St.

Paul College of Ilocos Sur

( Member, St. Paul University System)
St. Paul Avenue, 2727 Bantay, Ilocos Sur

NCM 101: Health Assessment

Module 8

ASSESSING SKIN, HAIR AND NAILS

Melanio P. Rojas Jr, MAN

Clinical Instructor

2023

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 Module No. 8
ASSESSING SKIN, HAIR AND NAILS

Learning Objectives:

After completing this module, the students will be able to:

1. Review the anatomy and functions of the skin, hair and nails

2. Teach client to perform a self-assessment of the skin, hair and nails.

3. Differentiate between normal and abnormal findings.

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 ANATOMY AND PHYSIOLOGY OF THE SKIN
1. It is the largest organ of the body
2. It is the first line defense mechanism against injury and microorganism.
3. It maintains body temperature.
4. It is a sensory organ. It has a numerous nerve receptor which are sensitive to pain,
temperature, touch, and pressure
5. It produces and absorbs Vitamin D through the action of ultraviolet rays from the sun which
activate Vitamin D precursor present in the skin
6. It is a secretory organ. It secretes sebum, oily substance which lubricates the hair and the
skin; prevents the hair from becoming brittle; decreases water loss from the skin; lessen the
amount of heat lost from the skin and has bacterial action.

Two types of Sweat Glands

1. Apocrine Glands
 They are primarily located in the axilla and anogenital areas.
 They begin to function at puberty under the influence of androgen.
 The secretion of these glands is odorless, but may become musky, unpleasant
when acted upon the microorganisms.
2. Eccrine Glands
 They are found on the palms of the hands, the soles of the feet and forehead.
 The sweat they produce cools the body through evaporation.

Common Problems of the Skin

1. Acne- an inflammatory condition of the skin which of the skin occurs in and around the
sebaceous gland.
Hygienic Measures
1. Encourage daily bath.
2. Keep the skin, clean and dry.
3. Avoid picking or squeezing of pimples.
4. Have exposure to natural light.
5. Avoid foods with high fat and carbohydrates e.g. nuts and chocolates.
6. Adequate rest and sleep.

2. Excessive dryness- Skin is scaly and rough.

Hygienic Measures:
1. Bathe the client less frequently, rinse skin thoroughly.
2. Avoid use of alcohol on the skin.
3. Apply cream or lotion on the skin.
4. Encourage to increase fluid intake. The most effective measure to relieve dryness
to skin.
3. Abrasions
 Superficial layers of the skin are scraped or rubbed away.
 The area appears red, with localized bleeding or serous sweeping.

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 Hygienic Measures:
1. Keep the wound clean and dry to prevent infection.
2. Lift instead of sliding, pulling or pushing the client in bed.
3. Do not wear jewelries when performing procedures to the client.
4. Erythema- redness of the skin which may be associated with rashes, exposure to sun and
elevated temperature.
Hygienic Measures:
1. Wash skin thoroughly to minimize microorganism.
2. Apply antiseptic or lotion to relieve pruritus.
5. Hirsutism – excessive growth among women.
Hygienic Measures:
1. Shave excessive hair growth.
2. Enhances client’s self -concept.

