History of Present Health Concern: SKIN Sensation problems may put the client at

Question risk for developing pressure ulcers

● Are you experiencing any current skin Question
problems such as rashes, lesions, dryness, ● Do you have trouble controlling body odor?
oiliness, drainage, bruising, swelling, or How much do you perspire?
increased pigmentation? What aggravates Rationale:
the problem? What relieves it? ● uncontrolled body odor or excessive or
Rationale insufficient perspiration may indicate an
● any of these symptoms may be related to abnormality with the sweat glands or an
a pathologic skin condition. Bruises, welts, endocrine problem such as
or burns may indicate accidents or trauma hypothyroidism or hyperthyroidism. Poor
abuse. If these injuries cannot be explained hygiene practices may account for body,
or the client’s explanation seems odor, and health education may be
unbelievable or vague, physical abuse indicated
should be suspected. Dry, itchy skin is a ● Perspiration decreases with aging because
common concern in obese clients sweat gland activity decreases.
Question ● Because of decreased sweat production,
● Describe any birthmarks or moles you now most Asians and Native Americans have
have. Have any of them changed color, mild to no body odor, whereas Caucasians
size, or shape? and African Americans tend to have strong
Rationale body odor (Andrews & Boyle, 1999) unless
● you need to know what is normal for the they use antiperspirant or deodorant
client so that future variations can be products. Any strong body odor may
detected. A change in the appearance or indicate an abnormality.
bleeding of any skin mark, especially mole, Question
may indicate cancer. ● Do you have any body piercings or
● Asymmetry, irregular borders, color tattoos?
variations, diameter greater than 0.5 cm, Rationale
and elevation are characteristics of ● Piercing needles place clients at risk for
cancerous lesions. infection. Tattooing pigments can cause
Question allergic reactions, keloid, and scars. Clients
● Have you noticed any change in your should be informed regarding these risks.
ability to feel pain, pressure, light touch, or Piercing and tattoos are gaining popularity
temperature changes? Are you History of Present Health Concern:
experiencing any pain, itching, tingling, or HAIR AND NAILS
numbness? Question
Rationale ● Have you had any hair loss or change in
● Changes in sensation may indicate the condition of your hair? Describe.
vascular or neurological problems such as Rationale
peripheral neuropathy related to diabetes ● Patchy hair loss may accompany
mellitus or arterial occlusive disease. infections, stress, hairstyles that put stress
 on hair roots, and some types of Question
chemotherapy. Generalized hair loss may ● Have you had a fever, nausea, vomiting,
be seen in various systemic illnesses such gastrointestinal (GI) or respiratory
as hypothyroidism and in clients receiving problems?
certain types of chemotherapy or radiation Rationale
therapy. ● some skin rashes or lesions may be related
● A receding hairline or male pattern to viruses or bacteria
baldness may occur with aging. Question
Question ● For female clients: are you pregnant? Are
● Have you had any change in the condition your menstrual periods regular?
or appearance of your nails? Describe Rationale
Rationale ● Some skin and hair conditions can result
● Nail changes may be seen in systemic from hormonal imbalance
disorders such as malnutrition or with local Question
irritation (e.g., nail biting) ● For male clients: do you have a history of
● Bacterial infections cause green, black, or smoking and/or drinking alcohol?
brown nail discoloration. Yellow, thick, Rationale
crumbling nails are seen in fungal ● A significant association between
infections. Yeast cigarette smoking, alcohol consumption,
● infection cause a white color and and psoriatic males has been found
separation of the nail plate from the nail Question
bed ● Do you have a history of anxiety,
PAST HEALTH HISTORY depression, or any psychiatric problems?
