Assessment: Hair, Skin, & Nails Study online at https://quizlet.com/_3kyfm PI-OO-II (P-I-N-G-O: Bingo dog song ending, dogs inspect skin) Inspection of Skin 1. Position (sitting, exam gown) 2. Instruct (will be looking carefully at skin) 3. Observe (cleanliness, perspiration, sheen, smell) 4. Observe (skin tone) 5. Inspect (pigmentation) 6. Inspect (superficial arteries & veins) I'D APPP IPP ("I'd tap it") Tempt Me To Thank Ellie's Little Sister 1. Instruct 2. Determine (skin temp) 3. Assess (moisture) 4. Palpate (texture) 5. Palpate (thickness) 6. Palpate (elasticity) 7. Inspect & Palpate (lesions) 8. Palpate (sensitivity) Palpation of Skin I Oc Oc At ODist IL 1. Instruct 2. Observe (cleanliness) 3. Observe (color) 4. Assess (texture) 5. Observe (distribution) 6. Inspect (lesions) Inspection of Hair & Scalp In A Hyper Insect's Pink Underwear, A Caterpillar Insists Playing a Sax & Cello, Putting Thousands of Regulars to Bed; It's a Party, Cutie! Assessment of Nails 1. Instruct 2. Assess (hygiene) 3. Inspect (even, pink undertone) 4. Assess (color) 5. Inspect & Palpate (shape & contour) 160 6. Palpate (thickness, regularity, attachment to bed) 7. Inspect & Palpate (cuticles) Spoon nail Assessment of Nails 6. Inspect & Palpate (shape & contour) -Concave. -Nail angle < 160 degrees Normal nail Assessment of Nails 6. Inspect & Palpate (shape & contour) -Slightly convex. -Nail angle ~160 degrees Clubbing Assessment of Nails 6. Inspect & Palpate (shape & contour) -Convex and wide. -Nail > 160 degrees Splinter Hemorrhage Assessment of Nails 6. Inspect & Palpate (shape & contour) -Reddish brown spots in nail. -Cause: Trauma or endocarditis (infection in heart) Onycholysis Assessment of Nails 6. Inspect & Palpate (shape & contour) -Nail plate loosens from distal nail and proceeds to proximal portion. Skin Inspection: Cleanliness (abnormal findings) Urea & ammonia salts found on skin --> kidney disorder 1/4 Assessment: Hair, Skin, & Nails Study online at https://quizlet.com/_3kyfm Skin Inspection: Skin Tone (abnormal findings) 1. Cynosis or pallor --> low plasma oxygen (at risk for altered tissue perfusion) 2. Pallor --> anemia Skin Inspection: Pigmentation (abnormal findings) Vitiligo: patchy, depigmented areas over face, neck, hands, feed, and body folds Skin Palpation: Moisture (abnormal findings) 1. Diaphoresis: profuse sweating (e.g. from hyperthyroidism, or impending myocardial infarction) 2. Pruritis: itching r/t dr skin Skin Palpation: Texture (abnormal findings) 1. Excessively smooth and velvety: Hyperthyroidism - thin, shiny skin --> impaired circulation 2. Excessively dry: Hypothyroidism - rough, scaly skin HIGHER T caused by: 1. Metabolic disorders, such as HYPERTHYROIDISM 2. After vigorous activity 3. External environment is warm Skin Palpation: Temperature (abnormal findings) LOWER T caused by: 1. Metabolic disorders, such as HYPOTHYROIDISM 2. External environment is cool Skin Palpation: Elasticity (abnormal findings) 1. "Tent": Skin turgor decreased (pinch @ clavicle) Caused by: Dehydration or losing a lot of weight 2. Increased skin turgor: scleroderma "hard skin" (scarred underlying connective tissue) 3. Edema: decrease in skin mobility caused by accumulation of fluid in intercellular spaces Increased accumulation of fluid in a dependent part that is caused by an accumulation of fluid in the intercellular spaces Edema Four-point scale for grading edema: +1: 2 mm +2: 4 mm +3: 6 mm +4: 8 mm 1. Ecchymosis: bruising (periumbilical & flank) 2. Cullen's sign: in periumbilical area --> bleeding in abdomen 3. Grey Turner's sign: in flank area --> bleeding in peritoneum 4. Pancreatitis: in flank area --> bleeding in peritoneum Skin Palpation: Lesions (abnormal findings) *Physical abuse should be assessed Primary Lesions Initial lesion of a disease on previously unaltered skin Secondary Lesions Skin condition or changes to the skin that occurs following a primary lesion (e.g. scratching, abrasion, infection) Skin Palpation: Sensitivity (abnormal findings) Track marks: potential substance abuse; injection of drugs into veins or other parts of the body Melanoma Assessment ABCDE A=Assymetry B=Border Irregularity C=Color Variegation D=Diameter greater than 6 mm E=Evolving changes (size, shape, symptoms, surfaces, shades of color) Hair Inspection: Cleanliness (abnormal findings) 1. Lesions may occur on scalp (cancerous). Use ABDCE method. 