Other skin problems

6. Hyperhidrosis- is excessive perspiration
7. Bromhidrosis- is foul smelling perspirations
8. Vitiligo – are patches of hypopigmented skin caused by destruction of melanocytes in the
area.
TYPES OF SKIN LESIONS
A. Primary Lesions
1. Macule- A flat, circumscribed area color with no elevation of its surface, 1 mm to 1 cm.
E.g. freckle, flat nevi (moles).
2. Patch- Same as macule but larger than 1 cm. E.g. Port wine birth mark.
3. Papule- A circumscribed, solid elevation of skin; less than 1 cm. E.g. Warts, acne.
4. Plaque- Same as papule but larger than 1 cm. E.g. Eczema.
5. Nodule- A solid mass that extends deeper into the dermis than of a papule. E.g.
pigmented nevi.
6. Tumor- A solid mass larger than a nodule. E.g. Epitheliomia.
7. Vesicle- A circumscribed elevation containing serous fluid or blood; less than 1 cm. E.g.
Blister, chicken pox.
8. Bulla- A large fluid- filled sac.
9. Pustule- A vesicle or bulla with pus. E.g. Acne vulgaris, impetigo.
10. Wheal- A relatively reddened, elevated localized collection of edema fluid; irregular in
shape. E.g. Mosquito bites.
11. Cyst- Elevated, thick-walled lesion containing fluid or semisolid matter.
12. Telangiectasia- Dilated capillary; fine red lines. E.g. Liver cirrhosis.
B. Secondary Lesions
1. Scale- Thickened cells that take off. Eg. Dandruff, psoriasis.
2. Crust - Dried serum or pus on the skin surface. E.g. Impetigo.
3. Fissure- A deep linear crack. E.g. Athlete’s foot.
4. Erosion- Loss of all part of the epidermis. Appears moist demarcated depressed area.
E.g. Ruptured chicken pox vesicle.
5. Excoriation- A superficial linear or hallowed out crushed area exposing dermis. E.g.,
scratch.
6. Atrophy- A decrease in the volume of epidermis. E.g. Striae, aged skin.
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 7. Scar- A formation of connective tissues. E.g. healed wound.
8. Ulcer- An excavation extending into the dermis or below. E.g. decubitus ulcer.
9. Lichenification- Epidermal thickening resulting in elevated plaque with accentuated skin
markings. Results from repeated rubbing or scratching. E.g. chronic atopic dermatitis.
General Guidelines for Skin Care
1. An intact, healthy skin is the body’s first line of defense.
2. The degree to which the skin protects the underlying tissue from injury.
3. Moisture in contact with the skin can result in increased bacterial growth and irritation.
4. Body odors are caused by resident skin bacteria acting on the body secretions.
Cleanliness is the best deodorant.
5. Skin sensitivity to irritation and injury varies among individuals and in accordance to
health.
6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent,
bath, oil, cream, lotion, powder, deodorant, and antiperspirant.

