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NR 302 Exam 2 Concept Review.
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1NR 302 Exam 2 Concept Review
CH.12
Structures and functions of skin, hair, nails
Skin: 3 layers
1. Epidermis (outer): thin but tough, cell are bound tightly together that form a ruggedprotective
barrier. The inner basal layer forms new skin cells.
2. Dermis: is the inner supportive layer consisting of connective tissue, or collagen . This is tough ,
fibrosis area that enable skin to resist tearing. The sensory receptor, blood vessel,and lymphatics lie in
the dermis.
3. Subcutaneous layer: composed of adipose tissue, which is made up of lobules of fat cells. This
layer store fat for energy, provide insulation for temperature control , aid in protection by its soft
cushion effect.
Hair: are threads of keratin composed of 3 parts
1. Hair shaft: visible, projecting part
2. Hair root: Below the surface embedded in the follicle.
3. At the root, Hair bulb: Is expanded area where the new cell are produced in high rate. There are 2
types of hair
1. Vellus hair (fine, faint): Cover most of the body (Except the palm, soles, dorsa and distal part of
the fingers, umbilicus, penis glans, inside the labia)
2. Terminal hair: The darker, thicker hair that grows on the scalp and eyebrows and afterpuberty, on
the axillae, pubic area, the face and chest in the male.
Nail: Hard plate of Keratin on the dorsal edges of the finger and toes.
Nail plate is clear, white fine longitudinal ridge that become prominent in aging. Nail take their pink
color is form the underlying nail bed of highly vascular epithelial cells. The lunular is white, opaque,
semilunar area at the proximal end of the nail.
Key terms
Function of the skin
1. Protection: Minimize injury form physical, chemical, thermal, light wave source
2. Prevent penetration: Barrier that stops invasion of microorganism and loos of water and
electrolytes from within body.
3. Perception: Is a vast sensory surface holding neurosensory end- organs for touch, pain,
temperature, and pressure.
4. Temperature regulation: Allow heat dissipation through sweat glands, heat also storageat
subcutaneous glands.
5. Identification: Identify one another by unique combinations of facial characteristics hair,skin color,
and fingerprint.
6. Communication: Emotions are expressed in the sign language of the face and bodyposture
7. Wound repair: Allow cell replacement of surface wound.
8. Absorption and excretion: Allows limited excretion of some metabolic wastes, by- product of
cellular decomposition (mineral, sugar, amino acids, cholesterol, uric acid, urea)
9. Production of vitamin D: At the surface where ultraviolet lights (UV) converts
cholesterol into vitamin D
Developmental competence
Infants and Children
o hair follicles develop in the fetus at 3 months’ gestation by midgestation most of the skin is covered
with Lanugo, the fine downy hair of the newborn infant. This is replaced by thefine vellus hair in the
first few month after birth.
o Also present at birth is Vernix caseosa, the thick, cheesy substance made up of sebumand shed
epithelial cells. This help to protect newborn from water in the placenta
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o The newborn skin is similar in structure to the adult’s skin but its functions are not fully develop. The
temperature regulation is ineffective. Eccrine sweat glands do not secrete inrespond to heat until the
first few months of life and then only minimally throughout childhood. The skin cannot protect much
against cold because it cannot contract and shiver and also subcutaneous layer is ineffective at birth.
As Child grows
o The epidermis thickens, toughens, and darkens, skin becomes better lubricate. Hair growthaccelerates.
At puberty secretion from apocrine sweat glands increase in response to heat and emotional stimuli,
producing body odor.
o Secondary sex characteristic that appear during adolescent are evident in the skin. In female, the
diameter of the areola enlarge and darkens, breast develop. Coarse pubic hairdevelop in male and
female, axillary hair, and coarse facial hair in males.
The pregnant woman
o The change in hormone levels results in increased pigment in the areolar and nipples,vulva, and
sometime in the midline of the abdomen (linea nigra) or in the face (Chloasma).
o Connective tissue develops increased fragility, resulting in striae gravidarum (stretchmark),
which may develop in the skin of the abdomen.
Aging adult
o The aging process carries a slow atrophy of skin structure. The aging skin loses itselasticity;
it folds and sags. It also look parchment thin, lax, dry, and wrinkled.
o Wrinkle occurs because the underlying dermis thins and flattens. Sweat and Sebaceousglands
decrease in number and function, leaving dry skin. Decrease response of sweat glands to
thermoregulatory demand also put the aging person at greater risk of heat stroke.
