HA1- Ch13, 14, 15, 16, 17 PDF

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Chapter 13- Skin, Hair, Nails OUTLINE pg-3 Layers of skin  Epidermis- inner Basal cell layer & outer Horny layer  Dermis- supportive layer made of connective tissue and collagen- nerves, sensory receptors, blood vessels, and lymphatics and hair follicles, and sweat glands.  Subcutaneous- ...

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Chapter 13- Skin, Hair, Nails OUTLINE pg.198-243 3 Layers of skin   

Epidermis- inner Basal cell layer & outer Horny layer Dermis- supportive layer made of connective tissue and collagen- nerves, sensory receptors, blood vessels, and lymphatics and hair follicles, and sweat glands. Subcutaneous- adipose tissue

Types of Glands  Sebaceous gland- hair follicle sebum, oily substance, for lubrication. Scalp, forehead, face, and chin. (everywhere EXCEPT palms and soles)  Eccrine gland- Sweat glands. Coiled Tubules. Mature at 2 months. Saline solution  Apocrine gland- thick, milky secretion, creates body odor. (axillae, anogenital area, nipples, and naval area) Common Appearance descriptions (pg.223)  Pallor- unhealthy, pale appearance o Causes- Anemia, shock, arterial insufficiency  Erythema- intense redness of the skin caused by excess blood (Hyperemia) in the dilated superficial capillaries. o Causes- carbon monoxide poisoning  Cyanosis- Light skin; dusky blue Dark skin: only severe cyanosis is apparent. Check Conjunctiva, oral mucosa, nail beds. o Causes- increase in unoxygenated blood, exposure to cold  Jaundice- light skin: yellow in sclera, hard palate Dark Skin: check sclera for yellow near Limbus, do not mistake normal yellow for jaundice yellow. Best noted on palms or hard and soft palate. o Caused- liver inflammation, severe hemolytic disease i.e., burns, some infections, hepatitis, cirrhosis, sickle- cell disease Skin Functions  Protection  Prevent Penetration  Temperature Regulation  Wound repair  Vitamin D production Causes of changes in skin temperature, texture, moisture, mobility, and turgor  Skin Temperature- Hypothermia, Hyperthermia, Hyperthyroidism  Skin texture- Hyperthyroidism, hypothyroidism  Skin Moisture- Diaphoresis due to increased metabolic rate (thyrotoxicosis, fever, heavy activity), Stimulation of nervous system (anxiety, Pain), or Dehydration.  Skin Mobility- edema and scleroderma cause decreased mobility

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Skin Turgor- poor turgor is Dehydration

Lesion and Signs Traumatic or pathological changes in previously normal structures  EXAMIN: Color, elevation, pattern or shape, size, location & distribution on body, Exudate  Can be Primary (develops on previously unaltered skin) or Secondary (from itching) Common types of Primary Lesions (pg.224)  Macule- color change, flat. Less than 1 cm – (Freckles, hypopigmentation, petechiae, measles, scarlet fever) 

Papule- palpable, solid, elevated less than 1 cm (mole, lichen planus, molluscum, wart (Verruca))

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Patch- larger than 1 cm (Mongolian spot, vitiligo, café au lait spot, chloasma, measles rash)

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Plaque- papules join to form surface elevation (psoriasis, lichen planus) Nodule- solid, elevated, hard or soft, larger than 1cm. (fibroma, intradermal nevi) Wheal- superficial, raised, transient, and erythematous; (mosquito bite, allergic reaction, dermographism)

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Tumor- larger than a few CM, firm, deep into dermis (Lipoma, hemangioma) Urticaria (Hives)- Wheals coalesce to form extensive reaction, intensely pruritic. Vesicle- elevated cavity containing free fluid “blister”. Clear serum flows if ruptured. (chickenpox, herpes zoster, contact dermatitis) Bulla- larger than 1 cm, single chambered (Unilocular); rupture easy (Friction blister, pemphigus, burns, contact dermatitis)

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Cyst- encapsulated fluid-filled cavity in dermis, tensely elevating skin (Sebaceous

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Pustule- Turbid fluid (pus) I the cavity. (Impetigo, acne)

Cyst)

