WE HOPE THAT WE “GOT UNDER” YOUR SKIN!

skin6

Our skin, hair, and nails blog has been a semester-long group effort to inform, entertain, and most importantly – EDUCATE our audience! Through this blog we hope our fellow BSN and PSU students learned some new information on the importance of:

  • taking a detailed patient history in beginning health assessment
  • thorough skin assessment
  • nutrition for healthy skin
  • proper skin care and hydration
  • seasonal skin care
  • assessment and treatment of burns
  • the dangers of the sun and tanning beds 

skin3We hope that this blog helps you in the care of your patients and also in the care of your self! We as nurses are in an excellent position to teach our patients and promote their health and self-care. Patients should be told to examine their skin in a well lit room monthly following the ABCDE (Asymmetry, Border, Color, Diameter, Elevation & Enlargement) rule. Full length and hand mirrors can be helpful in visualizing the body. Relatives, spouses, or trusted friends can come in handy in inspection of the skin’s harder to see areas – like behind the ears and the back. Two sets of eyes are better than one! Patients should also be instructed to report any suspicious lesions, rashes, or skin changes to their physician promptly (Jarvis, 2012).   

Below I pulled together a few more informative videos relating to our skin health. Enjoy! 

Be smart in the sun!

Be happy in the skin you were born with!

_Born_ skin cancer public service advertisement_ 30 seconds

You get out what you put in!

References

“Born” skin cancer public service advertisement: 60 seconds. (2012, May 2). YouTube. Retrieved April 13, 2014, from http://www.youtube.com/watch?v=vfry83vfUD8&list=PLR52zQsl4KczBU3Xr-dp2OuEfVmRVS7Tc

Jarvis, C. (2012). Physical examinations & health assessment (6th ed.). St. Louis, MO:Saunders Elsevier.

Mayo Clinic: Have Fun in the Sun, But Be Sun Smart – Skin Cancer Prevention PSA. (2013, April 29). YouTube. Retrieved April 13, 2014, from http://www.youtube.com/watch?v=wPCPxklEFAk

Assessment & Treatment of Burns in the Pre-Hospital Setting

Nursing plays a pivotal role in the care of patients with burn injury and requires a multifaceted approach to care of their injury. This blog post will focus on the assessment and immediate interventions necessary to care for the burn victim by the pre-hospital critical care nurse. The skin is the largest organ of the body and has important functions; including, protection, immunological, fluid, protein and electrolyte homeostasis, thermoregulation, neurosensory, social–interactive, and metabolism. Once scene safety is established and the immediate removal of the patient from the thermal source is successful, extinguishing and removing any burning clothing is of utmost priority. The effects of thermal energy on human skin are transferred by conduction, convection, and radiation. All of these mechanisms affecting heat transfer may deliver heat to, or away from, living tissues and sustained temperatures resulting in cellular dysfunction and early denaturation of protein. An accurate assessment must done quickly and interventions and transport decisions are crucial to successful treatment of burn victims.

The first priority is to stop the burning. Not all sources of thermal injury are treated the same; in the pre-hospital setting for example, when the patient has been exposed to flames, wet, smother, and remove smoldering clothing and jewelry; with Tar, cool the area until burning has stopped, but do NOT remove tar; with electrical, remove the patient from source without endangering self with a non-conductive material; with chemical (liquid) it require continuous, copious water lavage, prolonged eye irrigation; and lastly with chemical (dry), brush powder off skin surface, then flush with copious amounts of water for 10-20 minutes. Remove all contaminated clothing, and avoid self-injury by wearing gloves and PPE (Personal Protective Equipment). As prolonged exposure increases, cell damage increases and cooling demonstrates the beneficial effects of cooling on reducing tissue damage and wound healing time. The question often asked is how long after the burn injury is it still worthwhile to initiate cooling measures although immediate cooling is preferable. A 30-minute delay in application of cooling is still beneficial to the burn and the application of cooling measures 60 minutes after injury, does not demonstrate any benefit. Cover wounds with dry sterile dressing(s) or sheet(s) while keeping the patient warm and preventing hypothermia.

As with other emergencies, gathering the history is very helpful, but not always possible. Information important to gather at the scene include, the burn source/the circumstances of the injury, history of enclosed space fire and or smoke, past medical history, medications, allergies, any drug & alcohol use and tetanus vaccination status. Searching for life threatening and associated injuries is an essential step in assessment to assure that you are prioritizing nursing care interventions. Initial examination of the airway for signs of inhalation injury must be performed quickly; singed vibrissae, carbonaceous material in the upper airway, or edema or inflammatory change in the oral pharynx/upper airway must be determined. In the setting of trauma, initiate spinal immobilization if indicated; was there any known explosions or did the patient experience a fall. Assessment of the burns is characterized by degree, based on the severity of the tissue damage and the total body surface area affected. Estimating the extent and depth of the burn is performed by using the “Rule of Nines.” First degree burns are considered superficial burns and are not usually included in the Rule of Nines. Also, a patient’s palm represents 1% of total BSA (body surface area) and can be used to estimate scattered, irregular burns.

