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Physical assesment of the skin and nails
Frances Rose L. Alcaraz
BS Clinical Pharmacy
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SKIN largest organ of the body
created by special cells called melanocytes
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SKINMAJOR FUNCTIONS:
a. Protection
b. Sensationc. Insulation
- Adipose tissue
- Arrector pili muscles- Sweat glands
d. Temperature regulation
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SKINTHREE LAYERS:
Epidermis
Dermis
Hypodermis
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FIVE DIFFERENT LAYERS
OF EPIDERMIS
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nail
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NAIL
Free
edge
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PHYSICAL
ASSESSMENT ofskin and nails
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ASSESSMENT
To prepare for the skin and nail examination:
remove all clothing and jewelry
remove nail enamel, artificial nails, wigs, toupees, or
hairpieces
have the client sit comfortably
ensure privacy by exposing only the body part being
examined
keep the room door closed or the bed curtain drawn
explain what you are going to do
answer any questions the client may have
wear gloves when palpating any lesions
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ASSESSMENT
Equipment and supplies:
a. Examination light b. Penlight c. Mirror
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ASSESSMENT
Equipment and supplies:
d. Magnifying glass e. Centimeter ruler f. Gloves
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ASSESSMENT
Equipment and supplies:
g. Woods lamp h. Examination gown or drape
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ASSESSMENT
Obtain a history of the patient's skin condition.
Go over the detailed family history with the patient or patient's
family.
Also obtain a history of the patient's bathing routine and skin
care products.
Ask the patient:
* about skin changes
* if skin appearance changes with the seasons
* about any changes in nail
* about allergies
Document your findings in the medical record.
http://jxzy.smu.edu.cn/jkpg/UploadFiles/file/TF_06928151958_chapter9%20skin%20hair.pdf
http://jxzy.smu.edu.cn/jkpg/UploadFiles/file/TF_06928151958_chapter9%20skin%20hair.pdfhttp://jxzy.smu.edu.cn/jkpg/UploadFiles/file/TF_06928151958_chapter9%20skin%20hair.pdf7/29/2019 SKIN.pptx
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ASSESSMENT
REMEMBER:
COLDSPA
CHARACTER: Describe the sign or symptom.How does it feel, look, sound, smell, and so forth?
ONSET: When did it begin?
LOCATION: Where is it? Does it radiate?
DURATION: How long does it last? Does it recur?
SEVERITY: How bad is it?
PATTERN: What makes it better: What makes it
worse?
ASSOCIATED FACTORS: What other symptoms
occur with it?
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Skin
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Skin
SKIN
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SKINEvaluation:
1. Inspectiona. color
NORMAL: pinkish; appropriate for race & even pigmentation
PALLOR
CYANOSIS
REDNESS
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SKINa. color
YELLOWNESS DARKENING W/ LINEAR
STREAKLIKE
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SKINb. pigmentation c. rashes
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SKIN
d. lesions
e. trauma
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SKINf. note the distribution, amount and texture of the
body hair
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SKINEvaluation:
2. Palpation
a. mobility- how easily the skin can be pinched (edema)
b. turgor- skins elasticity and how quickly the skin returns to
its original shape after being pinched (dehydration)
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SKINc. edema
Assessment Chart for Pitting Edema adapted from the Guelph General Hospital Congestive Heart Failure Pathway
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SKINd. Thickness (thick & thin)
e. moistness
SKIN
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SKINf. temperature
TERMS DEFINITIONS
temperature increase increase in blood flow to dermis
causes this
temperature increase, localized burns or localized infections cause this
temperature increase, generalized fever causes this
temperature decrease decrease in blood flow to dermis
causes this
temperature decrease, localized arteriosclerosis causes this
temperature decrease, generalized shock causes this
lack of bilateral symmetery of
temperature
indicates circulatory problems or
infection
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BEDS
Evaluation:
1. Inspection
NORMAL: nails are white or light pink and have a narrow normal pink
band near the end of the fingernail.
a. Inspect nail grooming
and cleanliness
Normal: Clean and manicured
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BEDS
b. Inspect nail color and markings
Normal: Pink tones should be seen. Some longitudinal ridging is normal
cyanosis pale
splinter
hemorrhages
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BEDS
Yellow
discoloration
Nail pitting
Beaus nails
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BEDS
c. Inspect shape of nails
Normal: There is normally a 160-degree angle between the nail base and the skin
clubbing
spoon nails
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BEDS
Evaluation:
2. Palpation
a. Palpate nail to assess texture
Normal: Nails are hard and basically immobile. Dark-skinned clients may have thicker nails. Older
clients nails may appear thickened, yellow, and brittle because of decreased circulation in the
extremities.
thickened nails
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BEDS
b. Palpate to assess texture and consistency, noting
whether nail plate is attached to nail bed
Normal: Smooth and firm; nailplate should be firmly attached to nailbed.
paronychia oncholysis
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BEDS
c. Test capillary refill in nail beds by pressing the nail
tip briefly and watching for color change.