2. Excessive dandruff (dead, scaly flakes of epidermal cells)--> psoriasis or soborrheic dermatitis vs. head lice (pediculosis capitis) - nits 2/4 Assessment: Hair, Skin, & Nails Study online at https://quizlet.com/_3kyfm Hair Inspection: Color (abnormal findings) Graying in patches: nutritional deficiency (commonly protein or copper) Hair Inspection: Texture (abnormal findings) Dull, dry, brittle, coarse: hypothyroidism, nutritional deficiencies Hair Inspection: Distribution (abnormal findings) 1. Excessive hair loss (women): imbalance in adrenal hormones 2. Widespread hair loss: illness, infection, metabolic disorders, nutritional deficiencies, chemotherapy 3. Alopecia areta: patchy hair loss-->infection Hair Inspection: Lesions (abnormal findings) 1. Gray, scaly patches: Fungal infection (E.g. ringworm) --> Use Wood's lamp (UV) to fluoresce infection 2. Pediculosis capitis: head lice - nits, scratching. Check scalp for excoriation from scratching Nail Assessment: Hygiene (abnormal findings) Self-care deficit or r/t employment Nail Assessment: Even, pink undertones (abnormal findings) 1. Colorless: peripheral arteriosclerosis or anemia 2. Yellow: jaundice 3. Dark red: Polycythemia (pathologic increase in production of RBC) Nail Assessment: Capillary refill (abnormal findings) Blue nailbeds, sluggish color return: CV or Resp. disorders Nail Assessment: Shape & Contour (abnormal findings) 1. Clubbing: hypoxia or impaired peripheral tissue perfusion over time (cirrhosis, smoking, colitis, thyroid disease) >160 2. Spoon nail: Iron deficiency, concave <160 1. Onycholysis: sparation of nail plate from bed (trauma, infection, Nail Assessment: Thickness, regularity, attachment to bed (abskin lesions) normal findings) 2. Thick nails: circulatory disorders Nail Assessment: Cuticles (abnormal findings) Paronychia: infection of cuticle caused by untreated hangnails Macule (lesion) flat, nonpalpable change, < 1 cm, circumscribed border Patch (lesion) flat, nonpalpable change, > 1 cm, may have irregular border EX: Mongolian spots, port-wine stains, vitiligo, chloasma Papule (lesion) Elevated, solid palpable masses with circumscribed border. < 0.5 cm EX: moles, warts Plaque (lesion) -Elevated, solid palpable masses with circumscribed border. -Groups of papules that form lesions > 0.5 cm EX: psoriasis Nodule (lesion) -Elevated, solid, hard or soft palpable masses extending deeper into the dermis that a papule. -Circumscribed borders, 0.5 - 2 cm EX: small lipoma, squamous cell carcinoma Tumor (lesion) -Elevated, solid, hard or soft palpable masses extending deeper into the dermis that a papule. -May have irregular borders, > 2 cm EX: large lipoma, carcinoma Vesicle (lesion) -Elevated, fluid-filled, round or oval shaped, palpable masses with thin, translucent walls and cicrumscribed borders. Vesicles < 0.5 cm EX: herpes simplex/zoster, early chicken pox, small burn blisters, poison ivy Bulla (lesion) -Elevated, fluid-filled, round or oval shaped, palpable masses with thin, translucent walls and cicrumscribed borders. Bullae > 0.5 cm EX: contact dermatitis, friction blisters, large burn blisters Wheal (lesion) Elevated, often reddish area with irregular border caused by diffuse fluid in tissues EX: insect bites and hives (extensive) 3/4 Assessment: Hair, Skin, & Nails Study online at https://quizlet.com/_3kyfm Pustule (lesion) Elevated, pus-filled vesicle or bulla with circumscribed border. Size varies. EX: acne, impetigo, carbuncles (large boils) Cyst (lesion) Elevated, encapsulated, fluid-filled or semisolid mass orig. in subcutaneous tissue or dermis. Usually 1 cm or larger EX: sebaceous cysts, epidermoid cysts Seborrheic dermatitis "Cradle cap" common in infants. It appears as eczema of yellow-white greasy scales on scalp and forehead. 4/4