NSG121 HEALTH ASSESSMENT
EXAM 2 STUDY GUIDE
Unit 5 – Assessment of the Skin, Hair, and Nails – 11 Questions
Topic Student Notes
Structure & Function of the Epidermis
Skin, Hair, and Nails - 1st line of defense against pathogens, chemical irritants and moisture loss
- No blood supply, oxygenated by surface air
NSG121.05.01.01 - Contains specialized cells responsible for perception of pain, light touch vibration, &
a. Layers of the Skin temp, as well as detection of foreign antigens
- Keratinocytes- composed chiefly of keratin a protein proving resistance against
friction & trauma
- Melanocytes - produce 2 type melanin – eumelanin-darker & pheomelanin – lighter
- Merkel cells – associated w/cutaneous nerves & light touch sensations
- Langerhans cells – immunologically active
Dermis
- Supports epidermis
- Contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles&
sweat glands, which support nutritional needs & protective function of the
epidermis
- Dermal thickness varies across the life span & w/gender
- Papillary layer – primarily loose connective tissue& elastin, contains capillaries,
small blood vessels& nerve endings, connects directly to the epidermis facilitating,
exchange of oxygen, nutrients & waste.
- Reticular layer: composed of collagen & elastin, provides the resilience,
distensibility, elasticity, & turgor of the skin
Subcutaneous
- Provides insulation, storage of caloric reserve & cushioning against external forces.
Composed mainly of fat & loose connective tissue & contributes to skin mobility
Hair
- protect specific body areas, provides insulation
- enables sensory communication to the nerve system
- contributes to gender identification
Vellus hair
- fine, short, hypopigmented
- located throughout the body
Terminal hair
- darker, coarser
, - located on scalp, brows & eyelids
Post pubertal: axillae, perineum, legs
Post pubertal male: chest, abdomen
- composed of keratin
- produced by hair follicles, deep in the dermis
- all body areas except palms and soles
- Arrector pili muscles responsively contract
- Stimuli: environment, nerves (AKA goose bumps)
Sebaceous gland
- Secrete sebum to maintain moisture, condition
Nails
- Are epidermal appendages composted of hardened keratin
- Grows at varying rate, fingernails grow faster than toe nails
- Nail bed is highly vascular and appears pink thru transparent nails
- Some system diseases, infectious processes can affect nail growth rate & thickness
Integumentary Medical history & risk factors
NSG121.05.02.01 (x2) When assessing general skin conditions in pts w/out an identified concern, gather info abt
a. Medical History and general health, including nutritional status, which may identify any potential causes for
Risk Factors skin disorders, in pts at high risk for skin alterations such as immobile or bedridden
b. Health promotion patients, additional info related to potential alterations in skin integrity, medications- risk
factor
Health promotion
- Self-skin examination
- Patient education regarding
-limiting excessive UV radiation
-healthy diet, adequate hydration & exercise
-characteristics of normal/problematic moles
Subjective Data Collection Pruritus (itching skin)
NSG121.05.02.02 - Precedes atopic lesion, follows inflammatory lesions
Signs/Symptoms - May indicate toxic exposure, allergic reaction, insect bites, parasite infestations, or
a. Pruritus viral exanthems (wide spread rash) such as varicella.