Normal: Pink tone returns immediately to blanched nailbeds when pressure is released.
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SKIN
terminologies
SKIN l i
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SKIN lesionsPRIMARY LESIONS
a. Bulla (scarlet fever /sunburn)
- large (>1cm)
- circumscribed- elevated lesion
containing fluid
b. Ecchymosis (vasculitis,leptospirosis, endocarditis)
- large (>1cm) hemorrhage
- bruise
SKIN l i
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SKIN lesionsc. Macule (rubella, scarletfever, roseola infantum)
- small (1cm) solid lesion- below, even with or above
the surface
- more deeply rooted than a
papule
SKIN l i
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SKIN lesionse. Papule (dermatitis, psoriasis,ringworm, chicken pox, eczema)
- small (
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SKIN lesionsg. Petechia (severe systemicdisease)
- small (1cm)
- flat-topped and elevated
above the skin surface
- often formed by coalescenceof papules
SKIN l i
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SKIN lesionsi. Pustule (acne, impetigo, boils,Stap. infections)
- circumscribed
- elevated lesion of varying
size containing pus
j. Vesicle (insect bites, chemicalirritations, herpes)
- small (
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SKIN lesionsi. Wheal (mosquito bites or hives)
- edematous
- transitory papule
- evanescent
SKIN l i
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SKIN lesionsSECONDARY LESIONS
a. Crust (infectious dermatitis)- dried collection of blood,
serum, or pus from corrosive
lesion
b. Excoriation- scratch mark usually
covered with blood or serous
crusts
SKIN l i
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SKIN lesionsc. Fissure (skin dryness)
- vertical, linear crack
through the epidermis anddermis
d. keloid- firm raised mass of scar tissue at the
previous site of a wound
- growth of extra scar tissue where
the skin has healed after an injury
SKIN l i
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SKIN lesionse. Lichenification(dermatitis)
- roughening & thickening ofthe epidermis and dermis
f. scale (dandruff, fungalinfections, psoriasis, seborrheic dermatitis)
- Dead epidermal cells
SKIN l i
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SKIN lesionsg. Ulcer(acute or chronicconditions)
- lesion that involves loss of
the upper portion of the skinand part of the lower portion
h. scar- normal skin tissue has beenreplaced by connective tissue
SKIN l i
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SKIN lesionsOTHER LESIONS
a. comedo- Open comedone or
Blackhead
- small, flesh-colored papulewith a central orifice containing
a dark plug
b. millium- Closed comedone or
Whitehead
- small, pale-colored papulewith no visible opening
SKIN l i
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SKIN lesionsc. nervus
- mole
- flat or elevated pigmented
lesion
d. Oslers node (endocarditis)- small, raised, discolored, tender
lesion on the pads of the fingers andtoes
SKIN l i
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SKIN lesionse. Telangiectasias
- dilated superficial bloodvessels
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FINGERNAIL AND
TOENAILterminologies
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BEDSa. Beaus lines
(malnutrition)
- transverse horizontal
depression associated withsevere illness
b. Clubbing (hypoxia andCOPD)
- Increased angle (>180 degrees)
between the base of the nail and
the nail bed
- associated with chronic arterial
desaturation
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BEDS
c. Koilonychia (IDA)- spooning of the nails
d. Onycholysis (trauma,malnutrition, thyroid disease)
- detachment of nail plate from nail
bed
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BEDS
e. Splinter haemorrhages- red or brown linear streaks in the distal extremity of the nail bed
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References http://www.eucerin.com/skin-expertise/about-the-skin/the-skin-and-its-
cells/the-epidermis/. Retrieved August 10,2013.
http://sketchymedicine.com/2012/11/layers-of-the-epidermis/.Retrieved
August 10,2013
http://dermatology.about.com/od/glossaryl/g/langerhans.htm.Retrieved
August 10,2013 http://www.webmd.com/skin-problems-and-treatments/picture-of-the-
skin.Retrieved August 10,2013
http://www.clinimed.co.uk/Wound-Care/Education/Wound-
Essentials/Structure-and-Function-of-the-Skin.aspx. Retrieved August
10,2013
http://faculty.stcc.edu/AandP/AP/AP1pages/Units1to4/skin/skin1.htm.
Retrieved August 10,2013
http://medical-dictionary.thefreedictionary.com/Skin+Lesions. Retrieved
August 10,2013
http://www.siumed.edu/medicine/dermatology/student_information/skinphysi
calexam.pdf. Retrieved August 10,2013
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