king saud university college of nursing health assessment (nur 224) the skin, hair, and nails 1
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King Saud University
College of Nursing
Health Assessment (NUR 224)
The Skin, Hair, and Nails
1
Anatomy and PhysiologyMajor function of skin is to keep the body in
homeostasis
Provides boundaries for body fluid
Protects underlying tissues from microorganisms, harmful substances, and radiation
Modulates body temperature
Synthesizes vitamin D
Heaviest single organ in body
16% of body weight
Anatomy and Physiology (cont.)Three layers
EpidermisDermisSubcutaneous tissue
Hair, nails, and sebaceous and sweat glands are appendages of skin
Anatomy and Physiology (cont.)Hair
Vellus hair – short, fine, less pigmentation
Terminal hair – coarser, pigmented (scalp/eyebrows)
Nails - protect distal ends of fingers/toes
Sebaceous glands – present all surfaces except palms/soles; produce a fatty substance secreted onto skin surface through hair follicles
Sweat glands
Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature
Apocrine glands – found in axilla and groin, stimulated by emotional stress
The Health HistoryCommon or concerning symptoms
Hair loss
Rash
Moles
Ask the patient
“Have you noticed any changes in your skin or your hair?”
“Have you noticed any moles that have changed size, shape, color, or sensation?”
“Have you noticed any new moles?”
Health Promotion and Counseling
Clinicians play an important role in educating patients
Early detection of suspicious moles
Protective measures for skin care
Hazards of excessive sun exposure
Skin cancers are most common cancers in some countries.
Most prevalent on hands, neck, and head
HARMM Risk Factors for Melanoma
History of previous melanoma
Age over 50
Regular dermatologist absent
Mole changing
Male gender
Additional Risk Factors for Melanoma
≥50 common moles
Red or light hair
Heavy sun exposure (especially severe childhood
sunburns)
Light eye or skin color (especially freckles/burns
easily)
Family history of melanoma
ABCDE: Screening Moles for Possible Melanoma
A for asymmetryB for irregular borders, especially ragged, notched,
or blurredC for variation or change in color, especially blue or
blackD for diameter ≥6 mm or different from other
moles, especially changing, itching, or bleedingE for elevation or enlargement
Techniques of ExaminationExamination of the skin, hair, and nails begins with the
general survey of the patient
Make sure the patient wears a gown
Drape appropriately to facilitate close inspection of hair,
anterior and posterior surfaces of body, palms and soles,
and webspaces
Inspect entire skin surface in good light
Preferably in natural light (or artificial light that
resembles natural)
o Artificial light often distorts colors
Techniques of Examination (cont.)
Inspect and palpate skinNote characteristics of:
ColorMoistureTemperatureTextureMobility and turgorLesions
Techniques of Examination (cont.)
Color
Patients often notice change in color before physician
Look for increased pigmentation, loss of pigmentation
Look for redness, pallor, cyanosis, and yellowing
o Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
In dark-skinned people, palms and soles
o For central cyanosis, look in lips, oral mucosa, and tongue
o Jaundice - sclera
Techniques of Examination (cont.)
Moisture Dryness, sweating, and oiliness
Temperature Use back of fingertips Identify warmth or coolness of skin
Texture Roughness or smoothness.
Techniques of Examination (cont.)
Mobility and turgor Lift fold of skin
Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)
Techniques of Examination (cont.)
Lesions
Note characteristics
o Anatomic location and distribution
o Patterns and shapes
o Type of lesion (macules, papules, nevi,
vesicles)
o Color
Techniques of Examination (cont.)
Skin lesions in context
Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology
To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical
Examples of skin lesions
Techniques of Examination (cont.)
Hair
Inspect and palpate
Note quantity, distribution, and texture
Techniques of Examination (cont.)
Nails
Inspect and palpate fingernails/toenails
Note color and shape
Note lesions
o Longitudinal bands of pigment may be a normal finding in people with darker skin
Evaluating the Bedbound PatientPeople confined to bed are particularly
susceptible to skin damage and ulceration
Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin
Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.
Evaluating the Bedbound PatientRoll patient onto one side to see sacrum and
buttocks
Recording the Physical Examination
Initially you may use sentences to describe findings; later you will use phrases
Examples: “Color good. Skin warm and moist. Nails without clubbing or
cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”
“Marked facial pallor, with circuoral cyanosis. Palms cold and moist. Cyanosis in nail beds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”
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