Exam (elaborations)
Skin, Hair and Nails- Health Assessment.
- Module
- Gpstc Criminal Law.
- Institution
- Gpstc Criminal Law.
Skin, Hair and Nails- Health Assessment.
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Skin, Hair and Nails- Health AssessmentSubjective Data - correct answer-Previous history of skin disease
(allergies, hives, psoriasis, or eczema)
Change in pigmentation (size or color)
Change in mole
Excessive dryness( Xerosis) or moisture- (Seborrhea)
Pruritus: itching
Excessive bruising
Significant familial predisposition: allergies, hay fever, psoriasis, atopic dermatitis (eczema)
and acne.
Generalised change suggests systemic illness: pallor, jaundice, cyanosis
Edition Change: Incidence of melanoma in whites is noted to be 20 times higher than in
blacks and 4 times higher than in Hispanics.
Edition Change: Skin conditions that are noted to be specific to black patients are as follows.
Keloids- excess growth of scar tissue at site of healed injury
Pigmentary disorders- black/white
Pseudofolliculitis: razor bumps, ingrown hairs
Melasma: mask of pregnancy- darker parts of the face due to pregnancy/birth control
pills/sun exposure
Pruritis: most common skin symptom; occurs with dry skin, aging, drug reactions, allergy,
obstructive jaundice, uremia, lice. Mild or intense? Does it awaken you from sleep? Where
does it itch and when does it start? Any other skin pain or soreness? Where?
Excessive bruising: Multiple cuts and bruises, bruises in various stages of healing, bruises
above knees and elbows and illogical explanation- consider physical abuse. Frequent falls
may be due to dizziness of neuro or cardiac origin. Also, frequent minor trauma may be a
side effect of alcoholism or other drug abuse.
Subjective Data - correct answer-Rash or lesion
Medications
Hair loss
Change in nails
Environmental or occupational hazards
Self-care behaviors
symptoms; what do you think it means; coping strategies; new or increased stress? (pg 208)
Medications: Prescription and OTC. Recent change? Drugs may cause allergic skin
eruptions: aspirin, antibiotics, barbiturates. Drugs may increase sunlight sensitivity and give
a burn response: sulfonamides, thiazide diuretics, oral hypoglycemic agents and
tetracycline. Drugs that cause hyperpigmentation: antimalarials, antineoplastic agents,
hormones, metals, tetracycline.
Hair loss: any recent hair loss? A gradual or sudden onset? Symmetric? Associated with
fever, illness, increased stress?
Alopecia: is a significant hair loss.
Change in nails: change in shape, color, brittleness? Do you tend to bite or chew nails?
, Environmental or occupational hazards: work with/ exposed to dyes, toxic chemicals,
radiation; household or furniture repair work?
Edition change: Those at risk from environmental/occupational hazards now include outdoor
sports enthusiasts and coal workers.
Self-care behaviors: what cosmetics, soaps, chemicals do you use? Clip cuticles, use
adhesive for false nails? If you have allergies, how do you control your environment to
minimize exposure? Do you perform skin self-exam?
Objective Data- The Physical Exam - correct answer-Preparation
External variables that influence skin color
Equipment needed
Strong direct lighting
Small centimeter ruler
Penlight
Gloves
For special procedures
Wood's light
Magnifying glass
Materials for laboratory tests: KOH, glass slide
Variables that influence skin color include emotional states, temperature, cigarette smoking,
prolonged elevation/dependent position of extremities, and prolonged inactivity. Table 12-1
pg 211
Objective Data - correct answer-Skin—Inspect and palpate
Color
General pigmentation
Widespread color change
Pallor
Erythema
Cyanosis
Jaundice
Pallor: common in acute high-stress states, exposure to cold and cigarette smoking and in
the presence of edema. Anemia will also cause pallor. Generalized pallor can be observed in
the mucus membranes, lips and nailbeds. Ethnic considerations: brown-skinned individuals
will have a more yellowish-brown color and black-skinned individuals will appear ashen or
gray.
Erythema: intense redness of the skin from excess blood in the dilated superficial capillaries.
This sign is expected with fever, local inflammation or with emotional reactions such as
blushing in vascular flush areas (cheeks, neck and upper chest). Erythema also occurs with
polycythemia, venous stasis, carbon monoxide poisoning and the extravascular presence of
red blood cells (petechiae, ecchymosis and hematoma).
Cyanosis: Bluish, mottled color that signifies decreased perfusion: the tissues do not have
enough oxygenated blood. Do not confuse cyanosis with the common and normal bluish
tone on the lips of dark-skinned people and people of Mediterranean origin. Cyanosis is
difficult to observe in darkly pigmented persons. Given that most conditions causing
cyanosis also cause decreased oxygenation of the brain, other clinical signs- such as
changes in LOC and signs of resp distress-will be evident.
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