Rule of Nines:

rule_of-nines

Burn Coding:

burn-classification

Burn Assessment Video – Please see:

https://www.youtube.com/watch?v=DbE0iCq25Z4

Packaging and leaving the scene as quickly as possible after assessment & stabilization is important, therefore, Paramedics and EMT’s may have to rendezvous with flight nurses in order to decrease transportation time to the closest, most appropriate facility. Determining whether or not the patient needs to be transported directly to a burn center or be transported to the closest facility is an important decision that must take place very quickly. Bypassing a non-burn center and transporting to a further, more distant burn center is dependent on the patient’s condition. If the condition of the patient is emergent, such as a compromised airway, for example, the patient would be transported to the nearest facility for airway stabilization. Then, the emergency physician’s judgment and expertise at the non-burn center, along with the burn care resources available at that facility would be considered as to whether or when the patient is transferred out.

Criteria for Burn Center Referral:

  • Burn Size Criteria for Burn Center referral
  • Partial Thickness Burns >10% total TBSA (total body surface area)
  • Face, hands, feet, genitalia, perineum, or major joints
  • Third Degree Burns Any age group
  • Electrical Burns, including lightening
  • Chemical burns
  • Inhalation injury
  • Burn Injury in patients with preexisting conditions that could complicate management, prolong recovery, or affect mortality
  • Burns and concomitant trauma
  • Burned children in hospitals without qualified personnel or equipment for the care of children
  • Burn injury in patients Who require special social, emotional, or long-term rehabilitative intervention

(American Burn Association)

Stabilization and maintenance of the airway and ventilation is of utmost priority in burn victims. To expedite transport, this may be established enroute. Smoke inhalation is very common and serious injury and mortality rate for any burn will double if a patient has smoke inhalation. The most serious effects of smoke inhalation are not breathing in the products of combustion, but carbon monoxide, which is orderless, colorless, and not necessarily accompanied by smoke. Even when there is no evidence of smoke inhalation injury, all patients who are involved in fires in enclosed spaces should be treated with the administration of humidified 100% high flow oxygen by mask and breathing treatments are administered for smoke inhalation with symptoms of wheezing.  Stridor and hoarseness are considered late signs of airway compromise.

Endotracheal intubation may be required to maintain the airway with associated neck trauma, significant chest wall injury or in the case of severe inhalation airway, leading to acute airway edema. The decision to intubate is sometimes difficult and clinical experience is required to recognize signs of impending respiratory failure. Patient’s requiring intubation have one of the following indications: inability to maintain airway patency, inability to protect the airway against aspiration, failure to adequately oxygenate pulmonary capillary blood, and anticipation of a deteriorating course that will eventually lead to the inability to maintain airway patency or protection. These are all indications to drop an ET tube and perform mechanical ventilation with 100% oxygen. It is important to intubate early before swelling associated with burn and resuscitation set in. Rapid Sequence Intubation (RSI) may be necessary if the patient is conscious. Remember, patients have not fasted and are at much greater risk for vomiting and aspiration, so suction needs to be immediately available. RSI involves administration of weight-based doses of an induction agent, immediately followed by a paralytic agent to render the patient unconscious and paralyzed within one (1) minute (Lafferty, 2014). Therefore, RSI is not indicated in a patient who is unconscious and apneic; in this situation immediate bag-valve-mask ventilation and endotracheal intubation without pretreatment, induction, or paralysis is indicated. The cardiac monitor would be attached and initiate CPR would be initiated if no pulse or respirations were present (Gamelli, n.d.).

Fluid Resuscitation is required by patients with burns greater than 20% of total body surface.  The Parkland formula is used to calculate the amount of resuscitation fluid required for the first 24 hours in a victim of burns to ensure they remain hemodynamically stable.  The fluid for the first 24 hours is four times the product of the body weight and body surface area affected by burns; for example, a person weighing 75 kg with burns to 20% of his or her BSA would require 4 x 75 x 20 = 6,000 mL of fluid replacement within 24 hours. The first half of the calculated volume is delivered in the first 8 hours postburn and the remaining half is delivered in the remaining 16 hours (Besner 2014).

Ongoing optimal care of the burn patient requires a distinctive multidisciplinary approach. Positive patient outcomes are dependent on the composition of the burn care team and close collaboration among its members. At the center of this team is the burn nurse, who is the coordinator of all patient care activities. The complexity and multisystem involvement of the burn patient demand that the burn nurse possess a broad-based knowledge of multisystem organ failure, critical care techniques, diagnostic studies and rehabilitative and psychosocial skills. The nurse oversees the total care of the patient, coordinating activities with other disciplines such as occupational and physical therapy, social services, nutritional services and pharmacy. At the same time, the burn nurse is also a specialist in wound care. As a burn wound heals, either spontaneously or through excision and grafting, the nurse is responsible for wound care and for noting subtle changes that require immediate attention, prevention of infection and pain management. The nurse’s role is continuously expanding. Nurses are conducting nursing research and contributing to evidence-based practice of burn care. Practice guidelines, critical pathways and nursing care plans are all tools that help define and refine the nurse’s role in burn care.

