1. Chapter 26 Assessment of the Skin, Hair, and Nails

2. Pop Quiz!
The epidermis has its own blood supply and is the site for activation of vitamin D. (True or False?)
ANS: True

3. True!

4. Pop Quiz! (cont’d)
One function of the skin is to help communicate a person’s state of health. (True or False?)
ANS: True

5. True!

6. Pop Quiz! (cont’d) What is the main component of dermal tissue?
ANS: Collagen

7. Collagen

8. Pop Quiz! (cont’d)
Which skin layer contains capillaries, lymph vessels, and sensory nerves?
ANS: Dermis

9. Dermis

10. Pop Quiz! (cont’d)
What are the pigment-producing cells of the skin called?
ANS: Melanocytes

11. Melanocytes

12. Anatomy of the Skin

13. What are the Functions of the Skin?
Protection
Homeostasis
Temperature regulation
Sensory organ
Vitamin synthesis
Psychosocial

14. Nursing Assessment of the Skin Includes:
Demographic data
Socioeconomic status
Drug use
Allergies
Nutrition status
Family and genetic risk
Current health problems

15. Skin Assessment Color Lesions, primary and secondary
Assess each lesion for:
A—asymmetry of shape
B—border irregularity
C—color variation within one lesion
D—diameter >6 mm
E—evolving/changing features
Look for signs of:
Edema
Moisture
Vascular changes

16. Petechiae
Petechiae often indicate increased capillary fragility.

17. Integrity of Skin Skin tears Cleanliness Tattoos and piercings
Left: Abrasion. Note the superficial tears in the epidermis. There is bleeding under the skin as well.
Right: This tattoo has been present for 20 years. The original tattoo consisted of red ‘flames’ from the sun with yellow tips. Over the years the yellow has faded completely and the red has faded away by more than 95%.

18. Palpation
Confirms size of lesions, determines whether flat or slightly raised:
Macular—flat rash
Papular—raised rash
Skin temperature—assessed with back of the hand
Turgor—amount of skin elasticity

19. Hair Assessment
Inspect and palpate for cleanliness, distribution, quantity, quality
Dandruff—accumulation of patchy or diffuse white/gray scales on surface of scalp
Hirsutism—excessive growth of body hair; manifestation of hormonal imbalance

20. Hair Assessment (cont’d)
Left: Graying and thinning of the hair.
Right: Hirsutism.

21. Nail Assessment Dystrophy Color of nail plate Shape changes
Thickness, consistency, lesions
Acute and chronic paronychia

22. Nail Assessment (cont’d)
Normal variations in nail color. A, Diffuse nail pigmentation. B, Linear nail pigmentation.

23. Skin Assessment Techniques for Patients with Darker Skin
Assess for:
Pallor
Cyanosis
Inflammation
Jaundice
Skin bleeding

24. Group Work!
Break into groups & perform a skin, hair, & nail assessment on each other.

25. Diagnostic Assessment
Cultures for:
Fungal infections
Bacterial infections—unroofing
Viral infections
Skin biopsies
Punch
Shave
Excisional

26. Skin Biopsy
Excisional—lesion removed with margin of normal skin down to adipose tissue
Incisional—cross-section wedge of tissue through center of lesion
Shave—horizontal shave of skin lesion with only superficial portion of dermis
Punch—sampling of possible cancers, tumors, inflammatory skin conditions

27. Chapter 26
NCLEX Questions 27

28. Question 1 Which ethnic group has the highest incidence of melanoma?
Asian
African American
White
Hispanic/Latino
Answer: C
Rationale: According to the American Cancer Society, melanoma rates are more than 10 times higher in whites than in African Americans.
(Source: Accessed July 28, 2011, from

29. Answer
Answer: C
Rationale: According to the American Cancer Society, melanoma rates are more than 10 times higher in whites than in African Americans.

30. Question 2
Evaporation of the water contained in the sweat from eccrine sweat glands can cause the body to lose how much fluid in a single day?
500 mL
1 to 2 L
5 to 7 L
10 to 12 L
Answer: D
Rationale: Stimulation of sweat from the eccrine glands and the resultant water evaporation can cause the body to lose as much as 10 to 12 L of fluid in a single day.

31. Answer
Answer: D
Rationale: Stimulation of sweat from the eccrine glands and the resultant water evaporation can cause the body to lose as much as 10 to 12 L of fluid in a single day.