Skin, Head and Neck

Assessment

Ashfaq Ahmad Sahil

Lecturer INS-KMU
Objectives

By the end of the unit, learners will be able

to:
 Describe the component of health history
that should be elicited during the assessment
of skin, head and neck.

 Describe specific assessments to be made

during the physical examination of the
above systems.
Objectives cont……

 Apply braden scale to assess the bed

sores of patient

 Document findings

 Describe age related changes in the

above systems and differences in
assessment findings.
Anatomy of the skin

Layers of the skin

 Epidermis

Thin , divided in to two layers Outer

layer: Dead keratinized cells
Inner cellular layer: Melanin and keratin
formed
Cont….
 Dermis
 Well supply of blood
 Contain connective tissue, sebaceous
gland and hair follicles

 Subcutaneous
 Contains fat, sweat glands, remainder
hair follicles
Skin appendages

 Hair

 Nails

 Sebaceous glands

 Sweat glands
Functions of the skin

 Regulates body temperature.

 Prevents loss of essential body fluids.
 Protection of the body from harmful
effects of the sun and radiation.
 Excretes toxic substances with sweat.
 Sensory organ for touch, heat, cold, socio-
sexual and emotional sensations.
Nursing history of skin
 Pain or itching

 Presence or spread of any lesions

 Pigmentation spot

 Previous experience with skin problem

 Family history
History cont…..

 Use of medication
 Lotions, home remedies
 Excessive dry or moist
 Tendency to bruise
 Occupation
 Contact with allergens
Techniques of examination
 Skin color
 Increase pigmentation
 Loss of pigmentation
 Pallor
 Light skin people evident in the face,
conjunctiva of the eyes and nail
 Cyanosis
 Evident in nail beds, lips, and buccal
mucosa
 Jaundice
 Yellowish sclera of the eyes, mucus
membrane and skin is evident
Techniques of examination cont…

 Erythema
 Redness with variety of rashes
 Edema
 Skin appear swollen, shiny
 Moisture: Moist, dry, oily
 Temperature: Cool, warm
 Texture: Roughness or smoothness
 Mobility and Turgor: Elasticity
Techniques of examination cont…

 Skin lesions
 Distribution: Anatomic location and
distribution
 Configuration: Arrangement of lesion,
linear, clustered
 Type of lesion: Primary/Secondary
 Color of the lesion
Types of lesions

 Primary:
 In response to change in internal or
external environment

 Secondary:
 Due to trauma, infection of the primary
lesion
The elderly client

 Physical changes of the skin

 Loss of turgor
 Appearance of wrinkles
 Skin appear thin and translucent
 The skin is dry and flaky because
sebaceous glands are less active
Head Anatomy
Head Anatomy

 Frontal bone
 Temporal bone
 Parietal bone
 Occipital bone
 Nasal bone
 Parotid gland
 Submandibular gland
Head & Neck History
 Headaches
 Any history of loss of consciousness
 Dizziness , seizures, facial pain or injury
 Visual changes
 Swollen glands
 Trauma ( head, face)
 Itchy scalp
 Scalp infestations
 Allergies
Head & Neck History cont…

 Medications or treatment used

 Neck pain
 Neck masses
 Swollen glands
 Swollen thyroid glands (goiter)
The mouth, throat, and neck

 Ulcers in the mouth

 Sore throat
 Hoarseness
 Assess thyroid function
Examination of Head
 Scalp
 Scaliness
 Lumps
 Lesions
 Skull
 Size
 Contour
 Deformities
 Tenderness
 Unusual movements
Hair & Nail

 Hair nursing history focus on:

 Curling or straightening
 Recent chemotherapy
 Presence of disease hypothyroidism
(thin hair)
Cont….

 Nails nursing history focus

on:
 Previous illness or injury
 Peripheral circulatory disease
 Excessive thickening
Examination of Nails

 Inspect and palpate fingernails and toenails

 Adherence to nail beds
 Color ( cyanosis, pallor)
 Contour & shape
 Clubbing ( angle > 160)
 Symmetry and thickness
 Cleanliness
 lesions
Clubbing
Examination of Hair
 Quality
 Quantity
 Distribution
 Cleanliness
 Pattern of loss
 infestations
Examination of Face
 Contour
 Expressions
 Movements
 Sensations
 Lymph nodes
 Edema / Lesions
The Neck
 Anatomy and physiology
 Sternocledomastoid muscles
 Trapezius muscles
 Omohyoid muscles
 Hyoid bone
 Thyroid gland
 Two lobes
 Isthmus
Thyroid Gland
 Inspect the neck looking for the thyroid
gland. Note whether it is visible and
symmetrical. A visibly enlarged thyroid
gland is called a goiter.
 Identify the cricoids' cartilage with the
fingers of both hands.
 Move downward two or three tracheal
rings while palpating for the
isthmus.
Thyroid Gland cont…

 Move laterally from the midline while

palpating for the lobes of the thyroid.
 Note the size, symmetry and position of the
lobes as well as the presence of any
nodules.
 The normal gland is often not palpable
Neck lymph nodes: Palpation
 Preauricular
 Post auricular
 Occipital
 Sub mental
 Submandibular
 Tonsillar
 Superficial cervical
 Posterior cervical
 Deep cervical
 Supraclvicular
 infraclavicular