Chapter 26

Assessment of the Skin, Hair, and Nails

Mrs. M. Kreisel MSN, RNNU130 Adult Health 1Summer 2011

Anatomy and Physiology Review

• Structure of the skin• Subcutaneous fat• Dermis• Epidermis• Hair• Nails• Glands

Anatomy of the Skin

Anatomy of the Nail

Functions of the Skin

• Protection• Homeostasis• Temperature regulation• Sensory organ• Vitamin synthesis• Psychosocial

Assessment of the Skin

• Demographic data• Socioeconomic status• Drug use• Allergies• Nutrition status• Family and genetic risk• Current health problems

Skin Assessment

• Color• Lesions, primary and secondary• Assess each lesion for:

• A—asymmetry of shape• B—border irregularity• C—color variation within one lesion• D—diameter >6 mm

Inspect Skin

• Look for signs of:• Edema• Moisture• Vascular changes

Inspect Skin: Petechiae

Integrity of Skin

• Skin tears• Cleanliness• Tattoos and piercings

Palpation

• Palpation confirms the size of the lesions and determines whether they are flat or slightly raised:• Macular—flat rash• Papular—raised rash

• Skin temperature—assessed with the back of the hand

• Turgor—the amount of skin elasticity

Hair Assessment

• Inspect and palpate the hair for cleanliness, distribution, quantity, and quality.

• Dandruff is an accumulation of patchy or diffuse white or gray scales that appear on the surface of the scalp.

• Hirsutism is excessive growth of body hair, which is one manifestation of hormonal imbalance.

Nail Assessment

• Dystrophic (defective nutrition or metabolism) nails

• Color of nail plate• Nail shape changes• Nail thickness, consistency, lesions• Acute and chronic paronychia (infection of

the nail)

Nail Disorders

Iron deficiency can cause spoon shape nails

Skin Assessment Methods for Patients with Darker Skin

• Assess for:• Pallor: mouth/gums• Cyanosis: mouth/gums• Inflammation• Jaundice• Skin bleeding

Diagnostic Assessment

• Cultures for fungal infections• Cultures for bacterial infections—unroofing• Cultures for viral infections• Skin biopsies:

• Punch biopsy• Shave biopsy• Excisional biopsy

Skin Biopsy

• Excisional biopsy—complete lesion removed with margin of normal skin down to adipose tissue.

• Incisional biopsy—cross-section wedge of tissue through center of lesion.

• Shave biopsy—horizontal shave of the skin lesion with only superficial portion of dermis.

• Punch biopsy—for sampling possible cancers, tumors, and inflammatory skin conditions.

Wood’s Light Examination

Ultraviolet/black light used and certain infections will change color

NCLEX TIME

Question 1

According to the American Cancer Society, which race has the highest incidence of melanoma?

A. AsiansB. African AmericansC. WhitesD. Hispanics

Question 2

Evaporation of the water contained in the sweat from eccrine sweat glands can cause the body to lose how much fluid in a single day?

A. 500 mLB. 1 to 2 LC. 5 to 7 LD. 10 to 12 L

Question 3

Spoon-shaped nails are a possible outcome of which condition?

A. Lung cancer or hypoxiaB. Iron deficiency or diabetesC. Emphysema or chronic obstructive

pulmonary disease D. Severe malnutrition or psoriasis

Question 4

In dark-skinned patients, jaundice is best checked for in which area?

A. Skin over palms and solesB. ConjunctivaeC. Sclera nearest the corners of the eye D. Oral mucosa, especially the hard palate

membranes

Question 5

True or False: Untreated dandruff can cause hair loss.

A. True

B. False