b. Rash - Generalized pruritus is common in mediation or food allergies
c. Single lesion or - Sever pruritus interfering w/sleep is frequently from scabies
wounds Rash
d. Older adults - Contact or allergic dermatitis – usually on body parts exposed to an irritant or
e. Cultural allergen
considerations - Syphilis – over the entire body, including palms & soles
- Seborrheic dermatitis – on the face, head & hair covered body areas
- Herpes zoster: follows a dermatome (area that relies on a specific spinal nerve) & is
generally found on chest, back, abdomen, face & rarely extremities
, - STIs: Genital lesions in adults are commonly from STIs
- Single lesions could be cancer; multiple lesions could indicate an infection
- Also parasites, fungal infections, yeast infections and in infants diaper rash
- Macular lesions can be ecchymosis (discoloration from bleeding under the skin
caused by bruising), pressure point changes, or tinea versicolor
- Papular (elevated <10 mm in diameter) lesions may indicate acne, warts, nevi,
insect bites, or early varicella
- Pustular (big pimple) lesions include acne, furuncles, and carbuncles
- Vesicular (small blisters) lesion may be herpes simplex, varicella, or impetigo
- Plaque (elevated solid >10mm in diameter) lesion are commonly psoriasis or lichen
simplex
Single lesions or wounds
- Increase or decrease, & associated symptoms, suspicious explanation of injury
Older Adults
- Multiple ecchymoses may be from repeated trauma (falls), disorders or physical
abuse
- Aging causes the junction between the dermis & epidermis to flatten increasing the
tendency of the skin to tear
- Decrease eccrine gland functions results in a decrease sweat response
- The # of nerve endings in the skin decreases w/age, causing diminished sensation
to two-point discrimination, touch & vibration
Cultural considerations
- Practices like coining & cupping
Objective Data Collection Comprehensive Assessment
NSG121.05.03.01 (x2) - Inspect skin of each body area – observe for rash, lesions, wounds, bruises
Skin Alterations - Inspect skin over pressure points for skin breakdown in immobile pts
a. Comprehensive - Inspect nails – fingers & toes for hygiene, circulation, clubbing-indicates chronic
Assessment hypoxia
Technique - Inspect wounds – evaluate stage & healing
b. Primary lesions - Palpate skin for temp, turgor, vascularity, moisture & texture
c. Secondary lesions - Inspect hair – for lesions, nits infestation, sparsity
d. Older adults - Inspect the entire body to screen for cancer or other conditions
e. Cultural Primary lesions
considerations - Arise from previously normal skin & include maculae, papules, nodules, tumors,
polyps, wheals, blisters, cysts, pustules, vesicles, and abscesses. Primary lesions
may be further described as nonelevated, elevated-solid, or fluid-filled
Secondary lesions follow primary lesion e.g. Scar tissue, crusts from dried burns
Older Adults
- Decreases elasticity, thinness, excessive dryness, & lesions associated w/aging
such as seborrheic keratosis, actinic keratosis & lentigines
Cultural considerations
EXAM 2 STUDY GUIDE
Unit 5 – Assessment of the Skin, Hair, and Nails – 11 Questions
Topic Student Notes
Structure & Function of the Epidermis
Skin, Hair, and Nails - 1st line of defense against pathogens, chemical irritants and moisture loss
- No blood supply, oxygenated by surface air
NSG121.05.01.01 - Contains specialized cells responsible for perception of pain, light touch vibration, &
a. Layers of the Skin temp, as well as detection of foreign antigens
- Keratinocytes- composed chiefly of keratin a protein proving resistance against
friction & trauma
- Melanocytes - produce 2 type melanin – eumelanin-darker & pheomelanin – lighter
- Merkel cells – associated w/cutaneous nerves & light touch sensations
- Langerhans cells – immunologically active
Dermis
- Supports epidermis
- Contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles&
sweat glands, which support nutritional needs & protective function of the
epidermis
- Dermal thickness varies across the life span & w/gender
- Papillary layer – primarily loose connective tissue& elastin, contains capillaries,
small blood vessels& nerve endings, connects directly to the epidermis facilitating,
exchange of oxygen, nutrients & waste.
- Reticular layer: composed of collagen & elastin, provides the resilience,
distensibility, elasticity, & turgor of the skin
Subcutaneous
- Provides insulation, storage of caloric reserve & cushioning against external forces.
