Lecture Integumentary Presentation 09

8/14/2019 Lecture Integumentary Presentation 09

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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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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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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



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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



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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



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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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Slide 12-3

Chapter 12


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


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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Slide 12-5

Chapter 12


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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Objective Data

The Physical Exam, cont.

Slide 12-6

Chapter 12


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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Slide 12-12

Chapter 12


Objective Data


Promoting Health and Self-Care

Teach skin self-examination, using the ABCDE ruleAasymmetry

Bborder

Ccolor

Ddiameter

Eelevation and enlargement


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Chapter 12


Slide 12-7

Objective Data


SkinInspect and Palpate, cont.

Temperature Hypothermia: general/ localized

Hyperthermia

Moisture

Diaphoresis- profuse perspiration Dehydration


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Objective Data


Chapter 12


Slide 12-8


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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Ch 12


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Slide 12-9

Chapter 12


Objective Data



Lesions Primary or secondary

Color

Elevation

Pattern or shape

Size

Location and distribution on body

Exudate

Ch t 12


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Slide 12-9

Chapter 12


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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Slide 12-10

Chapter 12


Objective Data


HairInspect and Palpate

Color Texture

Distribution

Lesions Seborrhoea

Nits of lice

Ch t 12


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Slide 12-11

Chapter 12


Objective Data


NailsInspect and Palpate

Shape and contour Profile sign

Consistency

Color

Capillary refill

Ch t 12


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Slide 12-12

Chapter 12


Objective Data


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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Slide 12-13

Chapter 12


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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Urticaria (hives)

Vesicle

Cyst

Bulla

Pustule

Slide 12-14

Chapter 12


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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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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Slide 12-14

Chapter 12


Scar Atrophic scar

Keloid

-excsess scar tissue

Lichenification

-intense scratching

Chapter 12


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Slide 12-15

Chapter 12


Abnormal FindingsVascular Lesions

Hemangiomas Port-wine stain (nevus

flammeus)

Strawberry mark

(immature

hemangioma)

Cavernous

hemangioma (mature)

Chapter 12
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Slide 12-15

Chapter 12



Telangiectases

Spider or star angioma

Venous lake

Chapter 12


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Slide 12-15

Chapter 12



Purpuric lesions

Petechiae

Purpura

Lesions due to trauma or abuse

Pattern injury

Hematoma

Ecchymosis (bruise)

Chapter 12


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Slide 12-15

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Lesions due to trauma orabuse

Pattern injury

Hematoma Ecchymosis (bruise)


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Chapter 12


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Slide 12-16

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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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Slide 12-17


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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Chapter 12


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Slide 12-18


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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Slide 12-19


Abnormal FindingsSkin Lesions Associated with AIDS

Epidemic Kaposis sarcoma

Patch stage

Plaque stage Advanced disease
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Chapter 12
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Chapter 12
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Copyright 2003, Elsevier Science (USA). All rights reserved.Slide 12-21


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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Chapter 12


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Slide 12-22


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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Abnormal Findings

Abnormal Conditions of the Nails

Lecture Integumentary Presentation 09

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