Skin for Health Assessment
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| show | Keloid formation, traction alopecia, pseudofolliculitis, folliculitis barbarae, and perineal follicularis
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| show | Findings indicating dehydration, cyanosis, or impaired skin integrity (acute lacerations).
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| If a patient has a specific concern about his skin, when do you look at it? | show 🗑
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| What are the ABCDEF's of melanoma detection? | show 🗑
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| The presence of what on the skin increases risk for melanoma? | show 🗑
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| What is phototoxicity? | show 🗑
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| show | medications, sunscreens, perfumes, cosmetics and topical skin creams cause a reaction on the skin that usually presents with a rash after sun exposure.
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| show | Manifests with blisters and redness on exposed skin, occurs only after repeated exposure to an offending substance, and persists for some time after removal of the offending substance, UV exposure, or both.
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| What 5 features do normal moles possess? | show 🗑
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| show | Scabies
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| Localized pruritis is usually caused by what? | show 🗑
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| Generalized pruritis is usually caused by what? | show 🗑
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| show | Either Staph or Strep
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| What type of skin lesions are distinct and walled off, containing fluid or semi-solid material? Vary in size... | show 🗑
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| show | Pustule.
Ex: Pustular acne
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| show | Bulla.
Ex: Second-degree burns
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| show | Vesicle.
Ex: Herpes simplex, Chicken Pox
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| show | Macule.
Example: Freckles, stork bite.
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| show | Patch
Ex: Vitiligo, melasma
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| show | Plaque.
Ex: Psoriasis
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| show | Nodule.
Ex: Basal Cell Carcinoma
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| What skin lesion is raised, flesh-colored, or red edematous papules or plaques, vary in size and shape? Example? | show 🗑
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| show | Papule.
Ex: Wart, insect bite
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| show | linear break in skin surface, not related to trauma.
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| show | lesion resulting from scratching or excessive rubbing of skin
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| Lichenification? | show 🗑
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| show | several different shapes.
Ex: Urticaria, tinea corporis
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| Punctuate lesions? | show 🗑
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| show | Curving, snake-like.
Example: Scabies
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| Iris Lesions? | show 🗑
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| show | Ring-like, circular.
Ex: Tinea Corporis
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| Verrucaform Lesions? | show 🗑
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| show | Papilla-like for finger-like projections (similar to tongue papillae).
Ex: warts
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| Nummular/Discoid Lesions? | show 🗑
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| Umbilicated Lesions? | show 🗑
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| Zosteriform Lesions? | show 🗑
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| Satellite Lesions? | show 🗑
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| show | With enlargement or multiplication, begin to coalesce for form larger lesion.
Ex: Urticaria
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| Describe Primary vs. Secondary morphology of lesions? | show 🗑
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| Give Examples of Primary vs. Secondary Lesions | show 🗑
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| Patients with a Braden Score of ______ have a low risk of developing a pressure ulcer. | show 🗑
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| Patients with a Braden Score of _______have a moderate risk of developing a pressure ulcer. | show 🗑
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| show | 12 or less
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| True or False? Patients with a total Braden score of 16 or less are considered to be at risk of developing pressure ulcers? | show 🗑
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| show | 1. Sensory Perception (ability to respond to pressure-related discomfort)
2. Moisture exposure of skin
3. Activity level
4. Mobility
5. Nutrition
6. Friction and Shear
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| show | 18%
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| Each arm is given what percentage in regards to the TBSA and burn classification? | show 🗑
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| show | Head: 9%
Anterior: 18%
Posterior: 18%
Pubic Area: 1%
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| Skin Assessment involves what? | show 🗑
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| show | 1. location
2. Size
3. color
4. texture
5. drainage
6. margins
7. surrounding skin
8. healing status
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| show | 1. Superficial- (epidermal layers)
2.superficial-dermal (epidermis and pt of dermis)
3. dermal (epidermis and all of dermis)
4. full-thickness (all layers of skin and my extend to supportive fascia below)
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| When assessing a lesion, what do you identify? (6 things) | show 🗑
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| show | On the abdomen
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| An adult white patient visits your clinic for the first time. During assessment of the client's skin, the RN should assess for central cyanosis by observing the patient's? | show 🗑
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| show | A linear indentation on nailbed from slow or halted nail growth. Related to illness, physical trauma or poisoning.
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| The only layer of the skin that undergoes cell division is the: | show 🗑
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| What is Telangiectasis? | show 🗑
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| What is Onycholysis? | show 🗑
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| Describe Stage III pressure ulcers. | show 🗑
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| show | Partial thickness loss of dermis. Presents as shallow open ulcer with a red pink wound bed. NO SLOUGH!
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| Describe Stage I pressure ulcers. | show 🗑
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| Describe Suspected deep tissue injury | show 🗑
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| Describe Stage IV pressure ulcer. | show 🗑
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| show | Full thickness tissue loss in which the base of the ulcer is covered by slough(yellow, tan, gray, green, or brown), eschar (tan, brown, or black) or both. True depth cannot be determined.
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| Should you remove eschar from heels of feet? | show 🗑
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| show | Diabetes
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| When do you use the Wagner's Classification of ulcers? | show 🗑
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| What 5 skin conditions in newborns are indications of greater risk for morbidity and mortality? | show 🗑
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| What is carotenemia caused by? Symptoms? | show 🗑
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| Physiologic vs Pathologic Jaundice? | show 🗑
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| show | Apply light pressure to skin to cause blanching. JAUNDICE DOES NOT BLANCHE!!! yellowish skin from OTHER causes will turn white.
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| What are 3 abnormal skin findings in pregnancy? | show 🗑
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| show | RECENT!!!
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| Clubbing of nails. Angle of nail is more than ______degrees. | show 🗑
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| show | Hair on beard area, abdomen, upper back, shoulders, sternum, and inner upper thighs
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| show | Dorsal Surface
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| What part of your hand do you use to palpate for skin moisture and texture? | show 🗑
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| How do you assess for vascularity? | show 🗑
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| What areas are the best places to look for pallor or cyanosis? Why??? | show 🗑
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| The healing process is divided into what 3 phases? | show 🗑
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| Why does skin tear easily in the older population? | show 🗑
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| show | Begins with macular lesions, progresses to papular, then vesicular, and ultimately superficial ulcers.
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| show | Measles, Rubella, Varicella
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| Headache often accompanies what two skin disorders? | show 🗑
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| show | 1. Get naked and stand in front of full length mirror
2. Scan entire body using hand-held mirror
3. Use a comb for blowdryer to examine sections of scalp
4. Report any suspicious lesion to healthcare provider
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| UVB waves vs UVA waves? | show 🗑
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