6. Telangiectasis7. Spider Angioma8. Erythema
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Pitting Edema *
• 1+ < 0.25 inch (4.32mm) depression
• 2+ 0.25 - 0.5 inch (12.7mm)
• 3+ 0.5 - 0.75 inch (19 mm)
• 4+ 0.75 - 1 inch or more (25 mm)
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Pitting Edema *
• 1+ < 0.08 inch (2mm) depression __________
• 2+ 0.16 inch (4mm) ___________
• 3+ 0.24 inch (6 mm)
• 4+ >0.32 inch (8 mm)
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Aging Adult Health History1. Increased Risk of Damage2. Delayed Wound Healing3. Pruritis
1. Skin Turgor2. Lentigo (macule)3. Cutaneous Tags4. Cherry Angioma (red papule)5. Seborrheic keratoses / Actinic keratoses
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Older Adult
Approach:• Skin atrophies• Increase amount of pigmentation esp. in sun
exposed areas• Isolated areas of hypo pigmentation• Skin becomes drier and flattens, often
becoming paper like• Elasticity decreases and wrinkles develop
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Older Adult
• Decreased melanocyte function causes gray hair and pale skin
• Decreased axillary, pubic & scalp hairWomen: facial hair Men: nasal hair
• Nails grow more slowly, become thicker & more brittle, yellowish
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Older Adult• Temp/ moisture , mobility
– Increased dryness (xerosis)– Thinning of the skin– Hanging skin
• Hair:– Graying, thin texture– Symmetric balding may occur in men
• Facial & Body hair– Men increased coarseness
• Nail– Thickening, increases brittleness, deformity
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Cultural Considerations
• The oral mucosa is best for assessing color changes in dark-skinned persons
• Assessing the sclera for jaundice, rather than the skin in Asians
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Health Promotion• Immunizations• Sun Exposure & Protection• Skin Cancer • Teach client:
– skin self assessment– Toenail trimming – Ingrown toenail care
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