Assessing-Skin-Hair-and-Nails.pdf

Health Assessment Week 5: Course Material HEALTH ASSESSMENT ASSESSING SKIN, HAIR and NAILS Assessing Skin, Hair, and Nails 1 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment...

Health Assessment Week 5: Course Material HEALTH ASSESSMENT ASSESSING SKIN, HAIR and NAILS Assessing Skin, Hair, and Nails 1 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Table of Contents Pretest 3 Learning Outcomes 4 Required Materials and Resources 4 Pre- Activity 5 Contents and Discussion 6 Anatomy and Physiology of the Skin, Hair and Nail 6 Collecting subjective data 8 Collecting objective data 10 Abnormalities of the skin, hair, and nails 15 Assessment Activity 23 Online Resources 25 References 25 Posttest 25 Assessing Skin, Hair, and Nails 2 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material I- PRE-TEST: Instructions: Define the following terminologies. Two (2) points each. Name: Score: Year and Section: Date: Answer 1. Macule 2. Patch 3. Tumor 4. Nodule 5. Papule 6. Plaque 7. Wheal 8. Pustules 9. Erosion 10. Ulcer 11. Scar 12. Fissure 13. Koilonychia 14. Yellow nail syndrome 15. Longitudinal Ridging Assessing Skin, Hair, and Nails 3 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material II- LEARNING OUTCOMES At the end of the session, the student will be able to: 1. Use correct techniques to perform a physical assessment of the skin, hair, and nails & skull and face. 2. Differentiate between normal and abnormal findings of the skin, hair, and nails & the skull and face. 3. Clearly document and verbally communicate subjective and objective data findings. 4. Analyze collected assessment data to formulate valid nursing diagnoses, collaborative problems, and/or referrals. III- REQUIRED MATERIALS and RESOURCES Required materials and resources are: 1. Worksheets and cases study 2. Books 3. Powerpoint slides 4. Downloadable videos Assessing Skin, Hair, and Nails 4 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material IV- PRE- ACTIVITIY Name: Score: Year and Section: Date: Brief discussion: Discuss your skin, hair, and nails routine care. For five (5) points each. Answer Skin Hair Nails Assessing Skin, Hair, and Nails 5 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material V- CONTENTS and DISCUSSIONS ASSESSING SKIN, HAIR and NAILS Structure and Functions The integumentary system consists of skin, hair, and nails, which are external structures that serve a variety of specialized functions. THE SKIN  The largest organ of the body  It is a physical barrier that protects the underlying tissues and organs from microorganisms, physical trauma, ultraviolet radiation, and dehydration.  Plays vital role in temperature maintenance, fluid and electrolyte balance, absorption, excretion, sensation, immunity, and vitamin D synthesis.  It is composed of three layers the epidermis, dermis, and subcutaneous tissue. o EPIDERMIS:  The outer layer of the skin is composed of four layers namely: stratum corneum, stratum lucidum, stratum granulosum, and stratum germinativum.  The outer most layer consists of dead, keratinized cells that is insoluble in water.  The epidermis, hair, nails, dental enamel, and horny tissues are composed of keratin.  Completely replaced every 3 to 4 weeks.  The innermost layer is the stratum germinativum, the only layer that undergoes cell division and contains melanin (brown pigment) and keratin-forming cells.  Melanin is the major determinant of skin color o DERMIS  The inner layer of the skin, the dermal papillae connects the dermis to the epidermis.  The dermis is a well-vascularized, connective tissue layer containing collagen and elastic fibers, nerve endings, lymph vessels. It is also the origin of sebaceous glands, sweat glands and hair follicles. Assessing Skin, Hair, and Nails 6 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material o SEBACEOUS GLANDS  Are attached to the hair follicles and therefore are present over most of the body, excluding the soles and palms.  Secretes an oily substance called sebum that waterproofs the hair and skin. o SWEAT GLANDS  Eccrine and apocrine glands are two types  The Eccrine glands: are located over the entire skin. The primary function is secretion of sweat and thermoregulation, which is accomplished by evaporation of sweat from the skin surface.  The Apocrine glands: are associated with hair follicles in the axillae, perineum, and areolae of the breasts. The glands are small and non-functional until puberty.  