PHYSICAL

ASSESSMENT:

SKIN, HAIR,
and NAILS
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COLLECTING SUBJECTIVE DATA:
THE NURSING HEALTH HISTORY

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HISTORY OF
PRESENT Are you experiencing any
ILLNESS: current skin problems such as
rashes, lesions, dryness, oiliness,
SKIN drainage, bruising, swelling, or
increased pigmentation? What
aggravates the problem? What
relieves it?
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 RATIONALE:
HISTORY OF
PRESENT Any of these symptoms may be related
ILLNESS: to a pathologic skin condition. Bruises,
welts, or burns may indicate accidents
SKIN or trauma or abuse. If these injuries
cannot be explained or the client’s ex-
planation seems unbelievable or vague,
physical abuse should be suspected.
Dry, itchy skin is a common concern in
obese clients (Brown et al., 2004). 4
HISTORY OF
PRESENT Describe any birthmarks or
ILLNESS: moles you now have. Have any
of them changed color, size, or
SKIN shape?

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HISTORY OF You need to know what is normal for
PRESENT the client so that future variations can
ILLNESS: be detected. A change in the
appearance or bleeding of any skin
SKIN mark, especially a mole, may indicate
cancer.
Asymmetry, irregular borders, color
variations, diameter greater than 0.5
cm, and elevation are characteristics of
cancerous lesions. 6
HISTORY OF
Have you noticed any change in your
PRESENT
ability to feel pain, pres- sure, light
ILLNESS:
touch, or temperature changes? Are
you experiencing any pain, itching,
SKIN
tingling, or numbness?

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HISTORY OF RATIONALE:
PRESENT Changes in sensation may indicate
ILLNESS: vascular or neurologic prob- lems such
as peripheral neuropathy related to
SKIN diabetes mellitus or arterial occlusive
disease. Sensation problems may put
the client at risk for developing
pressure ulcers (see Promote Health—
Pressure Ulcers).
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HISTORY OF
PRESENT
Do you have trouble controlling
ILLNESS:
body odor? How much do you
SKIN perspire?

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HISTORY OF RATIONALE:
PRESENT Uncontrolled body odor or excessive or
ILLNESS: insufficient perspiration may indicate
an abnormality with the sweat glands
SKIN or an endocrine problem such as
hypothyroidism or hyperthyroidism.
Poor hygiene practices may account
for body odor, and health education
may be indicated.
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 Perspiration decreases with aging
HISTORY OF
because sweat gland activity decreases.
PRESENT
Because of decreased sweat production,
ILLNESS:
most Asians and Native Americans have
mild to no body odor, whereas
SKIN
Caucasians and African Americans tend
to have a strong body odor (Andrews &
Boyle, 1999) unless they use
antiperspirant or deodorant products.
Any strong body odor may indicate an
abnormality. 11
HISTORY OF
PRESENT Do you have any body
ILLNESS:
piercings or tattoos?
SKIN

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HISTORY OF RATIONALE:
PRESENT Piercing needles place clients at
ILLNESS: risk for infection. Tattooing
pigments can cause allergic
SKIN
reactions, keloids, and scars.
Clients should be informed
regarding these risks. Piercings
and tattoos are gaining popularity.
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HISTORY OF
PRESENT Have you had any hair
ILLNESS:
loss or change in the
HAIR and condition of your hair?
NAILS Describe.

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HISTORY OF RATIONALE:
PRESENT Patchy hair loss may accompany
ILLNESS: infections, stress, hairstyles that
put stress on hair roots, and some
HAIR and types of chemotherapy.
NAILS Generalized hair loss may be seen
in various systemic illnesses such
as hypothyroidism and in clients
receiving certain types of
chemotherapy or radiation therapy.15
HISTORY OF
PRESENT
ILLNESS: A receding hairline or male
pattern baldness may occur
HAIR and with aging.
NAILS

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HISTORY OF RATIONALE:
PRESENT Nail changes may be seen in systemic
ILLNESS: disorders such as malnutrition or with
local irritation (e.g., nail biting).
Bacterial infections cause green, black,
HAIR and
or brown nail discoloration. Yellow,
NAILS thick, crumbling nails are seen in
fungal infections. Yeast infections
cause a white color and separation of
the nail plate from the nail bed.
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BIG CONCEPT
Bring the attention of your audience over a key concept using icons or illustrations

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PAST HEALTH
HISTORY 19
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▪ COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION

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 - ask the client to remove all clothing and
PREPARING jewelry and put on an examination gown
THE CLIENT - ask the client to remove nail enamel, artificial
nails, wigs, toupees, or hairpieces as appropriate
- have the client sit comfortably on the
examination table or bed for the beginning of
the examination.
- to assess the skin on the buttocks and dorsal
surfaces of the legs properly, the client may lie
on her side or abdomen.
- ensure privacy by exposing only the body part
being examined 26
 - make sure that the room is a comfortable
PREPARING temperature and if available, sunlight is best
THE CLIENT for inspecting the skin. However, a bright light
that can be focused on the client works just as
well.
- Wear gloves when palpating any lesions
because you may be exposed to drainage.
- Clients from conservative religious groups
(e.g., Orthodox Jews or Muslims) may require
that the nurse be the same sex as the client.
Also, to respect the client’s modesty or desire
for privacy, provide a long examination gown 27
 • Examination light
EQUIPMENT • Penlight
NEEDED • Mirror for client’s self-examination of skin
• Magnifying glass
• Centimeter ruler
• Gloves
• Wood’s light
• Examination gown or drape
• Braden Scale for Predicting Pressure Sore
Risk
• Pressure Ulcer Scale for Healing (PUSH) tool
to measure pressure ulcer healing 28
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Each category is rated on a scale of 1 to 4, excluding the 'friction
and shear' category which is rated on a 1-3 scale. This combines
for a possible total of 23 points, with a higher score meaning a
lower risk of developing a pressure ulcer and vice versa. A score
of 23 means there is no risk for developing a pressure ulcer while
the lowest possible score of 6 points represents the severest risk
for developing a pressure ulcer. The Braden Scale assessment
score scale:
•Very High Risk: Total Score 9 or less
•High Risk: Total Score 10-12
•Moderate Risk: Total Score 13-14
•Mild Risk: Total Score 15-18
•No Risk: Total Score 19-23
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