Question Rationale
● Describe any previous problems with skin, ● Over one-third of dermatologic disorders
hair, or nails, including any treatment or have significant psychiatric comorbidity.
surgery and its effectiveness Depression often occurs in association
Rationale with dermatologic disease
● Current problems may be a recurrence of FAMILY HISTORY
previous ones. Visible scars may be Question
explained by previous problems ● Has anyone in your family had a recent
Question illness, rash, or other skin problem or
● Have you ever had any allergic skin allergy? Describe.
reaction to food, medications, plants or Rationale
other environmental substances? ● Acne and atopic dermatitis tend to be
Rationale familial. Viruses (e.g., chickenpox, measles)
● Various types of allergens can precipitate can be highly contagious. Some allergies
a variety of skin eruptions may be identified from family history
Question
● Has anyone in your family have skin
cancer?
Rationale
● a genetic component is associated with
skin cancer, especially malignant
melanoma
Question
● Do you have a family history of keloids
Rationale
● Ear piercing, if desired, should
performed before age 11 if there is a history
to avoid keloid formation
LIFESTYLE AND HEALTH PRACTICES
Question
● Do you sunbathe? How much sun or
tanning-booth exposure do you get? What
type of protection do you use?
Rationale
● Sun exposure can cause premature aging
of skin and increase the risk of skin cancer.
Hair can also be damaged by too much
sun
Question
● In your daily activities, are you regularly
exposed to chemicals that may harm the
skin (e.g., paint, bleach, cleaning products,
weed killers, insect repellents, petroleum)?
Rationale
● Any of these substances have the potential
to irritate or damage the skin, hair, or nails
Question
● Do you spend long periods of time sitting
or lying in one position?
Rationale
● Older, disabled, or immobile clients who
spend long periods of time in one position
are at risk for pressure ulcer
Question
● Have you had any exposure to extreme
temperatures?
Rationale
● Temperature extremes affect the blood
supply to the skin and can damage skin
layers. Example include frostbite and burns
Question
● What is your daily routine for skin, hair, and
nail care? What products do you use (e.g.,
be soaps, lotions, oils, cosmetics, self-tanning
products, razor type, hair spray, shampoo,
coloring, nail enamel)? How do you cut
your nails?
Rationale
● Regular habits provide information on
hygiene and lifestyle. The products used
may also be a cause of abnormality.
Improper nail-cutting technique can lead
to ingrown nails or infections
● Decreased flexibility and mobility may
impair the ability to some elderly clients to
maintain proper hygiene practices, such
as nail cutting, bathing, and hair care
Question
● What kinds of foods do you consume on a
typical day? How much fluid do you drink
each day?
Rationale
● A balanced diet is necessary for healthy
skin, hair, and nails. Adequate fluid intake is
required to maintain skin elasticity
Question
● Do skin problems limit any of your normal
activities?
Rationale
● Certain activities such as hiking, camping,
and gardening may expose the client to
allergens such as poison ivy. Moreover,
exposure to the sun can aggravate
conditions such as scleroderma. In
addition, general home maintenance (e.g.,
cleaning, car washing) may expose the
 client to certain cleaning products to 2. In addition, ask the client to remove
which he is sensitive or allergic enamel, artificial nails, wigs, toupes, or
Question hairpieces as appropriate.
● Describe any skin disorder that prevents 3. Have the client sit comfortable on the
you from enjoying your relationships examination table or bed for the beginning
Rationale of the examination.
● Skin, hair, and nail problems, especially if 4. The client may remain in a sitting position
visible, may impair the client’s ability to most of the examination. However, to
interact comfortably with others because assess the skin on the buttocks and dorsal
of embarrassment or rejection by others. surfaces of the legs properly, the client
Social stigma toward some dermatologic may lie on her side or abdomen.
disorders is widespread in Indian society 5. Ensure privacy by exposing, only that body
Question part being examined should be exposed.
● How much stress do you have in your life? 6. Make sure that the room is at a
Describe. comfortable temperature.
Rationale 7. If available, sunlight is best for inspecting
● Stress can cause or exacerbate skin the skin. However, a bright light that can be
abnormalities. focused on the client just as well.
Question 8. Keep the room door closed or the bed
● Do you perform a skin self-examination curtain drawn to provide privacy as
once a month? necessary.
