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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Skin, Hair, and NailsElla Yu (VL)
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-1
Chapter 12
Skin, Hair, and Nails
Structure and Function
Subjective DataHealth History Questions
Objective DataThe Physical Exam
Abnormal Findings
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Structure and Function
Skin three layers
1. Epidermis
Stratum germinativum or basal cell layer Fibrous protein keratine
Melanocytes (same amount)- melanin (varies)
Stratum corneum or horny cell layer
Dead keratinized cells
Slide 12-2
Chapter 12
Skin, Hair, and Nails
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Structure and Function
Skin three layers
2. Dermis
Connective tissue or collagen
Elastic tissue
Nerves, sensory receptors, blood vessel, lymphatic
Appendages from the dermis
Slide 12-2
Chapter 12
Skin, Hair, and Nails
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Structure and Function
Skin three layers
1. Subcutaneous layer
Adipose tissue
Lobules of fat cells
Stores fat for the energy
Provides insulation foe temperature control
Protection- soft cushioning effect
mobility
Slide 12-2
Chapter 12
Skin, Hair, and Nails
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Epidermal appendages
1. Hair
Threads of keratine
Hair shaft (visible projecting part)
Hair root (embedded in the follicles
Bulb matrix (cell production)
Arrector pili muscle- goose skin
2 types: vellus and terminal
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Epidermal appendages
1. Sebaceous glands
Sebum
Lubricate skin and hair Retards water loss from the skin
2. Sweat glands
Eccrine glands
Apocrine glands
3. Nails Hard plates of keratine
Nail matrix
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-3
Chapter 12
Skin, Hair, and Nails
Function of the Skin
Protection
Prevents penetration
Perception
Temperature regulation
Identification
Communication
Wound repair
Absorption and excretion
Production of vitamin D
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Pruritus
Excessive bruising
Rash or lesion Medications
Hair loss
Change in nails
Environmental oroccupational hazards
Self-care behaviors
Slide 12-4
Chapter 12
Skin, Hair, and Nails
Subjective Data
Health History Questions
Previous history of skindisease (allergies, hives,psoriasis, or eczema)
Change in mole
Change in pigmentation(size or color)
Excessive dryness ormoisture
Seborrhea
xerosis
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-5
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam Preparation
External variables that influence skin color
Equipment needed Strong direct lighting
Small centimeter ruler
Penlight
Gloves
For special procedures Woods light
Magnifying glass
Materials for laboratory tests: potassium hydroxide (KOH),
glass slide
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Objective Data
The Physical Exam, cont.
Slide 12-6
Chapter 12
Skin, Hair, and Nails
SkinInspect and Palpate
Color
General pigmentation
Vitiligo
Freckles, mole, birthmark
Abnormal: ABCDE
Widespread color change
Pallor- anemia
Erythema- carbon monoxide poisoning, hyperemia
Cyanosis- increased amount of unoxygenated hemoglobin
Jaundice- increase serum bilirubin
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-12
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.
Promoting Health and Self-Care
Teach skin self-examination, using the ABCDE ruleAasymmetry
Bborder
Ccolor
Ddiameter
Eelevation and enlargement
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 12
Skin, Hair, and Nails
Slide 12-7
Objective Data
The Physical Exam, cont.
SkinInspect and Palpate, cont.
Temperature Hypothermia: general/ localized
Hyperthermia
Moisture
Diaphoresis- profuse perspiration Dehydration
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Objective Data
The Physical Exam, cont.
Chapter 12
Skin, Hair, and Nails
Slide 12-8
SkinInspect and Palpate, cont.
Texture (smooth and firm)
Thickness (callus)
Edema (fluid accumulating in the intracellular space) 1+ , 2+, 3+, 4+
Mobility and turgor (anterior chest under clavicle)
Elasticity of skin Mobility- ease of rising (oedema) Turgor- ability to return to place promptly when release (dehydation)
Vascularity or bruising (abuse- different stage of healing) Cherry angioma tattoo
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Ch 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-9
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.
SkinInspect and Palpate, cont.
Lesions Primary or secondary
Color
Elevation
Pattern or shape
Size
Location and distribution on body
Exudate
Ch t 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-9
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.SkinInspect and Palpate,
cont.
Lesions Woods light detects
fluorescing lesions Lesions with blue-green
fluorescence indicatefungal infection, such astinea capitis (scalpringworm)
Potassium Hydroxide (KOH)preparation helps dignosesuperficial fungal infectionas it can dissolve nonfungalskin debris
Ch t 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-10
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.
HairInspect and Palpate
Color Texture
Distribution
Lesions Seborrhoea
Nits of lice
Ch t 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-11
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.
NailsInspect and Palpate
Shape and contour Profile sign
Consistency
Color
Capillary refill
Ch t 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-12
Chapter 12
Skin, Hair, and Nails
Objective Data
The Physical Exam, cont.
