The dermis is comprised of _______ and supports the nerve and vascular network.

Collagen bundles The subcutaneous layer of the integumentary system is composed of _________ Fat and loose connective tissue What are the two major types of epidermal cells Keratinocytes (majority) and the melanocytes Melanocytes are housed in the stratum ___________ of the epidermis, also known as the basal layer Stratum Germinativum What is the function of melanocytes To give color to the skin and hair and protect the body from UV light __________ are epidermal cells that are synthesized in the basal layer and move to the surface where they flatten and die to form the stratum corneum (outer layer) Keratinocytes Keratin is a fibrous protein produced by keratinocytes that is vital for __________ The protective barrier function of the skin Changes in _______ account for many skin problems, such as psoriasis Cell cycle What is the function of the dermis It assists in regulation of body temperature and blood pressure Which layer of the dermis is responsible for the formation of fingerprints Papillary layer

_________ forms the greatest part of the dermis and is responsible for the mechanical strength of the skin Collagen The primary cell type of the dermis is the __________ Fibroblast Fibroblasts produce collagen and elastin fibers and are important for _________ Wound healing Where are nerves, lymphatic vessels, hair follicles and sebaceous glands located in the integumentary system In the dermis T/F Subcutaneous tissue lies beneath the dermis and is part of the skin False. It is not part of the skin, it lies directly beneath the dermis attaches skin to underlying bone and muscle What are the functions of subcutaneous tissue It attaches skin to underlying muscle and bone, provides insulation, stores lipids, regulates temperature and provides shock absorption What structures are considered skin appendages Hair, nails, sebaceous, eccrine and apocrine glands The ________ layer develops skin appendages and the ________ layer provides nutrients, electrolytes, and fluids Epidermis develops them, dermis feeds them What places on the body grow no hair The lips, palms of the hands and soles of the feet Nails grow from the matrix, also called the _______ Lunula (crescent shaped area of the nail)

How long does a fingernail that has been lost from trauma take to regrow? How about a toenail? 3-6 months for a fingernail, 12 months for a toenail While inspecting the hands and nails of an African American patient, the doctor indicates the patient has melanonychea striata. You know this means. He has seen pigmented longitudinal bands that are present in 90% of all people with dark skin Sweat glands are more scientifically known as. Apocrine and Eccrine glands What are the major functions of sebaceous glands? To produce sebum which prevents the skin and hair from becoming dry and has mild bacteriostatic properties Where are sebaceous glands located? Everywhere but the soles of feet and palms of the hands. They are most concentrated on the face, back, scalp & upper chest. What regulates sebum production and secretion? Sex hormones, particularly testosterone Where are apocrine glands located? Axillae, breast areola, umbilical and anogenital areas, external auditory canals and eyelids. These are the stinky glands. When do apocrine glands become active? At puberty Where are eccrine glands located? Everywhere except for a few places like the lips.

What is the function of eccrine glands? To cool the body through evaporation, excrete waste products through the pores of the skin, and to moisturize surface cells. Between ______ and _______ mL of water are lost through the skin daily through insensible perspiration. 600-900 mL Which layer of skin synthesizes vitamin D for calcium and phosphorus balance? Epidermis What changes occur to the dermis as a result of aging? It loses volume, has fewer blood vessels and the junction between the dermis and epidermis is flattened __________ is the major contributor to photo-aging and wrinkling of the skin. Chronic UV exposure ____________ are skin lesions that appear in areas that have been chronically exposed to the sun, and people who are fair skinned with blue, green or hazel eyes are especially prone. They are a premalignant cutaneous lesions that increase the risk of developing basal cell or squamous cell carcinomas. Actinic keratosis T/F Chronic UV exposure from tanning beds causes the same amount of damage as UV exposure from the sun. TRUE How does aging contribute to the development of pressure ulcers? Aging causes decreased subcutaneous fat which leads to increased risk of skin trauma, shearing, and hypothermia.