References:
American Burn Association. (1999). Burn unit referral criteria. Retrieved from Burn unit referral criteria. (1999). Retrieved from http://www.ameriburn.org/BurnUnitReferral.pdf

Besner, Gail E. (2014). Surgical treatment of burns treatment and management. Retrieved from MDhttp://reference.medscape.com/article/934173-treatment

Gamelli, R. L. (n.d.). Assessment and Initial Care of Burn Patients. Retrieved from www.facs.org/trauma/publications/burnpatients.pdf
Lafferty, K. A. (2014). Rapid Sequence Intubation. Retrieved from http://emedicine.medscape.com/article/80222-overview
Rule of nines. (n.d.). Retrieved from http://medical-dictionary.thefreedictionary.com/rule+of+nines

SAY NO TO FAKE BAKE!!!!!

With spring time soon here, that means it’s time to get ready for summer.  One way people do so is with the use of sunbeds or also called “tanning.”  Tanning uses artificial tanning devices such as sunbeds or tanning lamps that emitted ultraviolet or UV radiation.  First thought to be a harmless way to tan has now turned into one of most dangerous ways to get that bronzed skin tone.  Evidence on the damage that UV radiation does to our skin is ever growing and increases a person’s risk of developing skin cancer (World Health Organization, 2010).

There are over two million cases each year of skin cancer and 132,000 cases a year that develop malignant melanoma; the most fatal type of skin cancer.  Most skin cancer cases can be attributed to overexposure to UV radiation.  There is no evidence that suggests that the UV exposure in sunbeds is less harmful than UV exposure from the sun.  With regular sunbed use a person can develop pre-cancerous actinic keratosis and Bowen’s disease in just two to three years (World Health Organization, 2010).

The sunbeds manufactured today emit predominantly UVA and UVB radiation.  Both can lead to the damage of DNA in skin cells.  In most sunbeds made, there are higher levels of UVB to mimic the solar spectrum which speeds the tanning process.  UVB has carcinogenic properties that are well known and lead to the development of skin cancers.  This is the same for UVA, the exposure to this longer wavelength can also impact the occurrence of skin cancer (World Health Organization, 2010).

Consequences of regular use of sunbeds include:

  • ·         Skin Cancers

 

  • ·         Disfigurement (from removal of skin cancers)

 

  • ·         Early Death

This also adds to the national health systems costs for screening, treating and monitoring skin cancer patients (World Health Organization, 2010).

Please watch video below.

https://www.youtube.com/watch?v=_4jgUcxMezM

Reference

World Health Organization. (2010, April). Sunbeds, tanning and uv exposure. Retrieved from http://www.who.int/mediacentre/factsheets/fs287/en/

WHAT’S ALL THE HOT AIR ABOUT?

The lungs are the primary organ of the pulmonary system, but there are many other parts. The pulmonary system begins in the oral and nasal cavities, the nasal cavity has 3 turbinates that warm the air as we breath in and creates a cyclone effect causing the air to accelerate and move very effectively to the nasopharynx and down the trachea. From there the air reaches the carina. The carina is the point at which the trachea separates into the left and right bronchi. When a patient is deep suctioned, this it the point the suction catheter reaches and causes the patient to cough. The bronchi further separate into bronchioles and into alveolar sacs and then into each alveolus. In the alveolus is where the gas exchanges occur and carbon dioxide is exhaled.

The Lungs are located in the thorax cavity and is surrounded by the thoracic cage which consists of the ribs, clavicles, sternum anteriorly, posterior is the scapula, ribs, and  vertebrae, and inferiorly, the diaphragm. This cage is made of bone and protects the lungs from damage. There are times when these bones can be a hazard to the lungs as well as in trauma or fractures of these bones can potentially puncture the lungs.

There are many disease that affect the pulmonary system. Different disease can cause adventitious lungs sounds upon auscultation. Some adventitious sounds include, crackles (or rales) which can be fine or course, plural friction rubs, high and low pitch wheezes, stridor, and rhonchi.

One of the many disease affecting the lungs is asthma. Asthma can be causes by variety of different things and can be a sensitivity to different allergens, irritants, microbes, stress, exercise, and even the cold. Jarvis, (2012),  describes asthma as an hypersensitivity that causes bronchospasms and inflammation, edema in the walls of the bronchioles, and secretion of highly viscous mucous (p. 449).  The different effects on the bronchi and respiratory tract with the swelling, edema, and mucous cause the airway resistance to greatly increase and make it difficult for the patient to move air in and out of their lungs.

The patient may complain of chest tightness, difficulty breathing, anxiety. Some of the clinical findings include use of accessory muscles, shortness of breath or dyspnea, prolonged expiration, tachypnea (rapid breathing), wheezing which in severe cases are sometimes heard without a stethescope and can be expiratory, inspiratory, both or in very extreme cases, no breath sounds at all.

Jarvis, C (2012). Physical examination & health assessment (6th ed.). St. Louis, MO:   Saunders Elsevier.

FIGHT AGAINST DRY SKIN

Our skin is the largest organ system in our body.  It covers the entire surface of our body and accounts for about 20 percent of our weight.  Maintaining the integrity of our skin is very important since it is our first line of defense against invading organisms (Williams, 2009). 

During our everyday life routines, our skin takes a lot of damage.  That damage can occur due to exposure to the sun, weather conditions, chemicals, detergents, etc.  The damage can also come from issues within the body from other organ systems as well (Williams, 2009).

