Integumentary System: Assessing the

SKIN

Spring 2012 1

Functions of the Skin

Spring 2012 2

1. Protects Against Trauma2. Protects Against Ultraviolet

Radiation3. Support Structure4. Maintains Body Temperature

Functions of Skin

5. Involved with Absorption and Excretion6. Involved with Immunity7. Synthesizes Vitamin D8. Helps Maintain Fluid Balance9. Provides Sensation with the External

Environment

Spring 2012 3

Structures of Skin

1. Epidermis2. Dermis3. Subcutaneous Tissue4. Epidermal Appendages:

– Hair– Nails– Sebaceous Glands

Spring 2012 4

Risk Factors

• . . . . . .• . . . . . .• . . . . . .• . . . . . • . . . . .

Spring 2012 5

SECONDARY SKIN LESIONS1. Crust *2. Scale3. Fissure4. Erosion5. Ulcer6. Scar 7. Excoriation8. Keloid9. Lichenification

Spring 2012 6

Descriptions of Lesions *

• Size• Shape• Color• Texture• Surface relationship• Exudate• Tenderness or pain

Spring 2012 7

Skin Assessment:

• Approach

• Inspection

• Palpation

Spring 2012 8

Examination

• General Inspection :– General pigmentation– Texture– Temperature– Moisture– Mobility– Turgor– Vascularity or bruising– Edema– Lesions or discoloration

Spring 2012 9

Adult

–Normal Variations:• Striae• Vitiligo• Moles• Freckles • Birthmarks

Spring 2012 10

Warning Signs of Cancer

• A = Asymmetry• B = Boarder irregular• C = Color variation• D = Diameter >6mm• E = Elevation & Enlargement

Spring 2012 11

Abnormal Skin Findings

• Central Cyanosis

• Peripheral Cyanosis

12Spring 2012

• Pallor:

• decreased Hgb-, decreased perfusion• Also on conjunctiva

and mucus membranes

Examination

• Palpate skin for temp, moisture, mobility and turgor

• Hair Distribution• Nail

– Thickening or hypertrophy– Thinning or Brittleness– Spoon Shaped– Pitting of Nail– Pigmented Bands– Splinter Hemorrhages

13Spring 2012

Vascular Lesions:

1. Petechiae2. Ecchymosis3. Purpura4. Hematoma5. Venous Star6. Telangiectasis7. Spider Angioma8. Erythema

Spring 2012 14

Pitting Edema *

• 1+ < 0.25 inch (4.32mm) depression

• 2+ 0.25 - 0.5 inch (12.7mm)

• 3+ 0.5 - 0.75 inch (19 mm)

• 4+ 0.75 - 1 inch or more (25 mm)

Spring 2012 15

Pitting Edema *

• 1+ < 0.08 inch (2mm) depression __________

• 2+ 0.16 inch (4mm) ___________

• 3+ 0.24 inch (6 mm)

• 4+ >0.32 inch (8 mm)

Spring 2012 16

Aging Adult Health History1. Increased Risk of Damage2. Delayed Wound Healing3. Pruritis

1. Skin Turgor2. Lentigo (macule)3. Cutaneous Tags4. Cherry Angioma (red papule)5. Seborrheic keratoses / Actinic keratoses

Spring 2012 17

Older Adult

Approach:• Skin atrophies• Increase amount of pigmentation esp. in sun

exposed areas• Isolated areas of hypo pigmentation• Skin becomes drier and flattens, often

becoming paper like• Elasticity decreases and wrinkles develop

Spring 2012 18

Older Adult

• Decreased melanocyte function causes gray hair and pale skin

• Decreased axillary, pubic & scalp hairWomen: facial hair Men: nasal hair

• Nails grow more slowly, become thicker & more brittle, yellowish

Spring 2012 19

Older Adult• Temp/ moisture , mobility

– Increased dryness (xerosis)– Thinning of the skin– Hanging skin

• Hair:– Graying, thin texture– Symmetric balding may occur in men

• Facial & Body hair– Men increased coarseness

• Nail– Thickening, increases brittleness, deformity

Spring 2012 20

Cultural Considerations

• The oral mucosa is best for assessing color changes in dark-skinned persons

• Assessing the sclera for jaundice, rather than the skin in Asians

Spring 2012 21

Health Promotion• Immunizations• Sun Exposure & Protection• Skin Cancer • Teach client:

– skin self assessment– Toenail trimming – Ingrown toenail care

Spring 2012 22