1. Health Assessment (NUR 224)
King Saud University
College of Nursing
Health Assessment (NUR 224)
The Skin, Hair, and Nails

2. Anatomy and Physiology
Major function of skin is to keep the body in homeostasis
Provides boundaries for body fluid
Protects underlying tissues from microorganisms, harmful substances, and radiation
Modulates body temperature
Synthesizes vitamin D
Heaviest single organ in body
16% of body weight

3. Anatomy and Physiology (cont.)
Three layers
Epidermis
Dermis
Subcutaneous tissue
Hair, nails, and sebaceous and sweat glands are appendages of skin

4. Anatomy and Physiology (cont.)
Hair
Vellus hair – short, fine, less pigmentation
Terminal hair – coarser, pigmented (scalp/eyebrows)
Nails - protect distal ends of fingers/toes
Sebaceous glands – present all surfaces except palms/soles; produce a fatty substance secreted onto skin surface through hair follicles
Sweat glands
Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature
Apocrine glands – found in axilla and groin, stimulated by emotional stress

5. The Health History Common or concerning symptoms Ask the patient
Hair loss
Rash
Moles
Ask the patient
“Have you noticed any changes in your skin or your hair?”
“Have you noticed any moles that have changed size, shape, color, or sensation?”
“Have you noticed any new moles?”

6. Health Promotion and Counseling
Clinicians play an important role in educating patients
Early detection of suspicious moles
Protective measures for skin care
Hazards of excessive sun exposure
Skin cancers are most common cancers in some countries.
Most prevalent on hands, neck, and head

7. HARMM Risk Factors for Melanoma
History of previous melanoma
Age over 50
Regular dermatologist absent
Mole changing
Male gender

8. Additional Risk Factors for Melanoma
≥50 common moles
Red or light hair
Heavy sun exposure (especially severe childhood sunburns)
Light eye or skin color (especially freckles/burns easily)
Family history of melanoma

9. ABCDE: Screening Moles for Possible Melanoma
A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement

10. Techniques of Examination
Examination of the skin, hair, and nails begins with the general survey of the patient
Make sure the patient wears a gown
Drape appropriately to facilitate close inspection of hair, anterior and posterior surfaces of body, palms and soles, and webspaces
Inspect entire skin surface in good light
Preferably in natural light (or artificial light that resembles natural)
Artificial light often distorts colors

11. Techniques of Examination (cont.)
Inspect and palpate skin
Note characteristics of:
Color
Moisture
Temperature
Texture
Mobility and turgor
Lesions

12. Techniques of Examination (cont.)
Color
Patients often notice change in color before physician
Look for increased pigmentation, loss of pigmentation
Look for redness, pallor, cyanosis, and yellowing
Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
In dark-skinned people, palms and soles
For central cyanosis, look in lips, oral mucosa, and tongue
Jaundice - sclera

13. Techniques of Examination (cont.)
Moisture
Dryness, sweating, and oiliness
Temperature
Use back of fingertips
Identify warmth or coolness of skin
Texture
Roughness or smoothness.

14. Techniques of Examination (cont.)
Mobility and turgor
Lift fold of skin
Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)

15. Techniques of Examination (cont.)
Lesions
Note characteristics
Anatomic location and distribution
Patterns and shapes
Type of lesion (macules, papules, nevi, vesicles)
Color

16. Techniques of Examination (cont.)
Skin lesions in context
Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology
To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical

17. Examples of skin lesions

18. Techniques of Examination (cont.)
Hair
Inspect and palpate
Note quantity, distribution, and texture

19. Techniques of Examination (cont.)
Nails
Inspect and palpate fingernails/toenails
Note color and shape
Note lesions
Longitudinal bands of pigment may be a normal finding in people with darker skin

20. Evaluating the Bedbound Patient
People confined to bed are particularly susceptible to skin damage and ulceration
Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin
Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.

21. Evaluating the Bedbound Patient
Roll patient onto one side to see sacrum and buttocks

22. Recording the Physical Examination
Initially you may use sentences to describe findings; later you will use phrases
Examples:
“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”
“Marked facial pallor, with circuoral cyanosis. Palms cold and moist. Cyanosis in nail beds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”

23. Question?