Among the most common skin conditions, dry skin (xerosis) is the key aspect in a number of diseases.  Some of these diseases include eczema and psoriasis.  Dry skin by itself is not considered a significant condition but it does have a major impact on a person.  The impact that it has is discomfort, continued itching or pruritis, and possible embarrassment for the affected person (Williams, 2009).

Dry skin occurs due to the loss of water and oils from the skin.  Some environmental factors that contribute to the evaporation of water from the skin include central heating, medications such as diuretics, and extremes of weather.  To replace this water lost, one must rehydrate themselves but be cautious if other medical conditions are present (Williams, 2009).

If you know you have dry skin, then you should be cautious of soap and bath products because these can cause further irritation and drying of the skin due to the alkalinity of the products.  The use of soap substitute can help reduce irritation and drying.  Another way to manage dry skin is with the use of emollients (Williams, 2009).

Emollients are recommended to be used daily on the skin to help restore hydration to the skin.  The use of emollients in people with eczema has shown to decrease the need for topical steroid creams as well as reduce the side-effects of topical steroids.  Choosing the correct emollient for your skin is important as well (Williams, 2009).

When choosing an emollient one must take into consideration the following:

  •   Degree of dryness

 

  •   Skin condition being treated

 

  •  Patient preference

 

  •   Cosmetic acceptability

Generally, the drier your skin is the greasier the emollient should be but this is not always acceptable.  Creams are used for moderate dryness and should be applied frequently.  Ointments are usually greasier so they are used for very dry skin and are needed to be applied less frequently (Williams, 2009). 

The use of emollients is just one way to help fight dry skin.  Here are some tips that can help with dry skin as well.

Reference

Williams, L. (2009). Managing dry skin. Practice Nurse, 37(12), 13-14, 16.

 

6 Quick and Easy Dry Skin Relievers

Give your dry skin the moisture it craves.

By Wendy C. Fries

Reviewed by Debra Jaliman, MD

WebMD Feature

When you have flaky, itchy, dry skin, you want fast relief. Easing your dry skin isn’t just about what you put on it. It also depends on how you clean your skin, the air around you, and even your clothes. 

Try these six tips to soothe your dry skin.

1. Warm Yes, Hot No.

A steamy shower feels good, but that hot water is not a good idea for your dry skin, says dermatologist Andrea Lynn Cambio, MD.

The problem is that hot showers strip your body of its natural oil barrier, and you need that barrier to help trap moisture and keep your skin smooth and moist.

So dial down the temperature and don’t linger too long. Skin care experts recommend short, warm showers or baths that last no longer than 5 to 10 minutes. 

Afterward, gently pat dry and moisturize your body.

2. Cleanse Gently.

Wash with a soapless cleanser when you shower. Cambio says gentle soaps that are free of fragrance are a great option. Products with deodorant or antibacterial additives can be harsh on skin.

You might also consider a cleanser that contains ceramides, says dermatologist Carolyn Jacob, MD. Ceramides are fatty molecules that make up the outer barrier of your skin. They help skin hold in moisture. Some skin care products use synthetic ceramides to replace those we lose with age.

Go easy on toners, peels, and other astringents made with alcohol, which is drying. When you exfoliate, don’t scrub too much or too hard, Jacob says. It can irritate and thicken skin.

3. Shave Smartly.

Shaving can irritate dry skin. As you shave unwanted hair, you’re also scraping off natural oils.

The best time to shave is after you shower, according to the American Academy of Dermatology. Hairs are softer and more pliable after bathing, making shaving easier.

Always use a shaving cream or gel, and shave in the direction the hair is growing to protect your skin. 

Make sure the razor is sharp. A dull razor blade can cause additional irritation. Change your razor blades often. If you are using a blade you’ve used before, soak it in rubbing alcohol to clean it. 

4. Cover Up.

Sun damage is one of the main causes behind dry skin, wrinkles, and roughness. You can help prevent that damage by wearing a broad-spectrum SPF 30 sunscreen year-round and dressing right.

In cool weather, Cambio says, be sure to “dress in layers to prevent overheating and perspiring excessively; both can irritate the skin.”

To prevent dry, chapped lips in winter, use a lip balm with SPF 15 sunscreen, and cover your lips with a scarf or a hat with a mask.

In summer, wear light, loose, long-sleeved shirts when out in the sun, and wear a 2-inch wide-brimmed hat to shade your neck, ears, and eyes.

5. Follow the Rules of Moisturizing.

The simplest moisturizing products can soothe dry skin. “Petroleum jelly makes a great moisturizer,” dermatologist Sonia Badreshia-Bansal, MD, says. Or you can use mineral oil, a favorite cream, or lotion.

If you like a very rich moisturizer, look for one with shea butter, ceramides, stearic acid, or glycerin, Leslie Baumann, MD, director of the Cosmetic Medicine and Research Institute at the University of Miami, says. “All are rich moisturizers that will help you replenish your skin barrier,” Baumann writes in her online article Winter Skin, where she also says she particularly loves glycerin.

Jacobs says that whichever product you choose, a consistent, smart moisturizing routine helps.