Rationale 9. Explain what you are going to do, and
● If clients do not know how to inspect the answer any questions the client may have.
skin, teach them how to recognize 10. Wear gloves when palpating any lesions
suspicious lesions early. because you may be exposed to drainage.
COLLECTING OBJECTIVE DATA: PHYSICAL
Clients from conservative religious groups may
ASSESSMENT
require that the nurse be the same sex as the
● Physical assessment of the skin, hair, and
client. Also, to respect the client’s modesty or
nails provides the nurse with data that
desire for privacy, provide long examination
may reveal local or systemic problems or
gown or robe
alterations in a client’s self-care activities.
● A separate, comprehensive skin, hair, and
nail examination, preferably at the
beginning of a comprehensive physical
examination, ensures that you do not
inadvertently omit part of the examination.
Preparing the Client
1. Ask the client to remove all clothing and
jewelry and put on an examination gown
 PHYSICAL ASSESSMENT: INSPECTION:
Impact for color variation. Inspect localized parts
INSPECTION AND PALPATION
of the body, noting any color variation
Normal Findings
Inspection:
● Keep in mind that some clients have
Inspect for general discoloration
suntanned areas, freckles, or white
Normal Findings
patches known as vitiligo.
● Inspection reveals evenly colored skin
● The variations are due to different
tones without unusual or prominent
amounts of melanin in certain areas.
discolorations
● Dark-skinned clients have lighter-colored
● Small amounts of melanin are common in
palms, soles, nail beds, and lips.
whiter skins, while large amounts of
● Frecklelike or dark streaks of pigmentation
melanin are common in olive and darker
are also common in the sclera and
skins.
nailbeds of dark-skinned clients.
● Carotene accounts for a yellow cast
Abnormal Findings
● The older client's skin becomes pale due to
● Rashes
decreased melanin production and
● Albisirm
decreased dermal vascularity.
● Erythema
Abnormal Findings
● Pallor
Detecting color variations in dark-skinned
● Cyanosis
people:
● Jaundice
● Cyanosis
● Acanthosis Nigricans
○ Examine the conjunctivae, palms,
soles, buccal mucosa, and tongue.
INSPECTION:
Look for dull, dark colors.
While inspecting skin coloration, note any odors
● Edema
emanating from the skin
○ Examine the area for decreased
color and palpate for tightness.
Normal Findings
● Erythema
● Client has slight or no odor of perspiration,
○ Palpate the area for warmth.
depending on activity
● Jaundice
Abnormal Findings
○ Examine the sclerae and hard
● A strong odor of perspiration or foul odor
palate in natural, not fluorescent ,
may indicate disorder of sweat glands
light if possible. Look for a yellow
● Poor hygiene practices or assistance with
color.
activities of daily living
● Pallor
○ Examine the sclerae, conjunctivae,
buccal mucosa, lips, tongue, nail
beds, palms, and soles. Look for an
ashen color.
 ● Petechiae INSPECTION:
○ Examine areas of lighter ● Inspect for lesions
pigmentation such as the ● Observe the skin surface to detect
abdomen. Look for tiny, purplish red abnormalities
dots. ● Note color, shape, and size of lesion
● Rashes ● For very small lesions, use a magnifying
○ Palpate the area for skin texture glass to note these characteristics
changes. Normal Findings
● Smooth, without lesions. Stretch marks
INSPECTION: (striae), healed scars, freckles, moles or
Check skin integrity, especially carefully in birthmarks are common findings.
pressure point areas. Abnormal Findings
Normal Findings ● Primary Lesions: arise from normal skin
● Skin is intact, and there are no reddened due to irritation or disease
areas. ● Secondary Lesions: arise from changes in
Abnormal Findings primary lesions
● Skin breakdown is initially noted as a ● Vascular Lesions: reddish-bluish lesions,
reddened area on the skin that may are seen with bleeding, venous pressure,
progress to serious and painful pressure. aging, liver disease, or pregnancy
● Depending on the color of the client’s skin, ● Skin Cancer Lesions: can be either primary
reddened areas may not be prominent, or secondary lesions and are classified as
although the skin may feel warmer in the squamous cell carcinoma, basal cell
area of breakdown than elsewhere. carcinoma, or malignant melanoma.