Sun exposure and cigarette smoking further accentuate aging changes in the skin.
Seborrhea vs. xerosis
Use to access the excessive of dryness or moisture of the skin.
Seborrhea = Oily
Xerosis = Dry
Subjective assessment
Examiner asks
1. Past history of the skin disease.
2. Change in pigmentation.
3. Change in mole
4. Excessive dryness or moisture
5. Pruritus
6. Excessive burning
7. Rash or Lesion
8. Medication
9. Hair loss
10.Change in nails
11. Environmental or occupational hazards
12. Patient-center care: what do you do to care for your skin, hair, nails
Additional story of infant
1. Dose child have any birthmark
2. Change in skin color in new born
3. Have you noted any rash or sores?
4. Does child have any diaper rash
5. Does child have any burn or bruises
6. Any exposure to contagious skin conditions: scabies, impetigo, lice?
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7. Habit or habitual movements such as nail-biting, twisting hair, rubbing head o mattress.
8. Which step are taken to protect child ?
Additional for adolescent
1. Have you notice any skin problem such as pimples, blackheadsAdditional for
aging adult
1. Which change have you notice on skin in the past few years
2. Delay in wound healing?
3. Skin pain?
4. Any change in feet toe nails?
5. Fall this year?
6. Diabetes, peripheral vascular disease?
7. What do you do to care for yourself?
Table 12-1 p.207
External Variables influencing skin color
Emotional Causes Misleading outcome
Fear, anger Vasoconstriction False pallor
Embarrassment Flushing in face and neck False Erythema
Environmental
Hot room Vasodilation Erythema
Chilly or A/C on Vasoconstriction Pallor, coolness
Cigarette smoking Vasoconstriction pallor
Physical
Prolong elevation Decrease arterial Pallor ,coolness
perfusion
Dependent position Venous pooling “sitting in Redness, warmth,
the bottom” distended veins
Immobilize, prolong Slowed circulation Pallor, coolness, pale nail
inactivity bed, long capillary filling
time.
Pooling (means “sitting” at the bottom)
Objective assessment—normal vs. abnormal Edema—pitting vs.
non-pitting and documentation
SKIN ASSESSMENT NORMAL ABNORMAL
Edema 1. Pitting Normally skin stay smooths, Edema shows in
Edema if your pressure leave a dent dependent body part,
2. Non pitting "Pitting", edema is present. where the skin look
Edema 1+ Mild pitting; indentation; puffy andtight it
make hair follicle
no perceptible swelling of the
look prominent; you
leg. note the pig skin or
2+ Moderate pitting; orange peel look.
indentation subsides rapidly
3+ Deep pitting; indentation
remains for a short time, leg
looks swollen.
4+ Very deep pitting;
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indentation last for long time,
leg is very swollen.
Skin turgor
SKIN ASSESSMENT NORMAL ABNORMAL
Skin Pinch up a large fold of Look for the Dehydration Dehydration, mucous
turgor skin on the anterior in the oral mucus membranes are dry,
chest under the clavicle. membrane, look smooth lips look parched and
and moist. cracked, with extreme
dryness on the skin,
Poor turgor is evident
in severe dehydration
or extreme weight loss
the pinched skin is
called Tent and stand
by itself
Color changes and why they occur
SKIN ASSESSMENT NORMAL ABNORMAL
Widesprea Pallor Common in acute high-stress Ashen grey color in
d color states such as anxiety or fear dark skin and pallor
change because the peripheral in light skin occurs
vasoconstriction from with anemia, shocks,
sympathetic nervous system. and arterial
Skin also look pale with insufficiency.
vasoconstriction from cold,
cigarette smoking, and
pressure of edema
Look for pallor in dark skin
people by absence of the red
tones, the brown skinned
individual shows yellowish-
brown color, and the black
skinned appears ashen
gray. Pallor also can
observes in mucus membrane
of lips, nail beds, palpebral
conjunctiva
(eyes).
Erythema Intense redness of the skin Erythema occurs with
from excessive blood polycythemia venous
(hyperemia) in the dilated stasis, carbon
superficial capillaries. This monoxide poisoning,
sign is expected with fever , extravascular
local inflammation, emotional presence of red blood
reaction such as blushing in cell.
vascular flush area such as
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