Physical Assessment

Lecture 4:Skin, Hair, and Nails

Prepared by: Dr. Rula Al-Rimawi
Second semester 2023/2024
 Structure: Skin
 Think of skin as body’s largest organ system.
 Skin guards our body.
 Skin has two layers
 Epidermis: outer highly differentiated layer
• Basal cell layer forms new skin cells.
• Outer horny cell layer of dead keratinized cells
 Dermis: inner supportive layer
• Connective tissue or collagen
• Elastic tissue
 Beneath these layers is a subcutaneous layer of
adipose tissue.
 Stores fat for energy, provides insulation for temperature
control and aids in protection
Layers of Skin
Structure of Nails
 Skin Function
 Skin is waterproof, protective, and adaptive
 Protection from environment
 Prevents penetration
 Perception
 Temperature regulation
 Identification
 Communication
 Wound repair
 Absorption and excretion
 Production of vitamin D
Subjective Data Health History
Questions
Subjective Data Health History
Questions
Subjective Data Health History
Questions
Subjective Data Health History
Questions
Subjective Data Health History
Questions
 Objective Data
 Preparation
 Consciously attend to skin characteristics; the
danger is one of omission.
 Equipment needed
 Strong direct lighting, gloves, penlight, and small
centimeter ruler
 For special procedures
• Wood’s light
• Magnifying glass
 Physical Examination
 Complete physical examination
 Skin assessment integrated throughout examination
 Examine the outer skin surface first before you concentrate
on underlying structures.
 Separate intertriginous areas (areas with skinfolds) such as
under large breasts, obese abdomen, and groin, and
inspect them thoroughly
 Always Remove the client's socks to inspect feet ,nails and
between toes.
 Regional physical examination
 Individuals may seek health care for skin problems
and assessment focused on skin alone.
 Assess skin as one entity; getting overall impression
helps reveal distribution patterns.
 Inspection and Palpation:
Skin (1 of 3)
 Color
 General pigmentation, freckles, moles, birthmarks
 Widespread color change
• Note color change over entire body skin, such as pallor (pale),
erythema (red), cyanosis (blue), or jaundice (yellow).
• Note if color change transient or due to pathology.
 Temperature
 Use backs of hands to palpate person.
 Skin should be warm, and temperature equal bilaterally;
warmth suggests normal circulatory status.
 Hands and feet may be slightly cooler in a cool
environment.
• Hypothermia
• Hyperthermia
 Inspection and Palpation:
Skin (2 of 3)
 Moisture
 Diaphoresis
 Dehydration
 Texture
 Normal skin feels smooth and firm with even surface.
 Thickness
 Observe for thickened areas (callus formation).
 Edema
 Assess for fluid accumulation in the interstitial space
 Mobility and turgor
 Assess skin elasticity
 Vascularity or bruising
 Assess for presence of tattoos and/or variations
 Inspection and Palpation:
Skin (3 of 3)
 Lesions: if any are present, note the
following:
 Color
 Elevation
 Pattern or shape
 Size
 Location and distribution on body
 Any exudate: note color and odor
 Inspection and Palpation: Hair
 Color
 Due to melanin production
 Texture
 Characteristics range from fine to thick to curly to
straight
and may be affected by use of hair care products.
 Distribution
 Lesions
 Identification by looking at scalp and dividing hair into
sections
 Inspection and Palpation: Nails
 Shape and contour
 Profile sign: view index finger at its profile and note angle of
nail base; it should be about 160 degrees
 Consistency
 Observe for smooth, regular, not brittle or splitting, uniform
nail thickness.
 Color
 Translucent nail plate to pink nail bed below
 Capillary refill
 Depress nail edge to blanch and then release, noting
return of color; indicates status of peripheral circulation.
Profile Sign: Clubbing
 ABCDEF Skin Assessment
 Promoting health and self-care
 Teach skin self-examination using ABCDEF rule to
detect suspicious lesions
• A: asymmetry
• B: border irregularity
• C: color variations
• D: diameter greater than 6 mm
• E: elevation or evolution
• F: funny looking— —different from others
 Primary Skin Lesions (1 of 2)
 Macules
 Solely a color change, flat and circumscribed, less than 1 cm
 Papules
 Felt and caused by superficial thickening of the epidermis
 Patches
 Macules that are larger than 1 cm
 Plaques
 Papules coalescing (merging) to form surface elevation wider than 1 cm
 Nodules
 Solid, elevated, hard or soft, greater than 1 cm that may extend deeper
into dermis than papule
 Wheals
 Superficial, raised, transient and erythematous, irregular in shape due to
edema
 Primary Skin Lesions (2 of 2)
 Tumors
 Larger in diameter, firm or soft, deeper into dermis, may be benign or
malignant,
 Urticaria (hives)
 Wheals coalesce to form extensive pruritic reaction.
 Vesicles
 Elevated cavity containing fluid up to 1 cm (blister)
 Cysts
 Encapsulated fluid filled cavity
 Bullas
 Larger than 1 cm diameter, usually single chamber, superficial in dermis
and ruptures easily
 Pustules
 Pus in cavity that is circumscribed and elevated.
Macule and Patch
Papule and Plaque
Nodule and Tumor
Wheal and Urticaria/Hives
Vesicle and Bulla
Cyst
Pustule
 Secondary Skin Lesions (1 of 2)
 Break in continuity of skin surface
 Ulcers—Deeper depression extending into dermis
with irregular shape, may bleed, leaves scar
Ulcer
 Pressure Injuries (PI)
Pressure Ulcer, Decubitus Ulcer
 Stages
 Stage I: Non-blanchable erythema
 Stage II: Partial-thickness skin loss
 Stage III: Full-thickness skin loss
 Stage IV: Full-thickness skin/tissue loss
 Vascular Lesions (2 of 2)
 Purpuric lesions
 Petechiae (pinpoint, round spots that form on the
skin. They're caused by bleeding).
 Ecchymosis
 Purpura (red, purple or brown blood spots or patches
on your skin.
 Summary Checklist: Skin,
Hair, and Nails
 Inspection of the skin, hair, and nails
 Color and pigmentation
 Texture and distribution
 Shape, contour, and consistency
 Palpation of the skin, hair, and nails
 Temperature and texture
 Edema, mobility, and turgor
 Note presence of lesions
 Shape, configuration, and distribution
 Teach self-examination
 Health promotion