Skin

Question 1

Functions of the Skin

Answer 1

-PROTECTION FROM ENVIRONMENT
* BODY TEMPERATURE REGULATION
* PREVENTS PENETRATION
* PERCEPTION
* TEMPERATURE REGULATION
* PSYCHOSOCIAL
* IDENTIFICATION
* COMMUNICATION
* SENSATION
* VITAMIN D PRODUCTION
* IMMUNOLOGIC
* ABSORPTION
* ELIMINATION

Question 2

MUCOUS MEMBRANES (functions)

Answer 2

• LINE BODY CAVITIES
• DIGESTIVE TRACT, RESPIRATORY PASSAGES, URINARY AND REPRODUCTIVE TRACTS
• SECRETE MUCOUS
• HAVE RECEPTORS THAT OFFER PROTECTION
• INSENSITIVE TO TEMPERATURE, BUT SENSITIVE TO PRESSURE

Question 3

What are the two layers of the skin

Answer 3

Epidermis
Dermis

Question 4

Epidermis layers and characteristics

Answer 4

• BASAL CELL LAYER- FORMS NEW SKIN CELLS- CONTAINS THE PROTEIN ‘KERATIN’
• MELANOCYTES – DERIVATION OF SKIN COLOR
• OUTER HORNY CELL LAYER OF DEAD KERATINIZED CELLS (OUTER LAYER)
• REPLACED Q4 WKS

Question 5

Dermis layers and characteristics

Answer 5

INNER SUPPORTIVE LAYER
* CONNECTIVE TISSUE (COLLAGEN)
* ELASTIC TISSUE

Question 6

Types of hair

Answer 6

• VELLUS HAIR
• TERMINAL HAIR

Question 7

Types of glands

Answer 7

• SEBACEOUS GLANDS-SEBUM SECRETION
• SWEAT GLANDS: IMPORTANT FOR FLUID BALANCE AND THERMOREGULATION
  * ECCRINE GLANDS
  * APOCRINE GLANDS

Question 8

Functions of the skin

Answer 8

• SKIN IS WATERPROOF, PROTECTIVE, AND ADAPTIVE
• PROTECTION FROM ENVIRONMENT
• PREVENTS PENETRATION
• PERCEPTION
• TEMPERATURE REGULATION
• IDENTIFICATION
• COMMUNICATION
• WOUND REPAIR
• ABSORPTION AND EXCRETION
• PRODUCTION OF VITAMIN D

Question 9

Factors affecting the skin

Answer 9

• UNBROKEN AND HEALTHY SKIN AND MUCOUS MEMBRANES ACT AS A DEFENSE
• RESISTANCE TO INJURY IS AFFECTED BY AGE, AMOUNT OF UNDERLYING TISSUE, AND ILLNESS.
• ADEQUATELY NOURISHED AND HYDRATED BODY CELLS ARE RESISTANT TO INJURY.
• ADEQUATE CIRCULATION IS NECESSARY TO MAINTAIN CELL LIFE.

Question 10

Risk factors affecting the skin

Answer 10

• IV DRUG USE
• PROLONGED SUN EXPOSURE
• BODY PIERCING
• INCREASED AGE
• DEHYDRATION AND MALNUTRITION
• REDUCED SENSATION
• DIABETES
• GI PREPARATIONS FOR TESTING
• BEDREST
• CASTS
• MEDICATIONS
• RADIATION THERAPY

Question 11

DEVELOPMENTAL CONSIDERATIONS

Answer 11

• UNDER AGE 2 THE SKIN IS THINNER, BUT BECOMES INCREASINGLY RESISTANT TO INJURY AND INFECTION AS CHILDREN AGE
• AGING CHANGES OF SKIN:
  
  • THINNER, MORE EASILY DAMAGED
  • DECREASED SENSATION OF PRESSURE
  • DECREASED SWEAT GLAND ACTIVITY – DRIER SKIN
  • DECREASED CELL RENEWAL – DELAYED HEALING
  • DECREASED MELANOCYTES – GRAY/WHITE HAIR AND UNEVEN PIGMENTATION OF SKIN

Question 12

DEVELOPMENTAL COMPETENCE: INFANTS

Answer 12

NEWBORN INFANTS:

• LANUGO: FINE DOWNY HAIR OF NEWBORN INFANT
• VERNIX CASEOSA: THICK, CHEESY SUBSTANCE
• SEBUM: HOLDING WATER IN THE SKIN PRODUCING