The interaction of sweat with skin bacteria produces a characteristic body odor.  In women apocrine secretions are linked with the menstrual cycle. o SUBCUTANEOUS TISSUE  Located beneath the dermis. A loose connective tissue containing fat cells, blood vessels, nerves, and the remaining portions of sweat glands and hair follicles.  Stores fats as an energy reserve, provides insulation to conserve internal body heat.  Serves as a cushion to protect bones and internal organs and contains vascular pathways for the supply of nutrients and removal of waste products to and from the skin. Assessing Skin, Hair, and Nails 7 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material HAIR  Consists of keratinized cells found over much of the body except for the lips, nipples, soles of the feet, palms of the hand, labia minora, and penis.  Hair develops within a sheath of epidermal cells called the hair follicle. Hair growth occurs at the base of the follicle, where cells in the hair bulb are nourished by the dermal blood vessels.  The hair shaft is visible above the skin and the hair root is surrounded by the hair follicle. Attached to the hair follicle are the erector pili muscles.  There are two general types of hair: vellus and terminal. Vellus hair (peach fuzz) is short, pale, fine, and present over much of the body. Terminal hair (particularly scalp and eyebrows) is longer, generally darker, and coarser than vellus hair. Puberty initiates the growth of additional terminal hair in both sexes on the axillae, perineum, and legs.  Hair color varies and is determined by the type and amount of pigment (melanin and pheomelanin) production. A reduction in production of pigment results in gray or white hair NAILS  The nails, located on the distal phalanges of fingers and toes, are hard transparent plates of keratinized epidermal cells that grow from the cuticle.  The nail body extends over the entire nail bed and has a pink tinge as a result of blood vessels underneath.  The lunula is a crescent-shaped area located at the base of the nail. It is the visible aspect of the nail matrix.  The nails protect the distal ends of the fingers and toes, enhance precise movement of the digits, and allow for an extended precision grip. Collecting Subjective Data: The Nursing Health History Diseases and disorders of the skin, hair, and nails may be local or caused by an underlying systemic condition. To perform a complete and accurate assessment it is important to collect data about current symptoms, the client’s past and family history, and lifestyle and health practices. The information obtained provides clues to the client’s overall level of functioning in relation to the skin, hair, and nails. Ask questions in a straightforward manner. Keep in mind that a nonjudgmental, sensitive approach is needed if the client has abnormalities that may be associated with poor hygiene or unhealthy behaviors. Also, some skin disorders might be highly visible and potentially damaging to the person’s body image and self-concept. HISTORY OF PRESENT HEALTH CONCERN Question SKIN Ask for skin problems such as rashes, lesions, dryness, oiliness, drainage, bruising, swelling, or changes in skin color? What aggravates the problem? What relieves it? Do you have any birthmarks or moles? If so, please describe them. Have any of them changed color, size, or shape? Have you noticed any change in your ability to feel pain, pressure, light touch, or temperature variations? Are you experiencing any pain, itching, tingling, or numbness? Are you taking any medications (prescribed or “over the counter”), using any ointments or creams, herbal or nutritional supplements, or vitamins? If so, how long have you Assessing Skin, Hair, and Nails 8 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material been taking each of these? Do you have trouble controlling body odor? Do you perceive yourself to have excessive perspiration? HAIR and NAILS Have you had any hair loss or change in the condition of your hair? Describe. PERSONAL HEALTH HISTORY Do you recall having severe sunburns as a child? Describe any previous problems with skin, hair, or nails, including any treatment or surgery and its effectiveness. Have you had any recent hospitalizations or surgeries? Have you ever had any allergic skin reactions to food, medications, plants, or