Chapter 13: Skin, Hair, and Nails Exam 2022
Skin - Answer- largest organ of the body, it covers 20 feet of surface area in the
average adult
What are
... [Show More] the two layers of the skin? - Answer- epidermis (outer layer)
dermis (inner layer)
Epidermis - Answer- -thin but tough
-gets replaced every 4 weeks
What is skin color derived from? - Answer- -mainly from brown pigment (melanin)
-from the yellow-orange tones of the pigment carotene
-from the red-purple tones in the underlying vascular bed (all people have skin of
varying shades of brown, yellow, and red; the relative proportion of these shades
affects the prevailing color
Dermis - Answer- inner supportive layer consisting of mostly connective tissue or
collagen
Subcutaneous Layer - Answer- adipose tissue, which is lobules of fat cells
Nails - Answer- hard plates of keratin on the dorsal edges of the fingers and toes
Function of the skin - Answer- -protection: skin minimizes injury from physical,
chemical, thermal, and light-wave sources
-prevents Penetration: skin is a barrier that stops invasion of microorganisms and
loss of water and electrolytes from within the body
-perception: skin is a vast sensory surface holding the neurosensory end-organs for
touch, pain, temp, and pressure
-temperature regulation: skin allows heat dissipation through sweat glands and heat
storage through subcutaneous insulation
-Identification: people identify one another by unique combinations of facial
characteristics, hair, skin, color, and even fingerprints. self-image is often enhanced
or diminished by the way society's standards of beauty measure up to each persons
perceived characteristics
-communication: emotions are expressed in the sign language of face and body
posture. vascular mechanisms such as blushing or blanching also signal emotional
states
-wound repair: skin allows cell replacement of surface
-absorption and excretion: skin allows limited excretion of some metabolic wastes,
by-products of cellular decomposition such as minerals, sugars, amino acids,
cholesterol, uric acid, and urea
-Production of Vitamin D: the skin is the surface on which ultraviolet (UV) light
converts cholesterol into vitamin D
The Aging Adult - Answer- -skin loses its elasticity; it looks parchment thin, lax, dry,
and wrinkled
-outer layer of epidermis thins and flattens
-a loss of elastin, collagen, and subq fat and reduction in muscle tone occur
-sweat and sebaceous glands decrease in number and function, leaving dry skin
-vascularity of the skin diminishes while the vascular fragility increases; a minor
trauma may produce dark red discolored areas or senile purpura
-coarse wrinkling, decreased elasticity, atrophy, speckled and uneven coloring, more
pigment changed, and a yellowed, leathery texture occur
Genetic Script - Answer- -determines the onset of graying and the number of gray
hairs
-hair distribution changes
-males have symmetric W-shaped balding in the frontal areas
-some testosterone is present in both males and females
-as females estrogen decreases, testosterone is unopposed and the female may
have some bristly facial hairs
-nails grow more slowly
Keloids - Answer- -scars that form from the site of a wound and grow beyond normal
boundaries of the wound
Hypopigmentation - Answer- Absence of pigment, resulting in light or white
splotches.
Hyperpigmentation - Answer- darkened areas of skin caused by excessive amounts
of melanin
Pseudofolliculitis - Answer- Also known as razor bumps; resembles folliculitis without
the pus or infection.
Melasma - Answer- The "mask of pregnancy," a patchy tan-to-dark brown
discoloration of the face.
Seborrhea - Answer- oily
Xerosis - Answer- dry
Subjective Data: What do you ask patient about? - Answer- 1. past history of skin
disease
2. change in pigmentation
3. change in mole
4. excessive dryness or moisture
5. pruritis (itching)
6. excessive bruising
7. rash or lesion
8. medications
9. hair loss
10. change in nails
11. environmental or occupational hazards
12. patient centered care
Additional History for the Aging Adult - Answer- 1. what changes have you notices in
your skin in the past few years
2. any delay in wound healing?
3. any other skin pain?