  • Wash with a non-soap liquid cleanser, preferably one with ceramides to replenish the skin’s outer layer. 
  • Pat skin dry for less than 20 seconds.
  • Apply a thick moisturizer to slightly damp skin within minutes of bathing to trap in moisture.
  • Moisturize your hands every time you wash them so that evaporating water doesn’t draw even more moisture from your dry skin.

Finally, look for a cream with sunscreen of SPF 30 or higher to get the added benefit of sun protection. You can find moisturizing sunscreens as ointments, creams, gels, even sprays. The AAD suggests creams as your best bet for helping to combat dry skin.

6. Humidify in Winter.

Cold, dry air is a common cause of dry, irritated skin. Heating your house keeps you warm, but it also removes moisture from the air, which can make dry skin even more parched.

To replenish that missing moisture quickly and easily, use a humidifier in your bedroom, Cambio says. You can track humidity easily with an inexpensive humidity meter, called a hygrometer. Aim for indoor humidity of about 50%.

http://www.webmd.com/beauty/skin/6-tips-relive-dry-skin-fast

Head,Neck,Ears,Eyes,Mouth

Assessment of Head, Face, Neck, Eyes, Ears, Nose, Mouth and Throat

HEENT (Head, Eyes, Ears, Nose, Throat)

 Assessment of Head, Face, Neck, Eyes, Ears, Nose, Mouth and Throat

HEENT (Head, Eyes, Ears, Nose, Throat)

Informative Web Videos:

http://youtu.be/FHWw8opmQdg

http://youtu.be/8vd-t-uYfbY

http://youtu.be/gv4jJr4aly0

 Head and Face-Head is rounded, normocephalic, symmetrical, and non-tender.  Look for scars, lumps, rashes, hair loss, or other lesions.  Look for general facial symmetry, hair distribution, general facial expressions, involuntary movements, or edema.  Palpate to identify any areas of tenderness or deformity and no nodules or masses and depression. Assess color and texture of hair and color, texture and temperature of skin.

Neck-Inspect for asymmetry, scars, or other lesions.  The neck muscles are equal in size and the client can show coordinated, smooth head movement and has normal range of motion with no discomfort.  Palpate the neck to detect areas of tenderness, deformity, or masses.   The lymph nodes should be non-palpable and non-tender.  The trachea should be midline in the neck and the thyroid gland should not be visible on inspection. You should assess for movement of the glands while the patient swallows.

Eyes-Check the sclera for color, the conjunctiva for color and moistness, the pupils for equally rounded, reactive to light and accommodating (PERRLA).  Use a Sneelen chart to check visual acuity.  Assess for color vision with an Ishihara test.  Check for extraocular movements and evaluate visual fields.  The external structures are symmetrical. Eyebrows and eyelashes are evenly distributed and eyelids open and close completely.  Corneas and lenses should be clear and irises should be round and illuminate when light is shined across them. An assessment of the inner eye can be done with an opthalmoscope in a darkened room.  The lacrimal apparatus can be palpated for discharge and tenderness.

Ears- The auricles are in proper alignment, symmetrical and have the same color as the facial skin.   When palpating for texture, the auricles are mobile, firm and non-tender.  The pinna recoils when folded.  You should check for lesions. The ear canal should be free of foreign bodies, redness, swelling or discharge.  Cerumen is expected.  The internal ear can be viewed by pulling the ear up and back.  Using an otoscope the tympanic membranes should be pearly grey and intact.  Light reflex is visible and well defined and cone shaped.  The other structures of the ear are clearly visible.  The ear canal should be pink with fine hairs.  A hearing aquity can be done with a watch tick test to see if the client can hear the ticking in both ears.

Nose-The nose should be appear straight, be midline, symmetrical and of normal color.  There should be no discharge or excessive flaring.  Each nostril should be patent.  The internal structures can be examined with a nasal speculum. The septum should be midline and intact and the mucosa should be pink and moist.  When the nose is lightly palpated there should be no lesions or tenderness.  Assess the smell factor by asking the client to occlude one nostril and identify a familiar smell.  Sinuses may be palpated for tenderness.

Mouth & Throat-The lips of the client are uniformly pink and darker than the skin color, moist, symmetrical and have a smooth texture.  The lips should not be cracked, blistered, or have lesions and should be non-tender.  Teeth should not be missing, loose or show discoloration.  Teeth should be shiny and white.  Dental caries, dentures or cracked teeth should be noted.  Gums should be pink and be tight against teeth with no retractions or bleeding noted when palpated.  The mucosal membranes should be uniformly pink, moist, soft and shiny with an elastic texture and free of lesions.  The tongue is centrally positioned.  It is pink in color, moist and slightly rough.  The underside should be smooth with a vascular pattern.  Ask client to move tongue in different ways to assess and check for lesions, white patches or ulcers. You can check taste by having client identify different foods with their eyes closed.  The hard and soft palate should be intact, pink, symmetrical and free of lesions.  The hard palate is firm and concave and the soft palate moves with vocalization.  The uvula is midline in the soft palate and should be pink, intact and move with vocalization.  The tonsils that are visible should be the same color as the surrounding mucosa and size, color and any discharge should be noted.  A gag reflex can be checked by using a tongue blade in the back of the throat.  Speech should be assessed during exam. For each category you should ask basic questions.  Have you noticed any pain, discharge, swelling, redness or change.

