HEALTH ASSESSMENT

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NURSING ASSESSMENT OF PHYSICAL SYSTEMS: Twitter: @DiaryniSN
ASSESSING SKIN, HAIR AND NAILS Email: diarynisn@gmail.com

Objectives: c. Stratum granulosum

1. Review the anatomy and physiology of d. Stratum spinosum
skin, hair and nails e. Stratum germinativum
2. Obtain subjective and objective data
from clients for accurate nursing history 2. Dermis – inner layer with the following
of the skin, hair and nails structures:
3. Use correct techniques to perform a. dermal papillae
physical assessment of skin, hair and b. nerve endings
nails c. lymph vessels
4. Difference between abnormal and d. elastic fibers
normal findings of skin, hair and nails e. collagen fibers
5. Clearly document and verbally f. sebaceous glands
communicate the subjective and g. sweat glands
objective data findings h. hair follicles
6. Analyze the collected data to formulate
nursing diagnosis, collaborative 3. Hypodermis – also called subcutaneous
problems and referrals tissue contains the following
7. Recognize how assessment findings may a. fat cells
vary in older adults b. blood vessels
c. nerves
d. remaining portion of sweat
 Anatomy and Physiology glands and hair follicles
Integumentary System- consists of the skin, hair
and nails B. Hair – consists of layers of keratinized cells
found over much of the body except for lips,
A. Skin – largest organ of the body nipples, soles of the feet, palms of the hands,
Functions: labia minora, penis
1. Physical barrier and protection
2. Temperature maintenance 2 types:
3. Fluid and electrolyte balance 1. velllus hair (peach fuzz) – short,
(absorption, excretion) pale, fine and present over much
4. Sensation of the body. Provides
5. Immunity thermoregulation by wicking sweat
6. Vitamin D synthesis away from the body
7. Individual identity to person’s 2. terminal hair – longer, darker,
appearance coarser.

C. Nail- located in the distal phalanges of

Parts of Skin fingers and toes, are hard, transparent plates
1. Epidermis – outer layer, composed of 5 of keratinized epidermal cells that grow from
strata: the cuticle. Protects the distal ends of the
a. Stratum corneum fingers and toes, enhances precise movement
b. Stratum lucidum

of the digit and allow for an extended
precision grip.
a. nail body – extends over the
entire nail bed and has a pink
tinge
b. lunula – crescent-shaped area
located at the base of the nail
 Collecting Subjective Data: SKIN
Ask the following relevant questions:
1. Are you experiencing current skin
problems?
a. rashes
b. lesions
c. dryness
d. oiliness
e. drainage
f. bruising
g. swelling
h. changes in the skin color
Glossary of Terms:
1. ________________ also called
hypopigmentation or hyperpigmentaton
2. ________________ edema or tumor
3. ________________ also called exanthem,
breaking out or eruption of the skin
4. _______________ also called seborrhea
because of overactive sebaceous glands
5. _______________ also called xerosis cutis,
usually a minor and temporary problems
6. ______________ removal of fluids or gases
from a body part
7. ______________ contusion or ecchymosis,
hematoma of the tissue, capillaries damaged
by trauma
8. _____________ any damage or abnormal
change in the tissue
2. Do you have any birthmarks or moles?
ABCDE of Skin Cancer-MELANOMA
A _________________________
(one half of the mole does not match the
other half)
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B _________________________
(the edges are irregular, jagged or blurred)
C _________________________
(uneven and not all the same, may include
shades of brown, black and sometimes
patches of pink, white, red or blue)
D _________________________
(the mole is larger than 6 mm across although
melanomas can sometimes be smaller)
E _________________________
(the mole is changing in size, shape or color)
3. Have you noticed any change in your
ability to feel pain, pressure, light touch
or temperature variation?
a. peripheral neuropathy
b. pressure ulcers (decubitus ulcers)
_________________ refers to the damage of the
nerves outside of the brain and spinal cord,
resulting to weakness, numbness and pain
________________ also called bedsores, are
injuries to the skin and underlying tissue
resulting from prolonged pressure on the skin.
Develops on skin that covers bony
prominences.
Staging of Pressure Ulcers
Stage 1. Sores are not open wounds
Stage 2. The skin breaks open, wears away or
forms an ulcer which is usually tender and
painful
Stage 3. The sore gets worse and extends to
the tissue beneath the skin forming a small
crater.
Stage 4. The pressure injury is deep, reaching
into the muscle and bone causing extensive
damage.
________________ is an evidenced-based tool
that predicts the risk for developing a hospital
or facility-acquired pressure ulcer/injury.
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4. Are you experiencing any pain, itching,
tingling or numbness?
a. pruritus
b. allergies
c. uremia
d. drug reactions
e. mycoses
f. lice infestation
g. paresthesia
h. anaphylaxis
Glossary of Terms
1. _______________ fungal infections
2. ______________ misguided reaction to foreign
substances by the immune system
3. ______________ reaction between two or
more drugs or between a drug and a food,
beverage or supplement
4. _______________ server form of allergy
5. _______________ burning or prickling
sensations in the hands, legs or feet
6. _______________ caused by
Pediculosis humanus capitis (head)
Pediculosis humanus corporis (body)
Phthirus pubis (pubic area)
7. _______________ unpleasant sensation that
provokes the desire to scratch
8. _______________ high levels of urea (one
primary components of urine) in the blood
1. ______________ abnormal reaction of the
immune system to a medication
2. ______________ an injury caused by taking
medication
3. ________________ repeated administration my
produce effects that are more pronounced
that those produced by the first dose
4. _______________ the primary or desired effect
of a drug
5. _______________ a therapeutic or adverse
effect that is secondary to the one intended
6. Do you have trouble controlling body
odor? Do you perceive yourself to have
excessive perspiration?
a. hidrosis
b. hyperhidrosis
c. bromhidrosis
Glossary of Terms
1. ________________ a foul smelling body odor
related to sweating
2. ________________ medical term for sweating
3. ________________ abnormally excessive
sweating that is not necessarily related to heat
or exercise
 Collecting Subjective Data: HAIR and
NAILS
Ask the following relevant questions:

