Assessment of the skin o Indicates hypoxia

(cardiovascular and respiratory

Physical examination of the nails:
problem)
1. shape and configuration
* Nails are hard and immobile
Normal findings:
Normal:
 Dorsal nail surface: slightly convex
 Nails are smooth and firm
 Nail thickness: 0.3-0.65 mm
 Nail plate attached to nail bed
 Angle at nail base: 160 degrees (skin-
nail interface) Abnormal:

Abnormal:  Thickened nails = decrease in circulation

o Onychomycosis
 Indicates malnutrition
 Spooning: concave nail plates; 2. color of the nails
associated with iron deficiency anemia
Normal:

 Pinkish
 Blueish in dark skinned

Abnormal:

 Cyanosis (blueish = poor oxygen

circulation)
 Nail lesions alter the color of nail plate

3. Capillary refill (squeeze nail)

Normal:

 Refills in < 3 secs = adequate tissue

perfusion

Abnormal:
 Clubbing >160 degrees  Refills in > 3 secs = poor tissue
perfusion

4. examine for presence of abnormalities

 Onycholysis
 Paronychia
 Beau’s lines
 Splinter hemorrhages
 Jarvis p.269
What to do in nails examination: (44 mins) o Size and shape of shape varies
in ethnicity but usually
 Examine shape/color
symmetrical
 Check cuticle/lunula/nail o Size of head is appropriate to
strength/texture and body size (normocephalic)
ridging/temperature/capillary refill  Abnormally small =
o No lunula on pinkie = normal microcephalic
o Missing lunula = protein  Abnormally big =
deficiency macrocephalic
o Vertical ridging =  Skull and facial bones
protein/mineral deficiency are larger and thicker =
 Ask about diet acromegaly
 Compare both hands  Acorn – shaped =
 Check feet for fungus (use gloves) Paget’s disease
o Dryness = fatty acids, hydration  Palpate thickening, tenderness and
Head assessment bruit
 inspect symmetry, movement,
Subjective: overlap several body systems – tenderness, nodules, sinuses, tremors,
nursing history is needed to detect the cause of twitch and paralysis of face
underlying problems o normal: face is symmetrical
Objective:  round
 oval
 Remove hat, wig and jewelries  elongated
 Ask client to sit in an upright position  square
with the back and shoulders held back o no abnormal movement
and straight o abnormal:
o Assess anterior and posterior of  drooping and weakness
the head or paralysis on one side
 Explain the importance of remaining of face may result from
still during most of the inspection and stroke (cerebrovascular
palpation of the neck accident)
 Explain – requested to move and bend  mask like expression
the neck for examination of muscles (parkinson’s disease)
and for palpation of the thyroid gland  has less facial
 Tell client what are you doing and share movement and
your assessment findings appears less
animated
Assessment of head and face
 reduction in the
Examination of head expressiveness
 scientific term =
Inspect and palpate the cranium hypomimia
 Inspect size shape and symmetry  palpate facial features and expressions
configuration and tenderness  head should be still and upright
  neurologic disorders may cause
horizontal jerking
movement/involuntary nodding
movement
o head tilted to one side
indicates:
 unilateral vision
 hearing deficiency
 shortening of
sternomastoid muscle
 palpate the head
o normal: hard and smooth,
w/out lesions
o lesions or lumps on the head
may indicate:
 recent trauma
 sign of cancer
 as the client opens and closes, palpate
the temporomandibular joint for
tenderness, swelling and crepitation

assessment of the neck

assess the trachea

 in midline
 palpate for tracheal shift
o Space should be symmetrical on
each side