Transcript NUR103ModE
Physical Assessment of the Integumentary System • Integument means covering. • The skin and its accessory organs, hair, nails and glands comprise the integumentary system of the body. • The skin is composed of several different tissue types and is considered an organ . Functions of the Integument • Protection • Physical Barrier • Perception • Temperature Regulation • Identification • Communication Functions of the Integument continued • Wound Repair • Absorption • Excretion • Vitamin D Production The Three Layers of the Integument • Epidermis - the outermost layer of the skin, made of stratified squamous epithelium . • Dermis - the inner layer of the skin, made of dense fibrous connective tissue . • Subcutaneous tissue - thick, fat-containing tissue. Below the skin; the tissues between the dermis and the muscles. Epidermal Appendages • Hair is threads of keratin • Sebaceous glands secrete the oil, sebum • Sweat glands – Eccrine glands secrete sweat – Apocrine glands secrete thicker, milky secretion as in anogenital, nipples, and illae areas • Nails are hardened keratin Receptors in the skin • The sensory receptors in the dermis are for cutaneous sensations which include: touch, pressure, heat, cold, and pain. • The purpose of sensory receptors is to provide the CNS with information about the external environment and its effect on the skin. Interview • Chief Complaint – – – – Recent Changes Pruritus (itching) Dryness (xerosis) Rashes (identify primary site, migration, pattern and evolution – Lesions – Ecchymoses (bruising) – Masses or lumps • Symptom analysis – Pages 225-229, Jarvis Interview (cont.) • Past Health History – Example: • Immunologic, Endocrine, Collagen, Vascular, Renal, Hepatic – Previous exposure to insects, infectious disease – Previous trauma & surgical intervention – History of past allergic reactions Interview (cont.) • Medications – Sensitivities – Photosensitizing drugs – Ask about self treatment with herbal remedies • Allergies – Medications & Foods Interview (cont.) • Family Health History – Helps determine genetic predisposition to skin disorders • Psychosocial History – Particularly important in long-term & chronic processes. – Determine & correct any misconceptions about skin problems. Interview (cont.) • Diet – Excessive dryness may indicate Vitamin A deficiency. • Occupation & Travel – What have they been exposed to. • Habits – Frequency of hygiene practices. – Exercise & Sleep Patterns • Affects circulation, nourishment, & repair of the skin. – Is there prolonged exposure to sun, unusual cold, or other skin damaging conditions. Dermatologic Assessment History • Chief complaint • Definition of problem (onset, location) • Duration • Accompanying manifestations • Evolution of lesion or eruption • Aggravating & relieving factors Dermatologic Assessment History • Medical intervention • Self-treatment • Compliance & treatment factors Preparation for the Physical Examination • Strong direct lighting, natural sunlight is best • Small centimeter ruler • Penlight • Gloves • Wood’s light (ultraviolet light) may be needed for special procedures Inspection • Color, Page 249 Jarvis – – – – – Pallor Cyanosis Erythema Jaundice Document presence of tattoos • General pigmentation • Areas of hypopigmentation or • hyperpigmentation Abnormal color changes Hair and scalp Inspection • Inspect distribution & quality • Texture • Inspect the Scalp: – Lesions – Excoriations – Lumps – Bruises – Lice Nails • Color, Shape & Contour • Texture • Integrity • Thickness • Capillary refill Palpation • Temperature – Assess with dorsum of hand – Warmth reflects circulation – Compare sides • Moisture – Refers to the skin’s hydration level in terms of both wetness & oiliness – Diaphoresis, dehydration • Texture – Should feel smooth, soft, & resilient Palpation continued • Tenderness • Thickness – Callus – Atrophic • Edema – Not a “normal finding” – Common in some disorders • Cardiovascular • Renal failure • Cirrhosis Edema grading – May be pitting – 1+ Barely Visible – 2+ Indentation < 5mm – 3+ Indentation of 5 to 10mm – 4+ Indentation of 10mm or > Palpation continued • Turgor – Reflection of skin’s elasticity & hydration – Turgor is decreased (less elasticity) as the skin “tents” and stands by itself • Hygiene, odor • Vascularity or bruising Lesion Types • Types of Lesions – Primary - those developing from previously unaltered skin – Secondary – those which develop over time because of a factor such as scratching or infection If any Lesions present, note the: • • • • • • • Color Shape and configuration Size Elevation Excudate Location and distribution Table 12-3 to 12-11, pages 250-265, Jarvis Self-Care Behaviors Teach skin self-examination, using the ABCDE rule A—asymmetry B—border C—color D—diameter E—elevation and enlargement Developmental Considerations • Infants – Lanugo (fine downy hair) from 3 months gestation to a few months after birth – Thin, smooth, highly permeable and elastic skin – Increased sebum through the first few weeks of life – Temperature regulation inefficient Developmental Considerations • Aging Adults – – – – – – – Skin loses elasticity and underlying fat reserves Vascularity diminishes Decreased response of sweat glands Lifetime of environmental trauma Wound healing decreased Melanocytes decreases melanin production Loss of self-esteem