The University of Alabama
Capstone College of Nursing
NUR 505 Advanced Health Assessment
Module 5 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.
, 10. Tumor:
Description: Elevated solid lesion, deeper in dermis, greater than
2cm in diameter.
Examples: Neoplasms, benign tumor, lipoma.
11. Cysts:
Description: Elevated, encapsulated lesion in dermis or
subcutaneous layer, filled with liquid or semisolid material.
Examples: Epidermal inclusion cyst, cystic acne.
12. Telangiactasia:
Description: Fine, irregular, red lines produced by capillary
dilation.
Examples: Telangiactasia in rosacea.
Secondary Skin Lesions:
1. Erosion:
Description: Loss of the epidermis, leaving a shallow, moist, and often painful
ulcer.
Example: Ruptured vesicle, moist areas in the mouth (aphthous ulcers).
Varicella.
2. Ulcer:
Description: Loss of both epidermis and dermis, often with a concave
appearance.
Example: Pressure ulcers, venous stasis ulcers.
3. Fissure:
Description: Linear crack or break in the skin, often painful. May be moist or dry.
Example: Athlete's foot, anal fissures.
4. Scale:
Description: Flakes or plates of desquamated, think or thick, oily or dry skin.
Example: seborrheic dermatitis, or after a drug reaction.
5. Crust:
Description: Dried serum, blood, or pus on the skin surface, slightly elevated,
size varies, red, black, tan, or straw colored.
Example: Scab from a healing wound, impetigo, eczema
Lichenification:
Description: Rough Thickening and hardening of the skin with prominent skin
markings secondary to persistent rubbing, itching, or skin irritation. Often
involves flexor surface of extremity.
Example: Chronic eczema, atopic dermatitis.
6. Excoriation:
Capstone College of Nursing
NUR 505 Advanced Health Assessment
Module 5 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.
, 10. Tumor:
Description: Elevated solid lesion, deeper in dermis, greater than
2cm in diameter.
Examples: Neoplasms, benign tumor, lipoma.
11. Cysts:
Description: Elevated, encapsulated lesion in dermis or
subcutaneous layer, filled with liquid or semisolid material.
Examples: Epidermal inclusion cyst, cystic acne.
12. Telangiactasia:
Description: Fine, irregular, red lines produced by capillary
dilation.
Examples: Telangiactasia in rosacea.
Secondary Skin Lesions:
1. Erosion:
Description: Loss of the epidermis, leaving a shallow, moist, and often painful
ulcer.
Example: Ruptured vesicle, moist areas in the mouth (aphthous ulcers).
Varicella.
2. Ulcer:
Description: Loss of both epidermis and dermis, often with a concave
appearance.
Example: Pressure ulcers, venous stasis ulcers.
3. Fissure:
Description: Linear crack or break in the skin, often painful. May be moist or dry.
Example: Athlete's foot, anal fissures.
4. Scale:
Description: Flakes or plates of desquamated, think or thick, oily or dry skin.
Example: seborrheic dermatitis, or after a drug reaction.
5. Crust:
Description: Dried serum, blood, or pus on the skin surface, slightly elevated,
size varies, red, black, tan, or straw colored.
Example: Scab from a healing wound, impetigo, eczema
Lichenification:
Description: Rough Thickening and hardening of the skin with prominent skin
markings secondary to persistent rubbing, itching, or skin irritation. Often
involves flexor surface of extremity.
Example: Chronic eczema, atopic dermatitis.
6. Excoriation:
