Skin Assessment

Skin is the largest organ in the body Skin is composed of

1. Epidermis- outermost portion of a relatively uniform, thin but tough, composed of thickness stratum germinativum and stratum corneum

◦ a. color derived from three sources Brown- pigment melanin Yellow-orange tones of pigment carotene Red-purple tone in underlying vascular bed

Skin Assessment

2 .Dermis- bulk of skin; the inner supportive layer

consisting mostly of connective tissue or collagen

is tough fibrous protein that enables skin to resist

tearing and allows skin to stretch with movement.

3 .Subcutaneous layer- adipose tissue made up of

lobules of fat cells used for energy. It provides

insulation for temperature control and aids in

protection by its soft cushioning effect

Skin function

• Protection/Barrier• Sensation• Temperature regulation• Identification• Communication• Wound Repair• Absorption/Excretion• Vitamin D

1. Previous history of skin diseases2. Skin Color- affected by genetic factors and

physiological factors. -Variations of skin color

• Cyanosis- blue tinge• Pallor- loss of rosy glow in skin, paleness• Erythema- redness of the skin, increase in

climate temperature, inflammation, infection

Assess Skin of Adults

• Plethora- redness of skin caused by increase red blood cell

• Ecchymosis- large diffuse areas usually black and blue , results of injuries

• Petechiae- small pinpoint hemorrhages can denote some type of blood disorder

• Jaundice- yellow staining of skin usually caused by bile pigments

3. Changes in mole • size, shape, tenderness, bleeding• check for abnormal characteristics of

pigmented lesions. • Note any freckles and changes and any

birthmarks (report any changes in size, itching, burning, bleeding of moles)

Abnormal characteristics of pigmented lesions:

ABCDE• Asymmetry of pigmented lesion -one that

is not regularly round or oval• Border irregularity -notching,

scalloping, ragged edges or poorly defined margins

• Color variation -areas of brown, tan, black, blue, red, white or combination

• Diameter greater than 6mm• Elevation and enlargement

4. Texture- palpate note any marks or scaring

skin should be smooth and firm

5. Temperature- symmetrically feel each part of

the body, compare upper area with lower areas

check for hypothermia and hyperthermia• Normal finding: warm• Changes: cool, cold, hot

6. Turgor-amount of elasticity in skin, grasp index finger pull it taut and quickly release- elastic skin immediately assumes in normal position, poor turgor suspended or tented; turgor shows hydration and nutrition

7. Moisture or dryness- check face, hands, axilla, skin folds; shows diaphoresis or dehydration

8. Are there any rashes or lesions; note color, elevation, pattern or shapes, size, location and distribution on body, any exudates

9. Is there any itching (purities)10. What medication are you taking11. Note mobility12. Note any edema- accumulation of fluid in the

intercellular spaces; to check for edema, imprint your thumbs firmly against the ankle malleolus or the tibia. If pressure leaves a dent in the skin “pitting” present

1=+ mild pitting, slight indentation, no perceptible swelling of the leg

2=+ moderate pitting, indentation subsides rapidly

3=+ Deep pitting, indentation remains for a short time; leg looks swollen 4=+Very Deep pitting, indentation

lasts a long time, leg is very swollen.

13.thickening uniform over body except thick over palms and soles of feet

Edema

Pitting edema

Assessing for Edema• Depress

pretibial area & medial malleolus for 5 seconds

• Grade pitting edema1 +to 4+

1. Hair- ◦ inspect for color (comes from melanin) graying may

begin at 3rd decade; ◦ Texture maybe fine or thick; straight, curly, or kinky;◦ Quality maybe shinny or dull;◦ Distribution- coarse or elastic

2. Scalp- inspect for ticks or lice3. Nails- Shape and Contour- curved or flat,

edges smooth, rounded, clean; - Consistency- smooth, regular, nor brittle or splitting,

thickness, firm - Color- translucent, pink nails base

- inspect nail beds for clubbing

Accessory structure of skin of adults

• Capillary return or refill: normal = less than 3 seconds– used to evaluate the ability of the circulatory system to restore

blood to the capillary system (perfusion).– Capillary refill is evaluated at the nail bed in a finger.

(a)Place your thumb on the patient’s fingernail and gently compress. (b)Pressure forces blood from the capillaries. (c)Release the pressure and observe the fingernail. (d) As the capillaries refill, the nail bed returns to its normal deep

pink color. (e)Capillary refill should be both prompt and pink. (f) Color in the nail bed should be restored within 2 seconds, about

the time it takes to say "capillary refill."

• Check color• Temperature• Abnormalities• Excessive dryness, moisture, itching, flaking• General texture of skin• Skin turgor• Edema• Cleanliness• Odor• Discoloration (ecchymosis, petechiae, purpura,

erythema, altered pigmentation)

Monitoring Skin Condition

Vocabulary

– Alopecia– Hirsutism– Clubbing of nail– Onycholysis

Benefits and Disadvantages

☺ •Quick

•Inexpensive •Can be done ‘on-site’

•Valid for all visibleskin conditions

• Subjective, noquantitative data• Requiresexperience/training• May not indicate subclinicaldamage• Surface conditions donot always correlatewith conditions in the

• Go to this website for a tutorial on skin assessment

• http://www.logicalimages.com:80/morphology/morphology3_content.html

Practice