Lesions: When evaluating a lesion, you’ll need to
PRESSURE ULCER CLASSIFICATION classify it as primary (new) or secondary (a
change in primary lesion). Then determine if it’s
solid or fluid-filled and describe its characteristics,
pattern, location, and distribution. Include a
description of symmetry, borders, color,
configuration, diameter, and drainage.
Lesion Shapes:
Lesion Configuration: Palpation: Palpate to assess thickness. Puts
gloves on and palpates the lesion between the
thumb and index finger for size, between the
thumb and index finger for size, mobility,
consistency, and tenderness if lesions are noted
when assessing skin thickness. Observes for
drainage or other characteristics.
Normal Findings
● Skin is normally thin but calluses (rough,
thick sections of epidermis) are common
areas of the body that are exposed to
constant pressure.
Abnormal Findings
● Very thin skin may be seen in clients with
arterial insufficiency or in those on steroid
therapy.
Palpation: Palpates to assess moisture. Checks
under skin folds and in exposed areas.
Lesion Distribution Normal Findings
● Generalized - distributed all over the body ● Skin surfaces vary from moist to dry
● Regionalized - limited to one area of the depending on the area assessed. Recent
body activity or a warm environment may cause
● Localized - sharply limited to a specific increased moisture.
area Abnormal Findings
● Scattered - dispersed either densely or ● Increased moisture or diaphoresis (profuse
widely sweating) may occur in conditions such as
● Exposed areas - limited to areas exposed fever or hyperthyroidism. Decreased
to the air or sun moisture occurs with dehydrated or
● Intertriginous - limited to areas where skin hypothyroidism
comes in contact with itself.
Palpation: palpates skin to assess texture. Uses Clammy skin is typical in shock or hypotension.
the palmar surface of three middle fingers to
palpate skin texture. Palpation: Palpates to assess temperature. Uses
Normal Findings the dorsal surface of hands to palpate the skin.
● Skin is smooth and even. Normal Findings
Abnormal Findings ● Skin is normally a warm temperature.
● Rough, flaky, dry skin is seen in Abnormal Findings
hypothyroidism. ● Cold skin may accompany shock or
● Obese clients often report dry itchy skin. hypotension
● Cool skin may accompany arterial disease
 ● Very warm skin may indicate a febrile state Normal Findings
or hyperthyroidism. ● Natural hair color, as opposed to
Palpation: Palpates to assess mobility and chemically colored hair, varies among
turgor. Asks the client to lie down, using two clients from pale blond to black gray or
fingers, gently pinches the skin over the clavicle, white. The color is determined by the
check skin mobility and turgor. amount of melanin present.
Normal Findings Abnormal Findings
● Normally, the skin is mobile, with elasticity ● Nutritional deficiency may cause patchy
and returns to its original shape quickly. gray hair in some clients.
Abnormal Findings ● Severe malnutrition in African-American
● Decreased mobility is seen with edema children may cause a copper red hair
● Decreased turgor (a slow return of the skin color.
to its normal state taking longer than 30 Inspection: At 1-inch intervals, separate the hair
seconds) is seen in dehydration. from the scalp and inspect and palpate the hair
Palpation: Palpates to detect edema. Uses and scalp for cleanliness, dryness, or oiliness,
thumbs to press down on the skin of the feet or parasites, and lesions. Wear gloves if lesions are
ankles to check for edema. suspected or hygiene if poor.
Normal Findings Normal Findings
● Skin rebounds and does not remain ● Scalp is clean and dry. Sparse dandruff
indented when pressure is released may be visible. Hair is smooth and firm,
Abnormal Findings somewhat elastic.
● Indentations on the skin may vary from Abnormal Findings
slight to great and may be in one area or ● Excessive scaliness may indicate
all over the body. dermatitis.
● Raised lesions may indicate infections or
tumor growth.