What types of medications can have side effects that manifest as skin problems? Vitamins, hormones, corticosteroids, antibiotics and antimetabolites What are intertriginous areas with respect to skin? An area where skin rubs against skin like under the breast or under the arms What skin conditions can indicate an electrolyte imbalance? Pruritis, edema, and dehydration _______ is a common skin problem associated with a person's occupation. Contact dermatitis Why is it important to assess sexualityreproductive patterns for a skin history/assessment? Some medications to treat skin conditions are teratogenic and should not be used by pregnant women (ex: Accutane, Efudex, Fluoroplex) _______ skin lesions occur on previously unaltered skin. Primary _________ skin lesions are lesions that change over time from factors such as scratching or infection. Secondary What are some general principles when conducting a skin assessment? Proceed from head to toe Compare symmetric parts Perform a general inspection, then a lesion specific inspection Use the metric system for measurements Use appropriate terminology/nomenclature for documentation Freckles, petechiae, measles and flat nevi are examples of ________. Macules

Any elevated lesion that is solid and less than 1 cm in diameter like a wart or mole is called a Papule Any elevated lesion that is circumscribed, filled with serous fluid and less than 1 cm like a lesion from varicella, herpes zoster or a seconddegree burn is called a __________. Vesicle A lesion that is circumscribed, elevated, solid and greater than 1 cm in diameter like those caused by psoriasis, seborrheic keratoses and active keratoses. Plaque A firm, edematous, irregularly shaped lesion like a bug bite or hive is a . Wheal An elevated, superficial lesion filled with purulent fluid like acne or impetigo is a . Pustule A linear crack or break from the epidermis to dermis; it can be dry or moist, like athlete's foot or cracks in the corner of the mouth. Fissure Excess dead epidermis cells produced by abnormal keratinization and shedding; an example would be flaking of the skin after scarlet fever. Scale An abnormal formation of connective tissue that replaces normal skin. Scar A lesion that results from loss of the epidermis and dermis that is crater-like and has an irregular shape. Ulcer Depression in the skin resulting from thinning of the epidermis or dermis, ex: striae Atrophy

Area in which the epidermis is missing, exposing the dermis. ex: abrasion, or scabies Excoriation Atrophy lesions are a primary or secondary lesion? Secondary lesion The critical factor in assessment of skin color is. Any change The most reliable areas in which to assess erythema, cyanosis, jaundice and pallor are the areas with the least pigmentation. These include: The sclera, conjunctivae, nail beds, lips and buccal mucosa To get the best indication of a client's skin color, you should look in a photoprotected area like: The buttocks A benign tumor of blood or lymph vessels is called... an angioma What are signs that can be observed on the skin of a vascular problem? Bruising, vascular or purpuric lesions, angiomas, petechiae, purpura, cyanosis How can you tell if a lesion is red because of dilated blood vessels (a normal inflammatory response) or because of interdermal or subcutaneous bleeding? Apply pressure to the lesion to see if it blanches. If it does, the lesion is red from dilated blood vessels. If it remains red, it is because of interdermal or subcutaneous bleeding. Changes in normal distribution of body hair or growth can indicate a ________ or _________ disorder. Vascular or endocrine

Temperature of skin is best assessed by using... The back of your hand How does cyanosis present in dark skinned clients? The conjunctiva, mucous membranes and/or nail beds are ashen or gray How does ecchymosis present in dark skinned clients? The area is purple to brownish black, but can be difficult to see unless it occurs in an area of light pigmentation How does erythema present in dark skinned clients? The skin has deeper brown or purple skin tone with evidence of increased skin temperature secondary to infection How does jaundice present in clients with dark skin tone? The sclera appears yellowish-green and the palms of the hands or soles of the feet appear yellowish-green How does pallor present in dark skinned clients? Underlying red tone of skin is absent, skin may be yellowish-brown in lighter skinned individuals or ashen gray in darker skinned individuals How does petechiae present in dark skinned individuals? It is difficult to see, may be evident in the buccal mucosa or the conjunctiva How does a rash present in dark skinned individuals? It is difficult to see, may be felt with light palpation Where is petechiae best observed in light skinned people? On the abdomen and buttocks With respect to lesions, annular means... Ring shaped

