1. Health Assessment

3. Functions of Skin Covers the internal structures of body Protects body from trauma and bacteria. Prevents the loss of water and electrolytes Senses temperature, pain, touch, pressure Regulates body temperature throught sweat production and evaporation Synthesizes vitamin D Promotes wound repair-cell replacement

4. Health History: Skin How?When? did the changes occur? Is it a skin rash or lesion? One area or has it spread? Bleeding or drainiage from the area? Does the area itch? How much time do you spend in the sun? How do you protect from the UV rays? –(continued)

5. H. History: Skin Allergies? Family hx of skin cancer or significant disease? Fever or joint pain, or weight loss? Recent insect bite? Do you take medications or herbal preparations? What changes in your skin have you observed in the past few years?

6. Health History: Hair When did first notice loss (gain)? Sudden or gradual? Few spots or all over body? What was happening in your life? Any dyes, medications or herbal preparations? Did you experience itching pain, discharge, fever, weight loss? Any serious illness?

7. Health History: Nails When did you first notice? What type of changes have you noticed? Sudden or gradual? Other signs - bleeding, pain, itching, or discharge? What is normal condition of your nails? Hx of serious illness? (continued)

8. Health History: Nails Hx of nail problems? Do you bite your nails? Acrylic nails, tips, chemicals?

9. Physical Assessment Equipment: –lighting –magnifying glass –clear flexible measure –gloves

10. General Techniques of Physical Exam: Inspection and Palpation Inspection –general to specific –drape –begin with exposed areas –compare symmetrical anatomical areas sun exposed: non-exposed areas –cleanliness

11. General Techniques of Physical Exam Palpation –Exposed areas first –compare –fingertips for general differences/moisture –dorsa (back) of hand, temperature

12. Skin Inspect: –Color –Integrity –Lesions –Primary –Secondary –Vascular –Odor Palpate –Moisture –Temperature –Texture –Turgor/elasticity –Tenting

13. Describing a Lesion Size Color Exudate Surface relationship: raised (papule), flat (macule), depressed(ulcer) Shape Texture Tenderness Blanching or pulsation of vascular lesion Pattern, configuration, distribution.

14. Nevus

15. Hair Inspect –Color – Quantity –Distribution –Condition of scalp –Lesions or pediculosis Palpate –Texture –Scalp

16. Nails Inspect –Color –Condition –Angle of attachment –Abnormalities Palpate –Texture –Consistency –Thickness –Adherence to nailbed

17. Interaction with Other Body Systems Respiratory: Bluish discoloration, cyanosis Cardiovascular: changes in skin color, temperature, necrosis GI: Jaundice (sclera, conjunctiva), skin; dietary lipids(xanthomas); vitamin def., skin, hair, nails Urinary:skin (cont’d)

18. Other body systems(con’d) Neurological: sensation, touch, temperature, skin vessels. Endocrine, diabetes, thyroid Immunological: allergies, rashes, itching

19. Older Adult Skin Skin atrophies - dec. sebum, dec. sweat Skin drier, flattens - paperlike Elasticity decreases and wrinkles develop’ Dec. melanocyte function-grey hair, pale, age spots. Dec. axil, pubic,scalp hair Inc. facial hair; men - ears, nose

20. Seborrhoeic Keratosis