NUR 2092 Health Assessment Exam 2 Study Guide
HEENT
Skin
The Aging Adult
Skin Color and Pigmentation. Senile lentigines are common variations of hyperpigmentation.
Commonly called liver spots, these are small, flat, brown macules (Fig. 12-21). These circumscribed
areas are clusters of melanocytes that appear after extensive sun exposure. They appear on the
forearms and dorsa of the hands. They are not malignant and require no treatment.
Common variations occurring in the aging adult are acrochordons, or “skin tags,” which are
overgrowths of normal skin that form a stalk and are polyp-like (Fig. 12-24). They occur frequently
on eyelids, cheeks and neck, and axillae and trunk.
Keratoses are raised, thickened areas of pigmentation that look crusted, scaly, and warty. One
type, seborrheic keratosis, looks dark, greasy, and “stuck on” (Fig. 12-22). They develop mostly on the
trunk but also on the face and hands and on both unexposed and sun-exposed areas. They do not become
cancerous.
Common Shapes and Configurations of Lesions ANNULAR, or circular, begins in center
and spreads to periphery (e.g., tinea corporis or ringworm, tinea versicolor, pityriasis
rosea).
CONFLUENT, lesions run together (e.g., urticaria [hives]).
DISCRETE, distinct, individual lesions that remain separate (e.g., acrochordon or skin
tags, acne).
GYRATE, twisted, coiled spiral, snakelike
GROUPED, clusters of lesions (e.g., vesicles of contact dermatitis). LINEAR, a scratch,
streak, line, or stripe. TARGET, or iris, resembles iris of eye, concentric rings of color in
lesions (e.g., erythema multiforme). ZOSTERIFORM, linear arrangement along a
unilateral nerve route (e.g., herpes zoster).
POLYCYCLIC, annular lesions grow together (e.g., lichen planus, psoriasis).
TABLE 12-4 Primary Skin Lesions The immediate result of a specific causative factor;
primary lesions develop on previously unaltered skin. Macule Papule Solely a color
change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi,
hypopigmentation, petechiae, measles, scarlet fever. Something you can feel (i.e., solid,
elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in
epidermis. Examples: elevated nevus (mole), lichen planus, molluscum, wart (verruca).
, Patch Plaque Macules that are larger than 1 cm. Examples: mongolian spot, vitiligo, café
au lait spot, chloasma, measles rash. Papules coalesce to form surface elevation wider
than 1 cm. A plateaulike, disk-shaped lesion. Examples: psoriasis, lichen planus. Nodule
Wheal Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis
than papule. Examples: xanthoma, fibroma, intradermal nevi. Superficial, raised,
transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in
the tissues). Examples: mosquito bite, allergic reaction, dermographism. Tumor Urticaria
(hives) Larger than a few centimeters in diameter, firm or soft, deeper into dermis; may
be benign or malignant, although “tumor” implies “cancer” to most people. Examples:
lipoma, hemangioma. Wheals coalesce to form extensive reaction, intensely pruritic.
Vesicle Elevated cavity containing free fluid, up to 1 cm; a “blister.” Clear serum flows if
wall is ruptured. Examples: herpes simplex, early varicella (chickenpox), herpes zoster
(shingles), contact dermatitis. Bulla Larger than 1 cm diameter; usually single
chambered (unilocular); superficial in epidermis; thin walled and ruptures easily.
Examples: friction blister, pemphigus, burns, contact dermatitis. Cyst Pustule
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin.
Examples: sebaceous cyst, wen. Turbid fluid (pus) in the cavity. Circumscribed and
elevated. Examples: impetigo, acne. Line drawings © Pat Thomas, 2010. See Illustration
Credits for source information. TABLE 12-5 Secondary Skin Lesions Resulting from a
change in a primary lesion from the passage of time; an evolutionary change. NOTE:
Combinations of primary and secondary lesions may coexist in the same person. Such
combined designations may be termed papulosquamous, maculopapular,
vesiculopustular, or papulovesicular. Debris on Skin Surface Crust Scale The thickened,
dried-out exudate left when vesicles/pustules burst or dry up. Color can be red-brown,
honey, or yellow, depending on fluid ingredients (blood, serum, pus). Examples:
impetigo (dry, honey-colored), weeping eczematous dermatitis, scab after abrasion.