other environmental substances? Have you had a recent viral or bacterial illness? For female clients: Are you pregnant? Are your menstrual periods regular? Do you have a history of self-injury? FAMILY HISTORY Has anyone in your family had a recent illness, rash, or other skin problem or allergy? Describe. Has anyone in your family had skin cancer? Do you have a family history of keloids? LIFESTYLE and HEALTH PRACTICES Do you sunbathe? What is the frequency and duration of sun or tanning-booth exposure? Do you use sun block and if so what type (specify SPF)? Do you perform skin self-examination once a month? In your daily activities, are you regularly exposed to chemicals or irritants that may harm the skin (e.g., coal, tar, pitch, creosote, arsenic compounds, radium, alcohol, hand foam, latex, bleach, peroxide)? Do you spend long periods of time sitting or lying in one position? Do you have any body piercing? Do you have any tattoos? What is your daily routine for skin, hair, and nail care? What products do you use (e.g., soaps, lotions, oils, cosmetics, self-tanning products, razor type, hair spray, shampoo, hair coloring, nail enamel)? How do you cut your nails? What kinds of foods do you consume in a typical day? How much fluid do you drink each day? Do you have a history of smoking and/or drinking alcohol? Do skin problems limit any of your normal activities? Describe any skin disorder that prevents you from enjoying your relationships. Assessing Skin, Hair, and Nails 9 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material SELF- ASSESSMENT: HOW TO EXAMINE YOUR OWN SKIN Collecting Objective Data: Physical Assessment  Physical assessment of the skin, hair, and nails provides data that may reveal local or systemic problems or alterations in a client’s self-care activities.  A separate, comprehensive skin, hair, and nail examination, preferably at the beginning of a comprehensive physical examination, ensures that you do not inadvertently omit part of the examination. Preparing the Client  Remove all clothing and jewelry and put on examination gown  Ask the client to remove nail enamel, artificial nails, wigs, toupees, or hairpieces as appropriate.  Have the client sit comfortably on the examination table or bed for the beginning of the examination.  During the skin examination, ensure privacy by exposing only the body part being examined. Make sure that the room is a comfortable temperature Equipment  Examination light  Penlight  Mirror for client’s self-examination of skin  Magnifying glass  Centimeter ruler  Gloves  Wood light  Examination gown or drape  Braden Scale for Predicting Pressure Sore Risk  Pressure Ulcer Scale for Healing (PUSH) tool to measure pressure ulcer healing Assessing Skin, Hair, and Nails 10 Prepared by: Dennis B. Brosola, RN, MSN  Health Assessment Week 5: Course Material ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS Inspect general skin Inspection reveals evenly PALLOR: (loss of color) is seen coloration colored skin tones without in arterial insufficiency, unusual or prominent decreased blood supply, and discolorations. anemia. Pallid tones vary from pale to ashen without underlying pink. CYANOSIS: may cause white skin to appear blue-tinged, especially in the perioral, nail bed, and conjunctival areas. Central cyanosis results from a cardiopulmonary problem, whereas peripheral cyanosis may be a local problem resulting from vasoconstriction While inspecting skin Client has slight or no odor of A strong odor of perspiration or coloration, note any odors perspiration, foul odor emanating from the skin. depending on activity may indicate disorder of sweat glands Inspect for color variations Common variations include Abnormal findings include suntanned areas, freckles, or rashes, such as the reddish (in white patches known as light-skinned people) or vitiligo. The variations are due darkened (in dark-skinned to different amounts of people) butterfly rash melanin in certain areas. (also called Malar rash) across the bridge of the nose and cheeks. Assess skin integrity Skin is intact, and there are Skin breakdown is initially no reddened areas. noted as a reddened area on the skin that may progress to serious and painful pressure ulcers. Inspect for lesions: Skin is smooth, without Primary lesions arise from Symmetry, borders and lesions. Stretch marks normal skin due to irritation shape, color, diameter of (striae), healed scars, freckles, or disease. lesions and change in lesion moles, or birthmarks are Secondary lesions (arise from over time. common findings. Freckles or changes in primary moles may be scattered over lesions. the Vascular lesions reddish-bluish skin in no pattern. lesions, are seen with bleeding, venous pressure, aging, liver disease, or pregnancy. Cancerous lesions can be either primary or secondary lesions and are classified as squamous cell carcinoma, basal cell carcinoma, or malignant melanoma Assessing Skin, Hair, and Nails 11 Prepared by: Dennis B. Brosola, RN, MSN  Health Assessment Week 5: Course Material PALPATION Palpate skin to assess Skin is smooth and even Rough, flaky, dry skin is seen in texture. Use the palmar hypothyroidism. Obese clients surface of your three middle often report dry, itchy skin. fingers to palpate skin texture. Palpate to assess thickness. Skin is normally thin but Very thin skin may be seen in calluses (rough, thick sections clients with arterial insufficiency of epidermis) or in those on steroid therapy. are common on areas of the body that are exposed to constant pressure (e.g., the heels). Palpate to assess moisture. Skin surfaces vary from moist Increased moisture or Check under skin folds and in to dry depending diaphoresis (profuse unexposed areas. on the area assessed. Recent sweating) may occur in activity or a warm conditions such as environment may cause fever or hyperthyroidism. increased moisture. Decreased moisture occurs with dehydration or hypothyroidism. Clammy skin is typical in shock or hypotension. Palpate to assess Skin is normally a warm Cold skin may accompany temperature. Use the dorsal temperature. shock or hypotension. surfaces of your hands to Cool skin may accompany palpate the skin arterial disease. Very warm skin may indicate a febrile state or hyperthyroidism. Palpate to assess mobility and Normally, the skin is mobile, Decreased mobility is seen with turgor. Ask the client to lie with elasticity and returns to edema. down. Using two fingers, original shape quickly. Recoil gently pinch the skin over the is usually immediate. clavicle. Mobility: How easily the skin is pinched. Turgor: refers to the skin’s elasticity and how quickly the skin returns to its original shape after being pinched. Palpate to detect edema. Use Skin rebounds and does not Indentations on the skin may your thumbs to press down remain indented when vary from slight to great and on the skin of the feet, ankles, pressure is released. may be in one area or all over or pretibial area to check for the body. edema (swelling related to accumulation of fluid in the tissue). SCALP and HAIR INSPECTION and PALPATION Inspect the scalp and hair for Natural hair color, as opposed Nutritional deficiencies may Assessing Skin, Hair, and Nails 12 Prepared by: Dennis B. Brosola, RN, MSN  Health Assessment Week 5: Course Material general color and condition. to chemically cause patchy gray hair in some Colored hair, varies among clients. Severe malnutrition in clients from pale blond to African black to gray or white. The American children may cause a color is determined by the coppered hair color. amount of melanin present. Excessive scaliness may indicate dermatitis. Raised lesions may indicate infections or tumor growth. Dull, dry hair may be seen with hypothyroidism and malnutrition. Pustules with hair loss in patches are seen in tinea capitis, a contagious fungal disease. Infections of the hair follicle (folliculitis) appear as pustules surrounded by erythema. Inspect amount and Varying amounts of terminal Patchy hair loss may result distribution of scalp, body, hair cover the scalp, axillae, from infections of the scalp, axillae, and pubic hair. body, and pubic areas discoid or systemic lupus according to normal gender erythematosus, and some types distribution. Fine vellus hair of chemotherapy. covers the entire body except for the soles, palms, lips, and Hirsutism (facial hair on nipples. Normal male pattern females) is a characteristic balding is symmetric of Cushing disease and polycystic ovary syndrome (PCOS) and results from an imbalance of adrenal hormones or it may be a side effect of steroids. NAILS INSPECTION Inspect nail grooming and Nails are clean Dirty, broken, or jagged cleanliness fingernails may be seen with poor hygiene. They may also result from the client’s hobby or occupation. Inspect nail color