5. Are you taking any medications? If so 1. Have you had any hair loss or damage in the
how long have you been taking each of condition of your hair?
these?
Conditions that may result to hair loss:
prescribed medications (Rx) a. hypothyroidism
over the counter drugs (non-Rx) b. chemotherapy
c. radiation therapy
a. side effects d. alopecia
b. cumulative effects e. malabsorption syndromes
c. intended effects f. malnutrition
d. drug allergy g. anorexia nervosa
e. adverse effects h. bulimia nervosa
i. gastric bypass
Glossary of Terms

Glossary of Terms
1. ___________________ partial or complete loss
of hair in patches (areata), entire head (totalis)
or over the entire body (universalis)
2. __________________ eating disorder
characterized by self-starvation and excessive
weight loss related to intense fear of becoming
fat and see themselves as fat even when they
are very thin
3. __________________ eating disorder in which a
person has a regular episodes of eating a very
large amount of food (bingeing) during which
the person feels a loss of control over eating.
The person then uses different ways such as
vomiting or laxative (purging) to prevent
weight gain
4. __________________ use of chemical agents
or cytotoxic drugs to destroy or inhibit the
growth and division of malignant cells in
cancer
5. _________________ cancer treatment that
uses beams of intense energy to kill cancer
cells
6. __________________ abnormally low activity of
the thyroid gland resulting in retardation of
growth and mental development in children
and adults
7. ___________________ a condition that results
from eating a diet in which one or more
nutrients are either not enough or are too
much such that diet causes health problems
8. ________________ the small intestine cannot
absorb enough of certain nutrients and fluids
9. ________________ a surgery that helps you
lose weight by changing how your stomach
and small intestine handle the food you eat
2. Have you had any change in the
condition or appearance of your nails?
Diseases of Nails:
a. nail injury
b. green nail syndrome
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c. ingrown toe nail
d. onychomycosis
e. paronychia
f. tumors of the nails
g. verruca vulgaris
h. Beau’s line
Glossary of Terms
1. ________________ deep horizontal ridges, may
be caused by stress, may stop the nail growth
until the underlying condition is treated
2. _______________ severe damage to the nail
bed that results in nail deformity
3. ______________ also called chloronychia,
caused by infection (bacteria that usually
thrive in damp or wet conditions)
4. ______________ also known as Tinea unguium,
is a fungal infection of the nail
5. _____________ a nail infection that is an often
tender bacterial or fungal infection of the
hand or foot where the nail and the skin meet
at the side or that base of a finer or toenail
6. ______________ also called onychocryptosis,
the nail grows so that it cuts into one or both
sides of the paronychium or nail bed
7. _____________ is the common wart, that
appear on the cuticle (skin at the base of the
nail) and sometimes the area beneath the nail
8. _____________ this could be myxoid cysts,
pyrogenic granulomas, glomus tumor,
onychocytic matricoma, Bowen disease
 Personal Health History
Ask the following relevant questions:
1. Do recall having sever sunburns as a
child?
Sunburn – red, sometimes swollen and painful
caused by overexposure to UV frays from ths
sun
2. Describe any previous problems with
skin, hair or nails including any
treatment or surgery and its
effectiveness.

