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L3 Integumentary System.docx

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Dalhousie University
NURS 2200
Cynthia Barkhouse Mckeen

Lecture 3: Integumentary Assessment Objectives  Review anatomy/physiology of skin, hair, nails  Practice focused inquiry  Explain client preparation for assessment of skin, hair, nails  Discuss factors that influence skin color  Differentiate normal from abnormal findings in physical assessment  Considers changes expected at end of life – e.g mottling in extremities  Describe variations in assessment techniques/findings: developmental, psychosocial, cultural, environmental  Discuss focus areas related to overall health of skin  Apply critical thinking related to physical assessment of skin, hair, nails Integumentary Assessment  Part of ―head to toe‖ assessment  Separated to discuss & focus on components  You will incorporate into ―regional‖ assessment i.e. head & neck, extremities, torso (front & back) Functions of Skin  Largest organ in body, provides unique ID e.g. fingerprints  Protects against heat, UV rays, trauma, infection, loss of H20 & electrolytes  Regulates temperature, synthesizes Vitamin D  Repairs surface wounds  Stores blood and fats  Excretes metabolic wastes  Allows sensing of world (touch, pressure, temperature, pain) Skin Anatomy & Physiology: Layers: 1. Epidermis: outermost layer, 5 strata (layers) 2. Dermis: layer of connective tissue embedded with hair follicles, sweat glands, oil glands, & sensory receptors new skin cells are formed in basal layer - in epidermis, strata above dermis - consist of a fibrous protein called keratin melanocytes (in epidermis) produce skin pigment: melanin subcutaneous tissue stores ~ 50% body’s fat cells Sweat glands: eccrine & apocrine Apocrine glands: found in axillary and anogenital regions Sebaceous glands: produce sebum, usually released in hair follicles Hair: thin fiber compound of dead keratinized cells Hair distribution: varies in different parts of the body Vellus hair – pale, short strands over most of body Terminal hair – darker, found in scalp & eyebrows, axillary region, pubic region, legs of adults, & male face &chest Nails: are thin plates of keratinized epidermal cells, covering distal ends of fingers & toes Skin Nail Special Considerations: Aging  skin elasticity decreases  sebum production decreases, causes dryness  amount of perspiration decreases  decrease in melanin production resulting in graying hair & increased light sensitivity  nails thicker, more brittle Other Factors Affecting Skin, Hair & Nail Health  Stress - may exacerbate skin conditions  visible skin disorders may contribute to problems with self-esteem & body image  culture, socioeconomic status, & environment  changes in skin color may be difficult to evaluate in people with dark skin - nurse inspects lips, oral mucosa, sclera, palms of hands, & conjunctiva to detect color changes Color Variations: See Jarvis text: Table 12.2 p. 248-249  Consider whether variations normal or abnormal  Consider possible causes  Consider differences in assessing for variations in light or dark skin Pallor  Loss of color in skin due to absence of oxygenated Hgb  Widespread; most apparent in face, mouth, conjunctivae, & nails  Possible causes: anemia, shock (decreased perfusion, vasoconstriction), local arterial insufficiency Absence of Color  Congenital or acquired loss of melanin pigment  Congenital loss typically  generalized (albinism), acquired loss typically patchy (vitiligo) Cyanosis  Mottled blue color in skin due to inadequate tissue perfusion with oxygenated blood  Most apparent in nails, lips, oral mucosa, tongue. Erythema  Redness of skin due to increased visibility of normal oxyhemoglobin  Generalized, or on face & upper chest, or localized to area of inflammation or exposure  Can be normal e.g. during exercise, ―blushing‖ Jaundice  Yellow undertone due to increased bilirubin in blood  Generalized, most apparent in conjunctivae & mucous membranes first Carotenemia  Yellow-orange tinge caused by increased levels of carotene in the blood & skin  Most apparent in face, palms of hands, soles of feet Uremia  Pale yellow tone due to retention of urinary chromogens in blood  Generalized, if perceptible Brown  increase in production & deposit of melanin  Generalized or localized Abnormal Findings -Skin 1. Primary Lesions 2. Secondary Lesions 3. Vascular Lesions 4. Infections 5. Malignant Lesions Lesion Configurations/Shapes 1. Annular- ringworm 2. Target - (shaped like target) 3. Confluent – rubella 4. Gyrate - (coiled or twisted) 5. Discrete- moles 6. Linear- scratches 7. Grouped- herpes simplex 8. Polycyclic- urticaria (hives) 9. Zosteriform- herpes zoster (shingles) Primary Lesions : develop on previously unaltered skin, See text p. 251-252  Macule/patch: Flat  Pustule: small with pus  Papule/plaque: Raised  Urticaria: hives  Nodule: More than 1 cm  Wheal - transient, circumscribed,  Vesicle/bulla: sm fluid filled raised, erythematous : due to edema, (blister) ie. Mosquito bite or allergy  Tumour, Cyst 1. Macule/Patch  Macule: flat, non-palpable ch
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