With respect to lesions, gyrate means... Spiral shaped With respect to lesions, iris lesion means... Concentric rings or Bull's eye With respect to lesions, linear means... In a line With respect to lesions, nummular means... Coin shaped With respect to lesions, discoid means... Coin shaped With respect to lesions, polymorphous means... occurring in several forms With respect to lesions, punctate means... Marked by points or dots With respect to lesions, serpiginous means... Snakelike With respect to lesions, asymmetric means... It is distributed unilaterally (on one side) With respect to lesions, confluent means... The lesions are merging together With respect to lesions, diffuse means... A wide distribution of lesions With respect to lesions, discrete means...A lesion is separate from other lesions With respect to lesions, generalized means... A diffuse (wide) distribution With respect to lesions, localized means... There is a limited area of involvement that is clearly defined

With respect to lesions, satellite means... A single lesion that is located in close proximity to a large grouping. With respect to lesions, symmetric means... Bilateral (both sides) distribution With respect to lesions, zosteriform means... band-like distribution along a dermatome What skin conditions are more common in clients with dark skin?

A worried mother brings her 18 month old child into the clinic because she's noticed his skin is turning yellow, especially on the palms of his hands and soles of his feet. She is really worried something is wrong with his liver. You assess the sclera and it is china white, moist and free of exudate. These findings leads you to believe that the child has... Carotenemia/carotenosis...caused by eating vegetables containing carotene like carrots and squash...common baby foods. It can also be caused by hypothyroidism.

What type of biopsy? Useful when good cosmetic results and entire removal is desired. Skin is closed with subcutaneous and skin sutures. Excisional What type of biopsy? Wedge-shaped incision made in lesion too large for excision. Incisional What type of biopsy? Single edged instrument is used to removal superficial lesions or to get a small sample of a large lesion. Provides full thickness specimen of the stratum corneum. Shave What is a Potassium Hydroxide microscopic test used for? To look at hair, scales, or nails for superficial fungal infections. What is the Tzanck test (Wright's and Giemsa's stain) used to diagnose? It is used to diagnose herpes infections, fluid and cells from vesicles are examined. What is tested when culturing for fungi? A scraping or swab of skin What is collected and cultured when looking for a bacteria? Material is obtained from intact bullae, pustules, or abscesses What is collected for a viral culture? A vesicle or bullae is scraped and exudate from the center of the lesion is taken What are mineral oil microscopic slides used to detect? Infestations What are immunofluorescent studies used to diagnose? Certain cutaneous diseases have specific, abnormal antibodies that can be detected in skin or serum (like lupus). This test is used to identify those proteins.

Pseudofolliculitis, keloids, and Mongolian Comedo is another word for... spots. An acne lesion, including whiteheads and blackheads. Interruption of venous return from an incompetent valves, tumors or inflammation causes increased prominence of superficial veins. This is called... Varicose veins (varicosity) Aging, dehydration, and cachexia commonly causes the failure of skin to return to its original position after being pinched. This is called... Tenting Visibly dilated, superficial, cutaneous small blood vessels that are commonly found on the face and thighs... Telangiectasia (caused by aging, acne, sun exposure, alcohol, liver failure, corticosteroids, radiation, some systemic diseases and skin tumors) Pinpoint, discrete deposits of blood less than 1-2 mm in the extravascular tissue ad visible through the skin or mucous membrane are called... Petechiae (common with thrombocytopenia, trauma, and inflammation) A benign overgrowth of melanocytes is called... a mole/nevus Dermatitis of overlying surfaces of the skin that is caused by moisture, irritation, and/or obesity is called... Intertrigo Repeated rubbing, scratching or irritation of the skin can lead to thickening with accentuated markings. This is called... Lichenification ________ is one of the most common diagnostic tests used in the evaluation of a skin lesion. A biopsy ________ is a special diagnostic technique used on biopsy specimens and may be indicated on specific specimens that are suspected to be part of bullous disease or lupus. Direct immunofluorescence What type of biopsy? A biopsy is taken using an instrument that is rotated to the appropriate level to include the dermis and some fat. May or may not require suturing... Punch biopsy

