Introduction

The skin is the largest organ in the body; The external surface of the •
body ,it serves as a barrier between a person’s outer and inner
surroundings. Skin reflects general health of the body. About 16% of
.an adult's total body weight
Structure of the Skin
:Two main parts

Epidermis-1 •
superficial •
thinner •
epithelial tissue •
.Dermis-2 •
Deeper •
thicker •
connective tissue •
 Subcutaneous layer (subQ) •
.Also called the hypodermis •
.Deep to the dermis, but not part ofthe skin •
.consists of areolar and adipose ct •
Attaches skin to underlying tissues and organs •
Accessory Structures of the Skin •
Hair •
Skin gland •
Nails •
 Function of Skin

.Appearance - reflects general health of the body •

Protection: against pathogens. Langerhans cells in the skin are part of •
.the immune system
.Storage: stores lipids (fats) and water •
Sensation: nerve endings detect temperature, pressure, vibration, •
.touch, and injury
Control water loss: the skin prevents water from escaping by •
.evaporation
Thermoregulation •
 Physical Assessment Skin

:Patient preparation •
.Explain procedures and answer any questions •
.Conduct the assessment in private space , and maintain privacy •
.Ask the patient to remove all clothing and to put on an examination gown •
Make sure the patient in comfortable position, and comfortable •
.temperature room
.Sunlight is best for inspecting the skin •
.Wash hand and Wear gloves •
.Ask help to turn the patient as needed •
Inspect for generalized color
Pallor: (loss of color) is seen in arterial insufficiency, decreased blood •
.supply and anemia
Cyanosis: (bluish or grayish discoloration) occurs with •
.vasoconstriction, MI, or pulmonary insufficiency
Jaundice: is a condition in which the skin, sclera (whites of the eyes) •
and mucous membranes turn yellow. This yellow color is caused by a
high level of bilirubin, a yellow-orange bile pigment. Bile is fluid
secreted by the liver. Bilirubin is formed from the breakdown of red
blood cells
 

Jaundice
 Ecchymosis
A discoloration of the skin resulting from bleeding underneath, typically caused by bruising
 Petechiae
Petechiae are tiny purple, red, or brown spots on the skin. They usually appear on your arms, legs,
stomach, and buttocks
 Cyanosis

Cyanosis is defined as a bluish •

discoloration, especially of the skin
and mucous membranes, due to
excessive concentration of
deoxyhemoglobin in the blood caused
by deoxygenation. Cyanosis is divided
into two main types: central (around
the core, lips, and tongue) and
peripheral (only the extremities or
fingers
 Inspect for skin integrity

Check carefully in pressure point areas (e.g., sacrum, hips, elbows) for skin •
.integrity
.Skin is intact and there are no reddened areas •
Skin breakdown is initially noted as a reddened area on the skin that may •
.progress to serious and painful ulcers
 Inspect for lesions

.Inspect all areas for lesions •

.Note color •
.Elevation or depression •
.Shape, location, distribution •
.Size of lesion and any exudates •
For very small lesions, use a magnifying glass to note these •
characteristics
.Smooth, without lesions •
Stretch marks (striae), healed scars, freckles are normal findings •
 Palpate for texture

.Use the palmer surface of the three middle fingers to palpate skin texture •
.Skin is smooth and flat •
.Rough, flaky, dry skin is seen in hypothyroidism •
 Palpate for thickness

Use the finger pads •

to palpate for skin
.thickness
Skin is normally •
.thin
 Palpate for temperature

Use the dorsal •

surfaces of the
hands to palpate the
.skin
Skin is normally a •
warm temperature
 Palpate for moisture

unexposed areas. Use the dorsal surfaces of the hands to assess for •
.moisture
Check under skin folds and in •
Varies from moist to dry depending on area assessed •
 Palpate for mobility and turgor

.Mobility torefers to how easily the skin can be pinched •

Turgor refers the skin’s elasticity and how quickly the skin returns to •
.its original shape after being pinched
.Ask the patient to lie down •
Use two fingers (thumb and forefinger) to pinch up the skin on the •
.sternum or under the clavicle, or forearm
.Skin pinches easily and immediately returns to its original position •
•
•
 Palpate edema for
Skin does not remain indented
.when pressure is released

Skin indentation may from slight

to great and may be in one area
.or all over the body
Use the thumbs to press down
on the skin of the feet or ankles
.to check for edema
 ?What Is Edema

is the medical term for swelling. "Edema" 

Body parts swell from injury or
inflammation. It can affect a small area or
the entire body. Medications, pregnancy,
infections, and many other medical
.problems can cause edema
Edema happens when your small blood 
vessels leak fluid into nearby tissues. That
extra fluid builds up, which makes the
tissue swell. It can happen almost anywhere
in the body
 Assessment of Nails

Inspect for grooming and cleanlines •

Normal findings Clean •
Abnormal findings Dirty, broken or jagged fingernails may be seen •
.with poor hygiene or depression
They may also result from the patient’s hobby or occupation •
 inspect for color and markings

.Normal findings Pink tones •

Some longitudinal ridging is normal •
Abnormal findings Pale or cyanotic nails may indicate hypoxia or •
.anemia
Splinter hemorrhages may be caused by trauma •
.Yellow discoloration may be seen in fungal infections or psoriasis •
Nail pitting is common in psoriasis •
 Inspect for shape

Assessment procedure View the index finger at its profile and note •
.the angle of the nail base
Normal findings There is normally a 160 angle between the nail base •
and the skin. Nail surface is Slightly curved, Nail edge is are smooth
.rounded clean
Abnormal findings Early clubbing (180 angle with spongy sensation) •
.and late clubbing (greater than 180 angle) can occur from hypoxia
 Common abnormal lesion of the skin

Skin lesions are an abnormal change of the skin compared to the •

surrounding tissue. They may be something you are born with or
something you acquire. They can be benign or severe, generalized or
.localized, symmetrical or irregular
A skin lesion's physical characteristics—including color, size, texture, •
and location—can be used to help establish if there is an underlying
cause. Skin lesions are broadly classified as being either primary or
.secondary
 Primary Lesions

Primary skin lesions are either present from birth or develop over •
your lifetime. They are associated with a specific cause or can be a
.reaction to either internal or external environments
 :They tend to be divided into three types of groups

Skin lesions formed by fluid within the skin layers, such as vesicles or •
.pustules

Skin lesions that are solid, palpable, masses, such as nodules or •

.tumors

Flat, non-palpable skin lesions like patches and macules •

 :Types of primary lesion include

Bulla: A vesicle that is greater than 0.5 centimeters (cm) or 1/5 of an •

inch and filled with fluid
Cyst: A raised, circumscribed area of the•
skin, filled with fluid or semi-solid fluid
Macule: A non-palpable, flat lesion that is different in color, and less than 0.5cm in
size
Plaque: Greater than 1-2 cm in diameter, raised like a papule, solid,
rough, and flat-topped