Transcript The Skin, Hair, and Nails

King Saud University
College of Nursing
Health Assessment (NUR 224)
The Skin, Hair, and Nails
1
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
Anatomy and Physiology (cont.)
 Three layers
 Epidermis
 Dermis
 Subcutaneous tissue
 Hair, nails, and sebaceous and sweat glands are
appendages of skin
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
The Health History
 Common or concerning symptoms
 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?”
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
HARMM Risk Factors for
Melanoma
 History of previous melanoma
 Age over 50
 Regular dermatologist absent
 Mole changing
 Male gender
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
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
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)

o
Artificial light often distorts colors
Techniques of Examination
(cont.)
 Inspect and palpate skin
 Note characteristics of:
 Color
 Moisture
 Temperature
 Texture
 Mobility and turgor
 Lesions
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
o
Red color of oxyhemoglobin best assessed at
fingertips, lips, and mucous membranes

In dark-skinned people, palms and soles
o
For central cyanosis, look in lips, oral mucosa,
and tongue
o
Jaundice - sclera
Techniques of Examination (cont.)
 Moisture
 Dryness, sweating, and oiliness
 Temperature
 Use back of fingertips
 Identify warmth or coolness of skin
 Texture
 Roughness or smoothness.
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)
Techniques of Examination
(cont.)
 Lesions
 Note characteristics
o
Anatomic location and distribution
o
Patterns and shapes
o
Type of lesion (macules, papules, nevi, vesicles)
o
Color
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
Examples of skin lesions
Techniques of Examination
(cont.)
 Hair
 Inspect and palpate
 Note quantity, distribution, and texture
Techniques of Examination
(cont.)
 Nails
 Inspect and palpate fingernails/toenails
 Note color and shape
 Note lesions
o
Longitudinal bands of pigment may be a normal
finding in people with darker skin
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.
Evaluating the Bedbound Patient
 Roll patient onto one side to see sacrum and buttocks
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.”
Question?
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