 References

Jarvis, Carolyn. (2012). Physical Examination & Health Assessment. St. Louis, MO:     Elsevier/Saunders.

(2012). Overview of Nursing Health Assessment-RN.com.  Retrieved from rn.com/.

(2012). Complete Head-to-Toe Physical Assessment Cheat Sheet.  Retrieved from nurseslabs.com.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You are What you Eat!

During assessment of the hair, skin, and nails, there may be signs of malnutrition. Lets look at some of the symptoms and their possible causes.

Vitamin A Deficiency:

Skin:

  • Dry, flakey, scaly
  • Dry, bumpy skin ( Follicular Hyperkeratosis)

Vitamin C Deficiency:

Skin:

  • Petechiae/ Ecchymoses

Nails:

  • Splinter Hemorrhages

Niacin Deficiency:

Skin:

  • Cracks in the skin
  • Lesions on hands, legs, face, or neck
  • Pellagrous dermatitis ( hyperpigmentation of sunlight exposed skin)

Iron Deficiency:

Nails:

  • Brittle
  • Ridged
  • Spoon Shaped (Koilonychia)

Protein Deficiency:

Hair:

  • Dull, Dry Sparse
  • Color Changes

Copper Deficiency:

Hair:

  • Corkscrew Hair

Vitamin B6 Deficiency:

Skin:

  • Nasolabia Seborrhea
  • Acneform forehead rash

Linoleic Acid Deficiency:

Skin:

  • Eczema
  • Follicular Hyperkeratosis (Dry, bumpy skin)

Excessive serum LDL or VLDL levels:

Skin:

  • Xanthomas (Excessive deposits of cholesterol)

Jarvis, C. (2012). Physical Examination & Health Assessment (6th ed.). St. Louis, Mo: Elsevier.

 

 

 

Quick Tips: 5 Ways to Feed Your Skin the Nutrients It Needs

Who knew eating healthy foods could improve your looks, too? Strawberries are a great source of vitamin C.
Wavebreak Media/Thinkstock

Unhappy with your dull complexion and sagging skin? You don’t need surgery — you need only eat the right foods to rejuvenate your skin and take years off your look, says dermatologist Nicholas Perricone, M.D.

Perricone, an assistant clinical professor of dermatology at the Yale University School of Medicine and author of “The Wrinkle Cure,” is not alone in focusing on nutrition as a path to healthy, radiant skin. Hope is growing in the scientific community that the aging process can be slowed with vitamins.

The shining stars in the scientific race against wrinkles: antioxidants such as vitamins A, C and E. Antioxidants have the potential to overwhelm destructive molecules called free radicals, which live in every cell of the body and can destroy the skin tissue.

To support healthy skin (and hair and nails), experts agree that certain vitamins and minerals are essential. The top five are:

  • Vitamin C: This vitamin is critical for strong, healthy skin because of its role in the body’s manufacture of collagen, a protein that keeps the skin supple and tight. Even a slight deficiency can compromise the production of collagen. Fruits like pink grapefruit, kiwi and strawberry contain lots of vitamin C, as do bell peppers.
  • Vitamin E: The vitamin is thought to help in the fight against free radicals, though deficiency of vitamin E is not known to cause any disease. Pick up some sunflower seeds, Swiss chard and papaya to get your fill.
  • Thiamine: This B vitamin is important in ensuring normal cellular function in the skin. You can find thiamine in tuna and all sorts of beans, from navy to pinto.
  • Zinc: Normal epidermal cell growth is reliant on this mineral, which you can find plenty of in venison, crimini mushrooms and spinach.
  • Selenium: This mineral is critical in the production of glutathione, a natural enemy of free radicals. Brazil nuts are a great source of selenium, as are scallops, shiitake mushrooms and lamb.

Perricone says it’s simply about “eating the way we were told.” Leaving nothing to chance, however, the doctor also specifies the contents of a healthful diet for skin should include:

  • high-protein foods
  • antioxidant-rich carbohydrates
  • essential fatty acids

The diet is aimed at reducing skin inflammation, explains the dermatologist, because it’s inflammation that makes skin look dull and wrinkled, makes pores appear larger and causes discoloration of the skin.

Perricone’s ideal skin-healthy meal would include a 6-ounce (170.1-gram) serving of fresh grilled salmon, a romaine lettuce salad with lemon juice and olive oil for a dressing, and fresh cantaloupe.

Says Nick Lowe, M.D., the author of “Skin Secrets: The Medical Facts Versus the Beauty Fiction,” and a clinical professor of Dermatology at the UCLA School of Medicine: “If you eat a normal, balanced diet and take vitamin and mineral supplements, that should be more than adequate, and assuming you don’t smoke, the skin is a remarkably resilient organ.”

Please check out this Video on the link below on Nail health.

http://bcove.me/py0qr94l

How Food Affects Your Hair

Besides being your “crowning glory,” your hair is also an important marker of your overall health. A good diet and smart lifestyle changes can have your hair–and your health–looking great.

healthy hair, Food cures

Now that you understand the basics of hair health, the best thing you can do is to start a hair–healthy diet today! By adding the correct foods into your diet you can have a healthier head of hair in less than a year.

