Faculty of Nursing-IUG

Chapter (6)Assessment of Skin, Hair and Nails

Structure of the Integument The skin is the largest organ of the body comprising 15

percent of total body weight. Layers of the skin A. Epidermis B. Dermis C.

Subcutaneous tissueEpidermal appendagesHairNailsGlands: two types of skin glands: 1. Sweat Gland Eccrine sweat glands: are widely distributed and

open directly onto the skin surface Apocrine sweat glands: open into hair follicle in

axillary and genital areas2. Sebaceous glands: Produce sebum(oily secretion)

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Functions of skin and epidermal appendages

Barrier to water and electrolyte loss

Regulation of body heat

Sensory organ for touch, temperature, and Pain

Production of protective skin film by eccrine and

sebaceous glands

Participation in production of vitamin

Wound repair

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Assessing the Integument

1. Subjective data

Skin infection, rashes, lesions, itching.

Precipitating factors: stress, weather, drugs

Changes in skin color, lesions

Amount of sun exposure

Scalp lesions, itching, and infections.

Changes in texture and amount of hair.

Changes in nails and cuticles nail breaking 5

2. History of current symptom Are you having experience of skin problem, such as

rashes, lesionDescribe any birthmarks, tattoos, or molesHave you noticed any changed in your ability to feel

pain, pressure, light touch, or temperature changed? Have you had any hair loss or change in the

condition of your hair?Have you had any change in the condition or

appearance of your nails? Describe any previous problem within the skin, hair

or nails ( past history)Have you ever had any allergic skin reaction to food,

medication, plants? Has anyone in your family had a recent illness, rash,

or other skin problem? (Family history)

3. Physical Assessment

Equipment Penlight Tongue depressor Centimeter rule

Gloves Magnifying glass Flashlight Wood’s lamp

Technique to examination of skin Inspection Palpation Inspections and palpation of skin Color Moisture Temperature

Thickness Turgor Vascular changes Edema

Lesions Skin odors are usually noted in the skin fold. 7

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Inspection color of skin

Skin color varies from body part to body part and

from person to person. Assessment first involves area of skin not

exposed to the sun e.g. palms of the hands. Pallor easily perceived in the buccal “mouth”

mucosa particularly in individuals with dark skin. Cyanosis readily seen in area of least

pigmentation e.g. lips, nail beds conjunctiva and palm.

Jaundice or Yellow seen in client’s sclera.

Erythema may indicate circulatory changes9

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Palpation moisture of skin

Skin is normally smooth and dry. Skin folds e.g. axillae are normally moist. In presence of lesions or ooze fluid, nurse must

wear gloves to prevent exposure to infections drainage

Moisture indicates: 1- Degree of client’s hydration 2- Condition of the outer lipid layer of the skin

surface

Dry (xerosis): Vitamin A def. and Myxedema

Oily: Acne11

Palpation of TemperatureTemperature of skin depends on the amount of

blood circulating through dermis.

Generalized warmth: (Fever, Hyperthyroidism)

Local warmth: (Inflammation)

Coolness: (Hypothyroidism, Frost bite,

Hypothermia, Shock, Low cardiac output)

Palpation of skin with dorsum of the hand.

Assessment of skin is critical point in some

conditions such as: after cast application, or after

vascular surgery. 12

Palpation of TextureTexture of skin normally smooth, soft and flexible

If any abnormalities in texture found you must ask

the client is he exposed to any recent injury to the

skin?

Nurse determines whether the client’s skin is smooth

or rough, thin or thick, tight or supple (flexible).

Very Soft: (Thyrotoxicosis)

Tight: (Scleroderma = hard skin)

Rough: (Hypothyroidism)

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Palpation of Turgor

Turgor: is the skin elasticity diminished by edema or dehydration.

Assessment of turgor done by pinching skin between the thumb and forefinger and released.

Normally skin return immediately to its position.

Failure of this process means dehydration.

Decrease in turgor predisposes the client to skin breakdown.

Palpation of Vascularity Vascularity: Assessment of circulation of skin E.g.

petechiae may indicate serous blood clotting disorders, drug reactions or liver disease.

Inspection and Palpation of EdemaEdema : "Build up of fluid in tissues“Inspected for location, color, and shape. Palpates areas of edema to determine mobility,

consistency, and tenderness

Inspection and Palpation of LesionsNormally skin free of lesions except common freckles. If lesion present, inspection must done for distribution,

arrangement, morphology, color and sizePalpation for lesion’s mobility, contour (flat, raised or

depressed) and consistency (soft or hard are indicated). Cancerous lesions frequently undergo changes in color and

size.

Hair and Scalp

Assessment done for distribution, thickness, texture,

and lubrication of the hair.

Some events which affect the distribution of hair over

the body e.g. client with hormone disorders, woman

with hirsutism

Amount of hair covering extremities may be reduced

as a result of aging and arterial insufficiency especially

in lower limbs.

Scaliness or dryness of the scalp is frequently caused

by dandruff or psoriasis. 16

Nails Assessment

Nails reflect an individual's general state of health, state of nutrition, and occupation.

Nails are normally transparent, smooth, and convex, with a nail bed angle of about 160 degrees.

The surrounding cuticles are smooth, intact and without inflammation.

Nail bed is normally firm on palpation.

Nails normally grow at a constant rate.

Abnormal condition of nailAnonychia: complete absence of nails

Platunychia: flatting nails

Koilonychia : nails like spoon shape (iron deficiencies

anemia)

Racket nail: fattened and expanded nails

Onycholysis: separation of nail form nail bed

(thyrotoxicosis)

Melanoychia: presence of brown color in nails plate

Paronychia: inflammation of tissue surrounding the nail

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