Slide 1Skin, Hair, and NailsStructure and Function (cont.)Structure of SkinSlide 5Slide 6Slide 7Slide 8Subjective DataSubjective Data (cont.)Slide 11Slide 12Slide 13Objective Data: Physical ExaminationObjective Data: Physical Examination (cont.)Slide 16Slide 17Slide 18Slide 19Slide 20Slide 21Slide 22Slide 23Abnormal FindingsAnnular or CircularConfluentDiscreteGyrateGroupedLinearTargetZosteriformPolycyclicAbnormal Findings (cont.)MaculePapuleNoduleWhealVesicle/BullaCystPustuleSlide 42UlcerKeloidSlide 45Lesions Caused by Trauma or Abuse: Pattern InjuriesSlide 47Slide 48Slide 49Slide 50Slide 51Slide 52Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsSlide 12-1Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Skin, Hair, and NailsSkin, Hair, and NailsChapter 12Chapter 12Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsStructure and Function (cont.)Structure and Function (cont.)Skin has two layers:Skin has two layers:Epidermis: outer highly differentiated layerEpidermis: outer highly differentiated layer•Basal cell layer forms new skin cellsBasal cell layer forms new skin cells•Outer horny cell layer of dead keratinized cellsOuter horny cell layer of dead keratinized cellsDerivation of skin colorDerivation of skin colorDermis: inner supportive layerDermis: inner supportive layer•Connective tissue or collagenConnective tissue or collagen•Elastic tissueElastic tissueBeneath these layers is a subcutaneous layer Beneath these layers is a subcutaneous layer of adipose tissueof adipose tissueSlide 12-3Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsStructure of SkinStructure of SkinSlide 12-4Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsStructure and Function (cont.)Structure and Function (cont.)Epidermal appendages:Epidermal appendages:HairHairSebaceous glandsSebaceous glandsSweat glands: important for fluid balance and Sweat glands: important for fluid balance and thermoregulationthermoregulation•Eccrine glandsEccrine glands•Apocrine glandsApocrine glandsNailsNailsSlide 12-5Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsStructure and Function (cont.)Structure and Function (cont.)Skin is waterproof, protective, and adaptiveSkin is waterproof, protective, and adaptiveProtection from environmentProtection from environmentPrevents penetrationPrevents penetrationPerceptionPerceptionTemperature regulationTemperature regulationIdentificationIdentificationCommunicationCommunicationWound repairWound repairAbsorption and excretionAbsorption and excretionProduction of vitamin DProduction of vitamin DSlide 12-6Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsChanges with agingChanges with aging LayersLayers Sweat GlandsSweat Glands ElasinElasin Senile PurpuraSenile Purpura Slide 12-7Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsThe nurse is bathing an 80-year-old man and The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to which dry. This finding would be related to which factor?factor?A) Increased vascularity of the skin in the A) Increased vascularity of the skin in the elderlyelderlyB) Increased numbers of sweat and B) Increased numbers of sweat and sebaceous glands in the elderlysebaceous glands in the elderlyC) An increase in elastin and a decrease in C) An increase in elastin and a decrease in subcutaneous fat in the elderlysubcutaneous fat in the elderlyD)An increased loss of elastin and a D)An increased loss of elastin and a decrease in subcutaneous fat in the elderlydecrease in subcutaneous fat in the elderlySlide 12-8Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsSubjective DataSubjective DataHealth History QuestionsHealth History QuestionsPast history of skin disease, allergies, hives, Past history of skin disease, allergies, hives, psoriasis, or eczema?psoriasis, or eczema?Change in pigmentation or color?Change in pigmentation or color?Change in mole size, shape, color, tenderness?Change in mole size, shape, color, tenderness?Excessive dryness or moisture?Excessive dryness or moisture?Pruritus or skin itching?Pruritus or skin itching?Excessive bruising?Excessive bruising?Rash or lesions?Rash or lesions?Medications: prescription and over-the-counter?Medications: prescription and over-the-counter?Slide 12-9Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsSubjective Data (cont.)Subjective Data (cont.)Health History Questions (cont.)Health History Questions (cont.)Hair loss?Hair loss?Change in nails’ shape, color, or brittleness?Change in nails’ shape, color, or brittleness?Environmental or occupational hazards?Environmental or occupational hazards?Self-care behaviors?Self-care behaviors?Slide 12-10Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Skin, Hair, and NailsChapter 12: Skin, Hair, and NailsSubjective Data (cont.)Subjective Data (cont.)Additional history for infants and childrenAdditional history for infants and childrenDoes child have any birthmarks?Does child have any birthmarks?Any change in skin color as a