1. Health Assessment Nur 211 Integument System Fall 2004
Curlissa Mapp RN, MSN

2. Skin and Epidermal Appendages

3. Function of the Skin Protection Prevents Penetration Perception
Temperature Regulation
Identification
Communication
Wound Repair
Absorption and excretion
Production of Vitamin D

4. Main Symptoms of Disease of Skin, Hair and Nails are:
Rash or skin lesion
Changes in skin color
Itching (Pruritus)
Changes in Hair
Changes in Nail

5. Subjective Data of Health History: Skin
Any previous skin disease or problem? Any family history of allergies or allergic skin problems? Any known allergies to drugs, plants or animals? Any birthmarks or tattoos?
Any change in skin color or pigmentation? Was color change generalized (all over body) or localized (in one area)?
Any change in a mole: color, size shape, sudden appearance of tenderness, bleeding or itching? Any “sores” that do not heal?
Any change in temperature, moisture or texture of your skin? Any excess dryness? Is this seasonal or constant?
(Jarvis, 2004)

6. Subjective Data of Health History: Skin
Any skin itching? Where is the itching? When did it start? Is this mild or intense?
Any excess bruising? Where on the body? How did this happen? How long have you had it?
Any skin rash or lesion? Onset. When did you first notice it? Where did it start? Describe the color. Is it raised or flat? How long have you had it? Anyone at home or work with similar rash? Have you been camping, have a new pet, tried a new food or drug? What home care have you tried? Any itching, fever?
What medications do you take? Prescription and over-the counter?
(Jarvis, 2004)

7. Subjective Data of Health History (cont’d)
Any recent hair loss? Was it a gradual or sudden onset? Symmetrical? Associated with fever, illness, increased stress?
Any unusual hair growth? Any recent change in texture, appearance?
Any change in nails: shape, color, brittleness? Do you tend to bite or chew your nails?
(Jarvis, 2004)
Any environmental or occupational hazards? Any hazard related problems with occupation, hobbies. How much sun exposure do you get from outdoor work, leisure activities, sunbathing, tanning salons?
Recently been bitten by insect: bee tick, mosquito?
Any recent exposure to plants, animals in yard work, camping?
What do you do to care for your skin, hair, nails? What cosmetics, soaps, chemicals do you use?

8. Physical Assessment Equipment: Strong Direct Lighting
Small Centimeter ruler
Penlight
Gloves
Magnifying glass

9. Techniques used in skin assessment: Inspection and Palpation
general to specific
drape
begin with exposed areas
compare
-anatomical areas
-sun exposed; non-exposed areas
cleanliness

10. Techniques used in skin assessment: Inspection and Palpation
Exposed areas first
Compare
Fingertips for general differences/moisture
Dorsa (back) of hand, temperature

11. Inspect and Palpate Skin
Color
Temperature
Moisture
Texture
Thickness
Edema
Mobility & Turgor
Vascularity or Bruising
Lesions

12. Inspect and Palpate the Hair
Color
Texture
Distribution
Lesions

13. Inspect and Palpate the Nails
Shape and Contour
Consistency
Color

14. Special Considerations in Assessment of skin, nails and hair
Infant
Adolescents
Pregnant female
Aging Adults
Cultural

15. Abnormal Findings Pallor Cyanosis Erythema Purpura Ecchymosis Petechia
Jaundice

16. Abnormal Findings: Lesions
Macule
Patch
Wheal Nodule
Vesicle
Pustule
Cyst
Scale
Crust
Excoriation
Scar
Keloid
Fissure/Ulcer

17. Interaction with other Body System
Respiratory- Bluish discoloration, cyanosis
Cardiovascular- Changes in skin color, temperature, necrosis
GI- Jaundice (sclera, conjunctiva), skin; dietary lipids (xanthomas); vitamin deficiency skin, hair, nails

18. Interaction with other Body System
Urinary- skin
Neurological- sensation, touch, temperature, skin vessels
Endocrine- Diabetes, Thyroid
Immunological- allergies, rashes, itching

19. Documentation of Findings
Describe:
Size
Color
Exudate
Shape
Texture
Tenderness
Blanching or pulsation of vascular lesion
Pattern, configuration, distribution