Composed mainly of fat & loose connective tissue & contributes to skin mobility
Hair
- protect specific body areas, provides insulation
- enables sensory communication to the nerve system
- contributes to gender identification
Vellus hair
- fine, short, hypopigmented
- located throughout the body
Terminal hair
- darker, coarser
, - located on scalp, brows & eyelids
Post pubertal: axillae, perineum, legs
Post pubertal male: chest, abdomen
- composed of keratin
- produced by hair follicles, deep in the dermis
- all body areas except palms and soles
- Arrector pili muscles responsively contract
- Stimuli: environment, nerves (AKA goose bumps)
Sebaceous gland
- Secrete sebum to maintain moisture, condition
Nails
- Are epidermal appendages composted of hardened keratin
- Grows at varying rate, fingernails grow faster than toe nails
- Nail bed is highly vascular and appears pink thru transparent nails
- Some system diseases, infectious processes can affect nail growth rate & thickness
Integumentary Medical history & risk factors
NSG121.05.02.01 (x2) When assessing general skin conditions in pts w/out an identified concern, gather info abt
a. Medical History and general health, including nutritional status, which may identify any potential causes for
Risk Factors skin disorders, in pts at high risk for skin alterations such as immobile or bedridden
b. Health promotion patients, additional info related to potential alterations in skin integrity, medications- risk
factor
Health promotion
- Self-skin examination
- Patient education regarding
-limiting excessive UV radiation
-healthy diet, adequate hydration & exercise
-characteristics of normal/problematic moles
Subjective Data Collection Pruritus (itching skin)
NSG121.05.02.02 - Precedes atopic lesion, follows inflammatory lesions
Signs/Symptoms - May indicate toxic exposure, allergic reaction, insect bites, parasite infestations, or
a. Pruritus viral exanthems (wide spread rash) such as varicella.
b. Rash - Generalized pruritus is common in mediation or food allergies
c. Single lesion or - Sever pruritus interfering w/sleep is frequently from scabies
wounds Rash
d. Older adults - Contact or allergic dermatitis – usually on body parts exposed to an irritant or
e. Cultural allergen
considerations - Syphilis – over the entire body, including palms & soles
- Seborrheic dermatitis – on the face, head & hair covered body areas
- Herpes zoster: follows a dermatome (area that relies on a specific spinal nerve) & is
generally found on chest, back, abdomen, face & rarely extremities
, - STIs: Genital lesions in adults are commonly from STIs
- Single lesions could be cancer; multiple lesions could indicate an infection
- Also parasites, fungal infections, yeast infections and in infants diaper rash
- Macular lesions can be ecchymosis (discoloration from bleeding under the skin
caused by bruising), pressure point changes, or tinea versicolor
- Papular (elevated <10 mm in diameter) lesions may indicate acne, warts, nevi,
insect bites, or early varicella
- Pustular (big pimple) lesions include acne, furuncles, and carbuncles
- Vesicular (small blisters) lesion may be herpes simplex, varicella, or impetigo
- Plaque (elevated solid >10mm in diameter) lesion are commonly psoriasis or lichen
simplex
Single lesions or wounds
- Increase or decrease, & associated symptoms, suspicious explanation of injury
Older Adults
- Multiple ecchymoses may be from repeated trauma (falls), disorders or physical
abuse
- Aging causes the junction between the dermis & epidermis to flatten increasing the
tendency of the skin to tear
- Decrease eccrine gland functions results in a decrease sweat response
- The # of nerve endings in the skin decreases w/age, causing diminished sensation
to two-point discrimination, touch & vibration
Cultural considerations
- Practices like coining & cupping
Objective Data Collection Comprehensive Assessment
NSG121.05.03.01 (x2) - Inspect skin of each body area – observe for rash, lesions, wounds, bruises
Skin Alterations - Inspect skin over pressure points for skin breakdown in immobile pts
a. Comprehensive - Inspect nails – fingers & toes for hygiene, circulation, clubbing-indicates chronic
Assessment hypoxia
Technique - Inspect wounds – evaluate stage & healing
b. Primary lesions - Palpate skin for temp, turgor, vascularity, moisture & texture
c. Secondary lesions - Inspect hair – for lesions, nits infestation, sparsity
d. Older adults - Inspect the entire body to screen for cancer or other conditions
e. Cultural Primary lesions
considerations - Arise from previously normal skin & include maculae, papules, nodules, tumors,
polyps, wheals, blisters, cysts, pustules, vesicles, and abscesses. Primary lesions
may be further described as nonelevated, elevated-solid, or fluid-filled
Secondary lesions follow primary lesion e.g. Scar tissue, crusts from dried burns
Older Adults
- Decreases elasticity, thinness, excessive dryness, & lesions associated w/aging
such as seborrheic keratosis, actinic keratosis & lentigines
Cultural considerations