and Pink tones should be seen. Pale or cyanotic nails may markings. Some longitudinal ridging is indicate hypoxia or anemia. normal. Splinter hemorrhages may be caused by trauma. Dark-skinned clients may have freckles or pigmented Yellow discoloration may be streaks in their nails. seen in fungal infections or psoriasis. Nail pitting is also common in psoriasis. Inspect shape of nails There is normally a 160- Early clubbing (180-degree Assessing Skin, Hair, and Nails 13 Prepared by: Dennis B. Brosola, RN, MSN  Health Assessment Week 5: Course Material degree angle between the nail angle with spongy sensation) base and the skin. and late clubbing (greater than 180-degree angle) can occur from hypoxia. Spoon nails (concave) may be present with iron deficiency anemia. PALPATION Palpate nail to assess texture. Nails are hard and basically Thickened nails (especially immobile. toenails) may be caused by decreased circulation and are also seen in onychomycosis. Palpate to assess texture and Nails are smooth and firm; Paronychia (inflammation) consistency, noting whether nail plate should be firmly indicates local infection. nail plate is attached to nail attached to nail bed. Detachment of nail plate from bed. nail bed (onycholysis) is seen in infections or trauma. Test capillary refill in nail Pink tone returns immediately There is slow (greater than 2 beds by pressing the nail tip to blanched seconds) capillary nail bed refill briefly and watching for nail beds when pressure is (return of pink tone) with color change. released. respiratory or cardiovascular diseases that cause hypoxia. Skin Types Classified by their reactions to Ultraviolet Radiation (UVR) Type Definition Description I Always burns but never tans Pale skin, red hair, freckles II Usually burns, sometimes tans Fair skin III May burn, usually tans Darker skin IV Rarely burns, always tans Mediterranean V Moderate constitutional pigmentation Latin American. Middle eastern V1 Marked constitutional pigmentation Black Health Promotion Diagnoses  Readiness for Enhanced Health Management: Skin, hair, and nail integrity related to healthy hygiene and skin care practices, avoidance of overexposure to sun.  Readiness for Health Management: Requests information on skin reactions and effects of using a sun-tanning booth. Risk Diagnoses  Risk for Impaired Skin Integrity related to excessive exposure to cleaning solutions and chemicals.  Risk for Impaired Skin Integrity related to prolonged sun exposure  Risk for Imbalanced Body Temperature related to immobility, decreased production of natural oils, and thinning skin.  Risk for Impaired Skin Integrity of toes related to thickened dried toenails  Risk for Imbalanced Body Temperature related to severe diaphoresis  Risk for Infection related to scratching of rash  Risk for Impaired Nail Integrity related to prolonged use of artificial nails  Risk for Imbalanced Nutrition: less than body requirements related to increased vitamin and protein requirements necessary for healing of a wound  Risk for Infection related to multiple body piercings  Risk for Infection related to periodic skin tattooing Actual Diagnoses Assessing Skin, Hair, and Nails 14 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material  Ineffective Health Maintenance related to lack of hygienic care of the skin, hair, and nails  Impaired Skin Integrity related to immobility and decreased circulation  Impaired Skin Integrity related to poor nutritional intake and bowel/bladder incontinence  Disturbed Body Image related to scarring, rash, or other skin condition that alters skin appearance  Disturbed Sleep Pattern related to persistent itching of the skin  Deficient Fluid Volume related to excessive diaphoresis secondary to excessive exercise and high environmental temperatures Abnormalities of the Skin, Hair and Nails: Common Skin Variations Freckles Vitiligo Pigmentation of Striae the skin Seborrheic keratosis Scar Mole Cutaneous tags Cutaneous horn Cherry angiomas Assessing Skin, Hair, and Nails 15 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Stages of Pressure Ulcer Stage 1: Intact skin with non-blanchable redness of a localized area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer, or cooler as compared with adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones Stage II Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured, serum filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising; bruising indicates suspected deep tissue injury. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration, or Assessing Skin, Hair, and Nails 16 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material excoriation STAGE III Full-thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a stage III pressure ulcer varies by anatomic location. The bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue, and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable. STAGE IV Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling. The depth of a stage IV pressure ulcer varies by anatomic Location. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon, or joint capsule), making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable. UNSTAGEABLE Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/ or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biologic) cover” and should not be removed. Assessing Skin, Hair, and Nails 17 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Primary Skin Lesions MACULE AND PATCH Small, flat, nonpalpable skin color change (skin color may be brown, white, tan, purple, red). Macules are less than 1 cm with a circumscribed border, whereas patches are greater than 1 cm and may have an irregular border. Examples: include freckles, flat moles, petechiae, rubella (pictured below), vitiligo, port wine stains, and ecchymosis. PAPULE AND PLAQUE Elevated, palpable, solid mass. Papules have a circumscribed border and are less than 0.5 cm; plaques are greater than 0.5 cm and may be coalesced papules with a flat top. Examples of papules include elevated nevi, warts, and lichen planus. Examples of plaques include psoriasis (psoriasis vulgaris pictured below) and actinic keratosis. Assessing Skin, Hair, and Nails 18 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material NODULE AND TUMOR Elevated, solid, palpable mass that extends deeper into dermis than a papule. Nodules are 0.5–2 cm and circumscribed; tumors are greater than 1–2 cm and do not always have sharp borders. Examples of nodules include keloid (pictured below), lipoma, squamous cell carcinoma, poorly absorbed injection, and dermatofibroma. Examples: of tumors include larger lipoma and carcinoma. Assessing Skin, Hair, and Nails 19 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Assessing Skin, Hair, and Nails 20 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Primary Skin Lesions Macule and Patch Small, flat, nonpalpable skin color change (skin color may be brown, white, tan, purple, red). Macules are less than 1 cm with a circumscribed border, whereas patches are greater than 1 cm, and may have an irregular border Papule and Plaque Elevated, palpable, solid mass. Papules have a circumscribed border and are less than 0.5 cm; plaques are greater than 0.5 cm and may be coalesced papules with a flat top. Examples of papules include elevated nevi, warts, and lichen planus. Examples of plaques include psoriasis. Vesicle and Bullae Circumscribed elevated, palpable mass containing serous fluid. Vesicles are less than 0.5 cm; bullas are greater than 0.5 cm. Examples of vesicles include herpes simplex/zoster, varicella (chickenpox, pictured below), poison ivy, and second-degree burn. Examples of bulla include pemphigus, contact dermatitis, large burn blisters, poison ivy, and bullous impetigo. Wheal Elevated mass with transient borders that is often irregular. Size and color vary. Caused by movement of serous fluid into the dermis, it does not contain free fluid in a cavity (e.g., vesicle). Examples include urticaria (hives, pictured below) and insect bites. Pustules Pus-filled vesicle or bulla. Examples include acne, impetigo, furuncles, and carbuncles. Assessing Skin, Hair, and Nails 21 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Secondary Skin Lesions Erosion Loss of superficial epidermis that does not extend to the dermis. It is a depressed, moist area. Examples include rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore. Ulcer Skin loss extending past epidermis, with necrotic tissue loss. Bleeding and scarring are possible. Examples include stasis ulcer of venous insufficiency (stasis dermatitis with venous stasis ulcer pictured below) and pressure ulcer. Scar Skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue. Young scars are red or purple, whereas mature scars are white or glistening. Examples include