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of
dead excess keratin cells. Examples: after scarlet fever or drug reaction (laminated
sheets), psoriasis (silver, micalike), seborrheic dermatitis (yellow, greasy), eczema,
ichthyosis (large, adherent, laminated), dry skin. Break in Continuity of Surface Fissure
Erosion Linear crack with abrupt edges; extends into dermis; dry or moist. Examples:
cheilosis—at corners of mouth caused by excess moisture; athlete's foot. Scooped out
but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without
scar because erosion does not extend into dermis. Ulcer Excoriation Deeper depression
extending into dermis, irregular shape; may bleed; leaves scar when heals. Examples:
stasis ulcer, pressure sore, chancre. Self-inflicted abrasion; superficial; sometimes
crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis,
varicella. Scar Atrophic Scar After a skin lesion is repaired, normal tissue is lost and
replaced with connective tissue (collagen). This is a permanent fibrotic change.
Examples: healed area of surgery or injury, acne. The resulting skin level is depressed
with loss of tissue; a thinning of the epidermis. Example: striae. Lichenification Keloid
Prolonged, intense scratching eventually thickens skin and produces tightly packed sets
of papules; looks like surface of moss (or lichen). A benign excess of scar tissue beyond
sites of original injury: surgery, acne, ear piercing, tattoos, infections, burns.16 Looks
smooth, rubbery, shiny and “clawlike”; feels smooth and firm. Found in ear lobes, back
of neck, scalp, chest, and back; may occur months to years after initial trauma. Most
common ages are 10-30 years; higher incidence in Blacks, Hispanics, and Asians.16 Line
drawings © Pat Thomas, 2010. See Illustration Credits for source information. TABLE 12-
6 Pressure Ulcer (Decubitus Ulcer) Pressure ulcers appear on the skin over a bony
HEENT
Skin
The Aging Adult
Skin Color and Pigmentation. Senile lentigines are common variations of hyperpigmentation.
Commonly called liver spots, these are small, flat, brown macules (Fig. 12-21). These circumscribed
areas are clusters of melanocytes that appear after extensive sun exposure. They appear on the
forearms and dorsa of the hands. They are not malignant and require no treatment.
Common variations occurring in the aging adult are acrochordons, or “skin tags,” which are
overgrowths of normal skin that form a stalk and are polyp-like (Fig. 12-24). They occur frequently
on eyelids, cheeks and neck, and axillae and trunk.
Keratoses are raised, thickened areas of pigmentation that look crusted, scaly, and warty. One
type, seborrheic keratosis, looks dark, greasy, and “stuck on” (Fig. 12-22). They develop mostly on the
trunk but also on the face and hands and on both unexposed and sun-exposed areas. They do not become
cancerous.
Common Shapes and Configurations of Lesions ANNULAR, or circular, begins in center
and spreads to periphery (e.g., tinea corporis or ringworm, tinea versicolor, pityriasis
rosea).
CONFLUENT, lesions run together (e.g., urticaria [hives]).
DISCRETE, distinct, individual lesions that remain separate (e.g., acrochordon or skin
tags, acne).
GYRATE, twisted, coiled spiral, snakelike
GROUPED, clusters of lesions (e.g., vesicles of contact dermatitis). LINEAR, a scratch,
streak, line, or stripe. TARGET, or iris, resembles iris of eye, concentric rings of color in
lesions (e.g., erythema multiforme). ZOSTERIFORM, linear arrangement along a
unilateral nerve route (e.g., herpes zoster).
POLYCYCLIC, annular lesions grow together (e.g., lichen planus, psoriasis).
TABLE 12-4 Primary Skin Lesions The immediate result of a specific causative factor;
primary lesions develop on previously unaltered skin. Macule Papule Solely a color
change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi,
hypopigmentation, petechiae, measles, scarlet fever. Something you can feel (i.e., solid,
elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in
epidermis. Examples: elevated nevus (mole), lichen planus, molluscum, wart (verruca).