Common types of Secondary Lesions (pg.224)  Crust- thick dried out exudate when vesicles open up or pop. Yellow, green, red brown. (Impetigo, weeping eczematous dermatitis, scab after abrasion)  Scale- Compact, flakes of skin, dry or greasy, silver or white (Scarlet fever, drug reaction, seborrheic dermatitis, eczema, dry skin)  

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Fissure- Linear crack with abrupt edge; extends into dermis (Cheilosis at mouth corners) Erosion- scooped out but shallow depression. Moist but no bleeding, no scar because it doesn’t go into dermis Ulcer- Deeper depression extending into dermis, irregular shape, may bleed, leaves scar (stasis, ulcer, pressure injury) Excoriation- Self- inflicted abrasion, superficial, scratches from intense itching (insect bites, scabies, dermatitis, varicella)

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Scar- after skin tissue is repaired, normal tissue is lost and replaced with connective tissue. (Acne, healed wounds) Atrophic scar- skin is depressed, loss of tissue. (Striae, stretch marks) Lichenification- prolonged, intense scratching producing papules. Keloid- benign excess of scarring beyond original site.

4 Stages of Pressure Ulcers 1. Non- Blanchable Erythema- Intact but red skin 2. Partial- Thickness Skin Loss- loss of epidermis and exposed dermis. Superficial ulcer looks like abrasion or open blister 3. Full- thickness skin loss- PI extends into subcutaneous tissue, resembles a crater 4. Full thickness Skin/Tissue loss- involves all skin layers and extends into supporting tissue. Exposed muscle, tendon, or bone. a. Slough- stringy matter attached to wound b. Eschar- black or brown necrotic tissue Abnormal Findings Vascular Lesions  Hemangiomas- Benign proliferation of blood vessels in the dermis  Port-Wine Stain (Nevus Flammeus)- large, flat macular patch covering scalp or face. Does not fade  Strawberry Mark- raised area, well defined borders, 2-3 cm, does not blanch w/ pressure. Birth to 5-7 years it fades.  Telangiectasis- caused by vascular dilation, permanently enlarged and dilated blood vessels visible on surface  Spider or Star Angioma- fiery red, star shaped marking with solid circular center- Pregnancy or chronic liver disease  Venous lake- blue-purple dilation of venules and capillaries  Purpuric Lesions- blood leaving breaks in vessels.  Petechiae- tiny puncture hemorrhages 1 to 3 cm. will not blanch.  Ecchymosis- Purplish patch from extravasation of blood into skin.  Purpura- Extensive patch of petechiae  Contusion (Bruise)- caused by blunt force trauma Common Shapes of Lesions  Annular- circular, begins in center and spread periphery. (Tinea corporis, versicolor tinea)  Confluent- lesions run together (Hives)  Discrete- distinct, individual lesions that remain separate (Tags, Acrochordon)  Gyrate- twisted, coiled spiral, snakelike  Group- Cluster of lesions (vesicles of contact dermatitis)  Linear- scratch, streak, line, or stripe  Target/ Iris- resembles eye, ring  Zosteriform- Linear arrangements along unilateral nerve route (herpes zoster)  Polycyclic- Annular lesions grow together (Lichen planus, psoriasis) Common Skin Lesions in Children  Diaper Dermatitis  Intertrigo (Candidiasis) scaling red, moist patches, loose scales, genital areas and folds.  Impetigo- moist thin roofed vesicles with thin erythematous base. Rupture to for erosions and thick crusts. Highly contagious bacterial infection.  Atopic Dermatitis (Eczema)- chronic inflammatory cause by overstimulated immune system, changes in skin, and environmental triggers.

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Measles- pink, popular rash. Appears on face then spreads. Does not blanch Chickenpox (Varicella) small tight vesicles appear on trunk then spread to face, hands, arms, legs. Shiny. They become pustules then crust.

Common Skin lesions in Adults  Primary contact dermatitis  Allergic drug reaction  Tinea Corporis (ringworm of body)  Tinea Pedis (ringworm of foot)  Psoriasis- Hereditary chronic inflammatory skin disease.  Tinea Versicolor  Herpes Zoster (Shingles)  Erythema Migraines of Lyme Disease  Labial Herpes Simplex (Cold Sores) Malignant Skin Lesions  Basal Cell Carcinoma  Squamous Cell Carcinoma  Malignant Melanoma Nail Beds -160 degree is normal - 180 or more is clubbing - less than 160 is curved.  Smooth and regular, not brittle or splitting.  Spongy nail accompanies clubbing  Translucent nail plate is window to even pink nail bed underneath.  