healed wound and healed surgical incision. Fissure Linear crack in the skin that may extend to the dermis and may be painful. Examples include chapped lips or hands and athlete’s foot. Interdigital tinea pedis with fissures and maceration. Assessing Skin, Hair, and Nails 22 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Nail Abnormalities Koilonychia Spoon-shaped nails that may be seen with trauma to cuticles or nail folds or in iron deficiency anemia, endocrine or cardiac disease). Yellow Nail Syndrome Yellow nails grow slow and are curved. May be seen in AIDS and respiratory syndromes. Paronychia Local infection. Longitudinal Ridging Parallel ridges running lengthwise. May be seen in the elderly and some young people with no known etiology. Half-and-Half Nails Nails that are half white on the upper proximal half and pink on the distal half. May be seen in chronic renal disease. Assessing Skin, Hair, and Nails 23 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material VI- ASSESSMENT ACTIVITY Case Study: Mrs. Moly, 49 years old British woman who works as an office manager was diagnosed of breast cancer stage 3 when she was 48 years old. Currently she is receiving her chemotherapy at the Cancer Institute of St. Michael Medical Center. She visits her oncologist, during the interview Ms. Moly stated “My hair was falling out in chunks, and I have a red rash on my face and chest. It looks like a bad case of acne. I feel so ugly and am concerned I may lose my job because of how I look.” She also revealed that her mother died from colon cancer and one of her cousins has recovered from breast cancer. Red rash that began 6 months ago. Located on face, neck, anterior chest, above nipple line, shoulders, and upper back. Recurring, with each episode lasting from 2 days to 2 weeks. Rates the pain as 0–1 on a 0–10 scale; rates the mental anguish as a 9–10 on a 0–10 scale. Rash worsens when exposed to sunlight while surfing. Increased level of anxiety related to the disfigurement. Reports areas of hair loss on her scalp where the rash is present. Ms. Moly loves to go to the fine dining restaurant together with her family on weekends. She never had a chance to do the self-breast examination because according to her it is not necessary for her. She smokes, maximum of 5 cigarettes per day and loves to drink red wine at night. The findings of the physical examination are skin is pink and intact with minimal rashes on the face and chest, skin is dry and there are areas with skin redness. Hair fall is present. Nail beds pink. Fingernails manicured with clear enamel. Nails are hard, smooth, and immobile, forming 160-degree angle at base. Cuticles smooth; no detachment of nail plate. Toenails hard, smooth, immobile, clean, and trimmed. Capillary refill of toes and fingers immediate. Think back of the case. Document the following subjective and objective assessment findings based on Mrs. Cruz eye examination. Biographic data: Reasons for seeking Health care: History of present health concern: Assessing Skin, Hair, and Nails 24 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material Personal health history: Family History: Lifestyle and health practices: Physical Examination findings: Assessing Skin, Hair, and Nails 25 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material VII- ONLINE RESOURCES 1. https://youtu.be/_YG2MdSa8f8 2. https://youtu.be/iH527j4vb0U VIII- REFERENCES Weber, J.R., & Kelley, J.H. (2018). Health Assessment in Nursing. Sixth Edition. Wolters Kluwer Health. Lippincott Williams & Wilkins. Philadelphia. (2) Weber, J.R., & Kelley, J.H. (2014). Health Assessment in Nursing. Fifth Edition. Wolters Kluwer Health. Lippincott Williams & Wilkins. Philadelphia. (3) Estes, M.Z.(2014). Health Assessment and Physical Examination. Fifth Edition. Delamar cengage Learning. New York. IX- POST- TEST Instructions: Define the following terminologies. Two (2) points each. Name: Score: Year and Section: Date: Answer 1. Pallor 2. Cyanosis 3. Jaundice 4. Primary lesions 5. Secondary lesions Assessing Skin, Hair, and Nails 26 Prepared by: Dennis B. Brosola, RN, MSN Health Assessment Week 5: Course Material 6. Vascular lesions 7. Raised lesions 8. Pustules 9. Patchy hair loss 10. Hirsutism 11. Early clubbing 12. Spoon nails 13. Paronychia 14. Central cyanosis 15. Peripheral cyanosis Assessing Skin, Hair, and Nails 27 Prepared by: Dennis B. Brosola, RN, MSN