Assessment and Care of Skin, Hair, and Nails

Condensed Study Notes: Assessment and Care of Skin, Hair, and Nails Chapter 20: Assessment of Hair, Skin, and Nails 1. Anatomy & Physiology of the Skin, Hair, and Nails - Skin Layers: Epidermis (outer), Dermis (blood vessels, hair follicles), Subcutaneous Fat (insulation, cushion). - Hair: Protects, regulates, and senses; growth affected by hormones/genetics. - Nails: Structure (nail plate, bed, matrix, cuticle, lunula); protects fingertips, enhances sensation. 2. Functions of the Skin: - Protection: Barrier against pathogens. - Regulation: Temperature control, prevents dehydration. - Sensation: Contains receptors for touch, pain. - Excretion: Sweat for waste elimination. - Vitamin D Synthesis: Important for bone health. 3. Age-Related Changes: - Thinning skin, senile angiomas, age spots from sun exposure. - Decreased sweat production causes dry skin. 4. Assessment Techniques: - **History**: Current health status, medication, family history. - **Inspection**: Check color, lesions (ABC's for assessment). - **Palpation**: Check lesion consistency, temperature, turgor. 5. Hair & Nail Assessment: - Hair: Check cleanliness, distribution, and texture (dandruff, hirsutism). - Nails: Look for dystrophy, clubbing, color changes. 6. Assessment for Dark Skin: - Check pallor (mucous membranes), cyanosis (palms, soles), jaundice (hard palate). - Infection may not be visible; tenderness is key. 7. Common Skin Disorders: - Pruritis, Urticaria, Xerosis (dry skin), Dandruff, Psoriasis. Chapter 21: Concepts of Care for Patients with Conditions of the Hair, Skin, and Nails 1. Pressure Injuries (Bedsores): - Caused by sustained pressure on bony prominences. - Stages: Stage I (erythema), Stage II (partial-thickness loss), Stage III (fat visible), Stage IV (muscle or bone exposed). - Prevention: Frequent repositioning, specialized mattresses, nutrition. - Treatment: Wound cleaning, dressings, NPWT (Negative Pressure Wound Therapy). 2. Inflammatory Skin Disorders: - **Eczema**: Itchy, inflamed skin; manage with hydrocortisone, moisturizing. - **Psoriasis**: Chronic autoimmune disorder causing red, scaly patches; manage with steroids, phototherapy. 3. Fungal Infections: - **Candidiasis**: Yeast infection; treated with Nystatin. - **Tinea**: Fungal infection; treated with antifungals. 4. Bacterial Skin Infections: - **Impetigo**: Contagious, honey-colored crusts; treat with antibiotics. - **Cellulitis**: Deeper skin infection; requires oral/IV antibiotics. 5. Viral Skin Infections: - **Herpes Zoster (Shingles)**: Painful, vesicular rash; treated with antivirals. 6. Common Medications for Skin Conditions: - **Hydrocortisone**: Reduces inflammation; avoid prolonged use. - **Betamethasone**: Stronger corticosteroid for severe inflammation. - **Adalimumab (Humira)**: Biologic for autoimmune conditions; immunosuppressive. - **Nystatin**: Antifungal for candidiasis. 7. Skin Biopsy Techniques: - **Punch Biopsy**: Removes tissue with a circular instrument. - **Shave Biopsy**: Removes raised lesions. - **Excisional Biopsy**: Deep excision, sutured. 8. Nursing Interventions and Psychosocial Support: - Educate on skin care, medication use, and lifestyle modifications. - Address body image concerns, especially with chronic conditions. - Provide emotional support and resources. 9. Wound Care Management: - Signs of infection: Redness, swelling, increased pain, pus. - Monitor for infection, clean wounds, and ensure proper nutrition.