Promoting Health and Self-Care
Teach skin self-examination, using the ABCDE ruleAasymmetry
Bborder
Ccolor
Ddiameter
Eelevation and enlargement
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-13
Chapter 12
Skin, Hair, and Nails
Abnormal FindingsCommon Shapes and
Configurations of Lesions
Annular or circular
Confluent
Discrete
Grouped
Gyrate
Target or iris
Linear
Polycyclic
Zosteriform
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Gyrate Grouped
Linear
Zosteriform
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Urticaria (hives)
Vesicle
Cyst
Bulla
Pustule
Slide 12-14
Chapter 12
Skin, Hair, and Nails
Abnormal FindingsPrimary and Secondary Skin Lesions
Primary skin lesions
Macule
Papule
Patch
Plaque
Nodule
Wheal Tumor
Excoriation
Scar
Atrophic scar
Lichenification
Keloid
Secondary skin lesions
Crust
Scale
Fissure
Erosion
Ulcer
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Primary Skin lesion
A lesion develops on previously unaltered skin
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Macule
Flat and circumscribed
Less than 1 cm
Papule
Solid, elevatedLess than 1 cm
Nodule
Solid, elevatedLarger than 1 cm
Extend to dermis
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Wheal-superficail,-Erythematous--mosquito bite
Pustule
- pus
- acne
Vesicle
-Up to 1 cm-Clear serum-Chicken pox-Herpes simplex
Cyst
- Fluid filled in dermis/
Subcutaneous layer-
Crust
-Dry on abrasion
Scab following
abrasion
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Secondary skin lesion
A lesion change over time or changes because of afactor such as scratching or infection
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Scale
-psoriasis
Fissure
-linear crack
-extend to dermis
-Athelets foot
Excoriation
-superficial, sometimes crusted
-self inflicted abrasion
-Scratches from intense itching-insect bits, scabies
Ulcer
-deeper depression to dermis
-Pressure sore
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-14
Chapter 12
Skin, Hair, and Nails
Scar Atrophic scar
Keloid
-excsess scar tissue
Lichenification
-intense scratching
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-15
Chapter 12
Skin, Hair, and Nails
Abnormal FindingsVascular Lesions
Hemangiomas Port-wine stain (nevus
flammeus)
Strawberry mark
(immature
hemangioma)
Cavernous
hemangioma (mature)
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-15
Chapter 12
Skin, Hair, and Nails
Abnormal FindingsVascular Lesions
Telangiectases
Spider or star angioma
Venous lake
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-15
Chapter 12
Skin, Hair, and Nails
Abnormal FindingsVascular Lesions
Purpuric lesions
Petechiae
Purpura
Lesions due to trauma or abuse
Pattern injury
Hematoma
Ecchymosis (bruise)
Chapter 12
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Slide 12-15
p
Skin, Hair, and Nails
Abnormal FindingsVascular Lesions
Lesions due to trauma orabuse
Pattern injury
Hematoma Ecchymosis (bruise)
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-16
p
Skin, Hair, and Nails
Abnormal FindingsCommon Skin Lesions in Children
Diaper dermatitis
Interigo (candidiasis)
Impetigo
Atopic dermatitis (eczema)
Measles (rubeola) German measles (rubella)
Chickenpox (varicella)
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Chicken pox
Psoriasis
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-17
Skin, Hair, and Nails
Abnormal FindingsCommon Skin Lesions
Primary contact dermatitis
Allergic drug reaction
Tinea corporis (ringworm of the body)
Tinea pedis (ringworm of the foot)
Psoriasis
Tinea versicolor
Labial herpes simplex (cold sores)
Herpes zoster (shingles)
Erythema migrans of Lyme disease
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-18
Skin, Hair, and Nails
Abnormal FindingsMalignant Skin Lesions
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
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Squamous cell carcinoma Malignant Melanoma
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Slide 12-19
Skin, Hair, and Nails
Abnormal FindingsSkin Lesions Associated with AIDS
Epidemic Kaposis sarcoma
Patch stage
Plaque stage Advanced disease
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.Slide 12-20
Skin, Hair, and Nails
Abnormal FindingsInfectious Disease
as a Biological Weapon
Anthrax
Smallpox (variola major)
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
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Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.
Copyright 2003, Elsevier Science (USA). All rights reserved.Slide 12-21
Skin, Hair, and Nails
Abnormal FindingsAbnormal Conditions of Hair
Seborrheic dermatitis (cradle cap)
Tinea capitis (scalp ringworm)
Toxic alopecia
Alopecia areata
Traumatic alopecia, traction alopecia
Trichotillomania
Pediculosis capitis (head lice) Folliculitis
Hirsutism
Furuncle and abscess
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright 2003, Elsevier Science (USA). All rights reserved.
Chapter 12
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Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright 2003, Elsevier Science (USA). All rights reserved.
Slide 12-22
Skin, Hair, and Nails
Abnormal Findings
Abnormal Conditions of the Nails
Koilonychia (spoonnails)
Paronychia Beaus line
Splinter hemorrhages
Late clubbing
Onycholysis
Habit-tic dystrophy
Pitting
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Chapter 12
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Skin, Hair, and Nails
Abnormal Findings
Abnormal Conditions of the Nails