1. Integumentary System
Skin and Glands
Hair
Nails

2. History Integumentary System
Previous skin history
Changes in pigmentation
Moles, any changes
Excessive dryness or moisture
Itching (pruritus)
Excessive bruising
Rash or lesions
Medications
Hair loss
Nail changes

3. Skin Color General pigmentation (skin tone) Freckles Mole Birthmarks
Vitiligo-absence of pigment
Freckles
Small, flat macules, brown
Mole
Proliferation of melanocytes,
macular or papular
Tan to brown
Birthmarks
Tan to brown in color

4. Widespread color changes
Pallor (white)
Unnatural paleness d/t constriction of cutaneous vessels
Anemia, Shock
Erythema (redness)
Excess blood in superficial capillaries d/t vasodilatation
Fever or localized inflammation

5. Cyanosis (blue)
Decreased perfusion
Shock, heart failure, bronchitis, congenital ht dx
Jaundice (yellow)
Excess bilirubin in the blood
Cirrhosis, sickle-cell anemia, transfusion reactions

6. Temperature and Moisture
Use back of hand
Hypothermia
Coolness
Surgery, immobilized extremity, shock
Hyperthermia
Increased metabolic rate
Hyperthyroidism, fever, heavy exercise, trauma, infection, sunburn

7. Moisture
Diaphoresis- excessive perspiration
Dehydration-dry, parched and cracked lips

8. Texture and Thickness Texture Thickness
Character of the skin’s surface. It is not normally uniform throughout. Elbow vs. cheek
Hyperthyroidism-velvet
Hypothyroidism-rough,dry, and flaky
Thickness
Thin over body
Thick over palms & soles

9. Mobility & Turgor Mobility = rise of skin
Turgor = return of skin, the elasticity of skin. It may be diminished by edema or dehydration. The skin normally loses elasticity with age
Elderly – chest
Infants – abdomen
Adult/teen - arms

10. Vascularity or Bruising
Petechiae
Tiny purple or redspots d/t minute hemorrhages in the dermis
Cherry angiomas
Small, smooth, raised red dots on trunk in adults over 30
Bruising (ecchymosis)
Tattoos

11. Hair 2 Types Color Texture Distribution Condition of scalp
Terminal Hair
Long, coarse, thick. Found on scalp, axilla and pubic areas.
Vellus Hair
Small, soft, tiny hairs. Covering entire body except hands, soles of feet and penis
Color
Texture
Distribution
Condition of scalp

12. Common Hair Abnormalities
Hirsutism
Male pattern growth in women, especially the face
Alopecia - Balding
Excessively oily hair
Associated with androgen hormone stimulation

13. Dry brittle hair
Associated with aging and excessive use of shampoo, etc
Dry coarse discolored hair
Suspect poor nutrition
Decreased hair on the extremities
Arterial insufficiency

14. Nails Shape & contour Strength/Thickness
Normally transparent, smooth, convex with white tips
Strength/Thickness
Can be a nutritional indicator
Color – determined by vascularity of nailbed
Linear pigmentation
Pigment bands normal in dark skinned individuals
Leukonychia striata
Markings from trauma, picking at cuticles
Capillary refill
Clubbing

15. Note if bite their nails
If nails are dirty, clean
Well trimmed or groomed