Question 13

Aging adults considerations/Changes

Answer 13

ELASTICITY
* LOSES ELASTICITY; SKIN FOLDS AND SAGS
* SWEAT AND SEBACEOUS GLANDS
* DECREASE IN NUMBER AND FUNCTION, LEAVING SKIN DRY
* SKIN BREAKDOWN DUE TO MULTIPLE FACTORS
* CELL REPLACEMENT IS SLOWER WOUND HEALING IS DELAYED
* SENILE PURPURA
* DISCOLORATION DUE TO INCREASING CAPILLARY FRAGILITY
* HAIR MATRIX
* FUNCTIONING MELANOCYTES DECREASE, LEADING TO GRAY FINE HAIR
* KERATOSES
* RAISED THICKEND AREA OF PIGMENTATION-CRUSTY OR WARTY IN APPEARANCE
* SKIN TAGS
* OVERGROWTH OF SKIN WITH A STALK.

Question 14

Risk factors for skin issues

Answer 14

• HIGH EXPOSURE TO UV RADIATION (SUN\TANNING BEDS)
• FAMILY HISTORY OF MELANOMA
• ATYPICAL OR NUMBERS MOLES (>50)
• INCREASE RISK FOR: EASY BURNERS, NATURAL BLOND\RED HAIR

Question 15

Subjective Data: Health history questions

Answer 15

• PAST HISTORY OF SKIN
  DISEASE, ALLERGIES, HIVES, PSORIASIS, OR ECZEMA?
• CHANGE IN PIGMENTATION OR COLOR?
• CHANGE IN MOLE SIZE, SHAPE, COLOR, TENDERNESS?
• EXCESSIVE DRYNESS OR MOISTURE?
• PRURITUS OR SKIN ITCHING?
• EXCESSIVE BRUISING?
• RASH OR LESIONS?
• MEDICATIONS: PRESCRIPTION and OTC drugs
• HEALTH HISTORY
• HAIR LOSS?
• CHANGE IN NAILS’ SHAPE, COLOR, OR BRITTLENESS?
• ENVIRONMENTAL OR OCCUPATIONAL HAZARDS?
• SELF-CARE BEHAVIORS?

Question 16

Objective data when assessing the skin

Answer 16

• PREPARATION
  * CONSCIOUSLY ATTEND TO SKIN CHARACTERISTICS; THE DANGER IS ONE OF
  OMISSION
• EQUIPMENT NEEDED
  * STRONG DIRECT LIGHTING, GLOVES, PENLIGHT, AND SMALL CENTIMETER RULER
• COMPLETE PHYSICAL EXAMINATION
  * SKIN ASSESSMENT INTEGRATED THROUGHOUT EXAMINATION
  * SCRUTINIZE THE OUTER SKIN SURFACE FIRST BEFORE YOU CONCENTRATE ON
  underlying structure
• SEPARATE INTERTRIGINOUS AREAS (AREAS WITH SKINFOLDS) SUCH AS UNDER LARGE BREASTS, OBESE ABDOMEN, AND GROIN AND INSPECT THEM THOROUGHLY
  * THESE AREAS ARE DARK, WARM, AND MOIST AND PROVIDE PERFECT CONDITIONS
  FOR IRRITATION OR INFECTION
• ALWAYS INSPECT FEET, TOENAILS, AND BETWEEN TOES

Question 17

Objective inspection of the skin

Answer 17

• COLOR-KNOW BASELINE!
• GENERAL PIGMENTATION, FRECKLES, MOLES, BIRTHMARKS
• WIDESPREAD COLOR CHANGE
  * NOTE COLOR CHANGE OVER ENTIRE BODY SKIN, SUCH AS PALLOR (PALE), ERYTHEMA
  (RED), CYANOSIS (BLUE), OR JAUNDICE (YELLOW)
• WHITE (PALLOR)
  * REFLECTS ANEMIA
• RED
  * ERYTHEMA
• BLUE
  * CYANOSIS
• YELLOW-ORANGE
  * JAUNDICE

Question 18

Objective Palpation of the skin

Answer 18

• TEMPERATURE
  * USE BACKS OF HANDS TO PALPATE PERSON
  * SKIN SHOULD BE WARM, AND TEMPERATURE EQUAL BILATERALLY; WARMTH
  SUGGESTS NORMAL CIRCULATORY STATUS
  * HANDS AND FEET MAY BE SLIGHTLY COOLER IN A COOL ENVIRONMENT
  * HYPOTHERMIA
  * HYPERTHERMIA
  * MOISTURE
  * DIAPHORESIS
  -Dehydration
  * TEXTURE
  * THICKNESS
  * EDEMA (0-4)
  * MOBILITY AND TURGOR