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 ASSESSING SKIN, HAIR AND NAILS
ASSESSMENT PROCEDURE
SKIN
Inspection
Inspect general skin
coloration. Keep in mind that
the amount of pigment in the
skin accounts for the intensity of
color as well as hue.
While inspecting skin coloration,
note any odors emanating from
the skin.
Inspect for color variations.
Inspect localized parts of the
body, noting any color variation.
NORMAL FINDINGS
Inspection reveals evenly
colored skin tones without
unusual or prominent
discolorations.
Client has slight or no odor of
perspiration, depending on
activity.
Common variations include
suntanned areas, freckles, or
white patches known as vitiligo.
The variations are due to
different amounts of melanin in
certain areas. A generalized loss
of pigmentation is seen in
albinism. Dark-skinned clients
have lightered colored palms,
soles, nail beds, and lips.
Freckle-like or dark streaks of
pigmentation are also common
in the sclera and nail beds of
dark-skinned clients.
ABNORMAL FINDINGS
Pallor (loss of color) is seen in
arterial insufficiency, decreased
blood supply, anemia. Pallid
tones vary from pale to ashen
without underlying pink.
Cyanosis may cause white skin
to appear blue-tinged, especially
in the perioral, nail bed, and
conjunctival areas. Dark skin
may appear blue, dull and
lifeless in the same areas.
Central cyanosis results from a
cardiopulmonary problem,
whereas peripheral cyanosis
may be a local problem resulting
from vasoconstriction.
Jaundice is characterized by
yellow skin tones, ranging from
pale to pumpkin, particularly of
the sclera, oral mucosa, palms,
and soles.
Acanthosis nigricans is velvety
darkening of skin in body folds
and creases, especially the
neck, groin, and axilla.
A strong odor or perspiration or
foul odor may indicate a need
for client teaching or assistance
with activities of daily living.
Abnormal findings include
rashes, such as the reddish (in
light skinned people) or
darkened (in dark-skinned
people) butterfly rash (also
called malar rash) across the
bridge of the nose and cheeks,
characteristic of systemic lupus
erythematosus (SLE).
Erythema (skin redness and
warmth) is seen in inflammation.
Allergic reactions, or trauma.
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 ASSESSMENT PROCEDURE
Assess skin integrity. Pay
special attention to pressure
point areas.
Use the Braden Scale to predict
pressure sore risk. If any skin
breakdown is noted, use the
PUSH tool to document the
degree of skin breakdown to
provide a baseline to compare
degree of healing or
deterioration over time.
Inspect for lesions. Observe
the skin surface to detect
abnormalities.
If you observe a lesion:
If you observe a lesion:
 Note symmetry, borders and
shape, color, diameter of
lesion, and change in lesion
over time.
 For very small lesions, use a
magnifying glass to note
these characteristics.
 Note its location,
distribution, and
configuration.
 Measure the lesion with a
centimeter ruler
If you suspect a fungus, shine a
Wood light (an ultraviolet light
filtered through a special glass)
on the lesion.
PALPATION
Palpate skin to assess
texture. Use the palmar surface
of your three middle fingers to
palpate skin texture.
Palpate to assess thickness.
NORMAL FINDINGS
Skin is intact, and there are no
reddened areas.
Skin is smooth without lesions.
Stretch marks (striae), healed
scars, freckles, moles, or birth
marks are common findings.
Freckles or moles may be
scattered over the skin in no
particular pattern.
Lesion does not fluoresce.
NORMAL FINDINGS
Skin is smooth and even
Skin is normally thin but calluses
(rough, thick sections of
epidermis) are common on
areas of the body that are
exposed to constant pressure
(e.g., the heels).
ABNORMAL FINDINGS
Skin breakdown is initially noted
as a reddened area on the skin
that may progress to serious
and painful pressure ulcers.
Depending on the color of the
client’s skin, reddened areas
may not be prominent, although
the skin may feel warmer in the
area of breakdown than
elsewhere.
Lesions may indicate local or
systemic problems. Primary
lesions arise from normal skin
due to irritation or disease.
Secondary lesions arise from
changes in primary lesions.
Vascular lesions, reddish-bluish
lesions, are seen with bleeding,
venous pressure, aging, liver
disease, or pregnancy.
Cancerous lesions can be either
primary or secondary lesions
and are classified as squamous
cell carcinoma, basal cell
carcinoma, or malignant
melanoma.
Blue-green fluorescence
indicates fungal infection.
ABNORMAL FINDINGS
Rough, flaky, dry skin is seen in
hypothyroidism. Obese clients
often report dry, itchy skin.
Very thin skin may be seen in
clients with arterial insufficiency
or in those on steroid therapy.
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If lesions are noted when
assessing skin thickness, put
gloves on and palpate the lesion
between the thumb and index
finger for size, mobility,
consistency, and tenderness.
Observe for drainage or other
characteristics.
Palpate to assess moisture.
Check under skin folds and in
unexposed areas.
Palpate to assess
temperature. Use the dorsal
surfaces of your hands to
palpate the skin.
Palpate to assess mobility
and turgor. Ask the client to lie
down. Using two fingers, gently
pinch the skin over the clavicle.
Mobility refers to how easily the
skin can be pinched. Turgor
refers to the skin’s elasticity and
how quickly the skin returns to
its original shape after being
pinched.
Palpate top detect edema. Use
your thumbs to press down on
the skin of the feet, ankles or
pretibial area to check for
edema (swelling related to
accumulation of fluid in the
tissue.
Scalp and Hair
INSPECTION AND
PALPATION
Inspect the scalp and hair for
general color and condition.
No lesions palpated.
Skin surfaces vary from moist to
dry depending on the area
assessed. Recent activity or a
warm environment may cause
increased moisture.
Skin is normally a warm
temperature.
Normally, the skin is mobile,
with elasticity and returns to
original shape quickly. Recoil is
usually immediate.
Skin rebounds and does not
remain indented when pressure
is released.
NORMAL FINDINGS
Natural hair color, as opposed to
chemically colored hair, varies
among clients from pale blond to
black to gray or white. The color
Infected lesions may be tender
to palpate. Non-mobile, fixed
lesions may be cancer.
Increased moisture or
diaphoresis (profuse sweating)
may occur in conditions such as
a fever or hyperthyroidism.
Decreased moisture occurs with
dehydration or hypothyroidism.
Clammy skin is typical in shock
or hypotension.
Cold skin may accompany
shock or hypotension. Cool skin
may accompany arterial
disease. Very warm skin may
indicate febrile state or
hyperthyroidism.
Decrease mobility is seen with
edema.
Decreased turgor (a slow recoil
or return of the skin to its normal
state) is seen in dehydration.
Recoil that occurs in less than 2
seconds suggests moderate
dehydration; more than 2
seconds suggests severe
dehydration; and more than 3
seconds is describe as tenting.
Indentations on the skin may
vary from slight to great and
may be in one area or all over
the body.
ABNORMAL FINDINGS
Nutritional deficiencies may
cause patchy gray hair in some
clients. Severe malnutrition in
African American children may
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 is determined by the amount of cause a copper-red hair color.
melanin present.