What is a Wood's lamp useful for diagnosing? Pseudomonas organisms, fungal infections and vitiligo will fluoresce What is a patch test used to identify? Allergies. Patient returns in 48 hours to have allergens removed and evaluated. May need a reevaluation at 96 hours. What dermatologic conditions are closely associated with sun exposure? (4) Actinic kurtosis, Basal cell carcinoma, Malignant melanoma, Squamous cell carcinoma ______ is a major factor in the development of sunburn and nonmelanoma skin cancer. UVB ______ contributes to the carcinogenic effects of UVB. UVA _______ is the sun wavelength that does not reach the earth because it is blocked by the atmosphere. UVC Why are fair skinned people more at risk for injury related to sun exposure? They naturally have less melanin and therefore less protection When is the worst time to be out in the sun? 10:00-2:00 EST/11:00-3:00 DST T/F Being in the snow increases the chances of getting a sunburn TRUE T/F Sunscreen can block all UVA and UVB rays and therefore should be considered effective protection. False. There is no sunscreen that blocks all UVA rays

What is the difference between chemical and physical sunscreens? Chemical sunscreens- they are light creams/lotions designed to absorb or filter UV light Physical sunscreens-Thick, heavy creams that reflect UV radiation as well as all visible light \ PABA is a chemical that blocks _______ rays, however it has been removed from many sunscreens due to allergic reactions and the fact it stained clothes. UVB Parsol blocks _____ rays and has been added to most sunscreens.UVA Benzophenones , found in sunscreen, blocks _______ rays. UVA/UVB What wording on sunscreen indicates that it reflects or absorbs both UVA and UVB rays (particularly UVB)? Broad spectrum Sunscreens should be applied ________ before going outdoors and reapplied every _________. Should be applied 20-30 minutes before going outdoors and reapplied every 2-3 hours What races have lower incidences of skin cancer than whites? African Americans and Native Americans T/F Melanoma does not occur in dark skinned people because of their natural protection from increased melanin. False. They do get melanoma, but it is often goes unrecognized until it is in the advanced stages T/F Benadryl can cause photosensitivity. TRUE

What groups of drugs are known for causing photosensitivities? Anticancer drugs, Antidepressants, Antidysrhythmics, antihistamines, antimicrobials, antifungals, antipsychotics, diuretics, hypoglycemics, NSAIDS What is the difference between irritant contact dermatitis and allergic contact dermatitis? Irritant Contact Dermatitis-caused by direct chemical injury to the skin Allergic Contact Dermatitis-antigen-specific, Type IV delayed hypersensitivity response Why is it important for a nurse to know if a patient had been treated with radiation for cystic acne 30 years ago? These patients have an increased incidence of basal cell carcinoma How does a deficiency of vitamin A impact skin condition? It causes dryness of the conjunctiva and poor wound healing Vitamin ____ is essential for maintenance of normal skin cell structure, specifically epithelial cells. It is necessary for wound healing. A Vitamin ______ is essential for complex metabolic functions. B complex How does a deficiency in the B vitamins impact skin condition? It can cause dermatologic conditions like erythema, bullae, and seborrhea-like lesions Vitamin ______ is essential for connective tissue formation and normal wound healing. C Vitamin _____ deficiency can cause symptoms of scurvy including petechiae, bleeding gums and purpura. C

Vitamin ______ is essential for synthesizing blood clotting factors. K A deficiency of vitamin ______ can lead to bruising due to abnormal prothrombin synthesis in the liver. K ________ is necessary in the diet for adequate cell growth and maintenance. It is also necessary for wound healing. Protein ________ is necessary to maintain the function and integrity of cellular and subcellular membranes in tissue metabolism. Unsaturated fatty acids, especially linoleic and arachidonic acid Development of velvety dark skin of the neck and body folds is called __________, and is related to obesity and Type II diabetes mellitus. Acanthosis nigricans