Hair, Skin, and Nail Disorders PDF

Focus on the following: ► Normal physiological mechanisms of integumentary Hair, Skin and Nail ► Selected skin/dermatological...

Focus on the following: ► Normal physiological mechanisms of integumentary Hair, Skin and Nail ► Selected skin/dermatological disorders ► Risk factors, clinical manifestations, Disorders diagnostics, treatment and complications ► Conditions that lead to death* ► ABCDE skin evaluation ► Health promotion regarding skin Shermel Edwards-Maddox PhD, RN, CNE, CHSE, RN-BC disorders Module Terminology The Integumentary System- Structure and Function ◆ The skin is the largest organ of the Pruritus body. Cyanosis ◆ Physical barrier that protects the Jaundice underlying tissues and structures from microorganisms, physical Erythema trauma, ultraviolet radiation, and dehydration. Excoriation ◆ Vital role in temperature Alopecia maintenance, fluid and electrolyte balance, absorption, excretion, Uticaria sensation, immunity, and vitamin D synthesis. Nevi Think-Pair-Share Nail- Structure and Function How does the skin do the following? ◆ Protect fingers and toes Give an example of each: ◆ Enhance dexterity ◆ Made up of dead matrix cells Control and regulate temperature ◆ Grow continuously Barrier protection Excretion and absorption ◆ Can inform about systemic Immunity disorders Vitamin D production Hair- Structure and Function Sweat Glands ◆ Filamentous, keratinized ◆ Eccrine- originate in the dermis and structure that originates from open to the skin surface hair follicles in the dermis ◆ Transport sweat to the outer skin surface to regulate body temperature ◆ Associated with sebaceous glands ◆ Several million located all over the body ◆ Arrector pili- muscle that contracts to “goose bumps” as ◆ Apocrine- located deep in the dermis, part of thermoregulation. open through a hair follicle ◆ Can reflect metabolic changes ◆ Found in axilla and groin ◆ Has growing and resting cycles ◆ Secrete oily substance that mixes with bacteria body odor  Diagnostic Tools to Assess the The Integumentary System as a Mirror Integumentary System ► The skin is the most visible organ ► Medical conditions in other body systems can manifest in ► Skin scraping the integumentary system ► Patch testing ► Example: Immunological ► Biopsy ► Changes in color or texture ► Wood’s UV Light ► Can help in diagnosing other disorders Common Changes Associated with Aging How does the integumentary system change with age? ◆ Skin ◆ Insert text here…. ◆ Pale ◆ Skin lesions ◆ Dry ◆ Loses turgor ◆ Hair: Thinner ◆ Nails: Thickened, yellow, brittle Skin Lesions Skin, Hair, and Nail Disorders Primary Secondary ◆ Macule and patch Erosion Skin Disorders Nail Disorders ◆ Hair Disorders ◆ Papule and plaque Ulcer ► Vitiligo Paronychia ◆ Pattern Baldness ◆ Nodule and tumor ◆ Scar ► Albinism Alopecia Onychomycosis ◆ Vesicle and bulla ◆ Fissure ► Melasma Ingrown Nails ◆ Wheal ► Cellulitis ◆ Pustule ► Pressure Ulcers ◆ Cyst ► Psoriasis ► Skin Cancers Be familiar with Box 41-1 on page 1100 Consider making mini concept maps on these integumentary orders ► Shingles* *Addressed in Module 1 Cellulitis and MRSA Skin Infections Disorders of Skin Color ► Often the source of cellulitis infections Albinism Vitiligo Melasma ► Spread through direct contact Genetic disorder Abnormal production Known as chloasma ► Risk factors: Skin, hair, and eyes of melanin ► Recent hospitalization/long term care facility Dark macules on the face lack pigment Unknown cause ► Having invasive medical device Related to pregnancy and ► Contact sports/sharing personal items Results in Discolored patches on sun damage photosensitivity the skin ► Appear as a bump or infected area that may be: ► Red, swollen or painful, warm to the touch ► Full of pus or other drainage ► Perform culture for identification of pathogen ► Treatment: ► Antibiotics/Ointments ► Dressing changes/surgical debridement ► Patient teaching  Measures to Reduce Risk Factors for MRSA Skin Injury / Pressure Ulcer Stages ► Referred to now as “pressure injury” ► Keep wounds covered. ► Also known as decubitus ulcers or ► Do not share personal items. bedsores ► Avoid unsanitary or unsafe nail care practices. ► Found on bony prominences ► If treatment has been started, do not stop until recovery ► Pressure decreases blood flow to the skin is complete. ► Sustained pressure produces blisters  skin ► Use universal precautions when touching others to avoid breakdown and tissue ulceration. contact with contaminated body fluids. Wash your ► Classified by: hands. ► Stage I ► Clean sports equipment between uses to avoid spread of ► Stage II infection. ► Stage III ► Wash clothes, sheets, towels, razors, and other personal ► Stage IV items before and after use. ► Unstageable ► Clean hands often. Treatment of Pressure Ulcers/Injuries ► Prevention is the best option ► Wound care Risk Factors ► Dressing changes ► Cleaning the wound for Skin Injury ► Medications / Pressure ► Topical creams ► Antibiotics Ulcer ► Antifungals ► Surgical intervention ► Wound Vacuum Therapy ► Hyperbaric chambers Hyperbaric Oxygen Chamber Vascular Skin Lesions Psoriasis Match the pictures with the correct term. A B ► Chronic thickening of epidermis T-cell-mediated autoimmune response to antigen Petechiae ► ► ► Presents with silver-white