1. Chapter 26 Assessment of the Skin, Hair, and Nails Mrs. M. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011

2. Anatomy and Physiology Review Structure of the skin Subcutaneous fat Dermis Epidermis Hair Nails Glands

3. Anatomy of the Skin

4. Anatomy of the Nail

5. Functions of the Skin Protection Homeostasis Temperature regulation Sensory organ Vitamin synthesis Psychosocial

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

7. 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

8. Inspect Skin Look for signs of: Edema Moisture Vascular changes

9. Inspect Skin: Petechiae

10. Integrity of Skin Skin tears Cleanliness Tattoos and piercings

11. Palpation Palpation confirms the size of the lesions and determines whether they are flat or slightly raised: Macular—flat rash Papular—raised rash Skin temperature—assessed with the back of the hand Turgor—the amount of skin elasticity

12. Hair Assessment Inspect and palpate the hair for cleanliness, distribution, quantity, and quality. Dandruff is an accumulation of patchy or diffuse white or gray scales that appear on the surface of the scalp. Hirsutism is excessive growth of body hair, which is one manifestation of hormonal imbalance.

13. Nail Assessment Dystrophic (defective nutrition or metabolism) nails Color of nail plate Nail shape changes Nail thickness, consistency, lesions Acute and chronic paronychia (infection of the nail)

14. Nail Disorders Iron deficiency can cause spoon shape nails

15. Skin Assessment Methods for Patients with Darker Skin Assess for: Pallor: mouth/gums Cyanosis: mouth/gums Inflammation Jaundice Skin bleeding

16. Diagnostic Assessment Cultures for fungal infections Cultures for bacterial infections—unroofing Cultures for viral infections Skin biopsies: Punch biopsy Shave biopsy Excisional biopsy

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

18. Wood’s Light Examination Ultraviolet/black light used and certain infections will change color

19. NCLEX TIME

20. Question 1 According to the American Cancer Society, which race has the highest incidence of melanoma? A.Asians B.African Americans C.Whites D.Hispanics

21. 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? A.500 mL B.1 to 2 L C.5 to 7 L D.10 to 12 L

22. Question 3 Spoon-shaped nails are a possible outcome of which condition? A.Lung cancer or hypoxia B.Iron deficiency or diabetes C.Emphysema or chronic obstructive pulmonary disease D.Severe malnutrition or psoriasis

23. Question 4 In dark-skinned patients, jaundice is best checked for in which area? A.Skin over palms and soles B.Conjunctivae C.Sclera nearest the corners of the eye D.Oral mucosa, especially the hard palate membranes

24. Question 5 True or False: Untreated dandruff can cause hair loss. A.True B.False