● Dull, dry hair may be seen with
hypothyroidism and malnutrition.
● Poor hygiene may indicate a need for
client teaching or assistance with activities
of daily living
● Pustules with hair loss in patches are seen
SCALP HAIR ASSESSMENT: INSPECTION in tinea capitis, a contagious fungal
AND PALPATION disease.
● Infection of the hair follicle appears as
Inspection: Have the client remove any hair clips, pustules surrounded by erythema.
hair pins, or wigs. Then inspect the scalp and hair Inspection: Inspect amount and distribution of
for general color and condition. scalp, body, axillae, and pubic hair. Looks unusual
growth elsewhere on the body.
Normal Findings Abnormal Findings
● Varying amounts of terminal hair cover the ● Pale or cyanotic nails may indicate
scalp, axillary, body, and pubis areas hypoxia or anemia. Splinter hemorrhages
according to normal gender distribution. may be caused by trauma.
Fine vellus hair covers the entire body ● Beau’s lines occur after acute illness and
except for the soles, palms, lips, and eventually grow out
nipples. Normal male pattern balding is ● Yellow discoloration may be seen in
symmetric. fungal infections or psoriasis. Nail pitting is
Abnormal Findings also common in psoriasis.
● Excessive generalized hair loss may occur
with infection, nutritional deficiencies, Inspection: Inspect shape of nails
hormonal disorders, thyroid or liver Normal Findings
disease, drug toxicity, hepatic or renal ● There is normally 160-degree angle
failure. between the nail base and the skin
● Patchy hair loss may result from infections Abnormal Findings
of the scalp, discoid or systemic lupus ● Early clubbing (180-degree angle with
erythematosus, and some types of spongy sensation) and late clubbing
chemotherapy. (greater than 180-degree angle) can
● Hirsutism (facial hair on females) is a occur from hypoxia.
characteristic of Cushing’s disease and ● Spoon nails (concave) may be present
results from an imbalance of adrenal with iron deficiency anemia
hormones or it may be a side effect of Palpation: Palpate nail to assess texture
steroids. Normal Findings
● Nails are hard and basically immobile
Inspection: Inspect nail grooming and ● Dark skinned clients may have thicker
cleanliness nails.
Normal Finding ● Older client’s nails may appear thickened,
● Nails are clean and manicured yellow, and brittle because of decreased
Abnormal Finding circulation in the extremities.
● Dirty, broken, or jagged fingernails may be Abnormal Findings
seen with poor hygiene. They may also ● Thickened nails (especially toenails) may
result from the client’s hobby or be caused by decreased circulation, and is
occupation. also seen in onychomycosis.
Inspection: Inspect nail color and markings Palpation: Palpate to assess texture and
Normal Findings consistency, noting whether nailpate is attached
● Pink toes should be seen. Some to the nail bed.
longitudinal ridging is normal Normal Findings
● Dark skinned clients may have freckles or ● Nails are smooth and firm; nail plate
pigmented streaks in their nails. should be firmly attached to nail bed
Abnormal Findings ● The first line of defense
● Paronychia (inflammation) indicated local ● Composed of the superficial epidermis
infection. Detachment of nail plate from and the dermis
nail bed (onycholysis) is seen in infections ● Protects against trauma & UV radiation,
or trauma. maintains body temp, & fluid balance,
Palpation: Test capillary refill in nail beds by provides sensation, involved w/ immunity,
pressing the nail tip briefly and watching for color and synthesizes vitamin D
change. HAIR
Normal Findings
● Pink tone returns immediately to blanched
nail beds when pressure is released
Abnormal Findings
● There is slow (greater than 2 seconds)
capillary nailbed refill (return of pink tone)
with respiratory or cardiovascular diseases
that cause hypoxia.
Validation and Documenting Findings
● Validate your normal and abnormal
findings with the client, other health care
workers , or your instructors.