scales covering red, ► Ecchymosis circumscribed, thickened plaques D ► Auspitz Sign ► Hematoma C ► Frequently found on elbows, knees, and scalp ► Cherry angioma ► Common in colder climates Increases with age ► Spider angioma ► ► Treatments: ► Telangiectasis E F ► Topical agents ► Steroid medications ► Emollients to soften and hydrate area Nevi Eczema- Atopic Dermatitis ► Known as moles ► Most common benign skin tumor ► Type of hypersensitivity that can be ► Can be pigmented or depigmented triggered by environment and/or allergens. ► Develop during childhood (3 to 5 years of age) ► Causes dry, lichenified lesions ► Present as papules and nodules ► Can be hypo or hyperpigmented ► Vary in size ► Seen in the antecubital, popliteal, ► Atypical = irregular in shape, vary in color neck, hands, feet, eyelids and ears. ► High susceptibility to cancerous changes ► Treatment: allergen control, topical steroid creams and immune ► Require biopsy to rule out cancer modulating medications.  Malignant Melanoma Risk ◆ Sun exposure Nonsolar sources of UV ◆ Male gender Chemical exposure Factors for ◆ ◆ radiation ◆ Human papillomavirus Medical therapies (HPV) Basal Cell Carcinoma Skin ◆ ◆ Family and genetic history ◆ Long-term skin Make sure to know the major differences between these types of Cancers ◆ Moles inflammation or injury skin cancers! ◆ Pigmentation ◆ Alcohol intake; smoking irregularities ◆ Inadequate niacin in Squamous Cell ◆ Fair skin that burns and diet Skin Cancer Carcinoma ◆ freckles easily; light hair and eye color Age ◆ Depressed immune system Risk Reduction Strategies to Prevent Skin Cancers ► Reduce skin exposure ABCDE’s For Skin Cancer ► Always use sunscreen when sun exposure is anticipated. ► Reapply every 2 hours or more often if sweating or swimming ► Minimum SPF 15 everyday; SPF 30 or higher if outside ► Wear long-sleeve shirts and wide-brimmed hats. ► Avoid sunburns. ► Wear sunglasses that wrap around. ► Have annual skin cancer screenings ► 2-3 times a year if at high risk or have a history of skin cancer ► Avoid sun exposure between 10am-4pm ► Layer clothing  Basal Cell Carcinoma Cultural Most common form of skin cancer Variations ► ► Begins in the basal cells (produce new skin cells) in Skin ► Cause: exposure to ultraviolet (UV) rays Cancer ► Slow-growing ► Often appearing on the face (nose), head, and neck ► Are not painful or itchy Melanoma Squamous Cell ► Arise because of malignant degeneration of melanocytes located either along the basal layer of the epidermis or Carcinoma ► in a nevus. Most lethal of the skin cancers; 70% of malignant melanomas arise from a preexisting nevus. ► Originates in upper portion of Squamous cell on the back of the hand ► Initially the cells grow radially through the epidermis; the dermis ► Spread vertically through the dermis, which allows for metastasis. ► Spreads through the lymphatic (lymph nodes) and ► Commonly on sun-exposed areas: vascular systems (liver, lungs, and central nervous system) face, ears, neck, lips, and backs Risk Factors: of the hands. ► ► Fair, sun-sensitive skin, burn easily, tans poorly, Scandinavian descent ► Appears red, scaly, patch-like, ► Red or blond hair with blue or green eyes thickened wart-like, and may ► 50-100 nevi ► Unusual or irregular nevi crust over ► Hx of sunburns or indoor tanning use ► Positive family hx ► Bleeds occasionally ► Age: 50 years or older Melanoma – Symptoms and Treatment Hair ► Atypical lesions that are asymmetric, with border irregularity; ► Can reflect metabolic changes ► dark black, blue or varied color ► Texture ► greater than 6 mm in diameter ► elevated above skin’s surface ► Growth ► Areas: ankles, back, legs, arms, face, back of ► Pattern knee Brittle Hair ► Loss ► Treatment Options: ► Examples: ► Surgery ► Hypothyroidism ► Local ablation therapy ► Surgical resection to remove tumor and 3 to ► Infections 5-cm margin ► Psoriasis ► Regional lymphadenectomy ► Pregnancy ► Medications ► Liver and kidney disease ► Chemotherapy ► Nutritional deficits/anemia ► Radiation therapy for metastasis Hair Loss Hair Disorders Nails Male & Female Pattern Baldness Alopecia ► The visual appearance ◆ Sudden loss of hair in one area of of the fingernails and Can begin at any age toenails may suggest an the scalp ◆ Etiology: genetics and male underlying systemic Hair loss occurs in clumps; size and ◆ hormones ◆ disease. shape of a quarter Cyanosis Clubbing ◆ Hair is lost on the front, sides, and ◆ Determine reason for loss crown of head ◆ Females experience more of a thinning over the whole head. Fungal Infection Circulatory Issues Paronychia Nail Disorders Paronychia Onychomycosis WEAR AVOID WEAR SOCKS AVOID GOING LEATHER WEARING THAT WICK BAREFOOT IN ◆ Inflammation of the paronchyial fold ◆ Fungal infection of the Risk SHOES EXCEPT CLOSED AWAY DAMP PUBLIC proximal and lateral nail folds FOR SPORTS. SHOES ALL MOISTURE. AREAS. ◆ Can affect finger or toenails ◆ Can affect finger or toenails Reduction THE TIME. ◆ Bacterial or fungal ◆ Causes discoloration Strategies ◆ Causes pain, redness, and swelling ◆ Can be hard to treat for Nails AVOID TOO AVOID AVOID IF TREATMENT MUCH TRAUMA TO UNSANITARY IS STARTED, PERSPIRATION NAILS. OR UNSAFE DO NOT STOP OR WATER NAIL CARE UNTIL (WEAR PRACTICES. RECOVERY IS GLOVES FOR COMPLETE. HANDS). Questions 39