1. Assessing the Integumentary System
Chapter 10
Assessing the Integumentary System

2. Structures of the Integumentary System
Skin layers
Epidermis
Dermis
Subcutaneous layers
Hair
Nails
Sweat glands
Eccrine glands
Apocrine glands
Sebaceous glands

3. Interaction with Other Body Systems
Respiratory system
Cardiovascular system
Gastrointestinal system
Urinary system
Neurological system
Endocrine system
Lymphatic system

4. Developmental, Cultural, and Ethnic differences
Infants
Adolescents
Pregnant women
Menopausal Women
Older Adults
Cultural and Ethnic differences

5. Lets get to the assessment!
As always…ABCs. Then, the health history and the skin assessment itself.
Questions to ask—Non-healing sores or ulcerations? Changes in moles? Pruritus? Rashes, seasonal disorders or changes in body hair or nails?
Assess for the skin turgor.

6. Some Drugs which may affect the skin
Steroids
Anticonvulsants
Antimalarials
Some chemo (bleomycin)
Barbiturates
Cephalosporins
Tetracyclines
Sulfonamides
Penicillins
Phenothiazines
Oral antidiabetic agents
NSAIDS
Others:
Allopurinol
Captopril
Oral Contraceptives
Thiazide Diuretics
Lithium
Warfarin

7. Describing a lesion Size Shape Color Texture Surface relationship
Exudate
Tenderness or pain

8. Size
What is the best way to assess the size of a lesion?

9. Shape your lesion Macules Wheals Vesicles Fissures Irregular borders
Circumscribed
Linear
Usually associated with melanoma

10. Color
Just what color does it look like? Remember, lesions can change colors throughout time. If you use a descriptive term to describe a color make sure it is a common term.
Periwinkle is not a well known color. Red, rust, blue, light blue, orange, brown, dark brown...these terms are well known and useful for the next practitioner to relate to.
Does it blanch?

11. Texture Macules are smooth. Warts are rough. Psoriasis is scaly.
For example, if your client is having a new rash form—chart if it is raised or flat.

12. Surface relationship
Just where is the lesion & how does the primary lesion differ from the secondary lesions?
Is it flat or raised?
If raised, is it solid or cystic?
Is it depressed or pedunculated?

13. Exudate
Thin, Clear, Pale, Straw-yellow: serous oozing/weeping from non-infected lesion.
Thick, purulent, creamy yellow: Infection
Red (dark, light), bloody, serous, sero-sanguinous.
Oozing or flowing or weeping or gushing

14. Comfort Level Is there discomfort to open air? Light touch?
Not all lesions hurt.
If pain is present measure it on a scale of 1-10.

15. Assessing The Nails Color (Pink, light brown, yellow, blue, etc.)
Trauma (missing, black, raised, etc.)
Nail texture (uniform and not brittle)
Clubbing?
Fungus, psoriasis?
In-grown?
Blanching (color return within 3 seconds)

16. Assessing The Hair Distribution (Thinning? Patchy? Bald?)
Color and condition of scalp
Any adherent material on the hair shaft?
Pediculosis (1-2mm white eggs, usually near scalp)
May see movement if already hatched
Is hair dry, coarse, fine, silky?
Is there tenderness?

17. Lets get into a focused exam
Inspect
Color
Lesions
Nail beds
Hair loss
Palpate
Skin tugor
Lesion
Temp of Arms
Palpate radial pulses. Note intensity of each pulse in relationship to the other side of the body. Remember not to ever press or massage the carotid area… (Do you know why?)

18. If time permits… read Case Study starting with Biographical Data Note significant findings

19. Begin reading Assess of Head, Face, Neck
1st Quiz tomorrow - 9/26/07
For next week:
Begin reading Assess of Head, Face, Neck