Bates Guide to Physical Examination -
Hair/Skin/Nails Lecture, Chapter 6
Nursing Assessement 2022
Common or concerning symptoms for hair/skin/nails?
... [Show More] - Answer- Hair loss, Rash,
Moles
When inspecting and palpating the skin, note characteristics of... - Answer- 1. Color
2. Moisture
3. Temperature
4. Texture
5. Mobility and turgor
6. Lesions
Best places to assess red color of oxyhemoglobin... - Answer- fingertips, lips, and
mucous membranes
(dark skin? - palms and soles)
Where to look for central cyanosis? - Answer- Lips, oral mucosa and tongue
Where to look for jaundice? - Answer- Sclera of eyes
Peripheral cyanosis occurs - Answer- when cutaneous blood flow decreases and
slows and tissues extract more oxygen than usual from the blood. This is normal,
and may be a response to anxiety or a cold environment.
Vellus hair - Answer- short, fine and inconspicuous
Terminal hair - Answer- coarser, thicker, more conspicuous, usually pigmented
(scalp, eyebrows)
Types of sweat glands - Answer- eccrine - control body temp
apocrine - axillary and genital regions
Causes of itching without rash... - Answer- dry skin
pregnancy
uremia
jaundice
lymphomas and leukemia
drug reaction
lice
diabetes and thyroid disease
Pallor - Answer- Results from decreased redness in anemia and decreased blood
flow (fainting or arterial occlusion)
Causes of central cyanosis - Answer- advanced lung disease, congenital heart
disease, hemoglobinopathies
Cyanosis of heart failure is - Answer- usually peripheral, reflecting deoxygenation or
impaired circulation
COPD and pulmonary edema may give rise to central cyanosis
Jaundice suggests - Answer- liver disease or excessive hemolysis of red blood cells
Erythema - Answer- Red skin hue due to increased blood flow
When testing mobility and turgor... mobility is... turgor is... - Answer- Mobility - the
ease with which the skin lifts up
Turgor - the speed with which the lifted skin returns to place
Café-Au-Lait Spot
Slightly but uniformly pigmented macule or patch with a somewhat irregular border,
benign - Answer- Six or more suggests neurofibromatosis
Tinea Versicolor
Common superficial fungal infection of the skin, causing hypo- or hyperpigmented ("
versicolor"), slightly scaly macules on the trunk, neck, and upper arms (short-sleeved
shirt distribution). - AnswerVitiligo
Depigmented macules appear on the face, hands, feet, extensor surfaces, and other
regions and may coalesce into extensive areas that lack melanin. The brown
pigment is normal skin color; the pale areas are vitiligo. The condition may be
hereditary. - AnswerCyanosis - Answer- Bluish color that is visible in fingers/toes
Jaundice - Answer- Diffusely yellow skin caused by liver disease and hemolysis of
red blood cells
Carotenemia - Answer- Caused by high diets in carrots or other yellow vegetables or
fruits
Heliotrope - Answer- violaceous patches over the eyelids in the collagen vascular
disease dermatomyositis
Pityriasis Rosea - Answer- Reddish oval ringworm-like papules or plaques
Psoriasis - Answer- Thick, small to very large plaques, which are pink or red with
silvery white scale. Typical locations are elbows, knees and lower back (sacral area).
Often pruritic.
Tinea versicolor - Answer- tan, flat, scaly plaques
Atopic Eczema (adult) - Answer- Appears mainly on flexor surfaces
Linear skin lesions - AnswerGeographic skin lesion
(Mycosis fungoides) - Answerlinear epidermal nevus - AnswerSerpiginous (Tinea corporis) - AnswerClustered (grouped vesicles of herpes simplex) - AnswerAnnular, acriform (annular plaque of tinea faciale) - AnswerMacule - Answer- Small flat spot up to 1.0 cm
(ex. hemangioma, vitiligo)
Patch - Answer- Flat spot, 1.0 cm or larger
(ex. cafe-au-lait spot)
Palque - Answer- Elevated lesion 1.0 cm or larger, often formed by coalescence of
papules
(ex. psoriasis)
Papule - Answer- Up to 1.0 cm
(ex. psoriasis)
Nodule - Answer- Knot-like lesion larger than 0.5 cm, deeper and firmer than a
papule
(dermatofibroma)
Cyst - Answer- Nodule filled with expressible material, either liquid or semi-solid
(ex. epidermal inclusion cyst)
Wheal - Answer- Somewhat irregular, relatively transient, superficial area of localized
skin edema
(ex. urticaria)
Vesicle - Answer- Up to 1.0 cm, filled with serous fluid
(ex. herpes simplex, herpes zoster)
Bulla - Answer- 1.0 cm or larger, filled with serous fluid
Pustule - Answer- filled with pus
Burrow (scabies) - Answer- minute, slightly raised tunnel in the epidermis, commonly
found on the finger webs and on the sides of the fingers - looks like a short, linear or
curved gray line and may end in a tiny vesicle. Lesions may include papules,
pustules, lichenified areas, excoriations.
