NUR 505 Module 5 Advanced
Health Assessment Skin, Hair, Nails,
and Lymphatics Study Guide
Chapter 9 Skin, Hair and Nails
1. Review the normal anatomy and physiology of the skin/hair and nails in your Seidel
book.
Skin hair & nails:
Examination of the skin, hair, and nails is performed as part of both the comprehensive and
focused physical examination. The skin, hair, and nails can provide externally visible clues to
systemic disease that may not otherwise be apparent
The skin performs integral functions:
• Protects against microbial/foreign substance invasion and minor physical trauma.
• Restricts body fluid loss; provides a restrictive barrier.
• Regulates body temperature.
• Provides sensory perception via free nerve endings and specialized receptors.
• Produces vitamin D from precursors in the skin.
• Contributes to blood pressure regulation through constriction of skin blood vessels.
• Repairs surface wounds by exaggerating the normal process of cell replacement.
• Excretes sweat, urea, and lactic acid.
• Expresses emotions.
,A&P of Skin Layers:
Epidermis
• outer most layer
Dermis
• Vascular connective tissue layer
• Elastin, collagen, reticulin fibers, sensory nerve fibers, autonomic motor nerve
Hypodermis
• subcutaneous layer
• Heat, insulation, shock absorption, reserve of calories
Appendages
, • Eccrine and apocrine sweat glands, sebaceous glands, hair, nails.
2. You will need to review basic types of skin lesions in your Seidel book. Please know this
information very well, as you will need to be able to document your examination
findings well, using appropriately descriptive terms. You should be able to describe and
identify the primary lesions. You will be asked to choose the correct term for it’s
appropriate definition.
Tables 9.4 and 9.5 show the characteristics of primary and secondary lesions. The nomenclature
is often used inaccurately; if you are uncertain about a lesion, use the descriptors rather than
the name. Be aware that several types of lesions may occur concurrently and that secondary
changes may obscure primary characteristics.
Primary Skin Lesions:
1. Macule:
• Description: Flat, discolored area on the skin surface.
• Example: Freckles, flat moles, petechiae.
2. Papule:
• Description: Raised, solid lesion, smaller than 1 cm in diameter.
• Example: Acne, warts, lichen planus.
3. Nodule:
• Description: Raised, solid firm lesion, larger and deeper than a papule.
• Example: erythema nodosum, rheumatoid nodules, dermatofibroma.
4. Plaque:
• Description: Elevated, flat-topped rough lesion with well-defined borders.
• Example: Psoriasis, atopic dermatitis
5. Vesicle:
• Description: Small, less than 1cm, fluid-filled blister on the skin surface.
• Example: Chickenpox blisters, herpes zoster blisters (shingles).
6. Bulla:
• Description: Large vesicle, more than 1 cm in diameter.
• Example: Blister from burns, pemphigus vulgaris.
7. Pustule:
• Description: Pus-filled lesion on the skin surface.
• Example: Acne pustules, impetigo.
8. Wheal:
• Description: Transient, raised, and edematous lesion, often itchy.
• Example: Hives (urticaria), insect bites, allergic reaction.
9. Patch:
• Description: Flat non palpable irregular shaped macule > 1cm in diameter.
• Examples: Vitillgo, port wine stains, café au lait patch.
Health Assessment Skin, Hair, Nails,
and Lymphatics Study Guide
Chapter 9 Skin, Hair and Nails
1. Review the normal anatomy and physiology of the skin/hair and nails in your Seidel
book.
Skin hair & nails:
Examination of the skin, hair, and nails is performed as part of both the comprehensive and
focused physical examination. The skin, hair, and nails can provide externally visible clues to
systemic disease that may not otherwise be apparent
The skin performs integral functions:
• Protects against microbial/foreign substance invasion and minor physical trauma.
• Restricts body fluid loss; provides a restrictive barrier.
• Regulates body temperature.
• Provides sensory perception via free nerve endings and specialized receptors.
• Produces vitamin D from precursors in the skin.
• Contributes to blood pressure regulation through constriction of skin blood vessels.
• Repairs surface wounds by exaggerating the normal process of cell replacement.
• Excretes sweat, urea, and lactic acid.
• Expresses emotions.
,A&P of Skin Layers:
Epidermis
• outer most layer
Dermis
• Vascular connective tissue layer
• Elastin, collagen, reticulin fibers, sensory nerve fibers, autonomic motor nerve
Hypodermis
• subcutaneous layer
• Heat, insulation, shock absorption, reserve of calories
Appendages
, • Eccrine and apocrine sweat glands, sebaceous glands, hair, nails.
2. You will need to review basic types of skin lesions in your Seidel book. Please know this
information very well, as you will need to be able to document your examination
findings well, using appropriately descriptive terms. You should be able to describe and
identify the primary lesions. You will be asked to choose the correct term for it’s
appropriate definition.
Tables 9.4 and 9.5 show the characteristics of primary and secondary lesions. The nomenclature
is often used inaccurately; if you are uncertain about a lesion, use the descriptors rather than
the name. Be aware that several types of lesions may occur concurrently and that secondary
changes may obscure primary characteristics.
Primary Skin Lesions:
1. Macule:
• Description: Flat, discolored area on the skin surface.
• Example: Freckles, flat moles, petechiae.
2. Papule:
• Description: Raised, solid lesion, smaller than 1 cm in diameter.
• Example: Acne, warts, lichen planus.
3. Nodule:
• Description: Raised, solid firm lesion, larger and deeper than a papule.
• Example: erythema nodosum, rheumatoid nodules, dermatofibroma.
4. Plaque:
• Description: Elevated, flat-topped rough lesion with well-defined borders.
• Example: Psoriasis, atopic dermatitis
5. Vesicle:
• Description: Small, less than 1cm, fluid-filled blister on the skin surface.
• Example: Chickenpox blisters, herpes zoster blisters (shingles).
6. Bulla:
• Description: Large vesicle, more than 1 cm in diameter.
• Example: Blister from burns, pemphigus vulgaris.
7. Pustule:
• Description: Pus-filled lesion on the skin surface.
• Example: Acne pustules, impetigo.
8. Wheal:
• Description: Transient, raised, and edematous lesion, often itchy.
• Example: Hives (urticaria), insect bites, allergic reaction.
9. Patch:
• Description: Flat non palpable irregular shaped macule > 1cm in diameter.
• Examples: Vitillgo, port wine stains, café au lait patch.