, Patch Plaque Macules that are larger than 1 cm. Examples: mongolian spot, vitiligo, café
au lait spot, chloasma, measles rash. Papules coalesce to form surface elevation wider
than 1 cm. A plateaulike, disk-shaped lesion. Examples: psoriasis, lichen planus. Nodule
Wheal Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis
than papule. Examples: xanthoma, fibroma, intradermal nevi. Superficial, raised,
transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in
the tissues). Examples: mosquito bite, allergic reaction, dermographism. Tumor Urticaria
(hives) Larger than a few centimeters in diameter, firm or soft, deeper into dermis; may
be benign or malignant, although “tumor” implies “cancer” to most people. Examples:
lipoma, hemangioma. Wheals coalesce to form extensive reaction, intensely pruritic.
Vesicle Elevated cavity containing free fluid, up to 1 cm; a “blister.” Clear serum flows if
wall is ruptured. Examples: herpes simplex, early varicella (chickenpox), herpes zoster
(shingles), contact dermatitis. Bulla Larger than 1 cm diameter; usually single
chambered (unilocular); superficial in epidermis; thin walled and ruptures easily.
Examples: friction blister, pemphigus, burns, contact dermatitis. Cyst Pustule
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin.
Examples: sebaceous cyst, wen. Turbid fluid (pus) in the cavity. Circumscribed and
elevated. Examples: impetigo, acne. Line drawings © Pat Thomas, 2010. See Illustration
Credits for source information. TABLE 12-5 Secondary Skin Lesions Resulting from a
change in a primary lesion from the passage of time; an evolutionary change. NOTE:
Combinations of primary and secondary lesions may coexist in the same person. Such
combined designations may be termed papulosquamous, maculopapular,
vesiculopustular, or papulovesicular. Debris on Skin Surface Crust Scale The thickened,
dried-out exudate left when vesicles/pustules burst or dry up. Color can be red-brown,
honey, or yellow, depending on fluid ingredients (blood, serum, pus). Examples:
impetigo (dry, honey-colored), weeping eczematous dermatitis, scab after abrasion.
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of
dead excess keratin cells. Examples: after scarlet fever or drug reaction (laminated
sheets), psoriasis (silver, micalike), seborrheic dermatitis (yellow, greasy), eczema,
ichthyosis (large, adherent, laminated), dry skin. Break in Continuity of Surface Fissure
Erosion Linear crack with abrupt edges; extends into dermis; dry or moist. Examples:
cheilosis—at corners of mouth caused by excess moisture; athlete's foot. Scooped out
but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without
scar because erosion does not extend into dermis. Ulcer Excoriation Deeper depression
extending into dermis, irregular shape; may bleed; leaves scar when heals. Examples:
stasis ulcer, pressure sore, chancre. Self-inflicted abrasion; superficial; sometimes
crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis,
varicella. Scar Atrophic Scar After a skin lesion is repaired, normal tissue is lost and
replaced with connective tissue (collagen). This is a permanent fibrotic change.
Examples: healed area of surgery or injury, acne. The resulting skin level is depressed
with loss of tissue; a thinning of the epidermis. Example: striae. Lichenification Keloid
Prolonged, intense scratching eventually thickens skin and produces tightly packed sets
of papules; looks like surface of moss (or lichen). A benign excess of scar tissue beyond
sites of original injury: surgery, acne, ear piercing, tattoos, infections, burns.16 Looks
smooth, rubbery, shiny and “clawlike”; feels smooth and firm. Found in ear lobes, back
of neck, scalp, chest, and back; may occur months to years after initial trauma. Most
common ages are 10-30 years; higher incidence in Blacks, Hispanics, and Asians.16 Line
drawings © Pat Thomas, 2010. See Illustration Credits for source information. TABLE 12-
6 Pressure Ulcer (Decubitus Ulcer) Pressure ulcers appear on the skin over a bony