Scale - Answer- thin flake of dead exfoliated epidermis
(ex. ichthyosis vulgaris)
Crust - Answer- The dried residue of skin exudates such as serum, pus, or blood
Lichenification - Answer- visible and palpable thickening of the epidermis and
roughening of the skin with increased visibility of the normal skin furrows (often from
chronic rubbing)
Scars - Answer- Increased connective tissue that arises from injury or disease
Keloids - Answer- Hypertrophic scarring that extends beyond the borders of the
initiating injury
Erosion - Answer- Nonscarring loss of the superficial epidermis; surface moist but
does not bleed
(ex. aphthous stomatitis - moist area after the rupture of a vesicle, as in chickenpox)
Excoriation - Answer- Linear or punctate erosions caused by scratching
Fissure - Answer- Linear crack in the skin, often resulting from excessive dryness
Ulcer - Answer- A deeper loss of epidermis and dermis; may bleed and scar
(syphilitic chancre)
Mild acne - Answer- open and closed comedone, occasional papules
Moderate acne - Answer- comedones, papules, pustules
Severe cystic acne - Answer-
acne with pitting and scars - Answeractinic keratosis - Answer- superficial, hyperkeratotic papules. Often multiple; can be
round or irregular, pink, tan or grayish.
Seborrheic Keratosis - Answer- Common, benign, whitish-yellowish to brown raised
papules or plaques that feel slightly greasy and velvety or warty and have a "stuck
on" appearance.
Basal cell carcinoma - Answer- 80% of skin cancers. Shiny and translucent,
grows slowly and almost never metastasizes.
Squamous cell carcinoma - Answer- 16% of skin cancers, crusted, scaly, and
ulcerated. grows more quickly than a basal cell, is firmer and looks redder
Benign Nevus - Answer- Round or oval shape
Sharply defined boarders
uniform in color, especially skin-colored, tan or brown
Diameter <6mm but >10mm if congenital
flat or raised surface
Atypical (dysplastic) nevi - AnswerMalignant Melanoma
ABCDEs - Answer- 4% of skin cancers, rapidly increasing in frequency, spread
rapidly.
Asymmetry
Irregular boarders
Variation in Color
Diameter >6mm
Evolution or change in size
Stage I pressure ulcer - Answer- Presence of a reddened area that fails to blanche
with pressure, and changes in temperature, consistency, sensation, or color
Stage II pressure ulcer - Answer- skin forms a blister or sore. Partial-thickness skin
loss or ulceration involving the epidermis, dermis or both
Stage III pressure ulcer - Answer- A crater appears in the skin, with full-thickness
skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but
not through, underlying muscle
Stage IV pressure ulcer - Answer- Full-thickness skin loss, with destruction, tissue
necrosis, or damage to underlying muscle, bone, and sometimes tendons and joints.
Alopecia areata - Answer- clearly demarcated round or oval patches of hair loss
Trichotillomania - Answer- hair loss from pulling, plucking, or twisting hair. Shafts are
broke and of varying lengths.
Tinea Capitis - Answer- Round scaling patches of alopecia. Hairs broken off close to
the surface of the scalp
Paronychia - Answer- Superficial infection of the proximal and lateral nail folds
adjacent to the nail plate. Usually from Staphylococcus aureus or Streptococcus
species.
Clubbing of the fingers - AnswerOnycholysis - Answer- Painless separation of the whitened opaque nail plate from
the pinker translucent nail bed.
Terry's Nails - Answer- Nail plate turns white with a ground-glass appearance, a
distal band of reddish brown and obliteration of the lunula.
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