Chapter 12: Skin, Hair, and Nails 1. Structure of Skin a. Know levels where burns & pressure ulcers take place 2. Structure of Nails a. Focus on color of nail bed to determine if good circulation i. Warm? Pink? Cyanotic? Pale? ii. Capillary refill is brisk; less than 2 seconds 3. Developmental Competence a. Newborns i. Lanugo = fine downy hair (replaced with fine vellus hair a few months after birth) ii. Vernix = thick, cheesy substance (made up of sebum & shed epithelial cells) iii. Sebum = water in skin producing milia (a common variation; white papules on the cheeks & forehead & across the nose & chin; caused by sebum that occludes the opening of the follicles); holds water in the skin; present first few weeks of life; produces cradle cap in some babies b. Pregnant Women i. Linea nigra = increased pigmentation midline of abdomen ii. Chloasma = discoloration in the face; “mask of pregnancy”; a blotchy, hyperpigmented area over cheeks & forehead that fades after delivery iii. Striae gravidarum = stretch marks (abdomen, breast & thighs) c. Aging Adult i. Loss of skin elasticity ii. Decrease in sweat & sebaceous glands leaving skin dry iii. Wound healing is delayed iv. Melanocytes decrease (gray fine hair) v. Bruise easier 4. Inspection & Palpation of Skin, Hair & Nails a. Color = pink, pale, cyanotic (blue), jaundice (yellow) i. Color change best seen in palms, nail beds, around mouth & in the mouth b. Turgor = c. Lesions = ALWAYS WEAR GLOVES i. Note color, elevation, pattern, size, location, exudate ii. Classified by shape & formation = Annular/Circular, Confluent, Discrete, Gyrate, Grouped, Linear, Target, Zosteriform & Polycyclic iii. Primary Skin Lesions = Macules, Papules, Patches, Plaques, Nodules, Wheals, Tumors, Urticaria (hives), Vesicles, Cysts, Bullas & Pustules iv. Secondary Skin Lesions *PAYATTENTION TO DIFFERENCES* 1. Debris on skin = Crust & Scale 2. Break in Continuity of skin surface = Fissure, Erosion, Ulcer, Exocoriations, Scars, Atrophic Scars, Lichenifications & Keloids (excessive scar tissue; common in African Americans, Hispanics & Asians) 3. Vascular Lesions = Heamangiomas, Telangiectases, Purpuric Lesions & Lesions caused by trauma or abuse v. Common Skin Lesions in Children = Diaper dermatitis, Intertrigo (candidiasis), Impetigo, Atopic dermatitis (eczema), measles (rubeola), German measles (rubella) & chickenpox (varicella) vi. Vascular Lesions 1. Petechiae = tiny punctate hemorrhages, 1-3 mm, round & discrete; dark red, purple, or brown; caused by bleeding in superficial capillaries; will not blanch 2. Ecchymosis = a purplish patch resulting from extravasation of blood into the skin, >3 mm in diameter 3. Purpura = confluent & extensive patch of petechiae & ecchymoses; >3 mm, flat, red to purple, macular hemorrhage d. Hair = note color, texture, distribution & lesions e. Nails = note shape & contour, consistency, color & capillary refill