Question 19

Objective Inspection- VASCULARITY OR
BRUISING

Answer 19

• CHERRY ANGIOMAS
• MULTIPLE BRUISES AT DIFFERENT STAGES OF HEALING AND EXCESSIVE BRUISES ABOVE KNEES OR ELBOWS SHOULD RAISE CONCERN ABOUT PHYSICAL ABUSE
• NOTE TATTOOS
• NEEDLE MARKS OR TRACKS FROM INTRAVENOUS INJECTION OF STREET DRUGS MAY
  BE VISIBLE ON ANTECUBITAL FOSSAE.
• PROMOTING HEALTH AND SELF-CARE
  * SELF INSPECTION
  * SUNSCREEN
  * HATS, CLOTHING
• EMOLLIENTS/LUBRICANTS

Question 20

ABCDE-EFG (name them, not specific)

Answer 20

TEACH SKIN SELF-EXAMINATION USING ABCDEF RULE TO DETECT SUSPICIOUS LESIONS
* A – ASYMMETRY
* B – BORDER
* C – COLOR
* D – DIAMETER
* E – EVOLVING

Question 21

• A – ASYMMETRY
• B – BORDER
• C – COLOR
• D – DIAMETER
• E – EVOLVING

Answer 21

-ELEVATED
* FIRM TO PALPATION
* GROWING PROGRESSIVELY OVER SEVERAL WEEKS
* LESIONS: IF ANY ARE PRESENT ALSO NOTE:
* PATTERN OR SHAPE
* SIZE
* LOCATION AND DISTRIBUTION ON BODY
* ANY EXUDATE: NOTE COLOR AND ODOR
* PALPATE LESION
* ROLL FOR DEPTH
* BLANCHING

Question 22

LESIONS- SHAPES AND CONFIGURATION

Answer 22

• ANNULAR OR CIRCULAR
• CONFLUENT
• DISCRETE
• GROUPED
• TARGET OR IRIS “BULLS EYE”
• LINEAR
• ZOSTERIFORM
• CONFLUENT
• DISCRETE
• GROUPED

Question 23

SECONDARY SKIN LESIONS: How do they develop?

Answer 23

RESULTING FROM A CHANGE IN A PRIMARY LESION FROM THE PASSAGE OF TIME; AN EVOLUTIONARY CHANGE

Question 23

Types of Primary Skin Lesions

Answer 23

• MACULES: FLAT
• PAPULES: SOLID, RAISED
• PUSTULES: PUS
• VESICLES/ BULLA: TRAPPED FLUID UNDER SKIN
• URTICARIA (HIVES): RED, ITCHY WELTS
  CYST: BENIGN, ROUND, DOME-SHAPED ENCAPSULATED LESION, CONTAINS FLUID OR SEMI-
  FLUID MATERIAL
• NODULE: SOLID, ELEVATED, HARD OR SOFT.
• WHEAL: SUPERFICIAL RAISED, TRANSIENT AND REDDENED, IRREGULAR SHAPE FROM EDEMA.

Question 23

PRIMARY SKIN LESIONS: Where do they develop?

Answer 23

PRIMARY LESIONS DEVELOP ON PREVIOUSLY UNALTERED SKIN

Question 24

Types of secondary skin issues

Answer 24

* DEBRIS ON SKIN SURFACE: * CRUSTS: DRYING OF PLASMA OR EXUDATE ON THE SKIN * SCALES: FLAKES REPRESENTING COMPACTED DESQUAMATED LAYERS * BREAK IN CONTINUITY OF SKIN SURFACE * FISSURES: LINEAR CLEAVAGE OF SKIN * EROSIONS: SLIGHTLY DEPRESSED AREAS * ULCERS: NECROSIS * EXCORIATIONS: ABRADED SKIN * SCARS: PERMANENT FIBROTIC * LICHENIFICATION: THICK AND LEATHERY SKIN

Question 25

ABNORMAL FINDINGS: VASCULAR AND PURPURIC

Answer 25

* VASCULAR LESIONS * PORT-WINE STAIN (NEVUS FLAMMEUS) * STRAWBERRY MARK (IMMATURE HEMANGIOMA) * SPIDER ANGIOMA * TELANGIECTASIA * PURPURIC LESIONS * PETECHIAE * PURPURA LESIONS CAUSED BY TRAUMA OR ABUSE * PATTERN INJURY * HEMATOMA * CONTUSION (BRUISE)