1. Integumentary System
Skin, Hair, Nails.

2. Review A & P Layers of skin Hair Nails Epidermis Dermis
Subcutaneous tissue
Glands of the skin
Hair
Nails

3. Copyright 1996 by W. B. Saunders Company. All rights reserved
Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.)

4. Anatomy of Nails
Image p 275

5. What are the major functions of the integumentary system?
*Prevents penetration: barrier
*Protection: physical, chemical and thermal
Regulation: temperature
Perception: sensory organ (pain, touch, pressure, temperature)

6. Other functions Identification Communication Wound repair
Absorption/excretion
Production of vitamin D

7. Functions of Hair Provides …….. Warmth Protection Sensation
………to underlying structures

8. Functions of Nails Provides …. Protection to distal surfaces
Can be used for self-protection

9. Health history (blue pages)
Subjective Data
Health history
(blue pages)

10. Integumentary System- Health History
any past skin problems and their management
skin colour changes
temperature changes
texture changes
sweating
any masses including warts or moles (nevi)

11. Integumentary System- Health History
changes in masses, warts, nevi – also, cosmetic concerns and physical discomfort
rashes or eruptions
changes in hair texture or oiliness, hair loss, dandruff, hair bleaching, dyeing
management of any problems with hair or scalp
medications

12. Integumentary System- Health History
complaints of tenderness, flakiness, itchiness, lumps, sores on scalp, bleeding
problems with nails including breaking, ingrown nails, paronyhia (hangnails), nail biting
Self-care behaviours

13. Inspection and Palpation
Describe how to assess the client’s integumentary system by inspection and palpation?
Inspection and Palpation

14. 1.How will you prepare the environment?
2. How will you prepare the client?
3.How will you protect the client’s privacy?
*4. What equipment is needed?
(Direct lighting, small ruler, penlight, gloves)

15. Objective Data

16. Inspection and Palpation of the skin
What are the general characteristics of the skin that should always be noted?
Inspection and Palpation of the skin

17. Inspect Colour
General pigmentation: freckles, mole (nevus), birthmarks.
Widespread colour changes: pallor, erythema, cyanosis, jaundice.

18. Palpate Temperature Should be warm & equal bilaterally
Hypothermia: immobilized extremity, cast, IV (normal)
Hyperthermia: fever, exercise, trauma, infection or sunburn.

19. Palpate Moisture Normal perspiration Diaphoresis
Dehydration in mucous membranes

20. Palpate Texture
Smooth and firm
Even texture

21. Palpate Thickness Epidermis is thin over most of the body
Calluses over palms and soles

22. Palpate Edema Not normally present Scale from 1+ to 4+
Most evident on feet, ankles, and sacral areas
Note extent and location

23. Palpate Mobility and Turgor
Mobility is the skin’s ease of rising
Turgor is its ability to return to place promptly.
Pinch up on skin and let go (ant. Chest under clavicle)

24. Inspect Vascularity or Bruising
Cherry (senile) angiomas
Ecchymosis (bruising): consistent with traumas of life.
Tattoos: document location on chart.

25. Inspect Lesions Colour Elevation Pattern or shape (p.250-251)
Size in cm (avoid quarter or pea)
Location and distribution on body-e.g. generalized or localized
Exudate, note colour and odor
(See OH for images on p )

26. Danger Signs….ABCDE Asymmetry of a pigmented lesion
Border irregularity
Colour variation
Diameter greater than 6 mm
Elevation and enlargement(any change)

27. How do you examine a lesion?
Palpate, wear gloves
Roll nodule between thumb and forefinger to assess depth
Does it blanche with pressure or when stretched?

28. Copyright 1996 by W. B. Saunders Company. All rights reserved
Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.252

29. Copyright 1996 by W. B. Saunders Company. All rights reserved
Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.253

30. Copyright 1996 by W. B. Saunders Company. All rights reserved
Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.254

31. What are the criteria used in assessing the hair and scalp?
Inspection and Palpation of the hair and scalp

32. Inspect Colour
Pale blonde to total black
graying

33. Palpate Texture
Fine or thick
Straight, curly or kinky
shiny

34. Palpate Distribution Fine hair coats the body
Coarse hair at the eyebrows, eyelashes and scalp
Puberty: hair to face (male), axillae and pubic region

35. Inspect Lesions Clean and free from lesions No nits or head lice
Seborrhea (dandruff) is normal

36. What criteria are used in assessing nails?
Inspection and Palpation of the nails

37. Inspect Shape and contour
Normally slightly curved or flat
Nail folds smooth and rounded
Nail edges are smooth, rounded and clean.
Normal nail angle degrees
Clubbing: occurs with long standing hypoxia - emphysema and chronic bronchitis

39. Inspect Consistency Smooth and regular, not brittle or splitting
Thickness is uniform throughout nail
Nail firmly attached to nail bed

40. Inspect & Palpate Colour
Nail bed is pink
Brownish-black linear bands or streaks along the nail edge in dark-skinned individuals
White hairline linear markings usual as well.
Capillary refill: colour return is instant or within a few seconds. A sluggish return takes longer than 1 to 2 seconds.