At 1-inch intervals, separate Scalp is clean and dry. Sparse Excessive scaliness may
the hair from the scalp and dandruff may be visible. Hair is indicate dermatitis. Raised
inspect and palpate the hair smooth and firm, somewhat lesions may indicate infections
and scalp for cleanliness, elastic. or tumor growth. Dull, dry hair
dryness or oiliness, parasites, may be seen with
and lesions. Wear gloves if hypothyroidism and malnutrition.
lesions are suspected or if Poor hygiene may indicate a
hygiene is poor. need for client teaching or
assistance with activities of daily
living.

Pustules with hair loss in

patches are seen in tinea
capitis, a contagious fungal
disease.

Infections of the hair follicle

(folliculitis) appear as pustules
surrounded by erythema.
Inspect amount and Varying amounts of terminal hair Excessive generalized hair loss
distribution scalp, body, cover the scalp, axillae, body, may occur with infection,
axillae, and pubic hair. Look and pubic areas according to nutritional deficiencies hormonal
for unusual growth elsewhere normal gender distribution. Fine disorders thyroid or liver disease
on the body. vellus hair covers the entire drug toxicity, hepatic or renal
body except for the soles, failure. It may also result from
palms, lips and nipples. Normal chemotherapy or radiation
male pattern balding is therapy.
symmetric.
Patchy hair loss may result from
Individuals may shave or infections of the scalp, discoid or
chemically remove axillary and systemic lupus erythematosus,
genital hair. Some individuals, and some types of
both male and female may also chemotherapy.
remove all body hair.
Hirsutism (facial hair on
females) is characteristic of
Cushing disease and polycystic
ovary syndrome (PCOS) and
results from an imbalance of
adrenal hormones or it may be a
side effect of steroids.
NAILS NORMAL FINDINGS ABNORMAL FINDINGS
INSPECTION
Inspect nail grooming and Nails are clean and manicured. Dirty, broken, or jagged
cleanliness. fingernails may be seen with
poor hygiene. They may also
result from the client’s hobby or
occupation.
Inspect nail color and Pink tones should be seen. Pale or cyanotic nail may
markings. Some longitudinal ridging is indicate hypoxia or anemia.
normal. Splinter hemorrhages may be
caused trauma. Beau lines

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Inspect shape of nails.
PALPATION
Palpate nail to assess texture.
Palpate to assess texture and
consistency, noting whether
nail plate is attached to nail
bed.
Test capillary refill in nail
beds by pressing the nail tip
briefly and watching for color
change.
There is normally a 160-degree
angle between the nail base and
the skin.
NORMAL FINDINGS
Nails are hard and basically
immobile.
Nails are smooth and firm; nail
plate should be firmly attached
to nail bed.
Pink tone returns immediately to
blanched nail beds when
pressure is released.
occur after acute illness band
eventually grow out. Yellow
discoloration may be seen in
fungal infections or psoriasis.
Nail pitting is also common in
psoriasis.
Early clubbing (180-degree
angle with spongy sensation)
and late clubbing (greater than
180-degree angle) can occur
from hypoxia. Spoon nails
(concave) may be present with
iron deficiency anemia.
ABNORMAL FINDINGS
Thickened nails (especially
toenails) may be caused by
decreased circulation, and are
also seen in onychomycosis.
Paronychia (inflammation)
indicates local infection.
Detachment of nail plate from
nail bed (onycholysis) is seen in
infections or trauma.
There is slow (greater than 2
seconds) capillary nail bed refill
(return of pink tone) with
respiratory or cardiovascular
diseases that cause hypoxia.
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PICTURES

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