3. Have you had any hospitalizations or
surgeries?
________________________ a bacterium that
causes infections in different parts of the body
which is resistant to some commonly used
antibiotics making it tougher to treat
4. Have you ever had any allergic skin
reaction to food, medications, plants, or
other environmental substances?
5. Have you had a recent viral or bacterial
infections?
_______________rapidly erupting rash that may
have specific diagnostic features of an
infectious disease
Ex. chickenpox, measles, roseola infantum and
rubella
Enanthem or enanthema – a sudden eruptive
lesion of the surface of a mucous membrane
Ex. Koplik’s spots (measles) inside the mouth
that look like a tiny grains of white sand
surrounded by a red ring
6. Female: are you pregnant? Are your
menstrual periods regular?
Hormonal changes of pregnancy or hormonal
imbalances – pregnant women experience
sudden and dramatic increases in estrogen
and progesterone
7. Do you have a history of self-injury?
___________________ is where a person
physically harms themselves (cutting, burning,
and scratching)
 Family History
Ask the following relevant questions:
1. Has anyone in your family had a recent
illness, rash, or other skin problems, or
allergy? Describe.
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Infectious diseases – spread directly from one
person to another
Contagious – spread from person to person in
several ways
2. Has anyone in your family had skin
cancer?
__________________ is an abnormal growth of
skin cells most often develops on skin exposed
to the sun
Malignant melanoma – with genetic
component
3. Do you have a family history of keloids?
__________________ overgrowth of collagenous
scar tissue at the site of skin injury
4. Do you sunbathe? What is the frequency
and duration of sun or tanning booth
exposure? Do you use sunblock and if
so what type?
________________shorter than visible light but
longer than X-rays, present in sunlight which
constitutes about 10% of the total
electromagnetic radiation
5. Do you perform skin self-examination
once a month?
Should include the scalp, face, neck, beneath
facial hair and trunk. On the upper part of the
body, should include the armpits, hands, finger
webs and nail beds.
6. In your daily activities, are you regularly
exposed to chemicals or irritants that
may harm the skin?
___________________ is an upper limit on the
acceptable concentration of a hazardous
substance in workplace for a particular
material or class of materials.
7. Do you spend long period of time sitting
or lying in one position?
___________________ prolonged inactivity of an
individual
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15. Describe any skin disorder that prevent

8. Have you had any exposure to extreme you from enjoying your relationships?
temperatures? Body image disturbance
_______________ injury to tissues of the body
caused by hot objects or flames, electricity, 16. How much stress do you have in your
chemicals, radiation, or gases life?
______________ traumatic effect of extreme Stress can exacerbate skin abnormalities
cold on skin and subcutaneous tissues
 Collecting Objective Data: PHYSICAL
9. Do you have any body piercings? EXAMINATION
Body piercings are form of body modifications
or the art of puncturing or cutting a part of the Equipment:
body creating an opening for jewelry or 1. Examination Light
implants 2. Penlight
3. Mirror
10. Do you have any tattoos? 4. Magnifying glass
5 major types of tattoos: 5. Centimeter ruler
1. Traumatic – caused by debris embedded in 6. Gloves
skin as after motorcycle accident 7. Wood Light
2. Amateur – placed by non-professionals using 8. Examination gown/drape
India ink with a pin 9. Braden Scale
3. Professional – applied by professional or 10. Pressure Ulcer Scale for Healing (PUSH)
skilled tattoo artist
4. Medical – used to delineate a landmark for  Physical Assessment
radiation 1. Inspect skin color, temperature, moisture,
5. Cosmetic – used for permanent eyeliner, texture
lipstick, hair, blush or eyebrows 2. Check skin integrity
3. Be alert for skin lesions
11. What is your daily routine for skin, hair 4. Evaluate hair condition
and nail care? What products do you 5. Note nail bed condition and capillary refill
use? How do you cut your nails?
Inspection
12. What kind of foods do you consume in a 1. Inspect the general skin
typical day? How much fluid do you coloration and variation
drink each day? A. ________________ loss of color, seen in arterial
Balanced diet is necessary for health skin hair insufficiency, decreased blood supply and
and nails as well as adequate hydration anemia
B. _______________bluish discoloration of the
13. 13. Do you have a history of smoking skin and mucous membranes caused by an
and or drinking alcohol? excess of deoxygenated hemoglobin in the
Triggers skin conditions such as psoriasis blood or structural defect in hemoglobin
molecule (methemoglobin)
14. 14. Do skin problems limit any of your C. ______________ yellow discoloration of the
normal activities? skin, mucous membranes and sclerae of the