Alopecia - Answer- significant loss of hair
Hirsutism - Answer- shaggy or excessive hair
Variables influencing skin color: Emotions - Answer- -fear, anger --> peripheral
vasoconstriction --> false pallor
-embarrassment --> flushing in face and neck --> false erythema
Variables influencing skin color: Environment - Answer- -hot room --> vasodilation --
> false erythema
-chilly or AC room --> vasoconstriction --> false pallor, coolness
-cigarette smoking --> vasoconstriction --> false pallor
Variables influencing skin color: Physical - Answer- -prolonged elevation -->
decreased arterial perfusion --> pallor, coolness
-dependent position --> venous pooling --> redness, warmth, distended veins
-immobilization, prolonged activity --> slowed circulation --> pallor, coolness, pale
nail beds, prolonged capillary filling time
The Complete Physical Examination - Answer- skin assessment is integrated
throughout the complete examination, it is not a separated step
The Regional Examination - Answer- help the person remove clothing and assess
the skin as one entity
Inspect and Palpapte: Color - Answer- observe skin tone
Vitiligo - Answer- complete absence of melanin pigment in patchy areas of white or
light skin on the face, neck, hands, feet, and body folds and around orifices
ABCDEF - Answer- Asymmetry
Border
Color
Diameter
Elevation
Feeling
Pallor - Answer- -when the red-pink tones from the oxygenated hemoglobin in the
blood are lost, the skin takes on the color of the connective tissue (collagen), which
is mostly white
-common in acute high-stress states such as anxiety or fear because of the powerful
peripheral vasoconstriction from sympathetic nervous system stimulation
What is oliguria? - Answer- Less than 400 cc of urine in 24 hours
Erythema - Answer- intense redness of the skin from excess blood (hyperemia) in
the dilated superficial capillaries
Cyanosis - Answer- -bluish mottled color from decreased perfusion
-the tissues have high levels of deoxygenated blood
-best seen in the lips, nose, cheeks, ears, and oral mucous membranes and in
artificial fluorescent light
Jaundice - Answer- yellowish skin color indicates rising amounts of bilirubin in the
blood
Temperature - Answer- palpate the skin, it should be warm, and the temp should be
equal bilaterally, warmth suggests normal circulatory status
(check with the back of hand (dorsal))
Diaphoresis - Answer- profuse sweating
Edema - Answer- -fluid accumulating in the interstitial spaces; t is not present
normally
-to check, imprint your thumbs firmly for 3-4 seconds against the ankle malleolus or
the tibia, normally the skin surface stays smooth
-if pressure leaves a dent, edema is present
Mobility and Turgor - Answer- -pinch up large fold of skin on anterior chest under
clavicle
-mobility: ease of skin to rise
-turgor: ability to return to place promptly when released
Cherry (senile) Angiomas - Answer- Small (1-5 mm), smooth, slightly raised bright
red dots, that commonly appear on the trunk in all adults older than 30 years. Not
significant and normally increase in size
Capillary Refill - Answer- with the index or middle fingertip at heart level, depress the
nail edge at least 5 seconds to blanch and then release, noting the return of color
NOTE: over 3 seconds --> delayed
(cyanotic nail beds or sluggish color return: consider cardiovascular or respiratory
dysfucntion, septic shock)
Senile lentigines - Answer- -common variations of hyperpigmentation, "liver spots",
small, flat, brown macules
-appear after extensive sun exposure
Keratoses - Answer- raised, thickened areas of pigmentation that look crusted, scaly,
and warty
Seborrheic Keratosis - Answer- looks dark, greasy, and "stuck on". Develop mostly
on the trunk but also on the face and hands and on unexposed as well as on sunexposed areas, do not become cancerous
Acrochordons - Answer- "skin tags," are overgrowths of normal skin that form a stalk
and are polyp-like. They occur frequently on eyelids, cheeks and neck, and axillae
and trunk.
Anemia - Answer- -etiology: decreased hematocrit
-light skin: generalized pallor
-dark skin:brown skin appears yellow-brown, dull; black skin appears ashen gray,
dull; skin loses its healthy glow
Shock - Answer- decreased profusion vasoconstriction..... [Show Less]