Brown linear lines are NOT normal in light skinned people: hint at melanoma White markings are Leukonychia striata

Capillary refill- 5 sec to blanch then immediate return to normal.  Cyanotic nail beds or sluggish color may be cardiovascular or respiratory dysfunction, septic shock Abnormal Conditions of Nails  Scabies  Paronychia- red, swollen, tender inflammation of nail folds.  Beau line- transverse furrow or grove. Trauma related  Splinter Hemorrhages  Onychomycosis- slow persistent fungal infection of fingernails and nailbeds  Late Clubbing- 180 degree or more nail bed angle  Pitting- pitting and crumbling of nailbed  Habit-tic Dystrophy 

Abnormal Conditions of Hair  Aids-related Kaposi Sarcoma  Toxic Alopecia  Tinea Capitis (Ringworm)  Tineas Capitis (Scalp Ringworm)

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Traction Alopecia Seborrheic Dermatitis (Cradle Cap) Folliculitis Barbae (Razor Bumps) Hirsutism- excess body hair in females Furuncle and abscess- tender red swollen pus-filled location caused by bacterial infection. Pediculosis Capitis (Head Lice)

Skin Color- General Pigmentation Issues and other Changes- INFANTS  Mongolian Spot- hyperpigmentation; deep dermal melanocytes  Café au Lait Spot- large round or oval patch of light brown pigmentation  Harlequin color change- side lying baby turns bottom red and top white  Erythema Toxicon- newborn rash, tiny red macules and papules on cheek, trunk, back, and buttocks.  Acrocyanosis- blueish color around lips, hands, and fingernails. Temporary  Associated with down syndrome or prematurity  Cutis Marmorata- reticulated red or blue pattern due to temperature. Temporary.  Greenish brown discoloration (skin, nails, cord) occurs with passing of meconium in utero  Carotenemia- yellow orange color from increased carotene, vitamin A precursor.

CH. 14 HEAD, FACE, NECK, and REGIONAL LYMPHATICS pg.245- 274 Structure & Function 1. Head A. Bones 1. . Cranial bones- frontal, parietal, occipital, and temporal 2. Sutures- meshed immovable joints. 1. Coronal- crowns from ear to ear 2. Sagittal- separates head lengthwise between 2 parietal bones 3. Lambdoid- separates parietal bones crown wise from occipital bone 3. 14 Facial Bones 1. Articulate at sutures, except the Mandible. 4. Cranium supported by cervical vertebrae 1. C1 “atlas”; C2 “axis” 2. down to C7 – vertebra promineas- spiny process on back of neck. 5. Membranous meninges- suspend and support brain 1. Injury or blow can cause concussion B. Muscles & Nerves 1. Appearances and expressions that reflect mood. 2. Mediated by cranial nerve Vii- Facial Nerve 3. Facial sensations of pain mediated by the 3 Sensory branches of Cranial nerve V, the Trigeminal. C. Salivary Glands- 2 are accessible, 1 is not 1. Parotid glands in cheek over mandible, anterior to and below ear 1. Largest but not palpable 2. Submandibular glands- beneath mandible at angle of jaw 3. Sublingual glands- floor of mouth D. Temporal Artery- pulsation is palpable anterior to ear 2. Neck A. Delimited by base of skull and inferior border of mandible B. Conduit for passage many structures in close proximity 1. Blood vessels, nerves, muscles, lymphatics, viscera of respiratory & digestive 1. Internal Carotid- runs in & up to brain 2. External Carotid–supplies face, salivary glands, & superficial temporal lobe 3. Carotid and Internal Jugular lie below mastoid; EJV runs diagonally across sternomastoid muscle.