Hair is a great marker of overall health. Good hair depends on the body’s ability to construct a proper hair shaft, as well as the health of the skin and follicles. Good nutrition assures the best possible environment for building strong, lustrous hair. But this is not a quick fix. Changing your diet now will affect only new growth, not the part of the hair that is already visible. You could get a completely fresh start if you shaved your head today and started eating a perfect, hair-improving diet tomorrow. Your new head of hair would positively radiate with health. But there’s really no need. Take my word for it: Starting a hair-healthy diet today will mean a more gorgeous head of hair within six months to a year, depending on how fast your hair grows. Hair growth rates vary between about 1⁄4″ and 11⁄4″ per month depending on age, gender, ethnicity, and other genetic and lifestyle factors. On average, a person can expect to have about 6 inches of new growth every year, so it will take about that long to notice the effects of your nutritional changes.

B Vitamins: Folate, B6, B12

These vitamins are involved in the creation of red blood cells, which carry oxygen and nutrients to all body cells, including those of the scalp, follicles, and growing hair. Without enough B vitamins, these cells can starve, causing shedding, slow growth, or weak hair that is prone to breaking.

BEST FOODS FOR VITAMIN B6: Chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, skinless chicken, potatoes (white and sweet), oats, bananas, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, winter squash (acorn, butternut), broccoli, broccoli raab, carrots, Brussels sprouts, peanuts and peanut butter, eggs, shrimp, tofu, apricots, watermelon, avocadoes, strawberries, whole grain bread

BEST FOODS FOR VITAMIN B12: Shellfish (clams, oysters, crab), wild salmon (fresh, canned), soy milk, trout (rainbow, wild), tuna (canned light), lean beef, veggie burgers, cottage cheese (fat-free, 1% low-fat), yogurt (fat-free, low-fat), milk (fat-free, 1% low-fat), eggs, cheese (fat-free, reduced-fat)

BEST FOODS FOR FOLATE: Lentils, black-eyed peas, soybeans, oats, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges and orange juice, Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), starchy beans (such as black, navy, pinto, garbanzo, and kidney), cauliflower, Chinese cabbage, corn, whole grain bread, whole grain pasta

Biotin

People ask me about biotin for hair health all the time. Usually, they’ve heard about it on a shampoo commercial or read a magazine article that recommended biotin supplements. Biotin is a B vitamin essential for hair growth and overall scalp health. Because our bodies make their own biotin in the intestines, and it is plentiful in many common foods, deficiency is very rare. In those few cases where people are very ill and don’t have use of their intestines, biotin deficiency causes hair loss. So yes, biotin is important for hair health, but you don’t need to take supplements. Just eat a balanced diet that includes some high biotin foods.

BEST FOODS FOR BIOTIN: Eggs, peanuts and peanut butter, almonds and almond butter, wheat bran, walnuts, Swiss chard, whole wheat bread, wild salmon (fresh, canned), cheese (fat-free, reduced-fat), cauliflower, avocadoes, raspberries

Iron-Rich Protein

Iron helps red blood cells carry oxygen. Iron deficiency can lead to anemia, a condition in which cells don’t get enough oxygen to function properly. The result can be devastating to the whole body, causing weakness, fatigue, and possibly hair loss. One large scale study found that premenopausal women who reported severe hair loss were more likely to have low iron reserves (as measured by a test for an iron storage protein called ferritin) than women who reported little or no hair loss. Women of childbearing age are more likely to experience iron deficiency because they lose a significant amount of iron from the blood shed during menstruation. Women with heavier periods will lose more iron than those with lighter flow.

For most people, foods can provide all the iron necessary for good health and strong hair. I recommend iron-rich protein for two reasons. First, protein is necessary for all cell growth, including hair cells. Hair gets its structure keratin, and without enough protein for keratin, your strands will weaken and grow more slowly. Second, the iron found in meat (called heme iron) is more easily absorbed by the body than the iron in plant foods (non-heme iron).

Vegetarians can meet their iron requirement by consuming plenty of iron-rich plant foods like starchy beans, lentils, and dark leafy greens. Vitamin C improves the body’s ability to absorb non-heme iron, so vegetarians should eat iron-rich foods and foods rich in vitamin C at the same meal. Before menopause, women may want to consider taking a multivitamin that contains iron.

BEST FOODS FOR IRON-RICH PROTEIN:Clams, oysters, lean beef and lamb, skinless chicken and turkey (especially dark meat), pork tenderloin, shrimp, egg yolks

BEST IRON–RICH PROTEIN (vegetarian sources): Tofu, tempeh, soybeans (edamame), lentils, starchy beans (such as black, navy, pinto, garbanzo, kidney), black-eyed peas

BEST IRON–RICH VEGETABLES (low in protein, but offer ample iron):Spinach, seaweed, Swiss chard, asparagus, Brussels sprouts, mustard greens, kale, broccoli

Vitamin C

Vitamin C is necessary for hair health for many reasons. Vitamin C helps the body use non-heme iron — the type found in vegetables — to assure that there is enough iron in red blood cells to carry oxygen to hair follicles. Vitamin C is also used to form collagen, a structural fiber that helps our bodies — quite literally — hold everything together. Hair follicles, blood vessels, and skin all require collagen to stay healthy for optimal growth. For example, some of the first signs of severe vitamin C deficiency are tiny bumps and red spots around the hair follicles on the arms, back, buttocks, and legs. These bumps are caused when tiny blood vessels leak around the follicles. Hair growth is also affected. On the body, the small hairs on arms and legs can become misshapen, curling in on themselves. On the head, even minor vitamin C deficiencies can lead to dry, brittle hair that breaks easily.