● Document the skin, hair, and nail
assessment data that you have collected ● Consists of layers of keratinized cells found
on the appropriate form your school or all over much of the body EXCEPT for lips,
agency uses. nipples, soles of the feet, pals of the hands,
● Abnormal findings would be carefully labia minora, and penis
documented too. Normal findings can act NAILS
as a baseline for findings that may change
later.

NRG 105: SKIN, HAIR, & NAIL

SKIN

● Located on the distal phalanges of fingers

and toes, are hard, transparent plates of
keratinized epidermal cells that grow from
 a root underneath the skin fold called the ● Risk for skin cancer related
cuticle ● Medical therapies
CULTURAL CONSIDERATIONS ● Genetic susceptibility
● Oral mucosa is best for assessing color ● Immunosuppression
changes in dark-skinned persons SKIN INSPECTION AND PALPATION
● Asses the sclera rather than skin in Asians ● Expose the body part to be inspected
for jaundice is more accurate ● Inspect skin for the ff:
● At risk for skin Ca w/ prolonged sun ○ Note color, odor, and integrity
exposure ○ Normal: uniform skin color w/
● Chinese men have very little facial hair slightly darker exposed areas. No
● African Americans have thick and kinky jaundice, cyanosis, pallor, and
hair hyperpigmentation.
● Asians produce less sweat/less body odor ○ Abnormal: color changes many be
● Dark-skinned clients have lighter colored benign and may indicate
palms soles, lips and nail beds underlying pathology
● Dark skinned person appears ashen gray if ■ Cyanosis - MI,
cyanosis vasoconstriction
DEVELOPMENTAL CONSIDERATIONS ● Central - lips, buccal
● Infants mucosa, tongue
● Adolescents ● Peripheral - nails,
● Pregnant clients skin of arms and legs
● Menopausal woman ■ Pallor - arterial insufficiency
● Older adults and anemia (nail beds, lips,
EQUIPMENT NEEDED oral mucous membrane,
● Adequate lighting conjunctiva)
● Comfortable room temperature ■ Jaundice - Liver cirrhosis
● Gloves (sclera, lips, hard palate,
● Penlight and skin)
● Magnifying glass SKIN PALPATION
● Transparent ruler ● Texture
SUBJECTIVE DATA: FOCUS QUESTIONS ○ The character of the skin’s surface
● Skin rashes, lesions, itching etc. (location, and the feel of deeper portions
onset, precipitating factors)? ○ The nurse uses the pads of the
● Methods of relief (medication)? fingers to determine whether it’s
● Scalp lesions, itching, infection? smooth or rough, thin or thick, tight
● History of skin disorders, surgical excision or supple, and hardened or soft by
● Changes in texture, condition and amount stroking it and palpating it lightly
of hair with the fingertips
● Skin, hair and nail habits; bathing pattern ○ Normal: soft and smooth
● Exposure to chemicals ○ Abnormal: rough, thick. Dry skin in
RISK FACTORS: hypothyroidism
● Temperature ○ Normal: no swelling, pitting, or
○ The temperature of the skin edema
depends on the amount of blood ○ Abnormal: swollen, shallow to deep
circulating through the dermis pitting, ascites
○ Temperature is more accurately ○ Note: generalized edema is seen in
assessed by palpating the skin with pt w/ CHF or kidney diseases
the dorsum or back of the hand ● If a skin lesion is detected, inspect and
○ Normally warm. May vary from one palpate for size, location, mobility, and
area to another pattern
○ Normal: warm, dry and smooth ○ Normal: striae, mole, freckles,
○ Abnormal: extremely cool and birthmarks
warm, wet, oily ○ Abnormal: primary lesions
● Moisture (response to irritation and disease),
○ The hydration of skin and mucous secondary lesions, vascular lesions
membrane (liver disease, pregnancy)
○ It helps to reveal body fluid ● Primary Lesions
