1. Integumentary Assessment Skin, Hair, and Nails Georgia Baptist College of Nursing Of Mercer University Mary M. Hudgins, RN, MSN Instructor

2. What Are We Talking About?  Structure and Function  Subjective Data  Health History Questions  Objective Data  The Physical Exam  Abnormal Findings

4. Structure and Function  Skin – _________ Layers  Epidermis ▫ Stratum Germinativum (basal skin layer) –Forms _____ ______ _______ ▫ Stratum Corneum (horny cell layer) –Constantly being _______ ▫ Derivation of skin __________ –Melanin –Carotene –Vascular bed

5. Skin Layers Continued….  Dermis  Connective tissue (__________)  __________ tissue  Subcutaneous Layer

7. Epidermal Appendages  Hair  __________ hair  ____________ hair  Sebaceous Glands  Sweat glands  __________ glands  ___________ glands  Nails

8. Functions of the Skin  Covers the _______ ________ of body  Protects body from trauma and ________  Prevents the loss of ________ and ______________  Senses __________, pain, ________, pressure

9. Functions of the Skin  Regulates body _______________ through _______ ____________ and evaporation  Synthesizes Vitamin ______  Promotes wound ___________ – _____ _________

10. Relationship of Skin, Hair, and Nails with Body Systems  Respiratory  Cardiovascular  Gastrointestinal  Neurological  Endocrine  Immune

11. Chief Complaints  Rash or skin _________  Changes in skin _________  Itching (________)  Changes in Hair  Changes in Nail

12. Subjective Data Health History Questions  Hx of skin disease?  Any known _________?  Family History?  Birthmarks or ___________?  Change in skin ______ or _________?  Generalized or localized?  Change in ______?  ________that does not heal?

13. Health History Cont.  Excessive dryness or moisture?  Itching?  Excessive ________?  Rash or __________?  _____________

14. Health History: Hair  Loss or gain?  Changes in _______ or appearance?  Associated with other symptoms?  Unusual ___________?  Serious illness?

15. Health History: Nails  Change in nails?  What is ________ condition?  Do you ______ or ________ nails?  __________ nails, tips, chemicals

16. Health History  Environmental/Occupational _________?  _______ exposure?  Recent __________ __________?  Exposure to plants/_________  Self-care

17. Objective Data The Physical Exam  Equipment  Strong Direct Lighting  Small Centimeter Ruler  Penlight  Gloves  Magnifying Glass

18. Physical Exam  Inspection  General to ____________  Drape  Begin with exposed areas  Compare ▫ __________ ____________ areas ▫ _________ exposed/non-exposed areas  Cleanliness

19. Palpation  ___________ areas first  Compare  ___________ for general differences/ Moisture  Back of hand (dorsa)

20. Skin Assessment  Color  General Pigmentation  Widespread __________ Change –Pallor –__________ –Cyanosis –___________

21. Skin Assessment Inspect and Palpate  Temperature  ___________  ____________  Moisture  ___________  ______________

22. Skin Assessment Inspect and Palpate  Texture  ___________  Edema  Mobility and __________  Vascularity or _____________

23. Skin Lesions Inspect and Palpate  Color  _________  Pattern or ________  Size  ________ and distribution  Exudate

24. Promoting Health and Self-Care  Teach skin self-examination  ABCDE rule – Abnormal Characteristics A______________ B_______ ___________ C________ ____________ D__________ ____________ E_________ and _____________

25. Hair Assessment Inspect and Palpate  Color  ________  Distribution  _________

26. Nail Assessment Inspect and Palpate  Shape and contour  ______ ________  Consistency  Color  ________ ________

27. Special Assessment Considerations  Infants  Adolescents  Pregnant Female  Aging Adults  Cultural/Ethnicity

28. Abnormal Findings Shapes/Configurations of Lesions  Annular or circular  Confluent  Discrete  Grouped  Gyrate  Target or Iris  Linear  Polycyclic  Zosteriform

29. Confluent

30. Grouped Lesions

31. Abnormal Findings Primary Skin Lesions  Macule  Papule  Patch  Plaque  Nodule  Wheal  Tumor

32. Papule Wheal

33. Abnormal Findings Primary Skin Lesions  Urticaria  Vesicle  Cyst  Bulla  Pustule

34. Vesicle Pustule

35. Vascular Lesions Purpura Petechiae

36. Abnormal Skin Findings Secondary Lesions  Crust  Scale  Fissure  Erosion  Ulcer  Excoriation  Scar  Atrophic Scar  Lichenification  Keloid

37. Ulcer Keloid

38. Malignant Skin Lesions  ___________ Cell Carcinoma  _________ cell carcinoma  ________________ Melanoma

39. Abnormal Conditions of Hair  _________ dermatitis  Alopecia  Pediculosis capitis  Folliculitis  __________

40. Abnormal Conditions of the Nails  ________ Lines  __________ Infection  Clubbing

41. Clubbing

42. Documentation of Findings: Lesions  - Size- Tenderness  - _____- Blanching or  - Exudate- _________of  - Shape vascular lesion  - _______- Pattern ___________, distribution