Faculty of Nursing-IUG Chapter (6) Assessment of Skin, Hair and Nails Faculty of Nursing-IUG

Structure of the Integument The skin is the largest organ of the body comprising 15 percent of total body weight. Layers of the skin A. Epidermis B. Dermis C. Subcutaneous tissue Epidermal appendages Hair Nails Glands: two types of skin glands: 1. Sweat Gland Eccrine sweat glands: are widely distributed and open directly onto the skin surface Apocrine sweat glands: open into hair follicle in axillary and genital areas 2. Sebaceous glands: Produce sebum(oily secretion)

Functions of skin and epidermal appendages Barrier to water and electrolyte loss Regulation of body heat Sensory organ for touch, temperature, and Pain Production of protective skin film by eccrine and sebaceous glands Participation in production of vitamin Wound repair

Assessing the Integument 1. Subjective data Skin infection, rashes, lesions, itching. Precipitating factors: stress, weather, drugs Changes in skin color, lesions Amount of sun exposure Scalp lesions, itching, and infections. Changes in texture and amount of hair. Changes in nails and cuticles nail breaking

2. History of current symptom Are you having experience of skin problem, such as rashes, lesion Describe any birthmarks, tattoos, or moles Have you noticed any changed in your ability to feel pain, pressure, light touch, or temperature changed? Have you had any hair loss or change in the condition of your hair? Have you had any change in the condition or appearance of your nails? Describe any previous problem within the skin, hair or nails ( past history) Have you ever had any allergic skin reaction to food, medication, plants? Has anyone in your family had a recent illness, rash, or other skin problem? (Family history)

3. Physical Assessment Equipment Penlight Tongue depressor Centimeter rule Gloves Magnifying glass Flashlight Wood’s lamp Technique to examination of skin Inspection Palpation Inspections and palpation of skin Color Moisture Temperature Thickness Turgor Vascular changes Edema Lesions Skin odors are usually noted in the skin fold.

Inspection color of skin Skin color varies from body part to body part and from person to person. Assessment first involves area of skin not exposed to the sun e.g. palms of the hands. Pallor easily perceived in the buccal “mouth” mucosa particularly in individuals with dark skin. Cyanosis readily seen in area of least pigmentation e.g. lips, nail beds conjunctiva and palm. Jaundice or Yellow seen in client’s sclera. Erythema may indicate circulatory changes

Palpation moisture of skin Skin is normally smooth and dry. Skin folds e.g. axillae are normally moist. In presence of lesions or ooze fluid, nurse must wear gloves to prevent exposure to infections drainage Moisture indicates: 1- Degree of client’s hydration 2- Condition of the outer lipid layer of the skin surface Dry (xerosis): Vitamin A def. and Myxedema Oily: Acne

Palpation of Temperature Temperature of skin depends on the amount of blood circulating through dermis. Generalized warmth: (Fever, Hyperthyroidism) Local warmth: (Inflammation) Coolness: (Hypothyroidism, Frost bite, Hypothermia, Shock, Low cardiac output) Palpation of skin with dorsum of the hand. Assessment of skin is critical point in some conditions such as: after cast application, or after vascular surgery.

Palpation of Texture Texture of skin normally smooth, soft and flexible If any abnormalities in texture found you must ask the client is he exposed to any recent injury to the skin? Nurse determines whether the client’s skin is smooth or rough, thin or thick, tight or supple (flexible). Very Soft: (Thyrotoxicosis) Tight: (Scleroderma = hard skin) Rough: (Hypothyroidism)

Palpation of Turgor Turgor: is the skin elasticity diminished by edema or dehydration. Assessment of turgor done by pinching skin between the thumb and forefinger and released. Normally skin return immediately to its position. Failure of this process means dehydration. Decrease in turgor predisposes the client to skin breakdown.

Palpation of Vascularity Vascularity: Assessment of circulation of skin E.g. petechiae may indicate serous blood clotting disorders, drug reactions or liver disease. Inspection and Palpation of Edema Edema : "Build up of fluid in tissues“ Inspected for location, color, and shape. Palpates areas of edema to determine mobility, consistency, and tenderness Inspection and Palpation of Lesions Normally skin free of lesions except common freckles. If lesion present, inspection must done for distribution, arrangement, morphology, color and size Palpation for lesion’s mobility, contour (flat, raised or depressed) and consistency (soft or hard are indicated). Cancerous lesions frequently undergo changes in color and size.

Hair and Scalp Assessment done for distribution, thickness, texture, and lubrication of the hair. Some events which affect the distribution of hair over the body e.g. client with hormone disorders, woman with hirsutism Amount of hair covering extremities may be reduced as a result of aging and arterial insufficiency especially in lower limbs. Scaliness or dryness of the scalp is frequently caused by dandruff or psoriasis.

Nails Assessment Nails reflect an individual's general state of health, state of nutrition, and occupation. Nails are normally transparent, smooth, and convex, with a nail bed angle of about 160 degrees. The surrounding cuticles are smooth, intact and without inflammation. Nail bed is normally firm on palpation. Nails normally grow at a constant rate.

Abnormal condition of nail Anonychia: complete absence of nails Platunychia: flatting nails Koilonychia : nails like spoon shape (iron deficiencies anemia) Racket nail: fattened and expanded nails Onycholysis: separation of nail form nail bed (thyrotoxicosis) Melanoychia: presence of brown color in nails plate Paronychia: inflammation of tissue surrounding the nail