Integumentary System Skin and Glands Hair Nails

History Integumentary System Previous skin history Changes in pigmentation Moles, any changes Excessive dryness or moisture Itching (pruritus) Excessive bruising Rash or lesions Medications Hair loss Nail changes

Skin Color General pigmentation (skin tone) Freckles Mole Birthmarks Vitiligo-absence of pigment Freckles Small, flat macules, brown Mole Proliferation of melanocytes, macular or papular Tan to brown Birthmarks Tan to brown in color

Widespread color changes Pallor (white) Unnatural paleness d/t constriction of cutaneous vessels Anemia, Shock Erythema (redness) Excess blood in superficial capillaries d/t vasodilatation Fever or localized inflammation

Cyanosis (blue) Decreased perfusion Shock, heart failure, bronchitis, congenital ht dx Jaundice (yellow) Excess bilirubin in the blood Cirrhosis, sickle-cell anemia, transfusion reactions

Temperature and Moisture Use back of hand Hypothermia Coolness Surgery, immobilized extremity, shock Hyperthermia Increased metabolic rate Hyperthyroidism, fever, heavy exercise, trauma, infection, sunburn

Moisture Diaphoresis- excessive perspiration Dehydration-dry, parched and cracked lips

Texture and Thickness Texture Thickness Character of the skin’s surface. It is not normally uniform throughout. Elbow vs. cheek Hyperthyroidism-velvet Hypothyroidism-rough,dry, and flaky Thickness Thin over body Thick over palms & soles

Mobility & Turgor Mobility = rise of skin Turgor = return of skin, the elasticity of skin. It may be diminished by edema or dehydration. The skin normally loses elasticity with age Elderly – chest Infants – abdomen Adult/teen - arms

Vascularity or Bruising Petechiae Tiny purple or redspots d/t minute hemorrhages in the dermis Cherry angiomas Small, smooth, raised red dots on trunk in adults over 30 Bruising (ecchymosis) Tattoos

Hair 2 Types Color Texture Distribution Condition of scalp Terminal Hair Long, coarse, thick. Found on scalp, axilla and pubic areas. Vellus Hair Small, soft, tiny hairs. Covering entire body except hands, soles of feet and penis Color Texture Distribution Condition of scalp

Common Hair Abnormalities Hirsutism Male pattern growth in women, especially the face Alopecia - Balding Excessively oily hair Associated with androgen hormone stimulation

Dry brittle hair Associated with aging and excessive use of shampoo, etc Dry coarse discolored hair Suspect poor nutrition Decreased hair on the extremities Arterial insufficiency

Nails Shape & contour Strength/Thickness Normally transparent, smooth, convex with white tips Strength/Thickness Can be a nutritional indicator Color – determined by vascularity of nailbed Linear pigmentation Pigment bands normal in dark skinned individuals Leukonychia striata Markings from trauma, picking at cuticles Capillary refill Clubbing

Note if bite their nails If nails are dirty, clean Well trimmed or groomed