eyes, caused by greater than normal amounts
of bilirubin in the blood
D. __________________ redness, especially when
accompanying inflammation
E. ________________ skin redness and warmth
seen in inflammation, allergic reactions or
trauma
F. _______________ velvety darkening of the skin
in body folds and creases especially the neck,
groin and axillae
G.__________________ benign acquired skin
disease of unknown cause consisting of
irregular patches of various sizes totally lacking
in pigmentation and often have
hyperpigmented borders
H. ___________________ rashes on cheek and
cheek bones (butterfly rash)
3. Note any odor emanating from the skin
To rule out disorders of the sweat glands, poor
hygiene practices
4. Asses skin integrity
A. _______________ necrosis of death of a tissue,
usually the result of ischemia (loss of blood
supply), bacterial invasion and subsequent
putrefaction
B. ______________ a part of the skin which has
suffered damage through injury or disease
such as wound, ulcer, abscess or tumor
C. ____________________also called bedsores,
are injuries to the skin and underlying tissue
resulting from prolonged pressure on the skin.
Develops on skin that covers bony
prominences.
Braden Scale – to predict pressure sore risk
PUSH tool – to document the degree of skin
breakdown as baseline data and compare
degree of healing or deterioration over time
BULLA
MACULE
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NODULE
PAPULE
PATCH
PUSTULE
TUMOR
VESICLE
WHEAL
a. ____________ is a flat, distinct discolored area
of skin less than 1 cm wide
ex. freckle, rubella, rubeola, petechiae
b. ___________ irregular areas where there are
changes in the skin color, similar to macule,
with a diameter of more than 1 cm
ex. Mongolian spot, vitiligo, melasma, Tinea
versicolor
c. ____________ is a small raised, solid swelling
but not pus-filled, elevated, firm and with a
diameter of more than 1 cm
ex. warts, pigmented nevi
d. ____________ is palpable, elevated, firm,
deeper in dermis than papule with a diameter
of 1 to 2 cm
ex. Erythema nodosum, cysts, lipomas,
fibromas
e. _______________ mass of tissue formed by an
accumulation of abnormal cells, elevated and
with solid diameter of more than 2 cm
ex. neoplasm, hemangioma
f. _____________ small, fluid-filled, elevated with
a diameter of less than 1 cm
ex. chicken pox, herpes simplex
g. _______________small blister, vesicle, filled
with pus
ex. impetigo, acne
h. ______________ is a fluid sac or lesion that
appears when a fluid is trapped under a thin
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layer of the skin, with a diameter of more than 2. Readiness for Health Management: Requests
1 cm information on skin reactions and effects of
ex. blisters using a sun-tanning booth

i. ______________ a patch on the skin that is Risk Diagnosis

elevated, irregular and edematous 1. Risk for Impaired Skin Integrity related to
ex. urticaria, skin bites excessive exposure to cleaning solutions and
chemicals
Palpation 2. Risk for Impaired Skin Integrity related to
Palpate skin to assess: prolonged sun exposure
a. Texture
b. Moisture Actual Diagnosis
c. Thickness 1. Impaired Skin Integrity related to immobility
d. Temperature and decreased circulation
e. Mobility and Turgor 2. Disturbed Body Image related to scarring,
f. Edema rash, or other skin condition

A. BULLA
 SCALP and HAIR B. MACULE
Inspection and Palpation C. NODULE
Inspect the scalp and hair for D. PAPULE
a. general color and condition E. PATCH
b. amount and distribution of scalp, body, F. PUSTULE
axillae and pubic hair G. TUMOR
 NAILS H.VESICLE
Inspection I. WHEAL
Inspect nails for
a. grooming and cleanliness
b. color and markings
c. shape

Palpation
Palpate the nail to assess:
a. Texture
b. Consistency (whether attached to nail bed)
c. Test capillary refill

Nursing Diagnosis
Health Promotion Diagnosis
1. Readiness for Enhanced Health
Management: Skin, hair and nail integrity
related to healthy hygiene and skin care
practices, avoidance of exposure to sun