BEST FOODS FOR VITAMIN C:Guava, bell peppers (all colors), oranges and orange juice, grapefruit and grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons and lemon juice, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, cabbage (all varieties), mangoes, white potatoes, mustard greens, tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, raspberries, blackberries, watermelon, tangerines, okra, lychees, summer squash, persimmons

Beta Carotene

Beta carotene in foods is converted to vitamin A in the body, and vitamin A is necessary for all cell growth, including hair cells. A deficiency can lead to dry, dull, lifeless hair, and dry skin, which can flake off into dandruff. Note that you can have too much of a good thing when it comes to vitamin A — excessive amounts can cause hair loss. My advice is to add more beta carotene–rich foods to your meals rather than take vitamin A supplements. If you should choose to take a multivitamin, check the label to make sure that your brand supplies no more than 50% DV of vitamin A in the form of retinol. Retinol is listed on supplement labels as palmitate or acetate. The other 50% or more should come in the form of beta carotene or mixed carotenoids, which are converted to vitamin A only as we need it.

BEST FOODS FOR BETA CAROTENE:Sweet potatoes, carrots, kale, butternut squash, turnip greens, pumpkin, mustard greens, cantaloupe, red peppers, apricots, Chinese cabbage, spinach, lettuce (romaine, green leaf, red leaf, butterhead), collard greens, Swiss chard, watercress, grapefruit, watermelon, cherries, mangos, tomatoes, guava, asparagus, red cabbage

Zinc

The mineral zinc is involved in tissue growth and repair, including hair growth. It also helps keep the oil glands around your hair follicles working properly. Low levels of zinc can cause hair loss, slow growth, and dandruff. The amount you get from eating foods rich in zinc is plenty to keep your tresses gorgeous. Aside from a multivitamin that provides up to 100% DV, I don’t recommend taking extra zinc supplements because excess zinc can inhibit your body’s ability to absorb copper, a minor but necessary mineral.

BEST FOODS FOR ZINC:Oysters, lobster, lean beef, crab, ostrich, wheat germ, skinless chicken or turkey (especially dark meat), lean lamb, clams, mussels, pumpkin seeds, yogurt (fat-free, low-fat), pork tenderloin, starchy beans (such as black, navy, pinto, garbanzo, kidney), lentils, black-eyed peas, soybeans (edamame), lima beans, pine nuts, cashews, peanuts and peanut butter, sunflower seeds and butter, pecans

 

http://www.joybauer.com/looking-great/how-food-affects-hair-health.aspx

 

 

 

 

 

NURSING ASSESSMENT: SKIN

Status

Our skin is the first line of defense from the rest of the world. The integrity of the skin is very important. Upon the first interaction with our patients, our attention is on his/her skin. This can tell us quite a bit about overall health without knowing the entire history. When we perform our health assessment, there are a few things we can ask our patients to be sure all skin conditions are reviewed, including allergies to medications, topical lotions and/or soaps, or even tape or latex. Certain skin conditions such as eczema, xerosis, wounds, rashes, skin discoloration, or any other skin abnormalities should be discussed at this time. It is also important to remember that our skin may have changes with the seasons. This could be when we ask our patient what type of soaps and lotions they use, and if they are bathing every day.

The physical assessment of the skin includes temperature, moisture, color, and turgor. When there is a skin condition that needs to be documented, there are few terms that describe different lesions:
Macule – flat, less that 1 cm, non-palpable lesion that has a change of skin color
 Patch – flat, larger than 1 cm, non-palpable lesion that has a change of skin color
 Papule – elevated, flat-topped, less than 1 cm, firm, rough, superficial lesion
 Nodule – elevated, firm, palpable, larger than 0.5 cm
 Cyst – nodule that is filled with either a liquid or semisolid material
 Vesicle – palpable fluid filled blister
 Bulla – 1 cm or larger filled with serous fluid
 Pustule – elevated, superficial, filled with pus
 Wheal – transient, elevated, localized skin edema (Hess, 2010)
When performing a skin assessment, nails need to be assessed as well. Ask the patient if they have noticed any changes in his/her nails; have they become more brittle, or breaking, discolored, or misshaped. Systemic conditions may be evidenced by changes in patient’s nails.

WELCOME TO WINTER

 

Ultimate-winter-skin-care-tips[1]

 

 

 

 

 

According to dermatologist, Dr. David Colbert (2011), we should be looking for these ingredients in lotions: glycerin, mineral oil, ceramides, dimethicone or linoleic acid. This will help to seal in moisture. He also reminds us of the importance of wearing sunscreen during the winter months. The snow can reflect the UV rays, causing an intense burn, so it is important to remind our patients that they should be applying sunscreen if they will be outside or visiting the slopes!!

6 Great Winter skin Tips-CheckInTheMirror-You Tube (2013, December 10). You Tube. Retrieved from http;//www.youtube.com/watch?v=zyY7JIXu4