C. Muscles in Neck 1. Sternomastoid- Sternum & Clavical extends across neck to mastoid process behind ear. 1. head rotation and flexion 2. sternomastoid divides each side of neck into triangles

a. Anterior triangle- front between sternomastoid and midline of body

b. Posterior triangle- behind muscle w/ trap muscle on other side and base along clavicle

2. Trapezius- 2muscles upper back from occipital bone and vertebrae and extend fanning out to scapula and clavicle 1. Move shoulders and turn head D. Thyroid Glands- endocrine gland 1. Straddles trachea- midline 2. Highly vascular 3. Synthesizes and secretes Thyroxin (t4) and Triiodothyronine (t3) 1. Stimulate rate of cellular metabolism 4. 2 lobes, council in shape, curve backwards 5. Connected by thin Isthmus 6. Thyroid Cartilage- small, palpable V “Adams apple” 7. Cricoid cartilage- upper tracheal ring E. Lymphatics 1. 60-70 lymph nodes- correspond to adjacent structures 1. 2. 3. 4.

Preauricular- front of ear Posterior auricular- behind ear Jugulodigastric-under angle of mandible Supraclavicular- above and behind clavicle

2. Drainage Patterns- identifies source of problem- proximal to enlarged nodes 3. Lymphatic System- separate from cardiovascular works with immune. 1. Lymph nodes are small, oval clusters of lymphatic tissue that filter and engulf pathogens. Prevent from entering blood. 2. Examinable in: Head and neck, arms, axillae, inguinal region 4. Parotid enlargement has been found in AIDS

Developmental Competence 1. Infants and Children a. Fontanels- “soft spot” space where sutures intersect – gradually ossify i. Posterior by 1 to 2 months ii. Anterior by 9 mths to 2 yrs. b. head circumference greatest at birth, 90% complete 6 yrs. old c. lymphoid tissue is well developed at birth, grows rapidly till 10/11 d. Facial hair begins to appear e. Pediatric Abnormalities i. Hydrocephalus-accumulation of CSF ii. Down syndrome- up slanting eye, flat nasal bridge, small hands iii. Plagiocephaly-positional/ deformational placement iv. Craniosynostosis- premature closing of cranial sutures v. Atopic Facies- “allergic shiners” vi. Fetal alcohol syndrome- flat midline, low nasal bridge, minor ear abnormalities 2. Pregnant women a. Thyroid gland enlarges slightly- hyperplasia of tissue

3. Aging Adult a. Decreased fat, moisture, and elasticity 4. Culture and Genetics a. Headache- acute pain 1. Tension- HA of musculoskeletal origin; both sides, across frontal. Foreheads, side, back of head. Lasts 30 mins. No throbbing. Situational. Stress, anxiety, depression, anxiety 2. Migraine- HA of heretically transmitted vascular and trigeminal nerve origin. 2-3 times more common in women than men common on one side. Pain behind eyes, temples, forehead. Throbbing. 1-2 hrs., rapid onset. Hormonal fluctuations, hunger, sleep deprivation. Aura. Prodrome, photophobia, phonophobia. Family history. 3. Cluster- rare HA that is intermittent, excruciating, unilateral, w/ automatic signs. Always one-sided around eye, temple, forehead. Continuous, burning, piercing, excruciating. Abrupt onset 45 mins1hr. Exacerbated by alcohol, stress, daytime napping. Nasal congestion, runny eye. 5. Abnormalities a. Swelling of head and neck i. ii. iii. iv. v.

Congenital torticollis- hematoma in sternomastoid muscle; head tilt; limited ROM Simple diffuse goiter (SDG)- chronic enlargement of thyroid gland, low iodine Thyroid- multinodular Goiter (MNG)-multinodular goiter rather than neoplasm Pilar Cyst- smooth, firm, swelling on scalp; sebum and keratin. Benign. Parotid Gland enlargement- rapid painful inflammation; mumps. No swelling below earlobe b. Thyroid Hormone Disorders i. Graves’ Disease- autoimmune disease w/ increased production of thyroid hormones causes an increased metabolic rate. Forceful tachycardia, SOB, excessive sweating, infrequent blinking. ii. Myxedema (hypothyroidism)- deficiency of thyroid hormone means reduce the metabolic rate, non-pitting edema or myxedema. Hashimoto thyroiditis c. Abnormal Facies with Chronic Illness i. Acromegaly- excessive secretion of growth hormones from pituitary gland after puberty creates enlarged skull and thickened cranial bones. ii. Cushing Syndrome- excessive secretion of ACTH and chronic steroid use. “moon-like” face iii.