imbalances changes in the skin’s ○ Flat and nonpalpable: Macule <1c,
environment, and regulating of the (freckle, melanoma); patch >1cm
body temperature (vitiligo, tinea versicolor)
○ Normally smooth and dry ○ Palpable, raised but superficial:
○ Skin fold such as the Axillae are Papule <1cm (mole, wart); Plaque
normally moist >1cm (psoriasis)
○ The nurse uses the pads of the ○ Raised, superficial: Wheal/Hive
fingers (urticaria/insect bite)
○ Normal: warm, dry and smooth ○ Palpable, solid w/ depth into
○ Abnormal: extremely cool and dermis: Nodule <2cm (fibroma,
warm, wet, oily xanthoma); Cyst fluid filled and
● Turgor encapsulated >2 cm (neoplasm
○ The skin’s elasticity, which can be lipoma)
diminished by edema or ○ Palpable, fluid filled: Vesicle
dehydration (serous) <1 cm (blister, herpes
○ Pinch up skin on sternum or under simplex); Bulla (serous) >1cm
clavicle (blister, burns); Pustule pus-filled
○ Normal: returns immediately (acne)
○ Abnormal: it takes 30 seconds to
return or no longer return
○ Note: turgor is decreased in
dehydration
● Edema
○ Press firmly for 5 seconds over tibia
and ankle
● Secondary Lesions ● Vascular Lesions
○ Thickening and scaling w/ ○ Ecchymosis: extravasation of blood
increased skin markings: into skin layer caused by
Lichenification (eczema) trauma/injury
○ Shedding, dead skin cells; Scales: ○ Petechiae: extravasation of blood
can be dry or oily (psoriasis) into skin caused by systemic
○ Dried exudates: Crust (dried herpes diseases, steroids
simplex) ○ Venous Star: blue color, linear or
○ Replacement connective tissue spider, caused by increased
formations: scar surgical site pressure on superficial veins
○ Hypertrophic scarring caused ○ Telangiectasia: red color, very fine,
excess collagen formation: Keloid seen w/dilation of capillaries
surgical site, tattoo ○ Spider Angioma: red color, types of
○ Abrasions other loss that does not telangiectasia, looks like a spider,
extend beyond the superficial seen in liver disease
epidermis: Excoriation scratch ○ Capillary Hemangioma: red color,
marks, scabies irregular shaped macular patches
○ Gradual loss of superficial HAIR INSPECTION AND PALPATION
epidermis: Erosion candidiasis ● Color
○ Linear breaks in the skin w/ ○ Normal: varies
well-defined borders, may extend ○ Abnormal: patchy gray areas
to dermis: FIssures syphilis cheilitis, (nutritional deficiencies),
athlete’s foot) copper-red hair in African
○ Thinning of skin w/ transparent American child (severe
appearance and loss of markings: malnutrition)
Atrophy (aging) ● Amount & Distribution
○ Normal: varies
 ○ Abnormal: alopecia (nutritional ○ Normal: first, immobile, in black
deficiencies, chemotherapy), (thick)
hirsutism (cushing syndrome) ○ Abnormal: paronychia (inflamed
abnormal facial growth in female nail head) indicates infection;
● Texture onycholysis (detached nail plate)
○ Normal: fine to coarse, pliant indicates trauma or infection
○ Abnormal: brittle. Dull, dry hair seen
malnutrition
● Presence of Parasites
○ Normal: none
○ Abnormal: lice (body or head),
accompanied by severe itching
SCALP INSPECTION AND PALPATION
● Symmetry
○ Normal: symmetrical
○ Abnormal: asymmetrical
● Texture
○ Normal: smooth, firms
○ Abnormal: bumpy, scaly,
excoriated (dandruff and
dermatitis)
● Lesions
○ Normal: none
○ Abnormal: open or closed
NAIL INSPECTION AND PALPATION
● Color
○ Normal: clean, pink nail bed
○ Abnormal: pale or cyanotic
(anemia or hypoxia); yellow
discoloration (fungal
infections/psoriasis); splinter
hemorrhages (vertical line): seen in
trauma; Beau’s line (horizontal):
seen in acute trauma
● Shape
○ Normal: round nail 160 degree nail
base
○ Abnormal: clubbing 180 degree or
more (hypoxia); spoon nails (IDA)
● Texture