HAIR NAILS

• Vellus hair(Peach Fuzz)


  • Short, pale, fine and present over much of the body
  • Provides thermoregulation by wicking sweat away from the body
• Hair color


  • Varies and is determined by the type and amount of pigment (Melanin and pheomelanin) Production
  • A reduction in the production of pigments results in gray or white hair
• Hair


  Consists of layers of keratinized cells found over the body except (lips, nipples, soles of the feet, palm of the hand, labia minora, and penis)
• Nails: The nail plate is normally colorless and convex in shape
• Assessment of the skin

  Includes inspection and palpation
• Pachy hair loss may accompany infections, stress, hairstyles that put stress on hair roots, and some types of chemotherapy
• Assessment of Hair

  Inspect and palpate hair for color, amount and distribution, texture, and presence of parasites
• Assessment of the skin

  In some instances, the nurse may also need to use olfactory sense to detect unusual odors
• General Types of Hair

  • Vellus hair (Peach Fuzz)
  • Terminal Hair (Particularly scalp and eyebrows)
• Terminal Hair


  • Longer, generally darker, and coarser
  • Puberty initiates the growth of additional hair (axillae, perineum, and legs)
  • Hair on head protects the scalp, provides insulation, and allows self-expression
  • Nasal, Auditory Canal, eyelashes, eyebrows filter dust and other airborne debris
• Generalized hair loss is seen in various systemic illnesses such as hypothyroidism and clients receiving radiation and chemotherapy, malabsorption syndrome, malnutrition, anorexia nervosa, bulimia, and common after gastric bypass surgery
• Assessment of Scalp

  Inspect and palpate scalp for symmetry, texture, and lesions
• Nails


  • Located on the distal phalanges of fingers and toes
  • Hard, transparent plates of keratinized epidermal cells that grow from the cuticle
  • The nail body extends over the entire nail bed and has a pink tinge as a result of blood vessels underneath
  • The lunula is a crescent-shaped area located at the base of the nail
  • The nails protect the distal ends of the fingers and toes, enhance precise movement of the digits, and allow for an extended precision grip
  • Nail changes may be seen in systemic disorders such as malnutrition or with local irritation (nail biting)
• Clubbed Nails


  • A condition in which the angle between the nail and the nail bed is 180 degrees or greater. May be caused by long term oxygen loss. The nail bed is highly vascular, a characteristic that accounts for its pink color. A bluish or purplish tint in the nail beds may reflect cyanosis. Pallor may reflect poor arterial circulation
• Fungal infections


  • Gray scaly patches
• Nail polish should be removed before the nails can be examined
• Koilonychia


  • Spoon-shaped nails that may be seen with trauma to cuticles or nail folds or in iron deficiency anemia, endocrine or cardiac disease
• Half-and-Half Nails


  • Nails that are half white on the upper proximal half and pink on the distal half. May be seen in chronic renal disease
• Yellow Nail Syndrome


  • Yellow nails grow slow and are curved. May be seen in AIDS and Respiratory Syndrome, fungal infection, or cyanosis
• Assessment

  Normal Findings: Grooming and cleanliness
• Psoriasis


  • Dandruff
• • Normal nails are translucent, shiny and firm in texture
  • Longitudinal bands of pigment can normally be seen in black patients
  • With aging nails may lose their luster, thicken and become yellow
  • Longitudinal ridging also develops with aging
• Nails


  • The nail plate is normally colorless and convex in shape
  • The angle between the nail and the nail bed is normally 160 degrees
  • Nail texture is normally smooth
  • The tissue surrounding the nails is normally intact in the epidermis
• Pitting


  • Seen with psoriasis
• Beaus Line - Horizontal --- Acute trauma.

  Pale or cyanotic – hypoxia or anemia
• Assessment


  1. It takes 6 months to totally replace a fingernail and 12 months to totally replace a toenail

  2. Inspect the nails for color, shape and texture
• Dermatitis


  • Scaly, dry flakes
• Paronychia


  • Local Infection
• Longitudinal Riding


  • Parallel ridges running lengthwise. May be seen in the elderly and some young people with no known etiology
• Test Capillary Refill in Nailbeds

  1. Press the nail tip briefly and watch for color change

  2. Pink tone returns immediately to blanched nail beds when pressure is released

  3. Normal = less than 3 seconds

  4. Slow capillary refill (more than 3 seconds) with respiratory and cardiovascular diseases
• Abnormal Findings when inspecting and palpating nails

  • Dirty, broken nails may be seen with poor hygiene
• Inspect and palpate nails for the following

  1. Condition of the nail bed

  2. Smooth, firm and pink

  3. Paronychia (inflamed nail head) - infection

  4. Onycholysis (detached nail plate from nail bed) - infection or trauma
• Inspect and palpate nails for the following

  1. Texture

  2. Nail is round, immobile

  3. In dark skin: may be thick thickened nails are seen with decreased circulation
• Inspect and palpate nails for the following

  1. Color

  2. Pink Nail Bed

  3. In dark skin: may have small or large pigment deposits, streaks, freckles

  4. Pale or cyanotic - hypoxia or anemia

  5. Yellow discoloration - fungal infection or psoriasis

  6. Splinter hemorrhages (vertical lines) - trauma

  7. Beau’s lines (horizontal) - acute trauma
• Common Nail Disorder

  Yellow Nail Syndrome - Yellow nails grows slow and are curved. May be seen in AIDS and Respiratory Syndrome. Fungal infection or cyanosis.

  Paronychia - Local Infection

  Round nail with 160 - degree nail base

  Clubbed Nails - 180 degrees or more nails base

  Pitting - Seen with psoriasis

  Koilonychia - ( Spoon nails) iron deficiency anemia cyanosis
• Half-White Nails are nails that are half white on the upper proximal half and pink on the distal half, may be seen in chronic renal disease
• Nail Disorder

  • Beaus Line - Horizontal
  • Acute trauma
  • Pale or cyanotic - hypoxia or anemia
• Blanch Test


  1. Test the capillary refill- that is the peripheral circulation

  2. Normal nail bed capillaries blanch when pressed but quickly turns pink

  3. A slow rate of capillary refill may indicate circulatory problems

  4. Normal capillary refill is <2 seconds
• Nails

  • Bacterial Infection - Green, black or brown nail discoloration
  • Fungal Infection – yellow, thick, crumbling nails
  • Yeast infection – white color and separation of nail plate from nail bed