Bell Palsy (left sided)- lower motor neuron rapid onset of cranial nerve vii paralysis of facial muscles iv. Stroke “brain attack- Upper motor neuron- acute neurologic deficit caused by blood clot or cerebral vessel rupture. v. Parkinson’s Syndrome- deficiency in neurotransmitter dopamine. Immobility produces flat face vi. Cachectic Appearance- chronic wasting disease; cancer, dehydration, starvation

Ch. 15 Eyes pg.276-317 Structure & Function 1. External Anatomy a. Eye lids- 2 rapid window shades, short hairs (eyelashes) filter particles b. Palpebral fissure- space between eyelids c. Limbus- border between cornea and sclera d. Canthus- m corner of the eye, angle e. Caruncle- small, fleshy mass containing sebaceous glands.

f. Tarsal plates- connective tissue giving shape g. Meibomian glands- midwifed sebaceous glands h. Conjunctiva- transparent protective covering between eyelids and eyeball i. Palpebral conjunctiva- lid ii. Bulbar conjunctiva- eyeball i. Lacrimal Apparatus- provides irrigation of conjunctiva and cornea i. Lacrimal glad ii. Lacrimal sac j. Puncta- drainage duct in eye 2. External Muscles a. 6 muscles attach eyeball to orbit and give eye straight and rotary movement. i. 4 straight or rectus- Superior, Inferior, lateral, and medial rectus ii. 2 slanting or Oblique- superior and inferior muscles.

iii. Eye muscles work parallel Conjugate movement iv. Movement of EOMs stimulated by Three cranial nerves 1. CN Vl = lateral rectus muscle (abducts eye) 2. CN lV= superior oblique muscle 3. CN III controls all the rest (Superior, inferior, medical rectus, inferior obliques) Superior oblique controls downward and inward vision

3. Internal Anatomy a. Sclera- outer fibrous coat- visible anteriorly i. Tough protective white covering ii. Cornea- thin, transparent,very sensitive, stimulates blinking- corneal reflex. (cnV) carries afferent sensation to brain, (cnVII) carries Efferent message stimulating blink b. Choroid- Middle vasculari. dark pigment to prevent light from reflecting internally ii. heavily vascularized to deliver blood to retina iii. Iris- controls amt of light in & out; accomidation iv. Pupil- round and regular. v. Lens- biconcave disc posterior pupil. Refracting medium 1. Bluges for focus on near objects 2. Flattens for far objects vi. Anterior Chamber- posterior to corner, infront of iris and lens. vii. Posterior Chamber- lies behind and to the side of lens. c. Retina- Inner nervous- visible through ophthalmoscope i. Visual receptive layer of eye, light changes to nerve impulses 1. Optic disc- fibers from retina converge to form Optic Nerve 2. Retinal Vessels- include paired artery and vein 3. Macula & Fovea centralis 4. Visual Pathways and Fields a. Retina is Upside Down and transform light into nerve impulses conducted through Optic Nerve and Optic Track where they crisscross. Right brain= left world 5. Visual Reflexes a. Pupillary Light Relfexes i. Normal contraction or pupils when bright light shines on retina ii. Subcortical reflex arc- no control iii. Sensory afferent link is CN II (optic nerve) AND motor efferent path is CNIII (oculomotor nerve) iv. Consensual light reflex b. Fixation i. Movement of eye towards object attracting attention- rapid eye movement c. Accomodation i. Near vision adaptation

Developmental Competence

1. Infants and Children a.

Peripheral vision intact in newborn b. Macula, area of keenest vision, absent at birth develops by 4 mths

c. d.

By 3 to 4 months Binocularity and single image fixation occur Soft plastic at birth to rigid glass in old age

2. Aging Adults a. Presbyopia- decrease ability to change shape to acomidate for near vision b. Cataract formation- clouding of crystalline lens c. Glaucoma- optic nerve neuropathy, loss of peripheral vision intraocular pressure d. Age related Macular Degeneration (AMD)- loss of central vision caused by yellow deposits and neovascularity e. Diabetic retinopathy- leading cause of blindness

Culture and Genetic 1. 2. 3. 4. 5.

Light retinas may equal better night vision African american men and women more prone to Cataracts Cateracts are leading cause of blindness in World. Glaucoma prevelences increaseswith ag...