NURS 3120 Lecture Notes - Lecture 3: Jaundice, Itch, Body Odor

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School
Department
Course
Skin, Hair and Nails
Review of Integumentary System
Includes
Skin & its structures
Hair, nails
Sweat & sebaceous glands
Our skin is a body organ, structurally intact covers entire body
Our skin protects us and our internal organs
Produces Vitamin D
Regulates our temperature
Assists with body fluid & electrolyte balancing
3 Layers of Skin
Epidermis: outermost layer, is AVASCULAR, new cells push old cells up to skin surface
where keratinization occurs (cells die, making them hard & waterproof)
Dermis: very vascular! Dermal blood supply feeds epidermis, contains the nerves for
touch/pain/temperature & allows our skin to stretch or contract with movement or
changes in temperature
SQ/hypodermis: this layer supports our epidermis & dermis. Composed of loose
connective tissue with SQ fat. Our fatty cells assist us with heat retainment, as a
cushion and caloric source
Hair
Developed from epidermal cells in dermis
Has a root, shaft & follicle
Our melanocytes provide the color of our hair
Nails
Epidermal cells which are converted to keratin
Nails have a free edge, plate & root
Lunula white crescent shape at end of nails
Cuticles grow on nail plate at the base of the nail
Look at them give clues to oxygenation & perfusion
Respiratory or cardiovascular problems
Sweat Glands
Eccrine
Regulates body temperature by water secretion through our skin
Distributed throughout our skin surface
Concentrated areas
Palms of hands
Soles of feet
Forehead
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Apocrine
Larger of glands
Secrete fluid in response to emotional stimuli
Body odor occurs when this fluid is decomposing forming sweat/perspiration
Found in axillae, nipples/areolae, anogenitals, eyelids/ears
Normal sweat should be odorless
Different cultures do different hygiene routines
Does’t ea the are’t lea if there is soe odor
Sebaceous Glands
Secrete SEBUM which keeps our skin/nails from drying out. SEBUM is a lipid substance
Found mostly on our face/scalp
Wear gloves, especially with pediatric population
Not on our palms of hands or soles of feet
Function and SEBUM secretion diminishes with age
Let’s go through a histor…
Present Health Status
Do you have any chronic illnesses?
Do you take any medications?
o What do you take, and how often?
Have you noticed changes in the way your skin and hair look or feel?
o Any changes in sensation of your skin?
What kind of work do you do?
To your knowledge, are you exposed to any chemicals at home or work?
Past Health History and Family History
Have you ever had problems with your skin such as skin disease, infections involving skin
or nails, or trauma involving skin?
Has anyone in your family ever had skin-related problems such as skin cancer or
autoimmune-related disorders such as systemic lupus erythematosus?
Common Problems to Inquire About
Most common skin condition = Pruritus
Itchy, scaly skin
Other commons problems include:
Rashes
Lesions/wounds
Alterations of skin texture/color, hair & nail integrity
Always ask your patient/client about:
When did it start?
Where?
How long has it been present?
Describe the problem for me please?
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Problem-Based History: Pruritus
When did itching first start?
o Did it start suddenly or over time?
o Where did it start?
o Has it spread?
Does anything make itching worse?
o Does anything relieve it?
o What have you done to treat it yourself?
What were the circumstances when you first noticed itching?
o Taking any medications?
o Contact with possible allergens such as animals, foods, drugs, plants?
Do you have dry or sensitive skin?
Problem-Based History: Rash
When did rash start?
o Describe what it looked like initially: flat? Raised?
o How long has rash been present?
Does it itch or burn?
o What makes it better? Worse?
o What have you done to treat it?
o Have you noticed other associated symptoms such as joint pains, fatigue, or
fever?
Do you have any known allergies?
Does anyone else in your family have a similar rash?
o Have you been exposed to others with a similar rash?
Problem-Based History: Pain/Discomfort of Skin
Describe pain or discomfort:
o When did pain start?
o Where is it located?
o Does pain stay on skin surface or go deep inside?
Describe pain or discomfort sharp, dull, achy, burning, itching:
o How bad on a scale of 0 - 10?
o Is pain constant, or does it come and go?
What triggers pain?
o What makes it worse?
o Better?
Problem-Based History: Lesions or Changes in Moles
Describe lesion you are concerned about. Where is lesion?
o When did you first notice it?
o Do you have any symptoms associated with lesion such as pain, discomfort,
pruritus, or drainage?
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Document Summary

Sweat & sebaceous glands: our skin is a body organ, structurally intact covers entire body, our skin protects us and our internal organs, produces vitamin d, regulates our temperature, assists with body fluid & electrolyte balancing. 3 layers of skin: epidermis: outermost layer, is avascular, new cells push old cells up to skin surface where keratinization occurs (cells die, making them hard & waterproof, dermis: very vascular! Dermal blood supply feeds epidermis, contains the nerves for touch/pain/temperature & allows our skin to stretch or contract with movement or changes in temperature: sq/hypodermis: this layer supports our epidermis & dermis. Composed of loose connective tissue with sq fat. Our fatty cells assist us with heat retainment, as a cushion and caloric source. Hair: developed from epidermal cells in dermis, has a root, shaft & follicle, our melanocytes provide the color of our hair.

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